J Obstet Gynaecol Res. 2016 Apr 14. doi: 10.1111/jog.12998.  Cimsit C1, Yoldemir T1, Akpinar IN1. Abstract Catamenial sciatic radiculopathy resulting from endometriosis is a rare presentation of a common disease in which the pathogenesis of pain is still under debate. A 32-year-old woman presented complaining of infertility, catamenial sciatica, and pelvic and gluteal pain. Magnetic resonance imaging showed endometriotic infiltration of the left proximal lumbosacral plexus, sacral nerve track, sciatic nerve at the sciatic notch and pudendal nerve along the iliococcygeus muscle, together with left endometrioma and deep infiltrating endometriosis lesions. Laparoscopic endometriosis surgery was performed after all of the complications and possible outcomes of the surgery were discussed with the patient. Our case report highlights the importance of magnetic resonance imaging evidence of perineural spread, outlining the pathophysiology of the pelvic pain associated with neuroendometriosis.  

Case Rep Obstet Gynecol. 2016;2016:2713943. doi: 10.1155/2016/2713943. Epub 2016 Feb 29. Hatirnaz S1, Colak S2, Reis A3. Abstract Uterine leiomyomas are the most common pelvic tumor in women. Leiomyoma can show atypical locations and degenerations and may not be easily differentiated from adnexal masses. Uterine leiomyoma can undergo cystic degeneration and is said to be found in 4% of all types of degenerations. The commonest type of degeneration is hyaline seen in 60% of patients. Usually uterine leiomyoma does not present as clinical and radiological diagnostic challenge. However, when leiomyoma undergoes massive cystic degeneration they may become clinical and radiological diagnostic dilemmas. The MRI showed a huge cystic mass protruding up to the pelvis not differentiated from bilateral endometriomas and accompanying subserous myomas. Surgery revealed that the mass is not bilateral endometriomas but a huge pedunculated leiomyoma with cystic degeneration and cystic endometriosis. Endometriosis is a troubling gynecologic condition occurring in 10% to 15% of women of reproductive age and is associated with fertility problems. As a peritoneal disease, the locations of endometriotic lesions are predominantly the ovaries (96.4%), followed by the soft tissue (2.8%), gastrointestinal tract (0.3%), and urinary tract (0.2%) and other rare locations. The presented case is multiple sized cystic endometriosis (endometriomas) located in a huge pedunculated subserous leiomyoma in an infertile woman having a history of laparoscopic bilateral endometrioma surgery. Conclusion. To our knowledge, this is the first reported case for endometriotic cysts (endometriomas) located in a huge cystic degenerated leiomyoma. PubMed search revealed no report concerning endometriotic implantation in the leiomyomas.  

Clin Exp Obstet Gynecol. 2016;43(1):25-30. Yesildaglar N, Yildirim G, Yildirim OK, Attar R, Ozkan F, Akkaya H, Yilmaz B. Abstract OBJECTIVE:  To evaluate the effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in SCID mice. MATERIALS AND METHODS:  Prospective, randomized, controlled, experimental study. Experimental Research Center of Yeditepe University (YUDETAM). Thirty female, non-pregnant, nulligravid severe combined immunodeficient (SCID) mice. Endometriotic cells collected from patients with endometriosis were implanted subcutaneously in 30 SCID mice. These mice were randomized into two study groups: in the first group, mice were administered melatonin (20 mg/kg/day) following induction of endometriosis for four weeks; in the second group, nothing was administered. All the mice were given a high dose of exogenous estradiol (50 µg/kg/d, twice weekly). Four weeks after inoculation, necropsies were performed and endometriotic lesions were collected. All the lesions were evaluated histopathologically and the levels of SOD and MDA were assessed in the lesions. RESULTS:  Successful implantation was observed in the 28 mice that survived. Mean MDA level was 5.0 ± 1.7 and 8.8 ± 2.6 in the melatonin and control groups, respectively (p = 0.01); mean SOD level was 1.1 ± 0.1 and 1.0 ± 0.1 in the melatonin and control groups, respectively (p = 0.49). Mean histopathological score was lower in the melatonin group (p = 0.04). CONCLUSIONS:  Melatonin was effective in the treatment of experimental endometriosis induced in SCID mice.  

Eur J Obstet Gynecol Reprod Biol. 2016 Apr;199:164-8. doi: 10.1016/j.ejogrb.2016.02.027. Epub 2016 Feb 22. Turkyilmaz E1, Yildirim M2, Cendek BD3, Baran P4, Alisik M4, Dalgaci F2, Yavuz AF5. Abstract OBJECTIVE: The aim of the study is to evaluate alterations in intracellular and extracellular antioxidant enzymes activities and serum oxidative stress markers in patients with endometriosis. STUDY DESIGN:  The current prospective study consisted of 31 female patients with endometriosis and 27 healthy controls. Serum total thiol, native thiol, disulphide, catalase, myeloperoxidase, and ceruloplasmin concentrations were measured. Laboratory and clinical data of all participants were recorded to compare the differences between the study and the control groups. RESULTS:  Serum native thiol and total thiol levels in the study group were significantly lower than those in the control group [(p=0.009, p=0.03, respectively)]. Serum catalase levels are significantly higher in patients with endometriosis comparing to the control group (p=0.009). CONCLUSIONS:  The finding that significant differences in serum total thiol, native thiol, and catalase levels observed in endometriotic patients supports that oxidative stress carries weigh in the pathophysiological aspects of endometriosis. Also significantly low levels of extracellular antioxidants and significantly high levels of intracellular antioxidants in endometriotic patients may arise from differences of free radicals in endometriosis and the activity levels of endometriosis. These non-invasive serum markers might give us an opportunity to monitor the disease's progress during the treatment.  

Kaohsiung J Med Sci. 2016 Jan;32(1):50-1. doi: 10.1016/j.kjms.2015.12.003. Epub 2016 Jan 19. Kaymaz Gezer E1, Ayhan Çınar E2, Gürsoy D1. Elevated Serum CD95/FAS and HIF-1α Levels, but Not Tie-2 Levels, May Be Biomarkers in Patients With Severe Endometriosis: A Preliminary Report. J Minim Invasive Gynecol. 2016 Feb 4. pii: S1553-4650(16)00074-1. doi: 10.1016/j.jmig.2016.01.025.  Karakus S1, Sancakdar E2, Akkar O3, Yildiz C3, Demirpence O2, Cetin A3. Abstract STUDY OBJECTIVE:  To evaluate serum values of cluster of differentiation 95 (CD95/FAS), hypoxia-inducible factor 1-alpha (HIF-1α), and tyrosine kinase receptor 2 (Tie-2) as possible biomarkers of disease presence and severity in women with endometriosis, and to characterize the changes in these values in women with stage I/II and stage III/IV endometriosis. DESIGN:  Prospective study (Canadian Task Force classification I). SETTING:  University hospital. PATIENTS:  Thirty women with endometriosis and 30 healthy women without endometriosis. INTERVENTION:  For the diagnosis of endometriosis and prediction of its severity, we measured the serum levels of CD95/FAS, which assess apoptotic conditions, and of HIF-1α and Tie-2, which assess angiogenesis. Endometriosis was diagnosed and staged through surgical laparoscopy and later confirmed histologically. During the surgery, the patients with endometriosis were divided into 2 groups based on disease stage. Eleven patients had stage I/II endometriosis, and 19 had stage III/IV endometriosis. MEASUREMENTS AND MAIN RESULTS:  Endometriosis was associated with increased serum CD95/FAS and HIF-1α levels, but not Tie-2 levels. We also determined that stage III/IV endometriosis was associated with higher serum CD95/FAS and HIF-1α levels, but not Tie-2 levels, compared with stage I/II endometriosis. CONCLUSION:  Endometriosis, in accordance with its severity, increases serum CD95/FAS and HIF-1α levels, but not Tie-2 levels. These biomarkers may be useful for reproductive surgeons to improve the quality of counseling women about the presence and severity of endometriosis.  

Eur J Obstet Gynecol Reprod Biol. 2016 Feb;197:159-63. doi: 10.1016/j.ejogrb.2015.12.013. Epub 2015 Dec 25. Yildiz C1, Kacan T2, Akkar OB3, Karakus S3, Seker M2, Kacan SB4, Ozer H5, Cetin A3. Abstract OBJECTIVE:  Currently, medical and surgical treatment options for endometriosis are limited due to suboptimal efficacy, and also safety and tolerance issues. Long-term use of gonadotrophin-releasing hormone analogs, androgenes, and the danazol, which are widely used drugs for endometriosis, is usually not possible due to their suboptimal safety and tolerance profile. The lack of an effective, tolerable and safe treatment option for endometriosis makes animal models of experimental endometriosis necessary to study candidate drugs. The aim of this study was to investigate the efficacy of imatinib on the experimental endometriosis in a rat model. STUDY DESIGN:  Endometriosis was induced by autotransplantation of uterine tissue into the peritoneal cavity. Twenty-four rats, which had visually confirmed endometriotic implants on subsequent laparotomy, were randomized into three groups to receive imatinib (25mg/kg/day, p.o.), anastrozole (0.004mg/day, p.o.), or normal saline (0.1mL, i.p.) for 14 days. After removal of endometriotic tissue and H & E staining, endometriosis score was determined according to a semiquantitative histological classification. Also, immunostaining with primary antibodies including VEGF, CD117, and Bax were used for immunohistochemical (IHC) examination. RESULTS:  Both anastrozole and imatinib suppressed the growth of endometriotic tissue and reduced the number of ovarian follicles. Although the difference was not statistically significant, imatinib was less effective than anastrozole for treatment of endometriosis. CONCLUSION:  Imatinib effectively treats experimental endometriosis by its inhibitor effects on angiogenesis and cell proliferation.

Indian J Surg. 2015 Dec;77(Suppl 2):682-6. doi: 10.1007/s12262-013-0978-1. Epub 2013 Sep 26. Uçar MG1, Şanlıkan F2, Göçmen A2. Abstract It is difficult to conduct studies with larger series in rarely observed diseases. We report our experience in managing cesarean scar endometriosis (CSE) and emphasize the diagnosis and treatment options. The objective of our study is to review the clinical characteristics of CSE and to evaluate our surgical outcomes. We have collected and documented a case series of 12 patients who underwent surgical wide en bloc excision with surrounding clear margins for CSE. Patients' demographic features, symptoms, and clinical and operative findings were evaluated. The mean age was 34.6 years. Cyclical pain was documented in seven patients, while three patients presented with noncyclical pain. Menstrually-related enlargement of the nodule was observed in four patients, and only one patient had a complaint of dark brown leakage. The mean operation time was 26 min. The endometriotic lesions ranged from a diameter of 2 to 8 cm in size. Patients recovered completely, and no recurrence was observed. To prevent iatrogenic transplantation, additional attention is needed during surgery that exposes endometrial tissue. Complete wide excision of CSE is both diagnostic and therapeutic. To avoid unnecessary referrals, awareness of its typical clinical manifestations remains the mainstay for intervention. The most important issues to be considered during surgery is nonspreading endometriosis while manipulation.  

Reprod Sci. 2015 Dec 20. pii: 1933719115620494. [Epub ahead of print Tokmak A1, Yildirim G2, Öztaş E2, Akar S2, Erkenekli K2, Gülşen P2, Yilmaz N2, Uğur M2. Abstract PURPOSE:  The objective of this study was to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) compared to CA-125 in patients with endometriomas. METHODS:  This study was designed as a retrospective comparative study. A total of 807 women who underwent surgery due to benign ovarian cysts between January 2008 and January 2013 were included in the study. The NLR and CA-125 levels were assessed separately and together, with a receiver-operating characteristic curve analysis for the diagnosis of endometriomas. RESULTS:  The mean serum levels of NLR, CA-125, and combined markers were significantly higher in the study group (all P < .001). According to the highest Youden index, the cutoff values were found to be 23.7 IU/mL for CA-125 at 75% sensitivity and 81% specificity and 1.89 for NLR at 70% sensitivity and 74% specificity. The cutoff value for the combined marker was 41.0 with 80% sensitivity and 82% specificity. There was a positive correlation between NLR and CA-125 (P < .001). Neutrophil-to-lymphocyte ratio was also positively correlated with the endometriosis score (P < .001). CONCLUSIONS:  Although NLR is a simple and easily applicable marker, CA-125 is superior for differentiating endometriomas from other benign ovarian cysts. The combination of these 2 markers improves diagnostic accuracy.  

Ulus Cerrahi Derg. 2015 Jul 10;31(4):250-2. doi: 10.5152/UCD.2015.2770. eCollection 201 Acar T1, Acar N1, Çelik SC1, Ekinci N2, Tarcan E1, Çapkınoğlu E1. Abstract Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Although it is common in women in the reproductive age, intestinal endometriosis is extremely rare and may lead to serious clinical problems. In this article, we present two rare cases of endometriosis localized in the sigmoid colon lumen. The first case is a 45 year-old female complaining of rectal bleeding for 6 months. A polypoid lesion with suspicion of malignancy, 3-4 cm in size was identified at colonoscopy. Laparoscopic anterior resection was performed since it was not suitable for colonoscopic polypectomy. The pathology examination revealed extragenital endometriosis. The second case is a 36 year-old female admitted for lower abdominal pain and rectal bleeding for the last 3 months. She was diagnosed with sigmoid diverticulitis. The patient's symptoms regressed with medical treatment, but due to early and multiple recurrent episodes it was decided to perform an elective laparoscopic anterior resection. The pathology report stated diverticulosis coli and intraluminal endometriosis. Intestinal endometriosis should be considered as part of the differential diagnosis in female patients of the reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhea and pelvic pain. In these patients, resection and anastomosis of the effected bowel segment is accepted as the choice of treatment.  

Semin Reprod Med. 2015 Nov;33(6):422-8. doi: 10.1055/s-0035-1567820. Epub 2015 Nov 23. Seyhan A1, Ata B2, Uncu G3. Abstract Endometriosis is a chronic disease mostly affecting women at reproductive age. There is a clear association between endometriosis and infertility; however, exact mechanisms are unknown. Some evidence suggests an adverse effect on oocytes. Endometriosis and its surgical treatment can affect quantitative ovarian reserve as well. In the presence of endometriomas, serum level of anti-Müllerian hormone (AMH) seems a more reliable marker of ovarian reserve than antral follicle count. Women with endometrioma have decreased serum AMH levels as compared with healthy controls. This is further declined after surgical excision, and the decline seems permanent. Bipolar cauterization of the ovary seems to be playing a role on ovarian damage. Extraovarian endometriosis and its surgical treatment can also be associated with decreased ovarian reserve, but there is limited information. Patients with endometriosis should be informed about fertility preservation options, especially in the presence of bilateral endometriomas or prior to surgery.  

Reprod Sci. 2016 May;23(5):662-9. doi: 10.1177/1933719115612134. Epub 2015 Nov 12. Taskin MI1, Gungor AC2, Adali E3, Yay A4, Onder GO4, Inceboz U5. Abstract OBJECTIVE:  The aim of this study was to investigate the efficacy of anti-interleukin 6 (IL-6) therapy in the treatment of endometriosis in a rat model. STUDY DESIGN:  After the peritoneal implantation of autologous endometrial tissue, 22 Wistar female rats were divided to create 2 intervention groups: the tocilizumab group (n = 13) and the control group (n = 9). After measuring implant volume, saline was administered to the rats in the control group and 8 mg/kg tocilizumab was administered intraperitoneally to the rats in the tocilizumab-treated group every 2 weeks. After a 4-week treatment period, the volumes and histopathological properties of the implants were evaluated. A scoring system was used to evaluate the preservation of epithelia. Fibrosis score was assessed between the groups. Ectopic and eutopic endometrium were evaluated immunohistochemically for IL-6 and vascular endothelial growth factor (VEGF). RESULTS:  There was a significant difference between the volumes of implants before and after treatment in the tocilizumab group (P < .05). The posttreatment volumes of lesions were smaller in the tocilizumab group than in the control group. Histologic and fibrosis scores were lower in the tocilizumab group than in the control group. Immunoreactivity intensity for VEGF was significantly decreased in the tocilizumab group for ectopic and eutopic endometrium (P < .05). Interleukin 6 levels and endometrial thickness for ectopic and eutopic endometrium were similar between the groups. CONCLUSION:  Tocilizumab treatment had a regressive effect on the endometriotic implants.  

J Clin Diagn Res. 2015 Sep;9(9):QD14-6. doi: 10.7860/JCDR/2015/14512.6533. Epub 2015 Sep 1. Vural B1, Vural F2, Müezzinoglu B3. Abstract Abdominal wall desmoid tumours (DT) are rare, slow-growing benign muscular-aponeurotic fibrous tumours with the tendency to locally invade and recur. They constitute 0.03% of all neoplasms and high infiltration and recurrence rate, but there is no metastatic potential. Although surgery is the primary treatment modality, the optimal treatment remains unclear. Abdominal wall endometriosis is also an unusual disease, and preoperative clinical diagnosis is not always easy. The preoperative radiologic imaging modalities may not aid all the time. Herein, we report an abdominal mass presenting as cyclic pain. Forty-two years old woman who gave birth by cesarean section admitted the complaints of painful abdominal mass (78x45 mm in size) under her cesarean incision scar. She had severe pain, particularly during menstruation. The clinical and radiological imaging findings mimicking endometrioma. We performed wide surgical excision of mass with a 1 cm tumor-free margin with the diagnosis of a benign mesenchymal tumor in the frozen section. The postoperative course was uneventful and recovered without any complication and recurrence three years after surgery. This report presents a case of abdominal wall desmoid tumor mimicking endometrioma. In this paper, shortcomings in diagnosis, abdominal wall endometriomas, and DTs were discussed in the view of literature.

J Obstet Gynaecol. 2016 Feb;36(2):153-9. doi: 10.3109/01443615.2015.1036403. Epub 2015 Oct Kokcu A1. Abstract The purpose of the study was to examine the role of epigenetic changes in the aetiopathogenesis of endometriosis. The analysis and review of the relevant current literature in English language related to the role of epigenetic changes in the aetiopathogenesis of endometriosis. Epigenetic changes are common denominators for hormonal, immunological and inflammatory aberrations which play a key role in the aetiopathogenesis of endometriosis. Many internal and external factors may cause the different running of the epigenetic mechanism. As yet fully unknown genetic factors may increase the sensitivity of the epigenetic mechanism to various internal and external factors. The breakdown of epigenetic regulation is the main factor initiating the pathogenetic mechanisms for endometriosis formation.  

Womens Health (Lond Engl). 2015 Aug;11(5):693-9. doi: 10.2217/whe.15.56. Epub 2015 Oct 6. Bozdag G1. Abstract While the incidence of endometriosis is up to 40-60% in women with severe dysmenorrhea/chronic pelvic pain, patients with subfertility carries a risk up to 20-30%. In symptomatic patients, although medical therapy is preferred in women with endometriosis, surgery might be needed in nonresponders or patients with an endometrioma. Following the surgery, recurrence of the disease and/or symptoms might be still noticed which will progressively increase as times goes by. Nevertheless, some risk factors have been identified for the risk of recurrence that decreases the success of the procedure. Those risk factors might be classified as patient-disease related and surgery-associated variables. Herein, we will address about the management of endometriosis regarding the risk factors for relapse, mechanisms of recurrence and potential biomarkers to predict the event.

Womens Health (Lond Engl). 2015 Aug;11(5):633-41. doi: 10.2217/whe.15.50. Epub 2015 Sep 23. Polat M1, Yaralı İ1, Boynukalın K1, Yaralı H1,2. Abstract Endometriosis is an enigmatic disease affecting 10-15% of reproductive aged women and is encountered in 25-35% of women suffering from infertility. IVF is an effective tool to overcome endometriosis-associated infertility when expectant management or surgery fails. Direct IVF should be envisioned if the female age is greater than 38 year and infertility is long lasting. Likewise, semen characteristics or tubal status that is incompatible with natural conception mandates going straight to IVF. IVF, not only bypasses the distortion of pelvic anatomy associated with advanced stage endometriosis, but also removes gametes from a hostile peritoneal environment. In this article, we address the impact, if any, of endometriosis and endometriomason IVF outcome, whether surgical treatment of early-stage disease, endometriomas or deep infiltrating endometriosis would enhance pregnancy rates in IVF, which protocol to employ for controlled ovarian hyperstimulation for IVF and finally the impact, if any, of controlled ovarian hyperstimulation for IVF on progression of endometriosis.

Womens Health (Lond Engl). 2015 Aug;11(5):643-52. doi: 10.2217/whe.15.42. Epub 2015 Sep 21. Gezer A1, Oral E1. Abstract Progestins are synthetic compounds that mimic the effects of progesteron. For over 50 years, oral progestins have been demonstrated to be effective in the treatment of endometriosis. They were reported to reduce or eliminate pain symptoms in approximately 90% of the patients. Progestins are available in many forms, including oral preparations, injections, subdermal implants and intrauterine systems. Continuous progestin use is an effective therapy for the treatment of painful symptoms associated with endometriosis but there had been no evidence of progestin use being superior to other types of treatment in endometriosis-related pain symptoms.  

Womens Health (Lond Engl). 2015 Aug;11(5):685-92. doi: 10.2217/whe.15.55. Epub 2015 Aug 28. Karaman Y1, Uslu H1. Abstract Endometriosis is a common chronic disease mostly seen in young women. Endometriosis surgery may be considered as rather challenging in gynecology. In this article, we tried to emphasize on basic concepts of endometriosis surgery, the best surgical method that should be applied and the complications and the management of the complications.  

Womens Health (Lond Engl). 2015 Aug;11(5):677-83. doi: 10.2217/whe.15.54. Epub 2015 Aug 28. Urman B1. Abstract Endometrioma surgery should be planned and executed very carefully as it is associated with risks that may hamper future reproductive potential. Symptoms, age, risk of malignancy, bilaterality, ovarian reserve, and desire to have children should all be taken into account prior to surgical intervention. Cyclic and noncyclic severe pain may be an indicator or deep infiltrating diseases. Laparoscopic surgery is the gold standard, however, the issue of resection versus ablation should be further studied.  

Womens Health (Lond Engl). 2015 Aug;11(5):653-64. doi: 10.2217/whe.15.51. Epub 2015 Aug 28. Attar R1, Attar E2. Abstract Endometriosis is defined as the presence of endometrial gland and stroma outside the uterine cavity. It is an estrogen-dependent disease and is associated with chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. The treatment of endometriosis is conservative or radical surgery, medical therapies or their combination. All currently used hormonally active treatments are effective in the treatment of endometriosis; however, the adverse effects of these hormonal treatments limit their long-term use. Moreover, recurrence rates are high after cessation of therapy, and the treatments have no benefit in endometriosis-associated infertility. Therefore, researchers are working on new treatment modalities with improved side effects, mainly focusing on the molecular targets involved in etiopathogenesis of endometriosis. Here we summarized these novel treatments modalities.  

Womens Health (Lond Engl). 2015 Aug;11(5):587-95. doi: 10.2217/whe.15.43. Epub 2015 Aug 28. Ulukus M1. Abstract Endometriosis is a common chronic gynecological disease that is classically defined by the presence of endometrial stromal and glandular tissues outside the uterine cavity. Pelvic pain and infertility are the nonspecific but the most common symptoms of the disease; however, no currently definitive treatment has been developed since its pathogenesis has not been completely understood. Currently, none of the proposed conventional theories can explain all aspects of endometriosis. Recent evidence supports the presence of endometrial stem/progenitor cells and their possible involvement in endometrial regeneration and differentiation. The stem cell theory is a new hypothesis which may clarify the underlying pathophysiologic mechanisms of endometriosis. However, this theory could not only account for an alternative pathogenic mechanism ofendometriosis but could also be involved in all conventional theories. This article will review the evidence for the presence of endometrial stem/progenitor cells, their possible sources and their possible involvement in the pathogenesis of endometriosis.  

Int J Fertil Steril. 2015 Jul-Sep;9(2):183-8. Epub 2015 Jul 27. Api M1, Boza AT1, Kayatas S1, Eroglu M1. Abstract BACKGROUND:  Endometriosis is a complex disease with a spectrum of pain symptoms from mild dysmenorrhea to debilitating pelvic pain. There is no concrete evidence in the literature whether endometriotic cyst per se, causes pain spectrum related to the disease. The aim of the present study was to evaluate the effect of surgical removal of endome- triomas on pain symptoms. MATERIALS AND METHODS:  In this prospective, observational, before-after study, which was conducted between March 2012 and January 2013 in Training and Research Hospital, Adana, Turkey, a total of 23 patients including 16 sexually active and 7 vir- gin symptomatic women were questioned for non-cyclic pelvic pain (NCPP), intensity of the NCPP, presence of cyclic dysmenorrhea, and dyspareunia before and after the endometrioma operation. Participants who were sonographically diagnosed and later pathologically confirmed as having endometrioma without sign and symptoms of deep infiltrative endometriosis (DIE) were also questioned for pain symptoms before and after the laparoscopic removal of cyst wall. Patients with intraabdominal adhesions, history of pelvic inflammatory disease, and pathological diagnosis other than endometrioma were excluded. No ancillary procedures were applied for pain management, but if pain was present, pelvic peritoneal endometriotic lesions were ablated beside the removal of ovar- ian endometriotic cysts. RESULTS:  Out of 23 cases with endometrioma, 91 and 78% reported to have NCPP and dysmenorrhea, respectively, before the operation, while 60 and 48%, respec- tively, after the operation (McNemar's test, P=0.016 for both figures). Among the sexually active cases, 31% (5/16) had dyspareunia before the operation and only 1 case reported the pain relief after the operation (McNemar's test, P=1). Intensity of NCPP were reported to be none (8.7%), moderate (21.7%), severe (56.5%) and un- bearable (13%) before the operation and decreased to none (43.5%), mild (43.5%), moderate (4.3%) and severe (8.7%) after the operation (Wilcoxon signed-rank test, P<0.001). CONCLUSION:  In symptomatic cases with ovarian endometrioma, without sign and symptoms of DIE, laparoscopic removal of the cysts with/without ablation of the peritoneal endometriotic lesions yields relief of NCPP and cyclic dysmenore.  

Taiwan J Obstet Gynecol. 2015 Jun;54(3):236-9. doi: 10.1016/j.tjog.2014.03.010. Ant Ö1, Özakşit G1, Güzel Aİ1, Cavkaytar S1, Kaba M1, Topçu HO2. Abstract OBJECTIVE:  To determine the clinical significance of serum follistatin levels in women with an ovarian endometrioma. MATERIALS AND METHODS:  This is a prospective study of 89 women, 56 with an ovarian endometrioma (endometrioma group) and 33 with a benign ovarian cyst (control group) who underwent laparoscopic excision. Age, parity, body mass index, serum CA-125, serum CA 19-9, and serum follistatin levels were determined for all participants and evaluated as potential prognostic factors prior to laparoscopic cystectomy. RESULTS:  There were no significant differences in demographic factors between the endometrioma group and the control group. However, serum follistatin levels were significantly higher in the endometrioma group (9350 ± 895 pg/mL vs. control group 725 ± 72 pg/mL, p < 0.05). The optimal diagnostic cut-off values (sensitivity and specificity) of CA-125, CA 19-9, and follistatin for ovarian endometrioma were 23.2 IU/mL (82.14% and 72.73%), 30.14 IU/mL (45.28% and 87.50%), and 2350 pg/mL (53.7% and 60.61%), respectively. CONCLUSION:  Despite the increased serum follistatin levels in patients with ovarian endometrioma, CA-125 was determined to be a more sensitive and specific marker than follistatin for the diagnosis of ovarian endometrioma and endometriosis.  

J Obstet Gynaecol. 2015;35(8):844-7. doi: 10.3109/01443615.2015.1022140. Epub 2015 Jul 8. Cavkaytar S1, Tapisiz OL2, Kiykac Altinbas S2, Tapisiz A3, Erdem O4, Goktolga U2. Abstract The aim of this study was to investigate the effect of clarithromycin in rat endometriosis and its association with matrix metalloproteinase-9 (MMP-9) expression. After surgical induction of endometriosis, 27 rats were randomised into three groups. Size of endometriotic implants were evalutated and rats in group I (n = 9) were given 100 mg/kg/day of oral clarithromycin, rats in group II (n = 9) were given single 1 mg/kg s.c. injection of leuprolide acetate and rats in group III (n = 9) were not given any medication for 21 days. At the end of 21 days of medication, remaining 23 rats were sacrificed to evaluate morphological and histological features of implants. There was a significant difference between the groups in implant volumes (p = 0.004) before and after medication. Regression of implants were significantly higher in groups I and II than that in control group (p = 0.009 and p = 0.011, respectively). After medication, in group I the implant volume decreased from 62 (12-166) mm(3) to 26 (3-87) mm(3) (p = 0.012) and in group II the volume decreased from 224 (76-1135) mm(3) to 62 (26-101) mm(3) (p = 0.028). There was a significant difference between groups in histopathological score (p = 0.024). The epithelial immunohistochemical score of MMP-9 was significantly lower in group II than that in control group (p = 0.014). In conclusion, clarithromycin regresses endometriotic implants in rats, but not via MMP-9.

Exp Ther Med. 2015 May;9(5):1813-1818. Epub 2015 Feb 19. Goktolga U1, Cavkaytar S2, Altinbas SK1, Tapisiz OL1, Tapisiz A3, Erdem O4. Abstract The aim of this study was to investigate the possible therapeutic effects of Doxycycline (Dox) on endometriotic lesions in an experimental rat model. Thirty-seven female Wistar albino rats with surgically induced endometriosis were randomized and divided into four groups. The rats were administered 5 mg/kg/day oral Dox in Group 1 (low-dose Dox group, n=9), 20 mg/kg/day oral Dox in Group 2 (high-dose Dox group, n=10) and 1 mg/kg single dose, subcutaneous leuprolide acetate in Group 3 (leuprolide acetate group, n=9). The rats in Group 4 (control group, n=9) were given no medication. The rats received medication for three weeks and were then sacrificed to evaluate the morphological and histological features of the implants. Matrix metalloproteinase (MMP)-9 immunoreactivity of the implants was also evaluated. The size of the endometriotic implants decreased in Groups 1-3 but statistically significant differences were not observed among the groups. The mean surface area of the endometriotic implants decreased from 69.3±30.8 to 52.1±27.0 mm² in Group 1 (P>0.05), from 60.2±18.9 to 38.6±28.7 mm² in Group 2 (P>0.05) and from 58.1±33.1 to 26±9.0 mm² in Group 3 (P=0.03). The epithelial MMP-9 immunohistochemical score was significantly higher in Group 1 and lower in Group 3 when compared with the control group (Group 4) (P=0.042 and P=0.014, respectively). When the stromal MMP-9 immunohistochemical and histopathological scores of the endometriotic implants were compared, no statistically significant differences were found among the groups. Although there was no statistically significant difference, Dox reduced the endometriotic implant area in the rat endometriosis model. Further studies are required to investigate the potential efficacy of Dox in endometriosis due to its widespread use and tolerability.

Fertil Steril. 2015 Aug;104(2):356-65. doi: 10.1016/j.fertnstert.2015.04.041. Epub 2015 Jun 13. Celik O1, Unlu C2, Otlu B3, Celik N4, Caliskan E5. Abstract OBJECTIVE:  To determine whether laparoscopic endometrioma resection alters peri-implantation endometrial HOXA-10, HOXA-11, LIF, ITGB3 and ITGAV mRNA expression. DESIGN:  Case-control study. SETTING:  Medical school. PATIENT(S):  Twenty infertile patients with uni- or bilateral endometrioma, five infertile patients having nonendometriotic benign ovarian cyst, and five fertile control subjects. INTERVENTION(S):  Mid-luteal-phase endometrial sampling was performed at the time of surgery. Second endometrial biopsies were obtained 3 months after laparoscopic endometrioma resection during the mid-luteal phase of the cycle. MAIN OUTCOME MEASURE(S):  Endometrial HOXA-10, HOXA-11, LIF, ITGAV, and ITGB3 mRNA expressions were evaluated with the use of reverse-transcription polymerase chain reaction. RESULT(S):  Significantly decreased endometrial ITGAV mRNA expression was noted in biopsies obtained from endometrioma and nonendometriotic cyst groups before surgery. Trends toward decreased endometrial HOXA-10, HOXA-11, LIF, and ITGB3 mRNA expressions were noted in the endometrioma and nonendometriotic cyst groups before surgery compared with the fertile subjects. However, the differences failed to show statistical significance. Compared with preoperative values, significantly increased HOXA-10 (12.1-fold change) and HOXA-11 (17.2-fold change) mRNA expressions were noted in endometrial biopsies obtained from subjects who were undergoing endometrioma surgery. Fold change in endometrial ITGAV mRNA after endometrioma surgery was found to be 30.1 and indicated a positive regulation. However, this fold increase was statistically insignificant. Expressions of these endometrial receptivity markers did not change significantly after surgical removal of nonendometriotic benign ovarian cysts. CONCLUSION(S):  Laparoscopic endometrioma resection increases peri-implantation endometrial HOXA-10 and HOXA-11 mRNA expression, suggesting an improvement in endometrial receptivity.

Quant Imaging Med Surg. 2015 Jun;5(3):485-7. doi: 10.3978/j.issn.2223-4292.2014.08.05. Akpınar S1, Yılmaz G1, Çelebioğlu E1. Abstract Endometriosis is a benign gynecological disease that is characterized by the presence of functional endometrial tissue outside the uterus. Although the ovaries and uterine ligaments are the most common locations, urinary tract involvement especially the bladder endometriosis is a rare entity in women of reproductive age with clinical symptoms of cyclical urgency, hematuria and suprapubic pain. We herein present magnetic resonance imaging (MRI) findings of spontaneous bladder endometriosis case with cyclical hematuria symptoms.

Gynecol Endocrinol. 2015;31(8):639-42. doi: 10.3109/09513590.2015.1029446. Epub 2015 May 26. Sahin L1, Bozkurt M1, Celik O2, Çelik N3, Aydin S4, Gencdal S1. Abstract OBJECTIVES:  The objective of this study is to evaluate plasma concentrations of salusin-α and salusin-β levels in women with endometrioma and non-endometriotic benign ovarian cysts. METHOD:  Endometrioma patients (n = 14), non-endometriotic ovarian cysts (n = 14), and age-matched normal healthy fertile subjects (n = 14) participated in this study. Plasma salusin-α and salusin-β levels at the time of mid-luteal phase before and 3 months after L/S cystectomy were measured using ELISA and EIA tests, and their relation with demographic parameters was also assessed. RESULTS:  The mean salusin-α and salusin-β levels were significantly higher in women with endometrioma before the removal of cyst compared with cases with non-endometriotic cyst and fertile cases. Surgical removal of the endometrioma decreased the mean salusin-α and salusin-β levels to the level of those with non-endometriotic cyst before and after the cystectomy and fertile women, in both unilateral and bilateral endometrioma cases. Plasma salusin-β concentrations were found to be positively correlated with age, size of cyst, bilaterality, and salusin-α levels. Salusin-β values showed no correlations to BMI and size of the ovarian cysts. CONCLUSIONS:  Plasma salusin-α and salusin-β levels are increased in endometrioma patients and positively correlated with endometrioma size. Laparoscopic removal of the endometrioma by stripping technique decreases the salusin levels to a similar level of fertile women.  

Clin Imaging. 2015 Sep-Oct;39(5):830-3. doi: 10.1016/j.clinimag.2015.05.003. Epub 2015 May 7. Balaban M1, Idilman IS2, Toprak H3, Unal O2, Ipek A2, Kocakoc E4. Abstract The aim was to determine the utility of diffusion-weighted magnetic resonance imaging (DW MRI) and apparent diffusion coefficient (ADC) measurements in differentiation of endometrioma and hemorrhagic ovarian cyst. A total of 24 female patients who underwent pelvic MRI with an initial diagnosis of ovarian cyst were included in the study. The final diagnosis was endometrioma in 12 patients and hemorrhagic ovarian cyst in 12 patients. We observed significantly lower ADC values in endometriomas compared with hemorrhagic ovarian cysts in all b values. DW MRI with quantitative ADC measurements can be used for differentiation of endometrioma from hemorrhagic ovarian cysts.  

Reprod Sci. 2015 Nov;22(11):1445-51. doi: 10.1177/1933719115584448. Epub 2015 May 11. Yildiz C1, Kacan T2, Akkar OB3, Karakus S3, Kacan SB4, Ozer H5, Cetin A3. Abstract We aimed to compare the effects of pazopanib, sunitinib, and sorafenib on endometriotic tissue morphology and histological characteristics as well as ovarian reserve in a rat model. Experimental endometriosis was established in 32 rats. They were randomly divided into 4 groups (8 rats for each group) to administer study drugs: pazopanib, sunitinib, sorafenib, and normal saline. Histological examination with hematoxylin and eosin staining to determine endometriosis score and immunostaining with primary vascular endothelial growth factor (VEGF), CD117, and Bax antibodies were performed. Bilateral ovaries excised to determine the ovarian follicle number. The endometriosis score was significantly reduced by pazopanib compared to other study drugs and by sunitinib compared to sorafenib and normal saline (P < .05). Sorafenib did not affect endometriosis score (P > .05). The VEGF score was significantly decreased similarly by pazopanib, sunitinib, and sorafenib compared to normal saline (P < .05). The CD117 score was reduced by pazopanib and sunitinib similarly compared to both sorafenib and normal saline that provided similar effect on the score (P < .05). The Bax scores of all the groups were found similar (P > .05). No study drugs caused meaningful change in the ovarian follicle number (P > .05). Pazopanib reduces the growth of endometriotic implants. This effect may be related to the suppressive effect of pazopanib on the endometriotic tissue expressions of VEGF and CD117 but not Bax. The study drugs do not affect ovarian reserve. The inconsistent effects of study drugs regarding study parameters require further studies to elucidate the molecular bases of their effects on the growth of endometriotic implants.

Balkan J Med Genet. 2015 Apr 10;17(2):73-80. doi: 10.2478/bjmg-2014-0077. eCollection 2014. Soysal D1, Kızıldağ S2, Saatlı B1, Posacı C1, Soysal S3, Koyuncuoğlu M4, Doğan Ö1. Abstract Our aim was to investigate the effects of anti-vascular endothelial growth factor (anti-VEGF) antibody Bevacizumab on endometrial explants and on apoptotic gene expression levels in the rat endometriosis model. Endometriotic implants were surgically formed, and rats treated with (i) 1 mg/kg single subcutaneous injection of depot leuprolide acetate; (ii) 2.5 mg/kg of single intaperitoneal injection of bevacizumab; (iii) intraperitoneal injection of saline. Histopathologic scores and adhesion scores of endometriotic foci and levels of Bcl-2-associated X protein (Bax), Cytochrome c (Cyt-c), B-cell lymphoma/leukemia 2 (Bcl-2) and B-cell lymphoma-extra large (Bcl-xl) mRNA gene expressions of endometriotic foci. Bevacizumab treatment decreased the endometriotic explant size compared with control. Bevacizumab-treated rats had lower total adhesion scores when compared with the control group. Semi-quantitative evaluation of the persistence of endometrial epithelial cells in the explants showed a lower score in gonadotropin-releasing hormone (GnRH) agonist-treated rats compared with control rats. In Bevacizumab increased expression of Bax 3.1-fold, Cyt-c 1.3-fold and decreased expression of Bcl-2 0.4-fold, Bcl-xl 0.8-fold compared with the control group. The GnRH agonist increased expression of Bax 3.0 fold, Cyt-c 1.3 fold and decreased expression of Bcl-2 0.4-fold, Bcl-xl 0.8-fold, compared with the control group. This study suggests that a novel angiogenesis inhibitor, anti-VEGF antibody bevacizumab is as effective as GnRH agonist in the regression of the endometriotic lesions in ratendometriosis model. One possible mechanism of this effect is the induction of apoptosis.  

Arch Gynecol Obstet. 2015 Sep;292(3):619-28. doi: 10.1007/s00404-015-3665-6. Epub 2015 Feb 21. Küpeli Akkol E1, Demirel MA, Bahadır Acıkara O, Süntar I, Ergene B, Ilhan M, Ozbilgin S, Saltan G, Keleş H, Tekin M. Abstract PURPOSE:  The aim of the present study is to evaluate the treatment potential of Alchemilla mollis (Buser) Rothm. and Alchemilla persica Rothm. in the experimentally induced endometriosis model in rats. METHODS:  Endometriosis was surgically induced in rats by autotransplanting endometrial tissue to abdominal wall. Thirty-six rats were randomly divided into six groups. The groups were orally treated with the methanol:water (80:20) extracts of aerial parts and roots of A. mollis and A. persica. Buserelin acetate (20 mg) was used as the reference drug. The phytochemical contents of the most active extracts were determined by high performance liquid chromatography. RESULTS:  The cystic formation was determined to be significantly decreased with the aerial part extract of A. mollis. A reduction in the endometrioma was also determined for the aerial part extract of A. persica group. However, significant reduction on the levels of cytokine were recorded for the A. mollis aerial part extract group. Therefore, the phytochemical contents of the aerial part extracts of A. mollis. and A. persica were analyzed. CONCLUSION:  The results of the present study revealed that the aerial part extracts of A. mollis and A. persica could be beneficial in the treatment of endometriosis.  

J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):363-72. doi: 10.1016/j.jmig.2014.12.168. Epub 2015 Jan 5. Ata B1, Turkgeldi E2, Seyhan A3, Urman B2. Abstract We reviewed the literature to determine whether different hemostatic methods used following laparoscopic endometrioma excision have differing effects on ovarian reserve. We performed a systematic literature search using the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and Ovid MEDLINE In-Process & Other Non-Indexed Citations databases to identify studies comparing the rate of change in levels of serum anti-Müllerian hormone (AMH) at 3 months after laparoscopic endometrioma excision using bipolar dessication (BD) or suturing/application of a hemostatic sealant (HS) for hemostasis. Abstracts of the annual meetings of the American Society of Reproductive Medicine, the European Society of Human Reproduction and Embryology, and the American Association of Gynecological Laparoscopists were searched as well. A total of 712 articles were identified, of which 6 were included in the qualitative analysis. Four studies involving 213 women were included in the meta-analysis. Our qualitative analysis suggested that BD is more detrimental to ovarian reserve than alternative hemostatic methods. There is moderate-quality evidence favoring HS and low-quality evidence favoring sutures over BD. The meta-analysis also showed that alternative hemostatic methods are associated with significantly less decline in ovarian reserve compared with BD. The mean decline in serum AMH levels was 6.95% less with alternative hemostatic methods than with BD (95% CI, -13.0% to -0.9%; p = .02) at 3 months after surgery. According to the best available evidence, the use of BD should be cautiously limited, even avoided when possible, during endometrioma excision in women who desire to have children.  

Clin Exp Obstet Gynecol. 2014;41(6):713-6. Kurt RK1, Dogan AC, Yesilyurt H, Karateke A, Okyay AG. Abstract AIM:  Although the exact pathogenesis of endometriosis is not known, it is proposed to be a chronic inflammatory disease. The asso- ciation between red cell distribution width (RDW) and inflammation is well established. Therefore, in the present study, the authors aimed to investigate the association between presence and severity of endometriosis and RDW. MATERIALS AND METHODS:  Fifty endometriosis patients and 48 controls were included in the study. The endometriosis group was categorized in two subgroups as mild-to-moderate (n = 35) and moderate-to-severe disease (n = 15). CA-125 and RDW values of all participants were measured. RESULTS:  Both RDW (17.7 ± 2.2 vs 14.9 ± 1.5, p < 0.001) and CA-125 (50.6 ± 35.1 vs 27.9 ± 4.8) levels were significantly higher in theendometriosis patients when compared to the control group. Moreover the authors found a significant positive correlation between RDW and CA-125 levels (r: 0.495, p < 0.001). CONCLUSION:  The present study results demonstrated that RDW levels were significantly increased in endometrio- sis patients and associated with the severity of endometriosis.  

Arch Gynecol Obstet. 2015 Jul;292(1):209-16. doi: 10.1007/s00404-014-3599-4. Epub 2014 Dec 19. Yilmaz B1, Kilic S, Aksakal O, Ertas IE, Tanrisever GG, Aksoy Y, Lortlar N, Kelekci S, Gungor T. Abstract PURPOSE:  The aim of this study was to test if melatonin causes regression of endometriotic implants and whether it influences implant levels of superoxide dismutase (SOD), malondialdehyde (MDA), vascular endothelial growth factor (VEGF), tissue inhibitor of metalloproteinase (TIMP)-2 and matrix metalloproteinase (MMP)-9 in rats. METHODS:  Endometriotic implants were introduced surgically to 20 female Wistar albino rats, which were either treated with melatonin via intraperitoneal injection for four weeks (melatonin group, n = 10) or with saline (control group, n = 10) after a second-look laparotomies. The main outcome measures included volume (mm(3)) and weight (mg) of explants and tissue levels of SOD, MDA, VEGF, TIMP-2 and MMP-9. RESULTS:  Before and after treatment implant volumes of the melatonin group were decreased significantly (P < 0.01) while there was no significant difference between the pretreatment and posttreatment implant volumes of the control group. Moreover, weight (P < 0.05) and histologic score (P < 0.05) of implants of the melatonin-treated rats were significantly lower than controls. Activity of SOD and TIMP-2 staining in melatonin group was significantly higher (both P < 0.01) while there were significant reductions in implant levels of VEGF and MMP-9 in melatonin group (both P < 0.01) than controls. CONCLUSIONS:  Melatonin induces the regression of endometriotic implants in rats by modulating implant levels of SOD, MDA, VEGF, MMP-9 and TIMP-2.  

J Coll Physicians Surg Pak. 2014 Dec;24(12):944-6. doi: 12.2014/JCPSP.944946. Goker A1, Sarsmaz K1, Pekindil G2, Kandiloglu AR3, Kuscu NK1. Abstract Endometriosis is characterized by an abnormal existence of functional endometrial tissue outside the uterine cavity, typically occuring within the pelvis of women in reproductive age. We report two cases with endometriosis of the abdominal wall; the first one in the rectus abdominis muscle and the second one in the surgical scar of previous caesarean incision along with the rectus abdominis muscle. Pre-operative evaluation included magnetic resonance imaging. The masses were dissected free from the surrounding tissue and excised with clear margins. Diagnosis of the excised lesions were verified by histopathology.

Eur J Obstet Gynecol Reprod Biol. 2015 Feb;185:41-4. doi: 10.1016/j.ejogrb.2014.11.039. Epub 2014 Dec 4. Selcuk S1, Sahin S2, Demirci O2, Aksoy B2, Eroglu M2, Ay P3, Cam C2. Abstract OBJECTIVES:  To validate the Turkish-translated versions of the Endometriosis Health Profile 5 (EHP-5) for use in patients with laparoscopically proven endometriosis. STUDY DESIGN:  This case control study was conducted in a tertiary referral teaching institution between April and June 2014. Fifty-eight patients with surgically proven endometriosis were enrolled. The EHP-5 questionnaire was evaluated for patients with laparoscopically diagnosedendometriosis. Test-retest reliability, descriptive statistics, reliability analysis (internal consistency and item-total correlation), data completeness, and known-group comparison were all assessed in the validation of the EHP-5 form as translated into the Turkish language. RESULTS:  Two weeks test-retest reliability showed statistically significant correlation; Spearman's rho was 0.885 (p<0.001) for the EHP-5 core questionnaire and 0.896 (p<0.001) for the EHP-5 modular questionnaire. Cronbach's alpha values for the translated form of the EHP-5 core and modular questionnaires were 0.829 and 0.804, respectively, with a high level of internal consistency. In known group comparison, there were statistically significant differences in all subgroups except in the infertility group on the core questionnaire. Pain scales on the core questionnaire and infertility scales on the modular questionnaire showed the highest mean scores (1.14±1.16 and 1.78±1.77). CONCLUSION:  Like the original English questionnaire, the Turkish-translated version of the EHP-5 is a reliable and valid instrument for assessing symptom severity and the impact of endometriosis on health-related quality of life in Turkish-speaking women.  

Case Rep Urol. 2014;2014:891295. doi: 10.1155/2014/891295. Epub 2014 Nov 18. Efe E1, Bakacak M2, Serin S2, Kolus E1, Ercan O2, Resim S1. Abstract The incidence of endometriosis cases involving the urinary system has recently increased, and the bladder is a specific zone where endometriosis is most commonly seen in the urinary system. In the case presented here, a patient presented to the emergency department with the complaint of side pain and was examined and diagnosed with severe hydronephrosis and bladder endometriosis was determined in the etiology. After the patient was pathologically diagnosed, Levonorgestrel-Releasing Intrauterine System (LNG-IUS) was administered to the uterine cavity. At the 12-month follow-up,endometriosis was not observed in the cystoscopy and symptoms had completely regressed. Hydronephrosis may be observed after exposure of the ureter, and silent renal function loss may develop in patients suffering from endometriosis with bladder involvement. For patients with moderate or severe hydronephrosis associated with bladder endometriosis, LNG-IUS application may be separately and successfully used after conservative surgery.

Arch Gynecol Obstet. 2015 Jun;291(6):1411-6. doi: 10.1007/s00404-014-3562-4. Epub 2014 Dec 13. Kerimoglu OS1, Yılmaz SA, Pekin A, Nergiz S, İncesu F, Dogan NU, Acar H, Celik C. Abstract OBJECTIVES:  The purpose of this study was to evaluate the influence of the follicle-stimulating hormone (FSH) receptor poymorphisms Asn680Ser and Thr307Ala on endometriosis in Turkish women. METHODS:  Polymorphic analysis of the FSH receptor gene was performed in 100 patients with endometriosis and 100 controls. Genomic DNA was obtained from peripheral blood leukocytes and polymorphisms were investigated using restriction fragment length polymorphism analysis. RESULTS:  There were no significant differences in genotype frequencies of FSH receptor gene between endometriosis patients and controls. When the patients were divided into two groups according to disease severity, we found that the patients with the SS (680 Ser/Ser) or AA (307 Ala/Ala) genotype were less likely to develop stage 3-4 endometriosis compared to the stage 1-2 endometriosis group (P = 0.004; OR: 0.177, 95% CI 0.055-0.568 and P = 0.040; OR: 0.240, 95% CI 0.061-0.938; respectively). CONCLUSIONS:  The distributions of FSHR polymorphisms may not have an effect on endometriosis development but they are associated with the severity of the disease. The polymorphisms encoding SS at the position 680 and AA at the position 307 and the patients with the genotype that included alanine or serine were less likely to develop stage 3-4 endometriosis compared to the stage 1-2 endometriosis group.

J Med Case Rep. 2014 Dec 11;8:420. doi: 10.1186/1752-1947-8-420. Karadag MA1, Aydin T, Karadag OI, Aksoy H, Demir A, Cecen K, Tekdogan UY, Huseyinoglu U, Altunrende F. Abstract INTRODUCTION:  Endometriosis can be defined as the presence of endometrial glandular and stromal tissue outside the uterus. Affected sites ofendometriosis can even be the urinary tract. Here, we present the case of a 30-year-old woman with right ureteral endometriosis. This case was important due to the unusual localization and no signs of the disease except for hydroureteronephrosis. CASE PRESENTATION:  A 30-year-old Caucasian woman with para 2 was admitted to our department for right side flank pain, dysuria and suprapubic pain. She had no complaints of vaginal discharge, bleeding or painful menstruation. Her menstrual cycles were normal and lasting for three to four days. She did not have a history of any surgical interventions. A physical examination revealed a right side costovertebral angle and suprapubic tenderness. Laboratory test results including a complete blood count, serum biochemical analysis, urine analysis and urine culture were normal. Urinary ultrasonography showed right side hydroureteronephrosis with renal cortical thinning. We suspected a right ureteral stone obstructing the ureter and a computed tomography scan was performed. The computed tomography scan revealed similar right side hydroureteronephrosis with obstruction of the ureter. No signs of stone were observed on the scan. Retrograde pyelography and diagnostic ureterorenoscopy were performed and they showed a focal stricture with a length of approximately 3 cm at the distal ureteral part and secondary hydroureteronephrosis. Open partial ureterectomy and ureteroneocystostomy with Boari flap were performed. The pathologic specimen of her ureter demonstrated intrinsic endometriosisof the right ureter with endometrial glandular cells and stromal tissue. CONCLUSIONS:  Clinicians should suspect ureteral endometriosis in premenopausal women with unilateral or bilateral distal ureteral obstruction of uncertain cause. The main goals of the treatment should be preservation of renal function, relief of obstruction and prevention of recurrence.

Eur J Obstet Gynecol Reprod Biol. 2015 Jan;184:7-12. doi: 10.1016/j.ejogrb.2014.10.026. Epub 2014 Oct 30. Kiykac Altinbas S1, Tapisiz OL2, Cavkaytar S3, Simsek G4, Oguztuzun S5, Goktolga U2. Abstract OBJECTIVE:  Montelukast, a selective antagonist of Type 1 cysteinyl leukotriene receptors (CysLT1Rs), antagonizes the proinflammatory and proasthmatic activities of CysLT1Rs. We investigated the effect of montelukast on a surgically induced endometriosis rat model. STUDY DESIGN:  Thirty-two sexually mature, cycling, female Wistar-Albino rats, in which endometriotic implants were surgically induced, were randomly divided into three groups. Group I [Montelukast (M), 10 rats)] was given 1.6 mg/kg/day of oral montelukast sodium. Group II [Leuprolide acetate (L), 11 rats] was given 1 mg/kg single dose of s.c.leuprolide acetate. Group III [Control (C), 11 rats] received saline solution through an orogastric tube and served as controls. After a 3-weeks medication, the rats were sacrificed to investigate the endometriotic implants for size and morphological and histological characteristics, including immunoreactivity of MMP-2 and VEGF. RESULTS:  The mean area of implants decreased from 48.2 ± 24.7 to 29.3 ± 15.8mm(2) in Group I (M) (P = 0.008) and from 62 ± 32.1 to 39.9 ± 18.1mm(2) in Group II (L) (P=0.003). In Group III (C), the mean area increased from 41.1 ± 31.1 to 60.4 ± 37.1mm(2) (P = 0.025). Histopathological analysis showed statistically significant lower scores in rats treated with montelukast compared to leuprolide and controls. MMP H scores were not different between the groups in both epithelial and stromal MMP-2 immunostaining. VEGF H scores were statistically lower in Group 1 (M) in epithelial VEGF immunostaining when compared to Group II (L) and Group III (C) (P=0.006). CONCLUSION(S):  Montelukast may effectively cause a significant decrease in the area of endometriotic implants.  

Eur J Obstet Gynecol Reprod Biol. 2015 Jan;184:1-6. doi: 10.1016/j.ejogrb.2014.10.041. Epub 2014 Nov 11. Bayoglu Tekin Y1, Guven S2, Kirbas A3, Kalkan Y4, Tumkaya L4, Guvendag Guven ES5. Abstract OBJECTIVE:  Resveratrol, a phytoalexin polyphenol, has anti-angiogenic, antioxidant, anti-inflammatory properties. We aimed to compare the anti-inflammatory and anti-angiogenic effects of resveratrol and leuprolide acetate (LA) in an experimental endometriosis model. STUDY DESIGN:  A prospective experimental study was conducted in a University Surgical Research Center. Thirty-three non-pregnant female Sprague-Dawley rats, in which experimental model of endometriosis were surgically induced were randomly divided into four groups. Group 1 was administered 30 mg/kg resveratrol i.m. for 14 days, group 2 was given 1mg/kg s.c. single dose LA, group 3 was administered both resveratrol and LA, and group 4 had no medication. After two weeks medication rats were sacrificed and size, histopathology and immunreactivity to matrix metalloproteinase (mmp)2, mmp9, vascular endothelial growth factor (VEGF) of the endometriotic implants were evaluated. Plasma and peritoneal fluid levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) were analyzed. RESULTS:  The endometriotic implant volumes, histopathological grade and immunreactivity to mmp2, mmp9 and VEGF were significantly reduced (p<0.001), and plasma and peritoneal fluid levels of IL-6, IL-8 and TNF-α were significantly decreased in group 1 and group 2 in comparison to group 3 and group 4 (p < 0.001). CONCLUSION:  Resveratrol alone is a potential agent for the treatment of endometriosis and may be an alternative to LA. In contrast, the combination of LA and resveratrol decreased the anti-inflammatory and anti-angiogenic effects of each agent. Since resveratrol is widely used as an alternative therapy for a variety of conditions, it can undermine the effectiveness of LA. Therefore, caution should be exercised when used in combination with other agents.

JSLS. 2014 Jul-Sep;18(3). pii: e2014.00128. doi: 10.4293/JSLS.2014.00128. Bastu E1, Yasa C1, Dural O1, Mutlu MF2, Celik C1, Ugurlucan FG1, Buyru F1. Abstract BACKGROUND AND OBJECTIVES:  The aim of this study was to compare the in vitro fertilization (IVF) outcomes of long gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) protocols in endometriosis patients who have undergone laparoscopic endometrioma resection surgery. To our knowledge, there is no study in the current literature that compares the effectiveness of long GnRH-a and GnRH-ant protocols in management of IVF cycles in endometriosis patients who underwent laparoscopic endometrioma resection surgery. METHODS:  Eighty-six patients with stage III to IV endometriosis who had undergone laparoscopic resection surgery for endometrioma were divided into 2 groups: those who had ovarian stimulation with a long GnRH-a protocol (n=44), and those who had ovarian stimulation with a GnRH-ant protocol (n=42). RESULTS:  The number of follicles on human chorionic gonadotropin injection day, duration of hyperstimulation, number of retrieved metaphase II oocytes, and total number of grade 1 embryos were statically significantly higher in the long GnRH-a protocol. There were no significant differences in positive β-human chorionic gonadotropin pregnancy rates (25% vs 21.4%; P=.269) and ongoing pregnancy rates per patient (20.5% vs 19.1%; P=.302) between the 2 protocols. CONCLUSIONS:  Long GnRH-a and GnRH-ant protocols both present similar IVF outcomes in patients with endometriosis who have undergone laparoscopic endometrioma resection surgery. A long GnRH-a protocol may lead to a higher number of embryos that can be cryopreserved, providing the possibility of additional embryo transfers without having to go through the process of ovarian stimulation again.

Gynecol Endocrinol. 2015 Mar;31(3):219-24. doi: 10.3109/09513590.2014.976197. Epub 2014 Nov 6. Ozcan Cenksoy P1, Oktem M, Erdem O, Karakaya C, Cenksoy C, Erdem A, Guner H, Karabacak O. Abstract The aim of our study was to evaluate the effectiveness of resveratrol in experimentally induced endometrial implants in rats through inhibiting angiogenesis and inflammation. Endometrial implants were surgically induced in 24 female Wistar-Albino rats in the first surgery. After confirmation of endometriotic foci in the second surgery, the rats were divided into resveratrol (seven rats), leuprolide acetate (eight rats), and control (seven rats) groups and medicated for 21 d. In the third surgery, the measurements of mean areas and histopathological analysis of endometriotic lesions, VEGF, and MCP-1 measurements in blood and peritoneal fluid samples, and immunohistochemical staining were evaluated. After treatment, significant reductions in mean areas of implants (p < 0.01) and decreased mean histopathological scores of the implants (p < 0.05), mean VEGF-staining scores of endometriotic implants (p = 0.01), and peritoneal fluid levels of VEGF and MCP-1 (p < 0.01, for VEGF and p < 0.01, for MCP-1) were found in the resveratrol and leuprolide acetate groups. Serum VEGF (p = 0.05) and MCP-1 (p = 0.01) levels after treatment were also significantly lower in the resveratrol and leuprolide acetate groups. Resveratrol appears to be a potential novel therapeutic agent in the treatment of endometriosis through inhibiting angiogenesis and inflammation. Further studies are needed to determine the optimum effective dose in humans and to evaluate other effects on reproductive physiology.

Arch Gynecol Obstet. 2015 May;291(5):1103-11. doi: 10.1007/s00404-014-3524-x. Epub 2014 Nov 4. Ercan CM1, Kayaalp O, Cengiz M, Keskin U, Yumusak N, Aydogan U, Ide T, Ergun A. Abstract OBJECTIVE:  To determine the effect of dopamine agonists in a surgically induced endometriosis model on rats. STUDY DESIGN:  In this prospective randomized experimental study, surgical induction of endometriosis was performed by autotransplantation technique on 52 adult female Wistar-Albino rats. Endometriosis formation was confirmed by a second-look laparotomy (n:48) 1 month later. Four study groups were randomly generated according to their treatment regimens: group 1 (leuprolide acetate, n = 12), group 2 (bromocriptine, n = 12), group 3 (cabergoline, n = 12) and group 4 (control, n = 12). Endometriotic implants were excised for histopathological examination after treatment at the setting of laparotomy. The mean surface areas and histopathological glandular tissue (GT) and stromal tissue (ST) scores of endometriotic implants were studied and compared among groups. RESULTS:  After 30 days of treatment, the mean surface area of the endometriotic implants of leuprolide acetate, bromocriptine and cabergoline groups was significantly decreased. The regression of endometriotic foci size in comparison to control was highest in group 1, followed by group 2, then group 3. In the histopathological evaluation both the ST and GT scores of group 1, 2 and 3 were significantly decreased in comparison to controls without a statistically significant difference between the groups. CONCLUSION:  Dopamine agonists are as effective as GnRH agonists in the regression of experimental endometriotic implants in rats. Further trials are needed to elucidate the pathways affected by dopamine agonists.  

Eur J Obstet Gynecol Reprod Biol. 2014 Nov;182:167-71. doi: 10.1016/j.ejogrb.2014.09.025. Epub 2014 Sep 22. Uzunlar O1, Ozyer S2, Engin-Ustun Y2, Moraloglu O2, Gulerman HC2, Caydere M3, Keskin SM2, Mollamahmutoglu L2. Abstract OBJECTIVES:  To determine whether propranolol has an inhibitory effect on the angiogenesis of endometriosis in an experimental rat model or not. STUDY DESIGN:  This was an experimental animal model study. Twenty-four female Wistar albino rats (200-250 g) were used to create a model for surgical induction of endometriosis. Two rats died during the surgeries. The rats were randomly divided into treatment (n=11) and control groups (n=10), which were treated with daily intraperitoneal propranolol (10 mg/kg) and saline (2 mL), respectively. Study duration was 8 weeks. The volumes and histopathological findings of the implants, and immunochemistry for vascular endothelial growth factor (VEGF), metalloproteinase (MMP)-2, and MMP-9 were evaluated. RESULTS:  Viable endometriotic implants were created in all animals. In the propranolol-treated group, the mean implant volume significantly decreased after treatment (142.5 vs. 32.1 mm(3), respectively; p=0.008), while the mean implant volume significantly increased in the control group (141.0 vs. 174.2 mm(3), respectively; p=0.009). There were also significant reductions in VEGF immunoreactivity scores and both stroma and epithelium MMP-2 and MMP-9 immunoreactivity scores in the propranolol-treated group compared with the control group (p<0.005 for all scores). CONCLUSIONS:  Propranolol may suppress endometrial tissue by its antiangiogenic activity through inhibitory actions on VEGF, MMP-2, and MMP-9. Therefore, propranolol is a promising candidate drug for effective treatment of patients with endometriosis, which needs to be confirmed with further studies.

Arch Gynecol Obstet. 2015 Apr;291(4):877-81. doi: 10.1007/s00404-014-3498-8. Epub 2014 Oct 4. Genc M1, Genc B, Cengiz H. Abstract OBJECTIVE:  The aim of the present study is to determine the potential risk factors for adenomyosis and to investigate its relationship with accompanying gynecological pathologies and clinical characteristics. MATERIALS AND METHOD:  This study is a retrospective analysis of 945 patients who underwent hysterectomy between May 2005 and January 2013 at the Sifa University Medical Faculty Hospital, Clinic of Obstetrics and Gynecology. The study included 327 patients with adenomyosis and 618 patients without adenomyosis by histopathological examination of the uterus. RESULTS:  There was a significant positive correlation between development of adenomyosis and presence of leiomyoma (p < 0.0001), history of previous abortion (p < 0.0001), history of previous pregnancy (p = 0.0002), and normal body mass index (p < 0.0001). However, no significant relationship existed between development of adenomyosis and smoking (p > 0.4300), normal delivery (p = 0.9600), cesarean delivery (p = 0.5705), endometrial hyperplasia (p = 0.1721), or ovarian endometriosis (p = 0.8595). CONCLUSION:  Women who are multiparous have leiomyoma, a previous history of abortion, and a normal body mass index are at increased risk for development of adenomyosis. Adenomyosis might be one cause of unexplained recurrent spontaneous abortion during pregnancy.

Minerva Chir. 2014 Oct;69(5):277-82. Guzel AI1, Topcu HO, Ekilinc S, Tokmak A, Kokanali MK, Cavkaytar S, Doğanay M. Abstract AIM:  The aim of this paper was to assess the risk factors for endometrioma recurrence in women underwent laparoscopic surgery for endometrioma. METHODS:  This retrospective designed study included 113 cases that underwent laparoscopic surgery for endometrioma; of these women, recurrent endometrioma was detected in 33 (29.20%) subjects and other showed no recurrence (70.80%). Age, gravidity, parity, diameter of the mass, bilaterality, previous pelvic surgery, operation type, presence of adhesions, Ca 125 levels and recurrence time was obtained from hospital records and special gynecology forms. RESULTS:  Demographic and obstetric past history of the cases showed no statistically significant difference between the groups (P>0.05). Higher diameter of the mass, previous pelvic surgery, operation type, presence of adhesion and higher Ca 125 levels were risk factors for endometrioma recurrence (P<0.05). Receiver operator curve (ROC) analysis demonstrated that diameter of the mass, previous pelvic surgery and Ca 125 levels may be discriminative risk factors for endometrioma recurrence. CONCLUSION:  Endometriomas ≥ 4.5 cm, especially in cases with pelvic adhesions, previous pelvic surgery and higher Ca 125 levels should be excised totally.

Arch Gynecol Obstet. 2015 Mar;291(3):591-8. doi: 10.1007/s00404-014-3466-3. Epub 2014 Sep 16. Cetinkaya N1, Attar R, Yildirim G, Ficicioglu C, Ozkan F, Yilmaz B, Yesildaglar N. Abstract AIMS:  To determine the effects of different doses of melatonin treatment on endometrial implants, the activity of antioxidant enzyme superoxide dismutase (SOD), the angiogenesis factor, the vascular endothelial growth factor (VEGF) and the waste metabolite product of lipid peroxidation malondialdehyde (MDA) in an oophorectomized rat endometriosis model. METHODS:  Thirty-two, female, non-pregnant, nulligravid Sprague-Dawley, albino rats were used in this prospective, randomized, controlled and experimental study. Endometriosis was surgically induced in oophorectomized rats, and estradiol treatment was started after the first operation and continued till the end of the study. Second look, third look and necropsy operations were performed in the 2nd, 4th and 6th weeks. Mean volumes, histological scores and biochemical parameters were evaluated throughout the study. RESULTS:  The mean volumes of endometriotic foci were 98.8 mm(3) ± 17.2 vs. 108.2 mm(3) ± 17.5, 54.1 mm(3) ± 15.6 vs. 25.8 mm(3) ± 3.6, 42.8 mm(3) ± 10.5 vs. 32.7 mm(3) ± 6.0 and histopathological scores were 2.2 ± 0.2 vs. 1.7 ± 0.1, 2.6 ± 0.2 vs. 2.2 ± 0.2, 2.6 ± 0.1 vs. 2.7 ± 0.2 in the 10 vs. 20-mg/kg/day melatonin group at the end of the second, fourth and sixth weeks, respectively. When the groups were compared, no significant differences were seen in the histopathologic scores, SOD and VEGF levels between the groups. However, the endometriotic foci volumes were significantly decreased in both melatonin treatment groups with respect to the control group at the end of the fourth and sixth weeks. Moreover, the mean MDA levels were significantly lower in the control group than in the 10-mg/kg/day melatonin group at the end of the fourth and sixth weeks. CONCLUSION:  Melatonin treatment resulted in the regression of endometriotic lesions in oophorectomized rats. Higher doses of melatonin treatment might be more effective in the regression of implants and improvement of histologic scores as well as in the precise evaluation of SOD, MDA and VEGF distributions in the rat experimental models.

Eur J Obstet Gynecol Reprod Biol. 2014 Sep;180:120-5. doi: 10.1016/j.ejogrb.2014.06.028. Epub 2014 Jul 19. Oktem M1, Ozcan P1, Erdem O2, Karakaya C1, Cenksoy C1, Guner H1, Karabacak O1, Dursun P3. Abstract OBJECTIVE:  To determine the effects of captopril on experimentally induced endometriosis in a rat model. STUDY DESIGN:  Twenty-four adult, mature female Wistar-Albino rats in which endometriotic implants were induced by transplanting autologous uterine tissue to ectopic sites on the peritoneum. After the endometriotic implants were formed surgically, the 24 rats were randomly divided into three groups. Group 1 (captopril group, eight rats) were given 50 mg kg(-1)d(-1) of oral captopril for 21 d. Group 2 (leuprolide acetate group, eight rats) were given a single 1 mg kg(-1) subcutaneous injection of leuprolide acetate. Group 3 (control) were given no medication and served as controls (eight rats). The surface area of the endometriotic implants and the score of histologic analysis. Also, VEGF and MCP-1 levels in peritoneal fluids and bloods were analyzed. RESULTS:  At the beginning of the medical treatment, the mean surface areas of the endometriotic implants were comparable in all three groups. At the end of the treatment the mean implant surface area in the captopril group and leuprolide acetate group was less than that in the control group. Mean histopathological examination score for the implants post treatment was lower in the captopril and leuprolide acetate groups. Peritoneal fluids VEGF level in the captopril and leuprolide acetate groups was lower than that in the control group. The post-treatment MCP-1 level was also lower in the captopril and leuprolide acetate groups than in the control group. The serum VEGF and MCP-1 levels post treatment were significantly lower in the captopril and leuprolide acetate groups than in the control group. CONCLUSION:  Administration of captopril reduced the size and progression of endometriotic lesions in a rat model.

Reprod Sci. 2015 Feb;22(2):258-63. doi: 10.1177/1933719114542029. Epub 2014 Jul 21. Kurt RK1, Pinar N2, Karateke A3, Okyay AG3, Silfeler DB3, Albayrak A4, Özdemir S5, Hakverdi AU3. Abstract OBJECTIVE:  Endometriosis is an estrogen-dependent chronic inflammatory disease observed in reproductive period. The aim of the present study is to assess the efficacy of colchicine, widely used to treat many inflammatory diseases, in an experimental rat endometriosis model. STUDY DESIGN:  Experimental endometriosis was constituted with implantation of autogenous endometrial tissue. Rats were divided randomly into 2 groups as colchicine group (n = 8) and control group (n =8). Although oral 0.1 mg/kg colchicine was administered 4 weeks to the colchicine group, the same amount of saline solution was administered to the control group. Before and after 30 days of treatment period, peritoneal and tissue tumor necrosis factor α (TNF-α), the volumes and histopathological properties of the implants were evaluated. RESULTS:  Although the implant volume decreased significantly in the colchicine group (89.2 ± 13.4 mm(3) to 35.2 ± 4.5 mm(3), P < .05), the implant volume increased in the control group (85.1 ± 14.2 mm3 to 110.3 ± 10.5 mm(3), P < .05). When compared to the control group, the colchicine group had significantly lower histopathologic sores (1.4 ± 0.2 vs 2.6 ± 0.4, P < .001). Although peritoneal fluid TNF-α levels were significantly decreased in the colchicine group (45.2 ± 5.3 pg/mL vs 12.1 ± 5.2 pg/mL, P < .001), the peritoneal fluid TNF-α levels were significantly increased in the control group after the treatment (44.2 ± 3.5 pg/mL vs 61.3 ± 12.2 pg/mL; P < .001). Tissue TNF-α levels were significantly lower in the colchicine group when compared to the control group (45.4 ± 8.6 pg/mL vs 71.3 ± 11.2 pg/mL; P < .001). CONCLUSION:  Colchicine resulted in regression of endometrial implant volumes in experimental rat endometriosis model and decreased peritoneal and tissue TNF-α levels.

J Cancer Res Ther. 2014 Apr-Jun;10(2):324-9. doi: 10.4103/0973-1482.136619. Yavuz S1, Aydin NE, Celik O, Yilmaz E, Ozerol E, Tanbek K. Abstract BACKGROUND AND AIMS:  The purpose of this study was to investigate the potential therapeutic efficiency of resveratrol in the treatment of experimental endometriosis in rats. SETTINGS AND DESIGN:  Experimental study was carried out in a University hospital. MATERIALS AND METHODS:  Endometriosis was surgically induced in 24 female rats. Four weeks after this procedure, the viability and dimensions of the endometriosis foci were recorded. Rats were then randomly divided into three groups: (1) Control group (n = 8); (2) low dose (10 mg/kg) resveratrol group (n = 8); (3) high dose (100 mg/kg) resveratrol group (n = 8). At the end of the 7-day treatment, blood samples were taken and laparotomy was performed. The endometrial implants were processed for biochemical, histological and immunohistochemical studies. STATISTICAL ANALYSIS USED:  The Kruskal-Wallis H test and one-way ANOVA test were used. RESULTS:  Resveratrol-treated rats showed significantly reduced endometriotic implant volumes (P = 0.004). After treatment, a significant and dose-dependent increase in activities of superoxide dismutase and glutathione peroxidase in serum and tissue of the rats in Group 2 and Group 3 was detected. Similarly, serum and tissue malonyl dialdehyde levels and tissue catalase levels were significantly higher in Group 3 than that of control animals. Histological scores and proliferating cell nuclear antigen expression levels were also significantly reduced in Group 2 and Group 3 than that of control group. CONCLUSION:  In a rat endometriosis model, resveratrol showed potential ameliorative effects on endometriotic implants probably due to its potent antioxidative properties.

ISRN Obstet Gynecol. 2014 Mar 26;2014:713542. doi: 10.1155/2014/713542. eCollection 2014. Avcioğlu SN1, Altinkaya SÖ1, Küçük M2, Demircan-Sezer S1, Yüksel H1. Abstract Objective. The aim of this study was to investigate whether platelet indices-mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) would be useful as noninvasive biomarkers for determining the severity of endometriosis. Methods. A retrospective review of the medical charts of 164 patients diagnosed with endometriosis and who were operated on between 2001 and 2013 was performed. The stage ofendometriosis was determined according to revised American Society for Reproductive Medicine criteria. Results. In patients with advancedendometriosis (Stages 3-4), PLT, PCT levels were found to be significantly higher and MPV, PDW values to be significantly lower when compared to initial endometriosis (Stages 1-2). In addition, there was a significant positive correlation between PLT (r: 0.800, P: 0.001) and PCT (r: 0.727, P: 0.002) and the inflammatory marker white blood cell count (WBC). Conclusion. Our finding may not sufficient for employing platelet indices solely in this differential diagnosis, but our finding could provide a suggestion for clinical physicians so that attention is paid to the value of platelet indices and that these may be taken into account when making decisions about the initial or advanced stages of endometriosis.

J Obstet Gynaecol. 2015 Jan;35(1):49-52. doi: 10.3109/01443615.2014.930110. Epub 2014 Jun 24. Kiykac Altinbas S1, Bayoglu Tekin Y, Dilbaz B, Dilbaz S. Abstract We assessed the impact of pain, dysmenorrhoea and dyspareunia on the quality of life among Turkish fertile women with severe endometriosis. A total of 33 patients with histopathologically diagnosed severe endometriosis (Stage IV, revised criteria of the American Fertility Society (rAFS score) were enrolled into the study. Patients reported chronic pelvic pain using a visual analogue scale (VAS) and severity of dysmenorrhoea, dyspareunia and pelvic tenderness using the verbal rating scale (VRS). Quality of life (physical, psychological, social, environmental domains) was evaluated using the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF). There were no correlations between quality of life and VRS and VAS scores of chronic pelvic pain in patients with dyspareunia (p > 0.05). VRS in patients with dysmenorrhoea negatively correlated with physical, social and environmental dimensions of quality of life (r = -0.382, r = -0.221, r = -0.373 and p = 0.028, p = 0.013, p = 0.033, respectively). Although the severity of dysmenorrhoea seems to be related with lower quality of life, chronic pelvic pain and dyspareunia due to endometriosis may not have any deleterious effects on the quality of life.

Arch Gynecol Obstet. 2014 Nov;290(5):999-1006. doi: 10.1007/s00404-014-3295-4. Epub 2014 Jun 10. Simsek Y1, Gul M, Yilmaz E, Ozerol IH, Ozerol E, Parlakpinar H. Abstract PURPOSE:  The purpose of this study was to examine the effects of atorvastatin in the treatment of experimental endometriosis. METHODS:  Endometriosis was induced in 24 female rats. 4 weeks after the procedure dimensions of the foci were recorded. Rats were divided into three groups: in Group 1 (n = 8), a daily dose of 10 mg/kg atorvastatin was given for 14 days. In the second group (n = 8), a single dose of 1 mg/kg leuprolide acetate was injected intraperitoneally. The rats in Group 3 (n = 8) were received 1 mg/kg i.p. 0.9 % NaCl. At the end of the treatment, laparotomy was performed, and the dimensions of the endometriotic foci were recorded. Biochemical, histopathological and immunohistochemical studies were performed and nociception was compared in groups. RESULTS:  Atorvastatin treatment exhibited significant analgesic activity in hot plate model (P = 0.022). The serum hs-CRP and tumor necrosis TNF-α levels were similar between the Group 2 and Group 3 (P > 0.05); however atorvastatin caused significant decrease in both serum markers. The histological and immunohistochemical scores were also found to be markedly lower in Group 1 and Group 2 (P < 0.05). CONCLUSION:  Atorvastatin treatment may have a therapeutic potential in the treatment of endometriosis through its anti-inflammatory and anti-nociceptive properties.

World J Clin Cases. 2014 May 16;2(5):133-6. doi: 10.12998/wjcc.v2.i5.133. Cöl C1, Yilmaz EE1. Abstract AIM:  To evaluate endometrioma located at cesarean scatrix. METHODS:  Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed. RESULTS:  All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin. CONCLUSION:  Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.

Gynecol Obstet Invest. 2014;78(1):59-64. doi: 10.1159/000360607. Epub 2014 May 22. Polat M1, Boynukalın FK, Yaralı I, Esinler I, Yaralı H. Abstract BACKGROUND/AIMS:  To analyze whether the presence of endometriosis per se is associated with inferior pregnancy rates in women undergoing in vitro fertilization (IVF). METHODS:  Between July 2005 and November 2012, a total of 485 patients with endometriosis under the age of 38 years undergoing their first IVF attempt at our center were included; 72 patients had minimal-mild disease and the remaining 413 patients had moderate-severe disease. 131 patients with laparoscopically confirmed tubal factor infertility not harboring endometriosis and hydrosalpinx under the age of 38 years undergoing their first IVF attempt at our center served as the control group. RESULTS:  The bilateral antral follicle count and controlled ovarian hyperstimulation response were diminished in the moderate-severe group. However, the implantation, clinical pregnancy, miscarriage and live birth rates were comparable among the three groups. The recurrence of endometrioma following pre-IVF cystectomy was not associated with inferior pregnancy rates. Female age, bilateral antral follicle count and number of embryos transferred were noted to be significant independent predictors of live birth. CONCLUSION:  We conclude that neither the presence nor the extent of endometriosis have any detrimental effect on IVF pregnancy rates.

Eur J Obstet Gynecol Reprod Biol. 2014 Jul;178:128-33. doi: 10.1016/j.ejogrb.2014.04.037. Epub 2014 May 6. Ozhan E1, Kokcu A2, Yanik K3, Gunaydin M3. Abstract OBJECTIVE:  To investigate the diagnostic potentials of the serum levels of nine different biomarkers in endometriosis. STUDY DESIGN:  In this case-controlled, prospective clinical study, 80 women underwent laparoscopy or laparotomy with a preliminary diagnosis of chronic pelvic pain, severe secondary dysmenorrhea, infertility, pelvic endometriosis or pelvic mass. The 60 women with confirmed pelvicendometriosis constituted the endometriosis group, and the other 20 women without endometriosis constituted the control group. Preoperative blood samples were obtained for serum biomarker measurements. Serum levels of nine different serum biomarkers including α-enolase, macrophage migration inhibitory factor, leptin, interleukin-8, anti-endometrial antibody, phosphoinositide dependent protein kinase 1, CA125, syntaxin-5, and laminin-1 were measured concurrently and compared between the control and endometriosis groups, and among control group and endometriosissubgroups including stage I, stage II, stage III and stage IV endometriosis. RESULTS:  The serum levels of α-enolase, macrophage migration inhibitory factor, leptin, interleukin-8 and antiendometrial antibodies showed a statistically significant difference neither between control and endometriosis groups nor among control group and endometriosis subgroups. The serum levels of CA125, syntaxin-5 and laminin-1 showed a statistically significant difference both between the control and endometriosis groups (p<0.01) and among control group and endometriosis subgroups (p<0.01). Serum levels of laminin-1 in stage II and IV endometriosis; syntaxin-5 in stage I and II endometriosis; and CA125 in stage III and IV endometriosis were found to have the different levels compared to control group. CONCLUSIONS:  These findings show that the concurrent measurement of CA125, syntaxin-5 and laminin-1 might be a useful non-invasive test in strengthening the diagnosis of endometriosis and in predicting its severity.

Eur J Obstet Gynecol Reprod Biol. 2014 Jun;177:34-7. doi: 10.1016/j.ejogrb.2014.03.012. Epub 2014 Mar 15. Şengül Ö1, Dilbaz B2, Halıcı Z3, Ferah I3, Çadırcı E4, Yılmaz F2. Abstract OBJECTIVE(S):  To investigate serum nesfatin-1 levels in endometriosis patients. STUDY DESIGN:  Twenty-five women who were laparoscopically and histopathologically diagnosed with endometriosis (endometriosis group) and 25 women without any pelvic pathology detected by laparoscopy (control group) were enrolled in the study. Serum nesfatin-1 levels were compared between the two groups before and after adjustment for body mass index (BMI) and age. RESULTS:  Patients in the endometriosis group had lower BMI than those in the control group (22.3 ± 4.8 kg/m(2) vs. 25.8 ± 4.2 kg/m(2), p=0.009). There was no statistically significant correlation between BMI and serum nesfatin-1 levels (p=0.870). Serum nesfatin-1 level was statistically significantly lower in the endometriosis group than in the control group (7.2 ± 1.3 pg/ml vs. 10.6 ± 2.8 pg/ml, p=0.0001). This result did not change after the adjustment for BMI and age. CONCLUSION(S):  Serum levels of nesfatin-1 are decreased in endometriosis patients but its exact role in the etiopathogenesis of endometriosisremains to be clarified.

Clin Med Res. 2014 Dec;12(3-4):160-5. doi: 10.3121/cmr.2013.1183. Epub 2014 Mar 25. Bozkurt M1, Çil AS2, Bozkurt DK3. Abstract Abdominal wall endometriosis (AWE) is a rare condition that usually develops in a surgical scar resulting from a Caesarean section. While commonly seen in the cutaneous and subcutaneous fat tissue at the Caesarean scar level, its intramuscular localization is quite rare. Its treatment options consist of the excision of the lesion and/or hormonal therapies, although wide surgical excision is the treatment of choice in the literature. Wide surgical excision may create a defect in the abdominal wall and may increase the risk of hernia formation and mesh complications. This case report describes the clinical and radiological findings and treatment modalities of endometriosis that have appeared in the rectus abdominis muscle of a 25-year-old patient at the Caesarean scar level. Sclerotherapy may be used for endometrioma. We present a new and alternative treatment method using ultrasound-guided intralesional ethanol injection for AWE. Compared with the complications of surgical excision, the complications of sclerotherapy by ethanol are at a more acceptable level. Sclerotherapy by ethanol injection may be an alternative treatment to surgery for AWE.

Iran J Reprod Med. 2013 May;11(5):405-14. Cetin C1, Serdaroglu H2, Tuzlali S3. Abstract BACKGROUND:  Endometriosis is a disease that is hard to diagnose without the gold standard method, laparoscopy. An easier diagnostic method is needed. OBJECTIVE:  The aim of the study is to determine whether the number of macrophage cells in the endometrium and/or the detection of nerve fibers can be used in the diagnosis of endometriosis. MATERIALS AND METHODS:  Endometrial sampling was done to 31 patients prior to laparoscopy (L/S) or laparotomy (L/T) at Istanbul University Istanbul School of Medicine Hospital between January 2010 February 2011. Also 34 patients who were retrospectively chosen from their files were added to the study. 5 patients were excluded from the study. Totally, 31 patients were placed in the endometriosis and 29 patients in the control group. Endometrial samples were evaluated immunohistochemically with the markers protein gene product 9.5 (PGP 9.5) and neurofilament (NF) for nerve fibers and CD68 for macrophages. RESULTS:  None of the samples were stained with PGP 9.5 and NF. As for CD68+cells, no statistically significant difference was observed between groups (endometriosis: 216.10±104.41; control: 175.93±43.05, p=0.06). RESULTS were also evaluated in the subgroups of menstruel phases and disease stages. Only in the proliferative phase there was a significant increase in the endometriosis group (p=0.03). No significant difference was observed between the stages. CONCLUSION:  The detection of nerve fibers in the eutopic endometrium with the markers of PGP 9.5 and NF is not found to be helpful in the diagnosis of endometriosis. Macrophage cells may be helpful in the diagnosis only in the proliferative phase.

Ginekol Pol. 2013 Dec;84(12):1041-4. Cirpan T1, Akman L1, Yucebilgin MS1, Terek MC1, Kazandi M1. Abstract OBJECTIVE:  The aim of the study was to investigate the reproductive outcomes of patients after surgical treatment of endometriosis. MATERIAL AND METHODS:  The study included 100 infertile women, aged 21 to 41 years, who underwent surgical treatment of endometriosis. From January 2007 to January 2012, excision of endometriosis was performed by operative laparoscopy or laparotomy Demographic, clinical, surgical and reproductive outcomes of 52 patients were retrospectively analyzed. RESULT:  Twenty-three pregnancies (44%) were obtained in 52 patients, resulting in 16 term pregnancies, 4 spontaneous abortions under 16 weeks gestation, 2 spontaneous abortions at 20 gestational weeks and 1 ectopic pregnancy Twenty nine patients did not achieve pregnancy and 68.9% (20/29) of them were treated with IVF-ICSI. Spontaneous pregnancies were obtained within 7 months after the surgery whereas IVF-ICSI pregnancies were obtained within the period of 11 months. Seven patients were stage 1, 14 patients stage II, 19 patients stage III, and 12 patients stage IV according to the American Fertility Society (AFS) Classification of Endometriosis. The pregnancy rate was 57% in stages I-II, 47% in stage III, 16% in stage IV endometriosis; and the rate of term pregnancies was 83%, 66%, and 0%, respectively Seven pregnancies (7/14) were obtained in patients with bilateral endometriosis and 5 of them resulted in term pregnancy Sixteen pregnancies (16/38) were obtained in patients with unilateralendometriosis and 11 of them resulted in term pregnancy CONCLUSION:  After surgical treatment of endometriosis, the pregnancy and live birth rates seem to be improved. Reproductive outcome is closely associated with the AFS score. Bilaterality of endometriosis does not affect pregnancy outcome.

Eur J Obstet Gynecol Reprod Biol. 2014 Apr;175:172-7. doi: 10.1016/j.ejogrb.2014.01.011. Epub 2014 Jan 14. Demirel MA1, Suntar I2, Ilhan M2, Keles H3, Kupeli Akkol E4. Abstract OBJECTIVE:  The aim of the present study is to assess the beneficial effects of Achillea biebersteinii Afan. in the treatment of endometriosis in order to find scientific evidence for the folkloric use of this plant. STUDY DESIGN:  Experimental endometriosis was induced in six-week-old female, nonpregnant, Sprague Dawley rats by suturing a 15mm piece of endometrium from uterine cornu into abdominal wall. After twenty-eight days, a second laparotomy was performed: the endometrial foci areas were measured and intra-abdominal adhesions were scored, and the abdomen was closed. Different groups then received n-hexane, ethyl acetate (EtOAc) and methanol (MeOH) extracts prepared from the aerial parts of A. biebersteinii, and a control group received inert material, administered per os once a day throughout the experiment. At the end of the treatment procedure all rats were sacrified and endometriotic foci areas and intra-abdominal adhesions were again evaluated and compared with the previous findings. The tissues were also histopathologically investigated. Moreover, peritoneal fluid was collected to detect tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) levels. Dunnett's test was used to determine the significance of differences between groups. In order to compare two groups Student's t test was used. RESULTS:  Post-treatment volumes of endometrial foci were found to be significantly decreased, and no adhesion was detected, in the EtOAc extract treated group. The levels of TNF-α, VEGF and IL-6 also fell after the treatment with EtOAc extract. The therapeutic effect of the EtOAc extract of A. biebersteinii could be attributed to the flavonoid aglycones found in the extract. CONCLUSION:  The EtOAc extract of A. biebersteinii appears to be a promising alternative for the treatment of endometriosis.

Arch Gynecol Obstet. 2014 Jul;290(1):75-82. doi: 10.1007/s00404-014-3163-2. Epub 2014 Feb 1. Tuten A1, Kucur M, Imamoglu M, Kaya B, Acikgoz AS, Yilmaz N, Ozturk Z, Oncul M. Abstract PURPOSE:  Endometriosis is defined as the presence of endometrial glands and stroma in ectopic locations and may be associated with local and systemic inflammatory processes. Copeptin is elevated in acute and chronic inflammation conditions. The aim of the present study was to determine whether serum copeptin levels were altered in women with endometriosis and played a role in the pathophysiology of the disease. METHODS:  A total of 86 women were recruited for this case-control study. 50 patients with surgically proven endometriosis were included, while 36 patients without endometriosis comprised the control group. Patients were classified as having minimal, mild, moderate and severe disease in accordance with American Society of Reproductive Medicine revised classification. Two subgroups were formed by combining patients with minimal and mild disease and with moderate and severe disease (Stage 1-2, stage 3-4; respectively). Levels of copeptin, tumor markers (CA-125, CA-19-9, CA-15-3) and C-reactive protein in serum were measured. RESULTS:  Serum copeptin, CA-125, CA-15-3 and CA-19-9 levels were higher in the endometriosis group (p: 0.002; 0.001; 0.017; 0.015; respectively). Copeptin and CA-19-9 levels were significantly higher in stage 3-4 group as compared to stage 1-2 group (p: 0.004; 0.036 respectively). Serum copeptin levels were positively correlated with stage of the disease and size of endometriomas. ROC analysis revealed that CA-125 had the highest AUC for predicting endometriosis (0.938; 95 % confidence interval 0.882-0.993; p: 0.001). CONCLUSIONS:  Serum copeptin levels were significantly higher in patients with endometriosis as compared to healthy controls. Moreover, severity of the disease was correlated with serum copeptin levels.

Eur J Obstet Gynecol Reprod Biol. 2014 Apr;175:134-9. doi: 10.1016/j.ejogrb.2013.12.034. Epub 2014 Jan 3. Yeniel AÖ1, Erbas O2, Ergenoglu AM3, Aktug H4, Taskiran D2, Yildirim N3, Ulukus M3. Abstract OBJECTIVE:  To determine the effects of oxytocin (OT) on surgically induced endometriosis in a rat model. STUDY DESIGN:  Twelve female Sprague-Dawley rats were included. After the implantation and establishment of autologous endometrium onto the abdominal wall peritoneum, the rats were randomly divided into two groups, treated with intramuscular oxytocin (OT group, 160μgkg/day, n=6) or isotonic NaCl solution (control group, 1mLkg/day, n=6) for 28 days. To evaluate the therapeutic effects of OT, the explant volumes were calculated and the levels of vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1, and TNF-α were measured in plasma and peritoneal fluid. Endometriotic explants were examined histologically by semiquantitative analysis. RESULTS:  After treatment, the mean endometriotic explant volume was decreased in the OT group (p=0.016). The histopathological score and VEGF immunoexpression of endometriotic explants were significantly lower in the OT group (p=0.007) than in controls (p=0.000). Inflammatory cytokine levels in plasma and peritoneal fluid were considerably decreased in the OT group. Moreover, TUNEL immunohistochemistry clearly demonstrated more apoptotic changes in the mononuclear cells of the OT group compared with controls. CONCLUSION:  We suggest that oxytocin might be considered as a potential candidate therapeutic agent for endometriosis.

Ulus Cerrahi Derg. 2014 Sep 1;30(3):165-8. doi: 10.5152/UCD.2014.2035. eCollection 2014. Karaman H1, Bulut F2, Özaşlamacı A3. Abstract The presence of endometrial glands and stroma outside the uterine cavity is called "endometriosis". Recklinghausen first defined this entity in 1896, and Sampson first named it in detail in 1921. Endometriosis is most often seen in the pelvis. Although extrapelvic endometriosis is rare, it can be seen in almost every organ. Endometriosis localized in the rectus abdominis muscle is very rare. A patient who had two previous cesarean sections presented with a 23 mm heterogeneous hypoechoic mass within the rectus abdominis muscle, approximately 1 cm superior to the Pfannenstiel incision that was diagnosed as endometriosis externa by fine-needle biopsy and excisional biopsy. Herein, we report this patient along with the literature.

Ulus Cerrahi Derg. 2013 May 28;30(2):106-8. doi: 10.5152/UCD.2013.19. eCollection 2014. Soylu L1, Aydın OU1, Aydın S1, Özçay N1. Abstract Appendicitis and endometriosis are commonly encountered surgical problems. Endometrial involvement of the appendix is rare and very few cases have been reported in the literature. True diagnosis of appendix invagination is highly difficult due to variable symptoms. Noting the findings which are in favour of invagination in patients diagnosed with acute appendicitis is of great significance in order to be prepared for changing surgical attempts. This case describes a 34 year old female patient diagnosed with infertility who was operated on for acute appendicitis. In the pathological assessment, endometrial involvement of the appendix was seen. The classification, symptoms, radiological appearance and treatment of appendix invagination described in the literature are discussed.

Gynecol Obstet Invest. 2014;77(1):35-9. doi: 10.1159/000356686. Epub 2013 Nov 27. Kilico I1, Kokcu A, Kefeli M, Kandemir B. Abstract BACKGROUND:  Cyclooxygenase-2 (COX-2) levels increase in women with endometriosis. COX-2, via increasing prostaglandin E2, contributes to an increase in vascular endothelial growth factor. In this way, COX-2 may contribute to the progression and continuity of endometriosis. We investigated the effect of dexketoprofen trometamol, a new selective COX-2 enzyme inhibitor, on experimentally induced endometriotic cysts. METHODS:  Experimental endometriotic cysts were created in 60 adult female Wistar albino rats. The rats were randomized to 2 equal groups, a control (group Con) and a dexketoprofen (group Dex) group. Six weeks later, cyst volumes were measured as in vivo (volume 1). Following volume 1 measurement, for 4 weeks group Con received 0.1 ml distilled water; group Dex received 0.375 mg dexketoprofen trometamol/0.1 ml distilled water, intramuscularly, twice a day. At the end of administration, the cyst volumes were remeasured (volume 2), and the cysts totally excised and weighed. Glandular (GT) and stromal tissues (ST) and natural killer (NK) cell contents in the cyst wall were scored. RESULTS:  NK cell content and volume 1 were not different between the 2 groups. Volume 2, cyst weight, and GT and ST contents in group Dex were significantly lower than those in group Con. CONCLUSION:  Dexketoprofen trometamol significantly reduced the development of experimentally induced endometriotic cysts both macroscopically and microscopically.

Asian Pac J Cancer Prev. 2013;14(10):5589-97. Verit FF1, Yucel O. Abstract The aim of this review article was to evaluate the relationship and the possible etiological mechanisms between endometriosis, leiomyoma (LM) and adenomyosis and gynecological cancers, such as ovarian and endometrial cancer and leiomyosarcoma (LMS). MEDLINE was searched for all articles written in the English literature from July 1966 to May 2013. Reports were collected systematically and all the references were also reviewed. Malignant transformation of gynecologic benign diseases such as endometriosis, adenomyosis and LM to ovarian and endometrial cancer remains unclear. Hormonal factors, inflammation, familial predisposition, genetic alterations, growth factors, diet, altered immune system, environmental factors and oxidative stress may be causative factors in carcinogenesis. Early menarche, low parity, late menopause and infertility have also been implicated in the pathogenesis of these cancers. Ovarian cancers and endometriosis have been shown to have common genetic alterations such as loss of heterozygosity (LOH), PTEN, p53, ARID1A mutations. MicroRNAs have also been implicated in malignant transformation. Inflammation releases proinflammatory cytokines, and activates tumor associated macrophages (TAMS) and nuclear factor kappa b (NF-KB) signaling pathways that promote genetic mutations and carcinogenesis. MED12 mutations in LM and smooth muscle tumors of undetermined malignant potential (STUMP) may contribute to malignant transformation to LMS. A hyperestrogenic state may be shared in common with pathogenesis of adenomyosis, LM and endometrial cancer. However, the effect of these benign gynecologic diseases on endometrial cancer should be studied in detail. This review study indicates that endometriosis, LM, adenomyosis may be associated with increased risk of gynecological cancers such as endometrial and ovarian cancers. The patients who have these gynecological benign diseases should be counseled about the future risks of developing cancer. Further studies are needed to investigate the relationship between STUMPs, LMS and LM and characteristics and outcome endometrial carcinoma in adenomyotic patients.

Ginekol Pol. 2013 Sep;84(9):765-9. Yavuzcan A1, Caglar M, Dilbaz S, Ustün Y, Ozdemir I, Yildiz E, Ozbilgeç S, Kumru S. Abstract OBJECTIVES:  The study included patients suffering from stage III-IV endometriosis complicated by an endometrioma (OMA). We investigated the association between age, presence of dysmenorrhea/dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility as well as the risk of intraoperative detection of hydrosalpinx that was not suspected on pre-operative assessment. MATERIALS AND METHODS:  The study included patients with stage III-IV endometriosis complicated by OMA who underwent a laparoscopic or open surgery due to pre-diagnosis of infertility or adnexal mass. RESULTS:  Dysmenorrhea had statistically significant association with infertility (p=0.031). There was no statistically significant relation between age, dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility (p=0.203, p=0.561, p=0.561 and p=0.668, respectively). No statistically significant relation was found between age, CA 125 level, dysmenorrhea, dyspareunia and detection of an unilateral/bilateral hydrosalpinx, that was not suspected on pre-operative assessment (p=0.179, p=0.295, p=0.895, p=0.424, respectively). There was an association between OMA size (p=0.023) and detection of unilateral/bilateral hydrosalpinx. CONCLUSIONS:  Patients who desire to have children but suffer from severe dysmenorrhea must be preoperatively informed about the possibility of having stage III-IV endometriosis. Infertile patients who are about to undergo an operation, especially due to a large OMA, may turn out to have hydrosalpinx. These patients should be informed preoperatively about the possibility of having salpingectomy or the proximal tubal surgery for improving fertility.

Clin Radiol. 2014 Feb;69(2):130-6. doi: 10.1016/j.crad.2013.08.015. Epub 2013 Oct 22. Genç B1, Solak A2, Sahin N2, Genç M3, Oğul H4, Sivrikoz ON5, Kantarcı M4. Abstract AIM:  To investigate the utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the diagnosis of abdominal wall endometrioma (AWE) and to compare the ADC (apparent diffusion coefficient) values of AWE with those of the uterine endometrium during two different phases of the menstrual cycle. MATERIALS AND METHODS:  A total of 22 women aged between 27 and 42 years (mean 32.8 years) and who had regular menstrual cycles were included in the study. These patients had a total of 25 AWE lesions. The mean and standard deviation of the ADC values of the normal endometrium/AWE were calculated for the menstrual and luteal phases. All examinations were performed using a 1.5 T magnet (b-values of 50, 400, and 800 mm/s(2)). The results were analysed using the Shapiro-Wilk test, the Pearson correlation test, the analysis of variance (ANOVA) test, and the paired sample t-test. RESULTS:  The ADC values of the endometrium were different in the two phases of the menstrual cycle (menstrual phase: 0.924 ± 0.171; luteal phase: 1.171 ± 0.135). Similarly, the ADC values of the AWE were different in these phases (menstrual phase: 0.937 ± 0.256, luteal phase: 1.256 ± 0.215). In both AWE and the uterine endometrium, the ADC measurements were significantly lower in the menstrual phase than during the luteal phase. This difference was statistically significant (p < 0.05). There was no significant difference in the ADC values between the endometrial layer and AWE during the same phase (p = 0.216 for menstrual phase, p = 0.104 for luteal phase, paired sample t-test). CONCLUSION:  The present study demonstrated that in all patients, the DWI features of AWEs were significantly similar to those of the uterine endometrial tissue. Additionally, the ADC measurements of the patients showed similar cyclical changes. These results suggest that the ADC values of a lesion close to the uterine endometrium may be used to differentiate AWE from the other disease entities of the abdominal wall.

Case Rep Obstet Gynecol. 2013;2013:238156. doi: 10.1155/2013/238156. Epub 2013 Jul 17. Bulut AS1, Sipahi TU. Abstract Adenomyosis, also known as endometriosis interna, is the presence of endometrial glands and stroma within the myometrium. Its localised form is called adenomyoma and mimics a leiomyoma. Rarely, adenomyomas are located outside the uterus and some of them form uterus-like masses with a thick muscle wall and an endometrium-lined central cavity. They are generally located in the ovary or broad ligament, and, although they are closely related to endometriosis, their pathogenetic mechanisms are different from each other. Müllerian duct fusion defect and subcoelomic mesenchyme transformation theory are two possible pathogenetic mechanisms for this rare entity. Here we report abscessed uterine and extrauterine adenomyomas forming uterus-like masses in the left and right broad ligament and an ectopic adrenal tissue in the left paraovarian region in a 56-year-old woman. Although there is a reported abscessed adenomyosis in the literature, this is the first abscessed extrauterine uterus-like masses with synchronous pelvic pathologies like endometriosis, leiomyomas, adenomyosis, an endometrial polyp, an endocervical polyp, and an ectopic adrenal tissue. This benign lesion gives the impression of leiomyoma, a uterine malformation, or even malignancy preoperatively. Frozen section helps in differential diagnosis.

J Reprod Infertil. 2013 Apr;14(2):50-5. Ozkan ZS1, Cilgin H, Simsek M, Cobanoglu B, Ilhan N. Abstract BACKGROUND:  Apelin is a mitogenic peptide; it has functions in vessel formation and cell proliferation. In this study we aimed to evaluate the serum and tissue levels and local expression pattern of apelin in eutopic and ectopic endometrium from patients with and without endometriosis and to compare the proliferative and secretory phase differences. METHODS:  Thirty women with endometriosis and 15 women without endometriosis undergoing surgery for benign indications as control group were included in the study. Serum and tissue concentrations and proliferative and secretory phase expression patterns of apelin were evaluated in the ectopic and eutopic endometrium using immunoassay and immunohistochemistry methods. The results were compared with Mann-Whitney U test. The p-values smaller than 0.05 were considered as statistically significant. RESULTS:  Apelin expression was detected in eutopic and ectopic endometrium of women with endometriosis and endometrium of control group. Intense immunoreactivity of apelin was observed in glandular cells of eutopic and ectopic endometrial tissues of women with endometriosis and endometrium of control group during secretory phase (p<0.01). In both groups, tissue concentrations of apelin were higher than of the serum (p=0.03) but, there were no significant differences between the two groups for tissue and serum concentrations of apelin. CONCLUSION:  Apelin expression showed cyclic changes in eutopic and ectopic endometrium. Its expression may be related to menstrual changes of angiogenesis in endometrium of women.

Arch Gynecol Obstet. 2014 Jan;289(1):193-200. doi: 10.1007/s00404-013-2963-0. Epub 2013 Jul 24. Onalan G1, Gulumser C, Mulayim B, Dagdeviren A, Zeyneloglu H. Abstract PURPOSE:  To assess the effects of amifostine, N-acetyl cysteine (NAC), and leuprolide as a scavenger in a rat endometriosis model. METHODS:  This is a prospective randomized animal study. Setting The Animal Laboratory of Medical University. Animals 40 rats were used for transplantation of an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. After allowing 3 weeks for growth, laparotomies were performed to check the implants. Then animals were randomized into four groups: Group I amifostine (200 mg/day loading dose after 20 mg/kg/day, p.o.); Group II NAC (200 mg/day, p.o.); Group III leuprolide acetate 1 mg/kg single dose, sc; and Group IV (controls) no medication. Three weeks later, implants were evaluated morphologically. Serum and peritoneal TNF-alpha levels were evaluated. The transmission electron microscopic examination of the peritoneal samples and ovaries was also performed. RESULTS:  Leuprolide acetate, amifostine and NAC caused significant decreases in the mean implant areas and significant decreases in serum and peritoneal TNF-alpha levels. On comparing all groups, these reductions were higher in Group II. According to the transmission electron microscopic findings, leuprolide seems to be protecting normal structure of peritoneum best when compared to the other groups. CONCLUSIONS:  Amifostine, NAC and leuprolide caused regression of endometriosis in this experimental rat model by a yet unsettled mechanism.

J Pak Med Assoc. 2013 Jan;63(1):114-6. Sevinç S1, Unsal S, Oztürk T, Uysal A, Samancilar O, Kaya SO, Ermete S. Abstract Thoracic endometriosis, rarely encountered, is characterized with the localization of functional endometrium tissue in pleura, lung parenchyma or tracheobronchial system. A 28 years old female patient visited our clinic with complaints of cough and shortness of breath for the last two months. Right-sided massive pleural effusion was detected in the chest radiography and thorax computed tomography. Exudative fluid was aspirated with a haemorrhagic appearance on thoracentesis. Cytology was evaluated as suspicious. "Signet ring cells" were reported in pleural biopsy. Diagnostic biopsy was performed by video-assisted thoracic surgery (VATS) on the patient whose fiber-optic bronchoscopy was normal. The histopathological diagnosis was reported as "pleural endometriosis". Chemical pleurodesis was applied with asbestos-free chalk. The thorax HRCT (high resolution computed tomography) performed during menstruation was normal. Thoracentesis was needed 3 times for recurrent pleural effusion in the follow-ups and then parietal pleurectomy was performed. The patient is in postoperative 10th month follow-up and evaluated as normal clinically and as radiologically. Pleural endometriosis should be considered as a differential diagnosis in female patients with infertility with chest symptoms. Video-assisted thoracoscopic surgery can be useful in the diagnosis and treatment of these patients and chemical pleurodesis and parietal pleurectomy should be considered among the treatment options.

Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):211-3. doi: 10.1016/j.ejogrb.2013.06.001. Epub 2013 Jul 9. Boyraz G1, Selcuk I, Yazıcıoğlu A, Tuncer ZS. Abstract OBJECTIVES:  Previous studies have suggested an association between endometriosis and development of ovarian cancer. A study was performed to evaluate the cases of ovarian carcinoma associated with endometriosis. STUDY DESIGN:  The study includes patients with ovarian carcinoma associated with endometriosis diagnosed between 2000 and 2010 at Hacettepe University Hospital, Ankara, Turkey. A total of 1086 patients who underwent surgical staging for ovarian carcinoma were analyzed retrospectively for the presence of histologically documented endometriosis. The clinical and pathological characteristics of 45 ovarian carcinoma patients associated with endometriosis were evaluated including histologic subtype, stage and grade. RESULTS:  Ovarian carcinoma was found to be associated with endometriosis in 4.1% (45/1086) of the cases. Of them, 17 patients (37.8%) had clear cell, 15 (33.3%) had endometrioid, 6 (13.3%) had serous papillary, 4 (8.9%) had mucinous and the remaining 3 patients had an undifferentiated subtype of ovarian carcinoma. Twenty-three (51.1%) patients had stage I, 4 (8.9%) had stage II and 18 (40.0%) had stage III disease. The frequency of coexistence of endometriosis was 20.4% (17/83) for clear cell carcinoma and 9.3% (15/161) for endometrioid cell carcinoma. CONCLUSIONS:  Only a small proportion of ovarian cancer cases were found to be associated with endometriosis. Endometriosis was most frequently associated with clear cell and endometrioid types of ovarian carcinoma. Ovarian carcinoma associated with endometriosis seems to represent a distinct disease entity with different histological subtypes, early presentation and a relatively favorable outcome.

Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):206-10. doi: 10.1016/j.ejogrb.2013.05.026. Epub 2013 Jul 2. Dolapcioglu K1, Dogruer G, Ozsoy S, Ergun Y, Ciftci S, Soylu Karapinar O, Aslan E. Abstract OBJECTIVES:  The aim of this study was to compare the effects of theranekron, medroxyprogesterone acetate (MPA), and leuprolide acetate (LA) on surgically induced endometriosis in a rat model. STUDY DESIGN:  Endometriosis was surgically induced in forty female rats during estrus. After 3 weeks, a second operation was performed and the rats were randomized using a randomization table into theranekron, MPA, LA, and control groups. These treatments were continued for 3 weeks. A third operation was performed to evaluate treatment results. Then, the experimental treatments were halted and estrogen was initiated again to maintain estrus. After three additional weeks; i.e. after 9 weeks, the recurrence rate of endometrial foci was evaluated in a fourth operation and the rats were sacrificed. The volume of endometriotic foci and histopathology scores before and after treatment were compared. RESULTS:  The respective mean volumes of the endometriotic foci after 3, 6, and 9 weeks were 86.4±21.2, 16.4±8.2, and 20.1±9.6 mm(3) in the theranekron group, 78.3±20.4, 42.6±13.5, and 66.7±16.2 mm(3) in the MPA group, and 91.8±30.2, 34.4±11.4, and 72.4±21.9 mm(3) in the LA group. The respective mean histopathology scores were 2.4±0.6, 1.8±0.6, and 1.6±0.6 in the theranekron group, 2.5±0.8, 2.0±1.1, and 2.7±1.0 in the MPA group, and 2.3±0.5, 2.1±1.2, 2.4±0.8 in the LA group. After 9 weeks, the mean volume of endometriotic foci and histopathology scores were significantly lower in the theranekron group. CONCLUSIONS:  Theranekron caused more evident regression of endometriotic foci than MPA or LA in a rat model. After stopping the theranekron treatment, the recurrence rate was also lower than that of the other groups.

Eur Rev Med Pharmacol Sci. 2013 Jun;17(11):1472-8. Turgut A1, Özler A, Görük NY, Tunc SY, Evliyaoglu O, Gül T. Abstract AIM:  To compare patients with advanced stage endometriosis with control patients without endometriosis with respect to serum Copper (Cu) and Ceruloplasmin (Cp) levels and oxidative stress markers in order to evaluate the importance of these parameters in the pathogenesis ofendometriosis. PATIENTS AND METHODS:  A total of 72 women who underwent laparoscopy or laparotomy for evaluation of infertility, pelvic pain, pelvic mass, tubal ligation or endometriosis were enrolled for this prospective clinical study. Patients were divided into two groups by visual diagnosis at surgery and histological confirmation of endometriosis: control patients (n=41) without endometriosis and study group (n=31) with stage III/IV (advanced stage) endometriosis. Serum Cu, Cp, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase-1 (PON-1), malondialdehyde (MDA), triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were compared between the two groups. Correlations between Cu, Cp and oxidative stress markers were determined. RESULTS:  Serum TOS, OSI, Cu, Cp, TG, TC, LDL were significantly higher, whereas TAS, PON-1 activity and HDL were significantly lower, in women with advanced-stage endometriosis than in control groups. There was no difference in serum MDA activities between the two groups. Positive correlations were found between Cu and TOS, Cu and OSI, Cu and Cp, while a negative correlation was found between Cu and PON-1 in the advanced-stage endometriosis group. Positive correlations were found between Cp and TOS, and Cp and OSI in the advanced-stage endometriosisgroup. CONCLUSIONS:  Cu and Cp appear to be associated with the etiopathogenesis of and oxidative stress in endometriosis.

Reprod Biomed Online. 2013 Aug;27(2):212-6. doi: 10.1016/j.rbmo.2013.04.016. Epub 2013 May 16. Urman B1, Alper E, Yakin K, Oktem O, Aksoy S, Alatas C, Mercan R, Ata B. Abstract Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve. It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker is more accurately reflects the post-operative reduction in ovarian reserve. This observational study assessed the damage inflicted by endometrioma removal with anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) pre and post-operatively. Twenty-five women with unilateral endometrioma underwent laparoscopic stripping of the endometrioma cyst capsule. There was a significant decrease both in AMH concentration (24%) and in AFC (11%) 1 month following surgery (P<0.01). At 6months post-operatively, the respective values were 24% and 15% less than preoperatively. AMH concentration and AFC showed no correlation with the use of bipolar electrocautery during surgery. Primordial follicles embedded adjacent to the cyst capsule were found in 61.5% of the specimens. Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time. AMH appears to be a better indicator for post-operative quantification of the ovarian reserve.

Eur J Radiol. 2013 Sep;82(9):e411-6. doi: 10.1016/j.ejrad.2013.04.030. Epub 2013 Jun 10. Solak A1, Sahin N, Genç B, Sever AR, Genç M, Sivrikoz ON. Abstract OBJECTIVE:  The purpose of this study is to investigate the value of susceptibility-weighted imaging (SWI) for the evaluation of cyclic morphological and hemorrhagic changes in abdominal wall endometriomas (AWE). MATERIALS AND METHODS:  Fourteen patients with a total of 17 lesions who were admitted with complaints of abdominal wall mass and cyclic pain were evaluated by MRI. Patients were scanned during the first three days of the menstrual cycle and during the mid-cycle phase (day 13-15). In addition to conventional images SWI was performed. The signal changes within the lesions on SWI were compared and graded on both studies. RESULTS:  There was no significant difference in the size of the lesions in the early days of the menstruation compared to the mid-menstrual period. The SWI taken on mid-cycle phase showed that the center was hyperintense and the peripheral zone was hypointense in all lesions. A signal void related to increased blood and the shrinkage of complete disappearance of hyperintensity in the venter of the lesion was seen 15 (88%) of the 17 cases on the SWI series performed during the menstrual phase scan. CONCLUSION:  SWI is a sensitive technique and has the capability to show hemorrhage and deposition of hemosiderin within the lesions. For patients suspected with AWE, valuable diagnostic findings may be obtained if the MRI examination including SWI is performed during the early and mid phase menstrual cycle.

Case Rep Obstet Gynecol. 2013;2013:386783. doi: 10.1155/2013/386783. Epub 2013 May 12. Uzunçakmak C1, Güldaş A, Ozçam H, Dinç K. Abstract Scar endometriosis is an infrequent type of extrapelvic endometriosis that is rather close together with obstetrical and gynecological surgeries. It is mostly confused with other dermatological or surgical conditions and delays the diagnosis. We report a case of a 50-year-old woman presenting with scar endometriosis 23 years after her last lower segment caesarean section. The epidemiology, diagnosis, pathogenesis, and treatment of the situation are discussed.

Balkan Med J. 2013 Jun;30(2):155-60. doi: 10.5152/balkanmedj.2012.102. Epub 2013 Jun 1. Solak A1, Genç B1, Yalaz S2, Sahin N1, Sezer TÖ3, Solak I3. Abstract BACKGROUND:  The diagnosis of abdominal wall endometrioma (AWE) is often confused with other surgical conditions. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. AIMS:  To present the clinical findings and ultrasonographic (US) features of AWE with special emphasis on size-related features. STUDY DESIGN:  This study reviewed abdominal wall endometriomas during a 2-year period in the Radiology Department of Sifa University Hospital, Izmir. METHODS:  Eleven women (mean age 32.6 years) with 12 scar endometriomas (mean diameter 29.2 mm) were consecutively evaluated by US and Colour Doppler examination (CDUS) prior to surgery. Lesions were grouped into large (≥3 cm) and small nodules. Vascularisation was classified as location (central, peripheral and mixed) and severity (absent, moderately vascular and hypervascular). In each patient, the nature of pain (absent, cyclic: associated with menstruation and continuous), historical and clinical data were documented. Four patients underwent Magnetic Resonance Imaging and their findings were presented. Fisher's exact test, χ(2) test for categorical data and the unpaired T-test for continuous variables were used for statistical analysis. RESULTS:  In all the women, US of the AWE showed the presence of a solid hypoechoic mass (less echogenic than the surrounding hyperechoic fat) within the abdominal wall. There was a significant correlation between AWE sizes with repeated caesareans and the mean time between the last operation and admission to hospital (p<0.05). Large endometriomas showed increased central vascularity (p<0.05). Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05). CONCLUSION:  AWE is often misdiagnosed clinically because endometriosis may occur years after the caesarean section, the pain is often non-cyclic in nature, and there is not always a palpable tender mass. The sonographic and Doppler findings, along with proper correlation with clinical data, may substantially contribute to the correct diagnosis of endometrioma.

J Obstet Gynaecol Res. 2013 Jul;39(7):1253-8. doi: 10.1111/jog.12050. Epub 2013 May 30. Durak Y1, Kokcu A, Kefeli M, Bildircin D, Çelik H, Alper T. Abstract AIM:  The aim of this study was to investigate the effect of vitamin C on the growth of experimental endometriotic cysts. MATERIAL AND METHODS:  The endometrium of the uterine horn wall (diameter, 4 mm) was implanted onto the inner surface of the anterior abdominal wall of 40 Wistar albino adult female rats, by laparotomy. The day after the implantation, the rats were randomly assigned into four groups (control group and experimental groups [V1, V2, and V3]) comprising 10 rats each. For 6 weeks, the control group (Group C) received 1 mL distilled water, whereas the experimental groups (Groups V1, V2, and V3) received 0.5 mg, 1.25 mg, and 2.5 mg of vitamin C in 1 mL of distilled water, respectively. The doses were given via oral gavage once per day. At the end of the administration, a second laparotomy was performed and endometriotic cyst volumes and weights of rats among the groups were compared. In addition, the stromal and glandular tissue and the natural killer cell contents of the cysts were compared among the groups. RESULTS:  The cyst volume in Group V3 and the cyst weights in Groups V2 and V3 were significantly lower than those in Group C. The natural killer cell content in Groups V1, V2, and V3 was significantly lower than that in Group C. Stromal and glandular tissue contents of the groups were not significantly different. CONCLUSIONS:  The dose-dependent vitamin C supplementation significantly reduced the volumes and weights of the endometriotic cysts.

Case Rep Obstet Gynecol. 2013;2013:728291. doi: 10.1155/2013/728291. Epub 2013 Apr 14. Tazegül A1, Seçilmiş Kerimoğlu O, Incesu FN, Doğan NU, Yılmaz SA, Celik C. Abstract During pregnancy, masses that are larger than 5 cm and appearing in the Doppler ultrasonography as having increased blood flow, echoes of heterogeneous density, and containing solid components are suspicious for malignancy; however, differential diagnosis of decidualized endometriomas should also be considered. The patient was an 8 weeks pregnant primigravida. The ultrasonographic evaluation showed a cystic mass of size 65 × 57 mm in the left ovary that was well circumscribed, heterogeneous, with highly dense internal echo, and containing a solid component of size 8 × 14 mm. In the 12th week, the ultrasonographic examination revealed an increase in the size of the mass and increased arterial blood flow in the mass. The patient underwent surgery. It was observed that both ovaries were adherent in the Douglas pouch and that the left ovary contained an endometrioma of size 8cm. While the capsule was being peeled, lesions of soft density, with irregular surfaces, and with adhesion in the Douglas pouch were observed. The results of the frozen section revealed decidualized endometrioma and decidual structures. Even in pregnant women when adnexal masses are encountered and the ultrasonography, Doppler, MRI, and CA 125 level analysis still do not favorendometriosis, decidualized endometrioma should be considered in the differential diagnosis.

J Gynecol Oncol. 2013 Apr;24(2):114-9. doi: 10.3802/jgo.2013.24.2.114. Epub 2013 Apr 5. Kulac I1, Usubutun A. Abstract OBJECTIVE:  Extrauterine involvement of endometrial carcinoma has a significant effect on the patients' prognosis and treatment decision. In classical method, macroscopic section is taken from the fallopian tube sparing the fimbrial ends. Fimbrial end of fallopian tube may be involved by tumors and precursor lesions. This study aims to determine the importance of sampling of fimbrial ends of fallopian tube in endometrioid endometrial carcinoma specimens. METHODS:  We reevaluated the fallopian tubes of 200 cases of endometrioid endometrial carcinoma cases that have no macroscopic tubal lesion. A hundred cases were sampled with classical method, and the other 100 were sampled with a new method that includes the fimbrial ends. Statistical difference was examined by Fisher's exact test. RESULTS:  No microscopic tubal lesion lesion was detected in cases that were sampled with the classical method. In contrast, there were 4 cases with tubal lesions in patients sampled with the new technique; 3 of them were located in the fimbrial end. Of the 3, there was one microscopic invasive carcinoma and two proliferative endometrial glandular lesions. Endometriosis was detected in two of the 4 cases with tubal lesions. CONCLUSION:  Including the fimbrial end of fallopian tube to macroscopic sampling could detect more tubal lesions, which might provide additional prognostic and pathogenetic information of endometrioid endometrial carcinoma.

Hum Reprod. 2013 Aug;28(8):2140-5. doi: 10.1093/humrep/det123. Epub 2013 Apr 26. Uncu G1, Kasapoglu I, Ozerkan K, Seyhan A, Oral Yilmaztepe A, Ata B. Abstract STUDY QUESTION:  Do the presence of endometriomas and their laparoscopic excision lead to a decrease in ovarian reserve as assessed by serum anti-Müllerian hormone (AMH) levels? SUMMARY ANSWER:  Both the presence and excision of endometriomas cause a significant decrease in serum AMH levels, which is sustained 6 months after surgery. WHAT IS KNOWN ALREADY:  No previous comparison of serum AMH levels between women with and without endometrioma has been reported. However, studies have suggested a decline in serum AMH levels 1-3 months after endometrioma excision but long-term data are needed. STUDY DESIGN, SIZE, DURATION:  A prospective cohort study including 30 women with endometrioma >2 cm were age matched with 30 healthy women without ovarian cysts. PARTICIPANTS/MATERIALS, SETTING, METHODS:  Women with endometrioma underwent laparoscopic excision with the stripping technique. Serum AMH level and antral follicle count (AFC) were determined preoperatively, 1 and 6 months after surgery. Correlation analyses were undertaken in order to identify determinants of surgery-related change in ovarian reserve. MAIN RESULTS AND THE ROLE OF CHANCE:  Compared with controls at baseline, women with endometrioma had lower AMH levels (4.2 ± 2.3 versus 2.8 ± 2.2 ng/ml, respectively, P = 0.02) and AFC (14.7 ± 4.1 versus 9.7 ± 4.8, respectively, P < 0.01). Serum AMH levels were further decreased 6 months after surgery (2.8 ± 2.2 versus 1.8 ± 1.3 ng/ml, P = 0.02), while AFC remained unchanged (9.7 ± 4.8 versus 10.4 ± 4.2, P = 0.63). The rate of decline in AMH was not correlated with age, laterality of endometrioma, cyst diameter or the number of primordial follicles on the surgical specimens. The preoperative serum AMH level was positively correlated with the rate of decline in serum AMH after surgery (r = 0.47, P = 0.02). LIMITATIONS, REASONS FOR CAUTION:  The absence of a non-treated group of women with endometriomas as a further control prevents comment on the presence of a progressive decline in ovarian reserve related to endometrioma per se. The sample size may be too small for detection of factors correlated with the extent of ovarian damage. WIDER IMPLICATIONS OF THE FINDINGS:  While the findings are mostly in agreement with previous studies, the present study is the first to show that the presence of endometrioma per se is associated with a decrease in ovarian reserve. The extent of surgery-related decline in ovarian reserve is not predictable using preoperative or perioperative factors. It may be prudent to measure AMH levels preoperatively and delay/avoid surgical excision as far as is possible if subsequent fertility is a concern. Additional studies are required to further investigate whether the endometrioma-related decline in ovarian reserve per se is progressive in nature and whether it exceeds the surgery-related decline. STUDY FUNDING/COMPETING INTEREST(S):  This study was funded by the Research Fund of the Uludag University School of Medicine. The authors have no conflict of interest associated with this study.

Reprod Sci. 2013 Oct;20(10):1224-9. doi: 10.1177/1933719113483012. Epub 2013 Mar 27. Sevket O1, Sevket A, Buyukpinarbasili N, Molla T, Kilic G, Ates S, Dansuk R. Abstract OBJECTIVE:  To examine the effect of ranibizumab on surgically induced endometriosis in rat models. STUDY DESIGN:  Endometrial tissue was implanted onto the abdominal peritoneum of 20 rats that were randomized into 2 groups. The rats in group 1 (n = 9) were given 0.6 mg/kg ranibizumab on the 1st and 14th days after the second operation. The rats in group 2 (control group, n = 9) received no medication. All the rats were observed for a total of 28 days. RESULTS:  At the end of the treatment, the mean volume and weight of the explants in group 1 (11.49 ± 6.87 mm(3) and 36.61 ± 17.84 mg) were significantly lower than that of the control group (190.6 ± 177.4 mm(3) and 187.3 ± 174.5 mg; both Ps < .01). Mean epithelial histologic scores were significantly lower in group 1 (1.11 ± 0.78) than that of the control group (2.33 ± 0.71; P < .01). When compared with the control group, vascular endothelial growth factor (VEGF) immunoreactivities in group 1 showed statistically significant reductions (1.67 ± 0.50; 2.67 ± 0.50; P < .01). CONCLUSION:  Ranibizumab has significantly regressed the size of the endometriotic implants and caused atrophy of these lesions in rats by decreasing explant levels of VEGF.

Reprod Sci. 2013 Oct;20(10):1230-6. doi: 10.1177/1933719113483014. Epub 2013 Mar 27. Ergenoğlu AM1, Yeniel AÖ, Erbaş O, Aktuğ H, Yildirim N, Ulukuş M, Taskiran D. Abstract OBJECTIVE:  To evaluate the effect of resveratrol on an experimentally induced endometriosis rat model. STUDY DESIGN:  After endometriotic implants were surgically formed, rats were randomly divided into 2 groups as control group (saline treated, n = 6) and resveratrol group (10 mg/kg/d, n = 6). The inflammatory markers and histopathological changes were assessed at the end of the treatment period. Results Our results showed (1) significant reduction in the implant size (P < .0005); (2) significantly decreased levels of vascular endothelial growth factor (VEGF) in the peritoneal fluid and plasma (P < .005); and monocyte chemotactic protein 1 (MCP-1) in the peritoneal fluid (P < .05), (3) highly significant suppression of VEGF expression in the endometriotic tissue (P < .0005); and (4) considerable histological changes in the endometriotic foci following resveratrol treatment. CONCLUSION:  Resveratrol appears to be effective on the development of endometriosis through its antiangiogenic and anti-inflammatory properties. Future studies with different doses of resveratrol might provide more comprehensive results regarding the treatment of endometriosis.

J Pediatr Adolesc Gynecol. 2013 Jun;26(3):176-9. doi: 10.1016/j.jpag.2013.01.062. Epub 2013 Mar 19. Özyer S1, Uzunlar Ö, Özcan N, Yeşilyurt H, Karayalçin R, Sargin A, Mollamahmutoğlu L. Abstract STUDY OBJECTIVE:  To evaluate clinical aspects of endometriomas encountered in late adolescent females and young women and to review the issues specifically related to the disease in this age group. DESIGN:  Retrospective medical chart review study. SETTING:  Adolescent gynecology and infertility clinic of a tertiary care hospital with women's health focus. PARTICIPANTS:  Sixty-three late adolescent females and young women aged ≤ 24 years with endometrioma. INTERVENTIONS:  Operative laparoscopy for endometriomas. MAIN OUTCOME MEASURES:  Baseline clinical characteristics of the patients including age, marital status, body mass index, symptoms on admission, family history of endometriosis, past medical history, CA-125 levels, presence of a müllerian anomaly, endometriosis characteristics at the time of surgery, and correlation between ASRM scores and patient characteristics. RESULTS:  The mean age and body mass index of the patients were 22 ± 2 (range 17-24) years and 20.8 ± 2.6 (range 16.6-28.5) kg/m(2) respectively. Chronic pelvic pain was the most common symptom (44%). Two patients had a diagnosis of genital malformation. Forty-one (65%) patients had endometrioma on the right ovary, and 14 (22%) patients had bilateral endometriomas. Only one patient had posterior cul-de-sac completely obliterated. Fifty-five (87%) patients had score <16 points for adnexal adhesions calculated according to the revised American Society for Reproductive Medicine classification. CONCLUSION:  Endometriomas, although rare, can be encountered in adolescents and young women. The disease in adolescent patient group offers particular importance since early intervention is essential in order to decrease pain, prevent progression of the disease and enhance future fertility.

Acta Med Iran. 2012;50(12):839-42. Bozkurt M1, Bozkurt DK, Çil AS, Karaman M. Abstract We report a case of 48-year-old woman with multiple hydatid cysts in pararectal region and right paraovarian localization with an unusual sonographic and computed tomographic presentation mimicking a pelvic endometriosis. During laparotomy, multiple pararectal and right ovarian cysts resemblingendometriosis were resected. Pathologic examination gives the diagnosis of hydatid cysts. Retrospectively, we investigate the primary infection but the patient had no history of hepatic and liver involvement, it is a case of primary infection.

Arch Gynecol Obstet. 2013 Jun;287(6):1225-33. doi: 10.1007/s00404-013-2767-2. Epub 2013 Feb 22. Kokcu A1. Abstract PURPOSE:  To examine possible effects of endometriosis-related immune events on reproductive function. METHODS:  The synthesis and review of the relevant current literature in English language. RESULTS:  The endometriosis-related immune events may have a negative impact on almost all components of the reproductive function including fallopian tube function, oocyte quality, sperm function, fertilization, embryo quality, endometrial receptivity, implantation and placentation. CONCLUSIONS:  An important portion of the cases of infertility or miscarriage seen in women with endometriosis may be due to some immunological alterations associated with endometriosis.

BMJ Case Rep. 2013 Jan 31;2013. pii: bcr2012008209. doi: 10.1136/bcr-2012-008209. Seval MM1, Cavkaytar S, Atak Z, Guresci S. Abstract Endometriosis of the uterine cervix is a rare lesion that is generally asymptomatic in gynaecological practice. We present a case with postcoital bleeding due to a cervical mass mimicking cervical polyp or fibroma which was histologically proven as cervical endometriosis later. Cervicalendometriosis should be considered in the differential diagnosis of cervical masses with postcoital bleeding.

Med Glas (Zenica). 2013 Feb;10(1):59-62. Bodur S1, Gün I, Alpaslan Babayigit M. Abstract AIM:  The present study was designed to assess the significance of mean platelet volume on the pathogenesis and management of adenomyosis. METHODS:  A total of 26 patients out of 123 with pathologically confirmed adenomyosis in hysterectomy specimens without concomitant gynecological pathology were selected for the study. Control group was consisted of 24 symptom-free subjects out of 35, with normal smear test and without infection. Groups were compared in terms of mean platelet volumes and platelet counts. RESULTS:  The mean platelet volume values of patients with pathologically confirmed adenomyosis were found to be significantly higher than the values in the control group (9.3±0.8 fL versus 7.3±0.8 fL; p less 0.05). Platelet count comparison between the two groups showed no statistical significance (p>0.05). CONCLUSION:  This study confirms the previous studies indicating endometriosis and adenomyosis as inflammatory processes. As a result, mean platelet volume has shown to be a significant clinical marker for chronic inflammatory process of adenomyosis and endometriosis. This basic finding should be supported by new studies concerning the correlation of mean platelet volume levels with severity and duration of the disease, as well as response of mean platelet volume levels to therapies targeting chronic inflammatory process in adenomyosis and endometriosis pathogenesis.

Vojnosanit Pregl. 2012 Nov;69(11):1013-6. Unalp HR1, Akguner T, Yavuzcan A, Ekinci N. Abstract INTRODUCTION:  Endometriosis is defined as the presence of benign endometrial glands and stroma outside the normal anatomical location. Endometriosis of the small bowel, especially symptomatic small bowel involvement, is very unusual. CASE REPORT:  We presented a 45-year-old woman with acute intestinal obstruction due to ileal endometriosis The patient complained of severe abdominal pain, nausea and vomitting. Immediate laparotomy was carried out. Above the ileocecal valve there was an ulcerated, edematous and fragile segmental lesion that caused intestinal obstruction. Histology of this ileal segment revealed endometriosis and an annular stricture that again showed foci of endometriosis. CONCLUSION:  In reproductive-age women with the symptoms of intestinal obstruction, intestinal endometriosis should be kept in mind.

Arch Gynecol Obstet. 2013 Jun;287(6):1251-7. doi: 10.1007/s00404-012-2704-9. Epub 2013 Jan 6. Sönmezer M1, Taşkın S, Gemici A, Kahraman K, Özmen B, Berker B, Atabekoğlu C. Abstract PURPOSE:  To compare the effect of hemostatic matrix (HM) and electrosurgical bipolar coagulation (EBC) on ovarian reserve in patients undergoing endometrioma surgery. METHODS:  Thirty patients with single ovarian endometrioma ≥4 cm were randomized to two groups. Ovarian reserve after laparoscopic excision of endometrioma was assessed by serum anti-Müllerian hormone (AMH); preoperatively and in postoperative months 1 and 3. RESULTS:  The preoperative AMH levels were similar between the groups. Intra-group comparisons: the AMH levels were significantly lower in the first and third postoperative months as compared to basal levels in both groups. In each group, AMH levels were significantly higher in the third postoperative month as compared to first postoperative month. Inter-group comparisons: AMH levels were significantly lower in the EBC as compared to the HM at 1st postoperative month (1.64 ± 0.93 vs. 2.72 ± 1.49 ng/mL). However, the AMH levels were increased and became similar at 3rd postoperative month. CONCLUSIONS:  Although acute ovarian damage was more in EBC group, ovarian reserve was compensated at 3rd month. Further studies with long-term follow-up will clarify the importance of these findings.

Clin Exp Obstet Gynecol. 2013;40(4):599-600. Sahin L1, Dinçel O2, Türk BA3. Abstract Endometriosis is the existence of endometrial tissue out of the intrauterine cavity. Abdominal wall endometrioma is a well-defined mass composed of endometrial glands and stroma that may develop after gynecologic and obstetrical surgeries. A cyclic painful mass at the site of a cesarean section scar is most likely due to an endometrioma, and wide local excision is the advisable treatment. The authors present a case of endometrioma in the abdominal wall, which was treated with local excision.

J Turk Ger Gynecol Assoc. 2013 Dec 1;14(4):210-5. doi: 10.5152/jtgga.2013.55452. eCollection 2013. Yavuzcan A1, Cağlar M1, Ustün Y1, Dilbaz S1, Ozdemir I2, Yıldız E1, Ozkara A1, Kumru S1. Abstract OBJECTIVE:  We compared the preoperative values of mean platelet volume (MPV) and peripheral systemic inflammatory response (SIR) markers (neutrophil/lymphocyte ratio and platelet/lymphocyte ratio) between patients with advanced-stage (stage 3/4) endometriosis having endometrioma (OMA) and patients with a non-neoplastic adnexal mass other than endometrioma (non-OMA). MATERIAL AND METHODS:  Patients who underwent operations with the pre-diagnosis of infertility or adnexal mass and who underwent laparoscopic tubal ligation were included. RESULTS:  Haemoglobin levels, leucocyte count, platelet count, neutrophil count and lymphocyte count were not significantly different between patients with advanced stage endometriosis having OMA, patients with non-OMA and patients in the control group (p=0.970, p=0.902, p=0.373, p=0.501 and p=0.463, respectively). Patients with stage 3/4 endometriosis having OMA, patients with non-OMA and control patients were also not significantly different in terms of MPV (p=0.836), neutrophil/lymphocyte ratio (NLR) (p=0.555) and platelet/lymphocyte ratio (PLR) (p=0.358). Preoperative cancer antigen 125 (Ca-125) levels were significantly higher in patients with OMA (p=0.006). Mean size of the OMAs was significantly lower than non-OMAs (p=0.000). CONCLUSION:  It is very important to determine advanced stage endometriosis and OMAs during preoperative evaluation in order to inform patients and plan an appropriate surgical approach. We demonstrate that MPV, NLR and PLR values are not useful for this purpose in patients with advanced stage endometriosis that are proven to develop severe inflammation at either the cellular or molecular level.

J Turk Ger Gynecol Assoc. 2013 Jun 1;14(2):98-103. doi: 10.5152/jtgga.2013.52385. eCollection 2013. Selçuk I1, Bozdağ G2. Abstract Endometriosis has a wide clinical spectrum and induces a chronic inflammatory process. The incidence of endometriosis in women with dysmenorrhoea is up to 40-60%, whereas in women with subfertility is up to 20-30%. Recurrence of endometriosis varies greatly among different studies. The overall recurrence rates range between 6 to 67% according to the criteria that are taken into consideration. Which of the various reasons is more predictive for recurrence is still unclear and controversial. The main aim of post-operative medical treatment is suppressing ovarian activity leading to atrophy of endometriotic lesions. The success of treatment depends on the resorption of all residual visible lesions and the eradication of microscopic implants. The recurrent lesions might originate from residual lesions or from de novo cells. Determining risk factors for recurrence may allow the identification of subgroups at risk for disease control. Potential biomarkers for recurrence could also maintain targeted therapy.

J Turk Ger Gynecol Assoc. 2013 Jun 1;14(2):81-6. doi: 10.5152/jtgga.2013.53179. eCollection 2013. Kocadal NÇ1, Attar R1, Yıldırım G1, Fıçıcıoğlu C1, Ozkan F2, Yılmaz B3, Yesildaglar N1. Abstract OBJECTIVE:  We aimed to determine the effects of melatonin treatment on endometrial implants in an oopherectomized rat endometriosis model. MATERIAL AND METHODS:  This study is a prospective, randomised, controlled experimental study. It was carried out at the Experimental Research Center of Yeditepe University (YUDETAM). Twenty-two, female, non-pregnant, nulligravid Spraque-Dawley albino rats were included in our study. Endometriosis was surgically induced in oopherectomized rats. Rats were randomised into two groups: control group and melatonin group. In the melatonin group, rats were treated with melatonin (20 mg/kg/day) for two weeks. After the operations were performed to assess the regression of the endometriotic lesions, melatonin treatment was stopped. At the end of the sixth week necropsies were performed to assess the rate of recurrence. The volume and histopathological scores of endometriotic foci were examined. RESULTS:  Volumes of the endometriotic lesions significantly decreased in the melatonin group. Also, when the melatonin group was analysed within itself, endometriotic lesion volumes decreased and histopathological scores increased significantly. CONCLUSION:  Melatonin causes regression of the endometriotic lesions in rats and improvement in their histopathological scores.

J Obstet Gynaecol. 2013 Jan;33(1):32-7. doi: 10.3109/01443615.2012.727044. Bayram C1, Osmanağaoğlu MA, Aran T, Güven S, Bozkaya H. Abstract A total of 57 pregnant women, who were admitted to the outpatient clinic having high visual analogue scale (VAS) and a history of chronic pelvic pain before pregnancy, were evaluated with the international pelvic pain assessment form (IPPAF). Gynaecological disorders, pain at ovulation, dysmenorrhoea, level of cramps with period and suspicion of endometriosis were determined to be higher in the pre-term group (p < 0.05). Regarding urological disorders, pain when the bladder was full, pain with urination, a positive answer to the question, 'Does your urgency bother you?' and suspicion of interstitial cystitis were also determined to be higher in the pre-term group (p < 0.05). Thus, the total IPPAF scores were significantly higher in the pre-term group (p < 0.05). The pregnant women with a higher total IPPAF score before pregnancy may thus have a higher probability of pre-term labour.

Reprod Sci. 2013 Jul;20(7):762-70. doi: 10.1177/1933719112466307. Epub 2012 Dec 7. Celik O1, Celik E, Turkcuoglu I, Yilmaz E, Ulas M, Simsek Y, Karaer A, Celik N, Aydin NE, Ozerol I, Unlu C. Abstract We aimed to investigate whether the surgical removal of endometrioma alters the nuclear factor-kappa B1 (NF-kB1; p50/105) and NF-kB p65 (Rel A) expression in the eutopic endometrium of infertile women with endometrioma before and after laparoscopic removal of the ovarian endometrioma during the mid-secretory phase. Infertile women with endometrioma (n = 15) were enrolled. Infertile patients with nonendometriotic ovarian cyst (n = 10) and healthy fertile women (n = 10) were recruited as controls. Endometrial samples were obtained before and 3 months after the laparoscopic cystectomy. The NF-kB1 (p50/105) levels were analyzed by enzyme-linked immunosorbent assay (ELISA) in the endometrium of all groups before and after laparoscopic ovarian cystectomy during implantation window. Expression of NF-kB1 (p50/105) in eutopic endometrium was significantly higher in infertile women with endometrioma compared to nonendometriotic cyst and fertile controls (P < .05). Laparoscopic cystectomy resulted in a significant decrease in NF-kB1 expression in women with endometrioma. The NF-kB p65 (Rel A) immunoreactivity of eutopic endometrium decreased significantly subsequent to the surgical removal of the endometrioma. In conclusion, increased endometrial NF-kB expression may contribute to endometriosis-associated infertility.

Balkan Med J. 2012 Dec;29(4):410-3. doi: 10.5152/balkanmedj.2012.042. Epub 2012 Dec 1. Ayas S1, Bayraktar M1, Gürbüz A1, Alkan A1, Eren S1. Abstract OBJECTIVE:  We aimed to evaluate uterine junctional zone thickness, cervical length and bioelectrical impedance analysis of body composition in women with endometriosis. MATERIAL AND METHODS:  This is a prospective study conducted in a tertiary teaching hospital. A total of 73 patients were included in the study.Endometriosis was surgically diagnosed in 36 patients (study group). The control group included 37 patients. MAIN OUTCOME MEASURE(S):  Bioelectrical impedance analysis was used to measure body composition. Uterine junctional zone thickness and cervical length were measured by transvaginal ultrasonography. RESULTS:  Patients' characteristics (age, gravida, parity, live baby, age of menarche, lengths of menstrual cycle, percentage of patients with dysmenorrhea, positive family history), body mass index (BMI) (kg/m(2)), amount of body fat (kg), percentage of body fat were not statistically different between the two groups (p>0.05). The length of menstruation and cervical length were longer in women with endometriosis. Similarly, the inner myometrium was thicker in women with endometriosis than the control group. CONCLUSION:  The relation between endometriosis and demographic features such as age, gravida, parity, gravida, BMI, lengths of the menstrual cycle, age of menarche are controversial. Longer cervical length and thicker inner myometrial layer may be important in the etiopathogenesis ofendometriosis.

Arch Gynecol Obstet. 2013 Apr;287(4):723-8. doi: 10.1007/s00404-012-2630-x. Epub 2012 Nov 2 Seckin B1, Oruc AS, Turkcapar F, Ugur M. Abstract PURPOSE:  To study the relation of pelvic pain symptoms and pelvic adhesions to Doppler ultrasound findings in patients with ovarian endometriomas. METHODS:  62 patients who underwent laparoscopic surgery for endometrioma were divided into two groups according to their pelvic pain symptoms. Group 1 (n = 27) included patients with pelvic pain, group 2 (n = 35) asymptomatic patients. Patients were evaluated for the vascularization of endometrioma by transvaginal color and power Doppler ultrasonography before the surgery. The presence and amount of blood flow reported in terms of a color scale, pulsed Doppler indices, and dense pelvic adhesions were compared between the groups. The relation of Doppler ultrasound findings to the dense pelvic adhesions was also analyzed. RESULTS:  Blood flow was present in 74.1 % (n = 20) of patients in group 1 and 68.6 % (n = 24) in group 2 (p = 0.63). The volume and vascularization of the endometriomas, pulsed Doppler indices, stage of endometriosis, and the presence of dense pelvic adhesions were also similar. Patients with dense pelvic adhesions had significantly higher amount of blood flow compared to patients without adhesions (p = 0.006), but the mean pulsatility index and resistance index were not different between the groups (p = 0.55 and 0.59, respectively). CONCLUSIONS:  Pelvic pain symptoms were not found to be related to endometrioma vascularization. On the other hand, we observed an association between higher vascularized endometrioma and the presence of dense pelvic adhesions.

Reprod Sci. 2013 Jun;20(6):639-45. doi: 10.1177/1933719112461188. Epub 2012 Nov 19. Sevket O1, Sevket A, Molla T, Buyukpınarbasılı N, Uysal O, Yılmaz B, Dane B, Kelekcı S. Abstract OBJECTIVE:  To examine the effect of somatostatin analogs on surgically induced endometriosis in rat models. STUDY DESIGN:  Endometrial tissue was implanted onto the abdominal peritoneum of 26 rats that were randomized into 3 groups. The rats in group 1(n = 9) were subcutaneously administered with 0.02 mg/kg/d of octreotide (a short-acting analog)for 28 days . The rats in group 2 (n = 8) were subcutaneously injected with 20 mg/kg of a single dose of a long-acting analogue lanreotide The rats in group 3 were given no medication and served as controls (n = 9). RESULTS:  Mean volume and histologic score of implants in groups 1 (P < .01 and P < .05, respectively) and 2 (P < .01and P < .05, respectively) were significantly lower than that in group 3. There were significant reductions in vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) immunoreactivities in group 1 (0.67 ± 0.50 and 1.22 ± 0.44, respectively; both P < .01) and group 2 (0.71 ± 0.48 and 0.86 ± 0.69, respectively; both P < .01) when compared with the control group (1.78 ± 0.83 and 2.11 ± 0.78, respectively). CONCLUSION:  Somatostatin analogs has regressed significantly the size of the endometriotic implants and caused atrophy of these lesions in rats by decreasing explant levels of VEGF and MMP-9.

Int J Surg Case Rep. 2013;4(1):54-7. doi: 10.1016/j.ijscr.2012.07.018. Epub 2012 Sep 19. Emre A1, Akbulut S, Yilmaz M, Bozdag Z. Abstract INTRODUCTION:  While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Appendiceal involvement may present as acute appendicitis and definitive diagnosis is made by only postoperative histological examination. PRESENTATION OF CASE:  In this study, we present two cases of female patients who underwent an appendectomy presumed diagnosis as acute appendicitis, and a histopathological examination of the retrieved specimen revealed appendiceal endometriosis. DISCUSSION:  Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. Gastrointestinalendometriosis is observed in 3-37% of all endometriosis cases, whereas appendiceal endometriosis accounts for only about 3% of gastrointestinalendometriosis. Appendiceal endometriosis is usually asymptomatic, although it sometimes causes abdominal cramps, nausea, chronic pelvic pain, lower gastrointestinal hemorrhage, intussusception, perforation, or acute appendicitis. CONCLUSION:  Appendiceal endometriosis is an unusual histopathological finding. A preoperative diagnosis is difficult, but this condition should be considered when women of childbearing age present with clinical symptoms of acute appendicitis.

Int Surg. 2012 Apr-Jun;97(2):135-9. doi: 10.9738/CC124.1. Emre A1, Akbulut S, Yilmaz M, Bozdag Z. Abstract Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.

Med Arch. 2012;66(5):353-4. Kesici U1, Yenisolak A, Kesici S, Siviloglu C. Abstract INTRODUCTION:  Primary umbilical endometriosis a rare case. It is mostly seen in women in the reproductive age group. CASE REPORT:  In this case report, a 38 year old woman is discussed who received antibiotherapy for omphalitis diagnosis established due to many complaints of umbilical secretion but who was diagnosed with primary umbilical endometriosis after histopathological examination. CONCLUSION:  Endometriosis must be certainly considered in differential diagnosis in especially inflammatory lesions resistant to noncyclic treatment, determined in umbilical region.

Case Rep Pathol. 2012;2012:742035. Epub 2012 Sep 11. Karaman K1, Pala EE, Bayol U, Akman O, Olmez M, Unluoglu S, Ozturk S. Abstract Endometriosis is characterized by the presence of endometrial tissue consisting of glands and/or stroma located outside the uterus. Involvement of the terminal ileum is extremely rare. Preoperative distinction of ileal endometriosis from other diseases of the ileocecal region is difficult in terms of clinical presentation, symptomatology, radiological appearance, and surgical and pathological findings. We report a case initially diagnosed as Crohn's disease due to a longstanding diarrhea with subsequent intestinal obstruction, but finally diagnosed as ileal endometriosis by histopathological evaluation after resection of the involved segment.

Bratisl Lek Listy. 2012;113(9):544-7. Kiran H1, Arikan DC, Kaplanoglu M, Bisak U, Cetin MT. Abstract OBJECTIVE:  To investigate the effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization (IVF). BACKGROUND:  The presence of endometrioma may be the most important predictor of a poor reproductive outcome. Literature data suggest that ovarian endometriomas might affect the response to ovarian stimulation and oocyte retrieval. METHODS:  The present retrospective study evaluates 2,023 women who applied to our center with an infertility complaint. Twenty-nine women with endometriomas (group 1) who were treated with IVF were included in the study. They were compared with 51 women with unexplained infertility (group 2) regarding the number of retrieved oocytes after egg retrieval and number of metaphase II oocytes. The diagnosis of endometrioma was made via ultrasound examination with the identification of low-density cystic masses in the ovaries. The patients underwent a controlled ovarian hyperstimulation (COH) with either the long agonist mini-dose protocol or the multi-dose antagonist protocol. RESULTS:  The incidence of endometrioma in infertile women was found to be 1.4 %. The women's ages ranged between 24 and 45 years, and the duration of their infertility ranged between 12 and 216 months. The endometrioma was bilateral in 24 % of the cases. The mean endometrioma diameter was 26.2±7.3 mm for the right ovary and 23.2±6.1 mm for the left ovary. The average number of retrieved oocytes after egg retrieval in groups 1 and 2 was 12.4±8.3 and 12.2±8.6, respectively. The average number of metaphase II oocytes in groups 1 and 2 was 8.6±6.1 and 9.4±7.3, respectively. The number of retrieved oocytes after egg retrieval and the number of metaphase II oocytes in both endometrioma group and unexplained infertile group were similar (p >0.05). CONCLUSION:  Endometrioma did not reduce the number of retrieved oocytes in a COH cycle for IVF treatment. However it should be noted that the ovarian response is affected by the size of endometriomas, bilaterality, previous surgeries, recurrence, and the patient's age (Tab. 1, Ref. 31).

Case Rep Pulmonol. 2012;2012:351305. doi: 10.1155/2012/351305. Epub 2012 Aug 30. Celik A1, Aydın E, Yazıcı U, Agackıran Y, Karaoglanoglu N. Abstract Pulmonary endometriosis is a rarely seen disease of the lung. On computed tomography, a cavitary lesion of 15 × 26 in size was detected in the lung parenchyma of a 38-year-old female patient who was examined due to hemoptysis. The pathologic result of the surgically excised cavitary lesion was reported as pulmonary endometriosis.

Med Glas (Zenica). 2012 Aug;9(2):268-72. Gün I1, Oner O, Bodur S, Ozdamar O, Atay V. Abstract AIM:  To evaluate an association of adenomyosis with endometrial cancer and to determine the frequency of adenomyosis at hysterectomy specimens. METHODS:  This study was carried out retrospectively on pathologic specimens of hysterectomies. A total of 472 women in the period 2007-2011 enrolled to the study. All pathologies seen in hysterectomy specimens were noted. The frequency of adenomyosis and the accompanying pathologies were determined. These women were categorized into two groups according to the presence of adenomyosis. The incidence of adenomyosis was analyzed together with the endometrial cancer. RESULTS:  The incidence of adenomyosis was 20.8% at hysterectomy specimens. There was no statistically significant difference between the mean age of the two groups (p = 0.069). There were 98 cases with adenomyosis and the only pathologic finding was adenomyosis, in 28 (28.5%) cases. The most common accompanying pathologies with adenomyosis were uterine myomas in 51 (52%), uterine polyps in 16 (16.3%) and endometrial carcinomas in 11 (11.2%) cases. However, statistically significant association of the presence of adenomyosis with uterine myoma (p = 0.227) and endometrial polyps (p = 0.997) and endometrial carcinoma (p = 0.771) was not found. CONCLUSION:  In hysterectomy specimens, no statistically significant difference was determined between the groups with and without adenomyosis in terms of co-occurrence with endometrial carcinoma.

Reprod Sci. 2013 Jan;20(1):26-32. doi: 10.1177/1933719112452941. Epub 2012 Aug 15. Ozer H1, Boztosun A, Açmaz G, Atilgan R, Akkar OB, Kosar MI. Abstract Blood vessels are necessary for development and maintenance of the endometriosis and blood flow supplies oxygen and essential nutrient to the disease. Local angiogenesis is regulated by vascular endothelial growth factor (VEGF) and inhibitors of VEGF may be a novel therapeutic approach. We inducted endometriosis in 43 rats and they were randomly allocated into 4 groups. The rats in group I (control n = 11) were given no medication. The rats in group II (n = 11) were given bevacizumab. The rats in group III (n = 11) were given Sorafenib, and the rats in group IV (n = 10) were given retinoic acid (RA). Then groups were compared for microvessel density, VEGF, soluble tyrosine-kinase receptor, ovarian reserve, and treatment effectivity. All these medications were effective on endometriosis and we detected that volume of endometriotic implants were significantly decreased. Ovarian reserve was not affected from the medication, in addition RA have induced reproductive capacity.

Gynecol Obstet Invest. 2012;74(4):261-4. doi: 10.1159/000339630. Epub 2012 Jul 10. Esinler I1, Bozdag G, Arikan I, Demir B, Yarali H. Abstract BACKGROUND:  Our aim was to determine the effect of single endometriomas ≤3 cm in diameter per se on ovarian reserve in intracytoplasmic sperm injection (ICSI) cycles. METHODS:  We enrolled 19 consecutive infertile patients (29 cycles) who had unilateral single endometriomas ≤3 cm in diameter and who underwent ICSI. RESULTS:  The mean age of the patients was 33.3 ± 4.9 years. The mean diameter of endometriomas was 21.8 ± 4.9 mm. Left- and right-sided endometriomas were 34.5 and 65.5%, respectively. The number of oocytes retrieved from ovaries with endometriomas and contralateral normal ovaries was comparable (5.9 ± 4.3 vs. 5.4 ± 3.8). CONCLUSION:  Endometriomas ≤3 cm in diameter per se did not have a deleterious effect on ovarian reserve in ICSI cycles.

Clin Exp Obstet Gynecol. 2012;39(1):107-11. Boztosun A1, Ozer H, Atilgan R, Açmaz G, Yalta T, Müderris II, Yanik A. Abstract OBJECTIVE:  The effects of fibrin glue (FG) and suture were investigated and compared with experimental induction in an endometriosis model. MATERIAL AND METHODS:  A randomized, controlled, and double-blind study was performed with 25 adult female Wistar Albino rats. Two autologous endometrial grafts were obtained from each of the rats. The endometrial grafts were transplanted by gluing with FG on the right abdominal wall and suturing with only 5/0 prolene on the left in ten rats. Gluing+suturing and after suturing over the covering with FG of the endometrial graft were performed, respectively, on the right and left in another ten rats. Covering with FG glue of the endometrial graft was performed in another five rats. The endometriosis-like lesions and intraperitoneal adhesions were evaluated macroscopically and histopathologically. RESULTS:  The mean volume (31.4 +/- 17.3), adhesion (0.8 +/- 0.7) and inflammatory reaction (1.2 +/- 0.7) score of the implants in the group using only FG were significantly lower than in the group using suture [respectively, (49.2 +/- 20.6), (2.4 +/- 0.8), (2.2 +/- 0.8)] (p < 0.05). CONCLUSIONS:  Our results demonstrate the general feasibility of reproducible and reliable endometrial graft fixation with FG onto the inner abdominal surface in rats. Furthermore, several advantageous characteristics could be demonstrated such as less inflammation and fewer adhesions.

Arch Gynecol Obstet. 2012 Sep;286(3):777-83. doi: 10.1007/s00404-012-2390-7. Epub 2012 May 31. Simsek Y1, Celik O, Karaer A, Gul M, Yılmaz E, Koc O, Colak C, Zengin S, Aydin NE. Abstract PURPOSE:  The current study investigated the potential therapeutic efficiency of atosiban, an oxytocin receptor antagonist, in an experimentalendometriosis model. METHODS:  Endometriosis was surgically induced in 35 female rats during estrus. Four weeks after this procedure, relaparotomy was performed. The viability and dimensions of the endometriosis foci were recorded. Rats were then randomly divided into three groups. In the first group (n = 8), a daily dose of 0.2 ml 0.9 % NaCl was injected intraperitoneally (i.p.) (control cases). In the second and third groups (n = 8 and n = 8), 0.5 mg/kg/day i.p. atosiban and 1 mg/day i.p. diltiazem were given, respectively. At the end of the treatment, laparotomy was performed, and the dimensions of theendometriosis foci were recorded. The endometrial implants were processed for histological and immunohistochemical studies. The volumes of endometriotic implants were measured, and immunohistochemical analyses were performed, and compared between the groups. RESULTS:  After the treatment with atosiban, volumes of endometriotic implants decreased significantly. Proliferating cell nuclear antigen expression levels were significantly reduced in the atosiban and diltiazem groups compared with the control group. CONCLUSIONS:  In a rat endometriosis model, atosiban, an agent used for the first time for the medical treatment of endometriosis, has shown significant therapeutic efficiency.

Iran J Reprod Med. 2012 May;10(3):275-8. Dogan E1, Okyay E1, Saatli B1, Olgan S1, Sarioglu S2, Koyuncuoglu M2. Abstract BACKGROUND:  Acute appendicitis with appendicial endometriosis is a very infrequently encountered condition during pregnancy. Decidualization is the hypertrophy of endometrial stromal cells by the effect of progesterone. Similarly, in pregnancy, ectopic stromal endometrial cells in endometriosiscan also be transformed by the same mechanism and ectopic decidua (deciduosis) may occur. CASE:  Here we report a 30 year old pregnant woman presenting twice with acute abdominal symptoms requiring surgery for appendicial and ovarianendometriosis and deciduosis. We emphasize that deciudualized endometriosis may first present during pregnancy with acute abdomen necessitating emergency laparotomy and complicating the course of gestation. CONCLUSION:  To our knowledge only 9 cases in which decidualized endometriotic tissue causing acute abdomen necessitating surgery during pregnancy were reported in the literature. What makes our case special is that the patient needed two laparotomies during the pregnancy period which was a very stressful situation for both the patient and the physicians.  

Fertil Steril. 2012 Jun;97(6):1472-8. doi: 10.1016/j.fertnstert.2012.03.027. Epub 2012 Apr 21. Celik HG1, Dogan E, Okyay E, Ulukus C, Saatli B, Uysal S, Koyuncuoglu M. Abstract OBJECTIVE:  To investigate the effect of laparoscopic endometrioma stripping on serum antimüllerian hormone (AMH) and the correlation between the clinicopathologic factors. DESIGN:  Prospective study. SETTING:  University hospital. PATIENT(S):  Sixty-five women with endometriomas. INTERVENTION(S):  All patients underwent laparoscopic cystectomy. Serum AMH, FSH, LH, E(2), and antral follicle count (AFC) were measured preoperatively, at 6 weeks, and at 6 months postoperatively. Specimens were analyzed histopathologically. MAIN OUTCOME MEASURE(S):  The primary end point was to assess the ovarian reserve damage based on alterations of AMH and the secondary end point was to detect the changes in FSH, LH, E(2), and AFC. RESULT(S):  Serum AMH decreased significantly at the sixth month (61%) postoperatively. The FSH level increased significantly at the sixth week, but returned to normal at the sixth month. The AFC increased significantly at the sixth week and at the sixth month. The AMH level decrease was more evident in patients with the cyst <5 cm (65.7% vs. 41.3%). The AMH decrease was more in bilateral compared with unilateral endometriomas (67% versus 57%, respectively). No correlation was detected between the histopathologic analyses and tAMH level. Initially the AMH level was the only independent factor affecting the AMH decrease (odds ratio, 3.68; 95% confidence interval 1.66-8.14). CONCLUSION(S):  Laparoscopic cystectomy of ovarian endometriomas causes a significant and progressive decline in serum AMH levels.

J Obstet Gynaecol Res. 2012 Mar;38(3):526-30. doi: 10.1111/j.1447-0756.2011.01739.x. Epub 2012 Feb 16. Ozel L1, Sagiroglu J, Unal A, Unal E, Gunes P, Baskent E, Aka N, Titiz MI, Tufekci EC. Abstract AIM:  The abdominal wall is an uncommon site of extrapelvic endometriosis. It usually develops in a previous surgical scar and should be considered in the differential diagnosis of any abdominal swelling. Classical symptoms of endometriosis may resemble abdominal wall lesions such as an incisional hernia, hematoma, granuloma, abscess or various soft tissue tumors; therefore, a definitive preoperative diagnosis is not always easy to determine in every case. The aim of this article is to review the clinical findings, imaging results and histopathology of those of our patients who have had cesarean scar endometriosis. METHODS:  Patients diagnosed with abdominal wall endometriosis in their surgical scars from February 2008 to March 2010 were documented. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, definitive operation, postoperative complications, histopathological evaluations and recurrences were recorded and analyzed. RESULTS:  There were 18 patients with a mean age of 34.5 ± 9.6 years. All (100%) had a gradually growing nodular abdominal mass in or adjacent to their cesarean incision scars. This was often associated with pain (83.3%), either noncyclical (26.6%) or cyclical (73.3%) in nature. Ultrasonography (100%), computerized tomography with intravenous contrast (22.2%) and/or magnetic resonance imaging (66.6%) were performed on the patients. All patients underwent surgery and their masses were completely excised. The mean diameter of the removed masses was 3.9 ± 1.4 cm. The final pathological diagnosis for each case was abdominal wall endometriosis. Biannual follow-up examinations for two years revealed that each patient had a complete and uneventful recovery without recurrence. CONCLUSION:  Abdominal wall endometriosis should be considered in the differential diagnosis of masses located at cesarean section incision scars, which should be excised for definitive diagnosis and treatment.

Cytokine. 2012 Apr;58(1):47-9. doi: 10.1016/j.cyto.2011.12.014. Epub 2012 Jan 20. Yilmaz N1, Ozaksit G, Keskin R, Tapisiz O, Mollamahmutoglu L, Uysal S, Astarci M, Ustun H, Mulazımoglu B. Abstract AIM:  The aim of this study is to investigate the effect of formoterol (β2 adrenergic receptor agonist) on peritoneal VEGF levels in rats withendometriosis. MATERIALS AND METHODS:  Experimental endometriosis was constituted with implantation of endometrial tissue. The implants were examined by second laparatomy and rats were divided randomly into four groups. One cc saline was applied ip to the control (C) group (n=8) daily, 22.5μg/kg/day ip formoterol was applied to the second (F) group (n=10) daily, 22.5μg/kg/day ip formoterol and 10mg/kg/day ip propranolol were applied to the third (FP) group (n=10) daily, 45μg/kg/day ip formoterol was applied to the fourth (FF) group (n=9). Before treatment and after 30 days treatment period, peritoneal VEGF levels, the volumes and histopathological properties of the implants were evaluated. RESULTS:  There were significant differences in between the peritoneal VEGF levels before and after treatment in group 2(F) and group 4(FF) (p(a): 0.01, 0.01 respectively). But there were no significant changes in between the volumes of implants before and after treatment among the groups (p>0.05). There were no significant differences among the groups in histopathological parameters (p>0.05). CONCLUSION:  Formoterol treatment was seen to have no effect on the volumes and histopathological structure of endometriotic implants in our study. On the other hand, based on the group 2(F) and 4's (FF) VEGF levels after the treatment, low dose or high dose formoterol may be effective with long term therapy. Formoterol may reduce the development of endometriosis.

Arch Gynecol Obstet. 2012 May;285(5):1483-6. doi: 10.1007/s00404-011-2189-y. Epub 2011 Dec 25. Ulukus M1, Yeniel AÖ, Ergenoglu AM, Mermer T. Abstract OBJECTIVE:  To investigate that endometrioma is an asymmetric disease with left lateral predisposition as compared to other benign ovarian cyst and also, whether endometrioma side is related with endometriosis severity. METHODS:  Operative and histopathologic findings of 340 women who underwent cystectomy for treatment of endometriotic (n = 239) and nonendometriotic ovarian cysts (n = 101) by laparoscopy (n = 268) or laparotomy (n = 72) between January 2005 and August 2009 were evaluated retrospectively. We compared left and right sided distribution of endometriotic and nonendometriotic ovarian cysts, and we also investigated the extent of endometriotic foci, obliteration of pouch of Douglas and endometriosis stage according to the revised American Fertility Society classification of endometriosis to assess whether endometrioma side is related with the severity of endometriosis. RESULTS:  Of 239 women with endometriosis, endometrioma was found in the left ovary (n = 109), right ovary (n = 58) and bilaterally (n = 72). Of 101 control group women functional and dermoid cysts were found in the left ovary (n = 48), right ovary (n = 43) and bilaterally (n = 10). Among women with unilateral ovarian endometrioma (n = 167) a left cyst (63.3%) was found more frequently than a right cyst (34.7%) (P < 0.0001). In women with a left ovarian endometrioma pouch of Douglas was open in 99 (90.8%) cases. However, it was partially obliterated in 3 (2.8%) and completely obliterated in 7 (6.4%) cases. On the other hand, in women with a right endometrioma it was open in 44 (75.9%) cases and partially obliterated in 2 (3.4%) and completely obliterated in 12 (20.7%) cases. In women with a right endometrioma, the possibility of the pouch of Douglas obliteration is significantly higher than the women with a left endometrioma (P = 0.006). CONCLUSION:  Moreover, we also showed that in women with a right endometrioma, incidence of the pouch of Douglas obliteration is higher and theendometriosis tends to be more severe compared to women with a left endometrioma. Our most relevant observation is obliteration of Douglas pouch which was found to be more extensive in women with right ovarian endometrioma. Our results showing left lateral predisposition of endometriomas are in agreement with the previous reports and highlight the retrograde menstruation theory for the pathogenesis of this enigmatic disorder.

Gynecol Endocrinol. 2012 Mar;28(3):220-3. doi: 10.3109/09513590.2011.589930. Epub 2011 Dec 1. Alanbay İ1, Coksuer H, Ercan CM, Sakinci M, Karaşahin E, Ceyhan ST, Ustun Y, Kurt I, Ozbilen N, Baser I. Abstract OBJECTIVE:  To study the levels of chitotriosidase activity in the peritoneal fluid and the plasma of patients with severe endometriosis and control subjects. MATERIALS AND METHODS:  Twenty-five women with laparoscopically and histopathologically confirmed endometriosis (study group) and 27 control patients who had undergone laparoscopic surgery were included. Peritoneal fluid and peripheral blood were obtained from all the patients before the surgery. Chitotriosidase activities were measured. RESULTS:  Analysis of chitotriosidase activity in the peritoneal fluid of patients with endometriosis showed that there was no significant difference between endometriosis and control group, respectively (32.04 ± 64.20 vs. 15.25 ± 31.17 nmol/mL/h; p > 0.05). Analysis of chitotriosidase activity in plasma of patients with endometriosis showed significantly increased levels of chitotriosidase levels compared with the control group (74.81 ± 60.54 vs. 14.10 ± 26.17; p < 0.001), respectively. CONCLUSION:  We found that the activity of chitotriosidase in plasma was statistically higher in severe endometriosis patients than women withoutendometriosis

ISRN Surg. 2011;2011:837501. doi: 10.5402/2011/837501. Epub 2011 May 2. Yildirim M1, Oztekin O, Oztekin D. Abstract Chest pain is a rare sign of thoracal endometriosis associated with endometrioma of the tubo-ovarian endometrioma. We report the case periodic episodes of chest pain concurrent with menstruation in a 35-year-old female, in which ovarian endometrioma was diagnosed and left-sided oophorectomy was performed. After surgery, patient underwent medical treatment which included a Gn-RH agonist and a combined oral contraceptive. In the follow-up period, there was no evidence of chest pain.

Clin Exp Obstet Gynecol. 2011;38(3):288-90. Demir B1, Senerbahce Z, Guzel AI, Demir S, Kilinc N. Abstract BACKGROUND:  Endometriosis is the presence of endometrial tissue outside the uterus. Abdominal wall endometriosis is a very rare location of this pathology. We aimed to report a series of five cases of abdominal wall endometriosis following cesarean section at our clinic. CASE REPORT:  All of our cases had had previous cesareans section and complained of pain at the pfannensteil incision scar. The cases presented palpable and tender masses near the scar. After excision of the masses histopathology reported the masses as endometriosis. CONCLUSION:  Abdominal wall endometriosis is a rare condition. Clinicians should be aware of this pathology especially in women presenting with a painful mass near the scar of a previous cesarean section.

Reprod Sci. 2011 Oct;18(10):941-7. doi: 10.1177/1933719111400635. Aydin Y1, Atis A, Uludag S, Tezer I, Sakiz D, Acar H, Toklu A. Abstract We designed this prospective, randomized controlled animal study to determine the effects of hyperbaric oxygen (HBO) on experimentally inducedendometriosis in a rat model. Surgical induction of endometriosis was performed in 40, nonpregnant, female, Wistar-Albino rats at the Experimental Medicine Research Center of Istanbul University (DETAE). Four weeks later, the first and second laparotomies for volume measurement and peritoneal fluid (PF) collection were performed, and the rats were divided randomly into the study and control groups. The study group was exposed to HBO treatment for 6 weeks. Then, a third laparotomy was performed on all of the rats. The volume, histopathologic scores, Ki-67 labeling of the endometriotic implants, and the levels of tumor necrosis factor-α (TNF-α) in the PF were measured. The mean volume of the endometriotic implants in the study group was significantly lower than that of the control group at the end of the study (57.4 ± 12.5 vs 94.6 ± 17.2 mm(3)). The mean histopathological scores (1.60 ± 0.50 vs 2.42 ± 0.51), Ki-67 immunohistochemical scores (1.50 ± 0.51 vs 2.37 ± 0.49) of the endometriotic implants, and the TNF-α levels (5.33 ± 1.02 vs 8.16 ± 1.76 pg/mL) were significantly lower in the study group than in the control group. Hyperbaric oxygen treatment for 2 hours a day for 6 weeks resulted in significant remission of endometriosis in rats.

Arch Gynecol Obstet. 2011 Dec;284(6):1473-9. doi: 10.1007/s00404-011-2047-y. Epub 2011 Aug 12. Kokcu A1. Abstract PURPOSE:  To examine the current mechanisms of the increased incidence of cancer in women with endometriosis. METHODS:  The synthesis and review of the relevant current literature in English language. RESULTS:  Compared with general population, women with endometriosis have two times higher risk for developing ovarian cancer, 30% higher risk for developing breast cancer, and 40% higher risk for developing hematopoietic malignancies, mainly non-Hodgkin lymphoma. CONCLUSIONS:  Endometriosis comprises many predisposing factors including genetic, epigenetic, local environmental, hormonal, inflammatory and immunologic changes, for the development of some cancers.

Gynecol Endocrinol. 2012 Mar;28(3):212-5. doi: 10.3109/09513590.2011.593669. Epub 2011 Aug 10. Özkan ZS1, Kumbak B, Cilgin H, Simsek M, Turk BA. Abstract BACKGROUND:  To compare demographic, clinical and histopathological characteristics of women diagnosed with adenomyosis (AG) after hysterectomy to those of women diagnosed with leiomyoma (LG) and to investigate the predisposing factors for AG. METHODS:  This study was carried out on 204 patients who underwent gynecologic surgery for various indications except for gynecologic malignancy between January 2005 and December 2009 and whose histopathological analysis of hysterectomy/myomectomy specimen revealed either AG or LG. Women with AG and those with LG were compared with respect to age, parity, menstrual pattern, history of induced abortion, history of prior uterine surgery, smoking, dysmenorrhea, dyspareunia, chronic pelvic pain and coexisting endometrial and ovarian pathologies. RESULTS:  The mean age of our patients was 51 ± 8 years (range 28-85), 40% of them were postmenopausal, and 64% had a history of uterine surgery. The mean age (p = 0.014), gravida (p = 0.018), parity (p = 0.017) and previous endometrial sampling (p < 0.01) were significantly higher in AG. Main symptoms were abnormal uterine bleeding (39%), dysmenorrhea (63%) and nonmenstrual pelvic pain (62%). Age (p = 0.01), menometrorrhagia (p = 0.02) and endometrial sampling (p < 0.01) were the significant covariants in binary logistic regression for AG. CONCLUSION:  AG is an enigmatic disease frequently causing gynecologic complaints and endomyometrial junction deterioration during endometrial sampling may be a trigger point for developing AG.

Eur J Obstet Gynecol Reprod Biol. 2011 Nov;159(1):184-9. doi: 10.1016/j.ejogrb.2011.06.029. Epub 2011 Jul 7. Islimye M1, Kilic S, Zulfikaroglu E, Topcu O, Zergeroglu S, Batioglu S. Abstract OBJECTIVE:  To determine the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in the rat endometriosis model. STUDY DESIGN:  A randomized, placebo-controlled, blinded study using rat endometriosis model. After the peritoneal implantation of endometrial tissue, twenty-eight Wistar female rats were randomized to two equal intervention groups: the control group and the etanercept-treated group. After measuring implant volume, pretreatment blood and peritoneal fluid samples were obtained. A vehicle treatment of 2 mL saline to the rats in control group and 0. 4 mg/kg etanercept SC once weekly were administered in the etanercept-treated group. After four weeks treatment period, the volumes and histopathological properties of the implants were evaluated. A scoring system was used to evaluate preservation of epithelia. Endometrial explants were evaluated immunohistochemically for tumor necrosis factor receptor type 2 (TNFR2). A scoring system was used to evaluate expression grade of TNFR2. RESULTS:  There was not a significant difference in spherical volume between control (131.0 (60.3-501.2)) and treatment groups (72.8 (31.2-149.6)) (p>0.025). There was a significant change in between the volumes of implants before and after treatment in etanercept group (p<0.05). At the end of the treatment significant differences among the groups were found in histopathological and immunohistochemical parameters (p<0.05) also histologic scores and HSCORES were decreased in the treatment group significantly (p<0.05). CONCLUSION:  These results indicate that etanercept was found to effectively reduce the development of endometriosis in this experimental rat model.

J Obstet Gynaecol Res. 2011 Nov;37(11):1596-600. doi: 10.1111/j.1447-0756.2011.01581.x. Epub 2011 Jul 6. Demir B1, Dilbaz B, Karadag B, Duraker R, Akkurt O, Kocak M, Goktolga U. Abstract AIM:  To investigate the coexistence of endometriosis and uterine septum patients whose complaints are abortion and infertility. METHODS:  Ninety-two patients with a uterine septum and 191 patients who had undergone diagnostic laparoscopy for infertility were reviewed. The incidence of endometriosis in patients with a uterine septum was compared with patients with a normal uterine cavity; then the incidence ofendometriosis was compared in association with having a preoperative diagnosis of presumed unexplained infertility in women with a partial or complete uterine septum. RESULTS:  There was no significant difference between the patients who had a uterine septum and those with a normal cavity in terms of the incidence of endometriosis (P = 0.39). Also, the incidence of endometriosis was not significantly different in patients who had a complete or partial uterine septum (P = 0.49). Endometriosis was observed in 8.7% of the patients who were presumed to have unexplained infertility in the complete uterine septum group and in 18.8% of the patients in the partial uterine septum group; but the difference was not statistically significant when complete and partial uterine septum groups were compared according to the type of infertility (partial uterine septum group, P = 0.13; complete uterine septum group, P = 0.28). CONCLUSION:  An increased incidence of endometriosis was not observed in patients with a septate uterus. The reason for infertility in women with a partial uterine septum may be related to endometriosis.

Int J Gynaecol Obstet. 2011 Aug;114(2):124-7. doi: 10.1016/j.ijgo.2011.04.002. Epub 2011 Jun 1 Dogan E1, Ulukus EC, Okyay E, Ertugrul C, Saygili U, Koyuncuoglu M. Abstract OBJECTIVE:  To evaluate follicle loss in ovarian tissue after laparoscopic excision by the stripping technique in endometriomas versus benign nonendometriotic ovarian cysts. METHODS:  Cystectomy samples obtained from 127 ovaries from 104 patients (mean age, 29.05 ± 05 years; range, 19-40 years) by laparoscopic excision (61 endometriomas and 66 benign nonendometriotic cysts) were evaluated for follicle loss. The samples including normal ovarian tissue were graded on a semiquantitative scale from 0 to 4, where 0 was complete absence of follicles and 4 was the pattern of primary and secondary follicles seen in a normal ovary. The results from endometriomas were compared with those from nonendometriotic cysts. RESULTS:  There were no differences in mean tissue thickness, or number of primordial, primary, or secondary follicles between the endometriomas and the nonendometriotic cysts (P > 0.05). Ovarian cortex was detected in 92% and 82% of the endometriomas and nonendometriotic samples, respectively, (P = 0.081). Semiquantitative scoring of ovarian tissue was significantly higher in endometriomas (1.64 ± 1.35 versus 1.11 ± 1.22, P = 0.022). CONCLUSION:  In up to 92% of the cystectomy samples, normal ovarian tissue was found adjacent to the benign cyst; however, functional follicle loss was slightly, but significantly, higher in the endometriomas.

Eur J Obstet Gynecol Reprod Biol. 2011 Oct;158(2):280-4. doi: 10.1016/j.ejogrb.2011.04.043. Epub 2011 May 31. Ercan CM1, Duru NK, Karasahin KE, Coksuer H, Dede M, Baser I. Abstract OBJECTIVE:  To evaluate the ovarian reserve after laparoscopic stripping of unilateral endometriomas by comparing the operated and non-operated ovaries. STUDY DESIGN:  Bilateral ovarian volumes, antral follicle counts, and stromal blood flows were assessed by ultrasonography and anti-mullerian hormone (AMH) levels were analysed in 36 patients who had undergone laparoscopic cystectomy for unilateral ovarian endometrioma. RESULTS:  Mean antral follicle counts (AFC) of the operated side ovaries were significantly lower on the second postoperative day (3.1 ± 2.4 vs 5.2 ± 3.7; p<0.05) and in the third month (3.7 ± 2.1 vs 6.4 ± 2.7; p<0.05). Pulsatility indices of the operated ovaries were significantly decreased on the second postoperative day (2.22 ± 0.46 vs 1.76 ± 0.51; p<0.05) while resistance indices were increased (0.81 ± 0.06 vs 0.88 ± 0.13; p<0.05). Doppler parameters had recovered and a non-significant decrease in AMH levels of the patients was recorded in the third month after surgery (2.03 ± 0.41 ng/mL vs 1.95 ± 0.62 ng/mL; p>0.05). CONCLUSION:  Although laparoscopic stripping of endometriomas seems to affect the ovarian reserve in terms of AFCs, it does not have a significant negative impact at the end of three months as assessed by ovarian volumes, Doppler indices and AMH levels. Endometrioma surgery techniques are important in preserving normal functioning ovaries and further studies are necessary for optimising these surgical approaches.

Fertil Steril. 2011 Jun;95(7):2247-50. doi: 10.1016/j.fertnstert.2011.03.078. Epub 2011 Apr 9. Var T1, Batioglu S, Tonguc E, Kahyaoglu I. Abstract OBJECTIVE:  To evaluate the effect of two different laparoscopic methods on ovarian reserve as determined by antral follicle count (AFC) and ovarian volume in patients with bilateral endometriomas. DESIGN:  Randomized prospective study. SETTING:  Tertiary education and research hospital. PATIENT(S):  Forty-eight patients with bilateral endometriomas. INTERVENTION(S):  AFC and ovarian volumes determined before and after surgery; coagulation and cystectomy performed on one randomly selected side of each patient for their endometriomas; in vitro fertilization and embryo transfer. MAIN OUTCOME MEASURE(S):  Ovarian reserve damage as determined by AFC and ovarian volume, and number of dominant follicles and retrieved oocytes after controlled ovarian hyperstimulation. RESULT(S):  In vitro fertilization and embryo transfer were performed for 37 of 48 patients. The number of dominant follicles and the retrieved oocytes were assessed after controlled ovarian hyperstimulation. The postprocedural AFC was 3.67±1.26 and 4.75±0.60 after cystectomy and coagulation, respectively. A statistically significantly greater decrease in AFC was found after cystectomy as compared with coagulation. Postprocedural ovarian volumes were 6.27±1.95 and 9.87±2.01 after cystectomy and coagulation, respectively. A decrease in ovarian volume was found after cystectomy when compared with coagulation. CONCLUSION(S):  The decreases in AFC and ovarian volume were found for both coagulation and cystectomy, but the decrease was statistically significantly more frequent in cystectomized ovaries than in coagulated ovaries. Also, in the in vitro fertilization cycles, the ovarian response to ovulation induction was statistically significantly reduced in cystectomized ovaries as compared with coagulated ovaries.

J Obstet Gynaecol Res. 2011 Aug;37(8):1041-7. doi: 10.1111/j.1447-0756.2010.01482.x. Epub 2011 Apr 12. Cayci T1, Akgul EO, Kurt YG, Ceyhan TS, Aydin I, Onguru O, Yaman H, Cakir E, Yasar M, Bilgi C, Erbil KM. Abstract AIM:  To investigate the levels of nitric oxide (NO) and asymmetric dimethylarginine (ADMA) in all the rat endometriosis models. MATERIAL & METHODS:  Forty-one rats with endometriotic implants were divided into four groups (1 to 4) and administered infliximab, etanercept, letrozole and control, respectively. There were 11 rats in group 5 (normal). The size of implants, plasma ADMA and nitrate/nitrite (NO(x) ) levels and histological score were assessed. RESULTS:  In groups 1, 2 and 3, plasma ADMA levels were higher than groups 4 and 5, 296.8 ± 66.2, 285.9 ± 35.7, 200.3 ± 41.0, 125.3 ± 16.7, 111.3 ± 6.5 µmol/L, respectively, while NO(x) levels were lower than groups of control and normal 19.6 ± 3.8, 19.8 ± 4.4, 39.3 ± 6.1, 80.5 ± 5.3, and 91.1 ± 5.0 µmol/L, respectively. CONCLUSIONS:  Infliximab, etanercept and letrozole have regressed endometriotic implants, decreased plasma NO(x) levels, and increased plasma ADMA levels.

Ginekol Pol. 2011 Jan;82(1):71-3. Evsen MS1, Sak ME, Yalinkaya A, Firat U, Caca FN. Abstract A 25-year-old woman was referred to our clinic for atypical cyclic pain and masses at both ends of a Pfannenstiel incision scar. Ultrasound of the anterior abdominal wall showed two masses. Both masses were hypoechoic, heterogeneous lesions located at opposite ends of the scar. The lesions were surgically excised with. Microscopic examination revealed endometrial gland structures with endometrial stroma in fibroadipose tissue in sections of both specimens indicative of endometriosis. Incisional endometriosis (IE) is a form of extrapelvic endometriosis especially in scars of obstetric or gynecologic surgery IE may be multifocal at surgical scars. We report the a case of bifocal incisional endometriosis in Pfannesteil scar. Whole scar evaluation should be done for incisional endometriosis and surgical excision should be performed for treatment.

JNMA J Nepal Med Assoc. 2011 Apr-Jun;51(182):87-9. Turan V1, Ergenoglu M, Yeniel O, Emiroglu G, Ulukus M, Zekioglu O. Abstract Endometriosis is a benign and common disorder that is characterized by ectopic endometrium outside the uterus. Extrapelvic endometriosis, like of the vulva, is rarely seen. We report a case of a 47-year-old woman referred to our clinic due to complaints of a vulvar mass and periodic swelling of the mass at the time of menstruation. During surgery, the cyst ruptured and a chocolate-colored liquid escaped onto the surgical field. The cyst was extirpated totally. Hipstopathological examination showed findings compatible with endometriosis. She was asked to follow-up after three weeks. The patient had no complaints and the incision field was clear at the follow-up.

Eur J Gynaecol Oncol. 2010;31(6):719-21. Kazandi M1, Zeybek B, Terek MC, Zekioglu O, Ozdemir N, Oztekin K. Abstract Adenomyosis is defined by the presence of endometrial tissue (glands and stroma) within the myometrium and malignant transformation of adenomyosis in premenopausal women with normal endometrium is extremely rare. Adenocarcinomas arising within adenomyosis need to be distinguished from endometrial carcinomas which arise from the eutopic endometrium, then extend into preexisting adenomyosis of the uterine wall. We report a case of grade 2 endometrioid adenocarcinoma arising from an adenomyotic focus in the uterus.

Appl Radiat Isot. 2011 Feb;69(2):381-8. doi: 10.1016/j.apradiso.2010.11.007. Epub 2010 Nov 20. Kurudirek M1, Doğan B, İngeç M, Ekinci N, Özdemir Y. Abstract Human tissues with endometriosis have been analyzed in terms of energy absorption (EABF) and exposure (EBF) buildup factors using the five-parameter geometric progression (G-P) fitting formula in the energy region 0.015-15 MeV up to a penetration depth of 40 mfp (mean free path). Chemical compositions of the tissue samples were determined using a wavelength dispersive X-ray fluorescence spectrometer (WDXRFS). Possible conclusions were drawn due to significant variations in EABF and EBF for the selected tissues when photon energy, penetration depth and chemical composition changed. Buildup factors so obtained may be of use when the method of choice for treatment of endometriosis is radiotherapy.

Clin Exp Obstet Gynecol. 2010;37(3):237-9. Yerli H1, Askar N, Zekioglu O, Baglan Z, Elmas N. Abstract A 32-year-old female with a clinical history of abdominal swelling underwent CT of the abdomen. A huge biloculated cystic mass with a mural nodule in the abdominal and pelvic region was seen. The lesion showed slightly homogeneous enhancement. The imaging findings suggested an ovarian tumor. Histopathological evaluation after surgical resection revealed that the lesion was a bilateral ovarian endometriosis.

Fertil Steril. 2011 Feb;95(2):497-502. doi: 10.1016/j.fertnstert.2010.10.009. Epub 2010 Nov 12. Ozdegirmenci O1, Kayikcioglu F, Akgul MA, Kaplan M, Karcaaltincaba M, Haberal A, Akyol M. Abstract OBJECTIVE:  To compare the levonorgestrel intrauterine system (LNG-IUS) with hysterectomy in patients with adenomyosis and to study the effects of both treatments on quality of life (QOL). DESIGN:  Prospective randomized clinical trial. SETTING: Women's health teaching and research hospital. PATIENT(S): Eighty-six patients (43 patients for each group) were enrolled, but only 75 women continued the study. INTERVENTION(S): Women interpreted as having adenomyosis on transvaginal ultrasound and magnetic resonance imaging were assigned to receive either LNG-IUS or hysterectomy. MAIN OUTCOME MEASURE(S): Clinical measures of menstrual bleeding as number of used pads/day during menstruation, hemoglobin levels, and health-related QOL variables were assessed. Each woman was followed up for 1 year after treatment. RESULT(S): LNG-IUS increased the hemoglobin levels at the sixth month and first year of the treatment to the comparable levels with hysterectomy. When pretreatment and post-treatment QOL scores of groups were compared, three of the five mean domain scores (physical, environmental, environmental-TR) were increased in patients treated with hysterectomy, while in patients managed with LNG-IUS, all five mean domain scores were increased. CONCLUSION(S): It seems that LNG-IUS demonstrates significant and comparable improvements in hemoglobin levels to hysterectomy in treating adenomyosis-associated menorrhagia during the first year. Although both treatments lead to improvements in health-related QOL, LNG-IUS seems to have superior effects on psychological and social life. It may be a promising alternative therapy to hysterectomy.

Eur J Obstet Gynecol Reprod Biol. 2011 Jan;154(1):100-4. doi: 10.1016/j.ejogrb.2010.09.003. Epub 2010 Oct 28. Ceyhan ST1, Onguru O, Fidan U, Ide T, Yaman H, Kilic S, Baser I. Abstract OBJECTIVE:  Novel treatment strategies are needed in the treatment of endometriosis due to limited success rates with the currently available options. As inflammatory and immunological mechanisms have been shown to be involved in the mechanism of the disease, new modalities are likely to emerge. We investigated the effects of infliximab (INF), etanercept (ETA) and letrozole on the regression of experimental endometriosis. STUDY DESIGN:  In this experimental randomized trial, endometriosis was induced surgically in 44 adult female Sprague-Dawley rats. Establishment of implants was confirmed in 41 animals by a second operation on the 21st day. The rats were then randomly divided into four groups. Group I (n = 10) served as controls. Group II (n = 11) received letrozole (0.18 mg/kg, i.p.), group III (n = 10, i.p.) ETA (2.016 mg/kg, i.p.), and group IV (n = 10) INF (15.12 mg/kg, i.p.) for a second 21-day period. Endometriotic implant size along with peritoneal fluid VEGF level and immunoreactivity were determined before and after the treatment in each group. RESULTS:  Endometriotic implant size reduced in all treatment groups. The effect of letrozole and ETA on implant size was similar but was significantly better than INF. Level of VEGF in peritoneal fluid did not change in any treatment group but post-treatment VEGF immunoreactivity was found significantly lower in the letrozole treated group. CONCLUSIONS:  Letrozole and ETA caused a regression on the implant size in experimental endometriosis. The only group with decreased VEGF expression was letrozole.

Fertil Steril. 2011 Feb;95(2):492-6. doi: 10.1016/j.fertnstert.2010.08.042. Bayoglu Tekin Y1, Dilbaz B, Altinbas SK, Dilbaz S. Abstract OBJECTIVE:  To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months. DESIGN:  Prospective, randomized, controlled study. SETTING:  The reproductive endocrinology unit of a tertiary, research and education hospital. PATIENT(S):  Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study. INTERVENTION(S):  The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks. MAIN OUTCOME MEASURE(S):  Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP). RESULT(S):  The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction. CONCLUSION(S):  Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis.

J Surg Res. 2010 Nov;164(1):e77-81. doi: 10.1016/j.jss.2010.07.043. Epub 2010 Aug 15. Bektaş H1, Bilsel Y, Sari YS, Ersöz F, Koç O, Deniz M, Boran B, Huq GE. Abstract BACKGROUND:  Abdominal wall endometrioma is a rare condition, which usually develops in a surgical scar of Cesarean section or hysterectomy. Certain factors relating to knowledge of the clinical pattern of this disease make correct diagnosis and treatment difficult. The aim was to identify the different forms of presentation of this disease entity through publishing the results from our experience of surgical management of such lesions. METHODS:  Patients diagnosed with abdominal wall endometrioma over a period of 10 y were identified from the comprehensive surgical database of our institution. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, current operation, and recurrences were surveyed and analyzed. RESULTS:  There were 40 patients with a mean age of 32.3 ± 5.2 y. All of the patients (100%, n = 40) had an abdominal mass in or adjacent to surgical scars. The main symptom was pain, noncyclic (45%, n =18), or cyclic (40%, n = 16) in nature. The mean duration of symptoms was 18.2 ± 23.4 mo. The preoperative diagnosis was correct in 47.5% (n = 19) of the cases. Surgical treatment failed in 3 cases (3/33, 9.1%), and the operations were performed once again. CONCLUSIONS:  Abdominal wall endometriosis may be difficult to diagnose as it is comparatively an unfamiliar entity that has not received its due attention among general surgeons, so far. Therefore, in patients with a palpable subcutaneous mass in or around surgical scars with a history of violation of uterus, a thorough history and physical examination is necessary, and usually sufficient to make correct diagnosis of endometrioma.

Ulus Travma Acil Cerrahi Derg. 2010 Jul;16(4):371-2. Barlas D1, Bozkurt S, Kaya MA, Celik F. Abstract Endometriosis is defined as the presence of ectopic functional endometrial tissue outside the uterine cavity. The most common locations are within the pelvis. Unusual sites ofendometriosis outside the pelvis have been reported, including the bladder, intestine, appendix, surgical scars, hernia sac, lung, kidney, and extremities. The diagnosis of scar endometriosis is usually not difficult and is based on history and physical examination. We report here two cases who developed endometriosis on the abdominal wall in the rectus abdominis muscle and were treated with local excisions.

Arch Gynecol Obstet. 2011 Mar;283(3):513-8. doi: 10.1007/s00404-010-1664-1. Epub 2010 Sep 7. Gungor T1, Kanat-Pektas M, Ozat M, Zayifoglu Karaca M. Abstract BACKGROUND:  The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer toendometriosis presenting either with only ascites or with massive ascites with pleural effusion. METHODS:  To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. RESULTS:  Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. CONCLUSION:  Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.

Acta Chir Belg. 2010 May-Jun;110(3):303-7. Akbulut S1, Sevinc MM, Bakir S, Cakabay B, Sezgin A. Abstract PURPOSE:  Endometriosis in surgical scars develops in 0.1% of those women who undergo Caesarean section or other obstetric surgery. Herein we analyse and discuss the clinico-pathological characteristics of 15 patients with scar endometriosis in the abdominal wall. METHODS:  Fifteen cases of scar endometriosis in the abdominal wall that were treated surgically in our department between 2003 and 2009 were examined retrospectively. Age, parity, complaint, medical or surgical history, pre/postoperative hormonotherapy, size of the mass, surgical procedure, follow-up and disease recurrence were analysed. RESULTS:  This retrospective study included 15 patients presenting with 17 postoperative abdominal wall masses. The mean age of the patients was 32.1 +/- 6.0 years (range, 23-48). Eleven of the patients had a painful mass that became bigger before menstruation, two had palpable masses only, and two were hospitalised because of a mass with persistent pain. The locations of the masses were as follows: eight were close to the right side and three were close to the left side; two were in the middle of the Pfanenstiel incision and two were in trocar tracts. The patients' surgical histories included Caesarean section in thirteen, bilateral laparoscopic ovarian cyst excision in one, and laparoscopic appendectomy in one. CONCLUSIONS:  If a patient presents with incision pain and a palpable mass after gynaecologic surgery, an incisional endometrioma should be considered. Surgical excision and hormone therapy are effective treatment approaches in these patients

In Vivo. 2010 May-Jun;24(3):297-301. Attar R1, Agachan B, Kuran SB, Toptas B, Eraltan IY, Attar E, Isbir T. Abstract BACKGROUND/AIMS:  Endometriosis is regarded as a complex disese, in which genetic and environmental factors contribute to the disease phenotype. Whether vascular endothelial growth factor (VEGF) -460 C/T and +405 G/C polymorphisms are associated with susceptibility toendometriosis was investigated. PATIENTS AND METHODS:  Diagnosis of endometriosis was made on the basis of laparoscopic findings. Stage of endometriosis was determined according to the Revised American Fertility Society classification. Sixty out of the 112 women enrolled had no endometriosis, 11 had mild or early-stage endometriosis and 41 had severe endometriosis. Polymerase chain reaction (PCR), restriction fragment length polymorphism and agarose gel electrophoresis techniques were used to determine the -460 C/T and +405 G/C genotypes. RESULTS:  The VEGF +405 G/C genotype frequencies among the cases and controls were CC 55.8% and 35%; GC 30.8% and 50.0%; GG 13.5% and 15.0%, respectively. The allelic frequencies were C 71.15% (cases) and 60.0% (controls) and G 28.8% (cases) and 40% (controls). Patients with endometriosis had a higher incidence of the VEGF +405 CC genotype compared with the controls (p=0.027). Women with VEGF +405 CC genotype had 2.3-fold higher risk for endometriosis. VEGF +405 GC genotype and G allele in the control group was higher than the endometriosisgroup (p=0.039, p=0.027 respectively). The VEGF -460 C/T genotype frequencies among the cases were CC 21.2%, CT 26.9% and TT 51.9%; the C and T allelic frequencies were 34.6% and 65.3%, respectively. The VEGF -460 genotype frequencies among the controls were CC 31.70%, CT 18.3% and TT 50.0%; the C and T allelic frequencies were 40.8% and 59.1%, respectively (p>0.05). There was linkage disequilibrium between VEGF -460 C/T and +405 G/C polymorphisms (D': 0.197, r(2)=0.013). We observed that the VEGF 460T/405C haplotype frequency was significantly higher in patients compared to controls (p=0.011). CONCLUSION:  Our data suggest that the CC genotype of VEGF +405 and 460T/405C haplotypes of VEGF may be associated with the risk ofendometriosis, but the G allele of VEGF +405 appears to be protective against endometriosis.

Arch Gynecol Obstet. 2011 Jun;283(6):1297-302. doi: 10.1007/s00404-010-1543-9. Epub 2010 Jun 12. Yildirim G1, Attar R, Ficicioglu C, Karateke A, Ozkan F, Yesildaglar N. Abstract OBJECTIVE:  To determine the effects of etanercept (anti-TNF-α) on surgically induced endometriosis in a rat model. MATERIALS AND METHODS:  This is a prospective, randomized, controlled, experimental study that was carried out at the Experimental Research Center of Yeditepe University (YUDETAM). Thirty female nonpregnant, nulligravid Wistar-Hannover albino rats were used. The summary of the technique: surgical induction of endometriosis, administration of estrogen for 2 weeks, and laparotomy; administration of etanercept for 2 weeks following the induction of endometriosis and laparotomy; administration of estrogen for 2 weeks and necropsy. The volume and histopathological scores of the endometriotic foci were evaluated. RESULTS:  One-hundred twenty uterine horns were implanted in 30 rats. Endometriosis was completely formatted in 112 lesions (93.3%). No rats were lost. In the etanercept group, the lesions' volumes were 83.9 ± 13.1, 47.2 ± 8.4, and 96.7 ± 34.8 mm(3) at the end of the second week (pretreatment stage), at the end of the fourth week (post-treatment stage), and at the end of the sixth week, respectively (P = 0.007). Histopathologic scores were 2.3 ± 0.2, 1.7 ± 0.2, and 1.9 ± 0.1, respectively (P = 0.08). The changes in the other groups were not statistically significant. CONCLUSIONS:  Etanercept, a fusion protein consisting of human recombinant soluble TNF receptor-2, neutralizes TNF activity. Anti-TNF therapy could be a new non-hormonal therapeutic option for the treatment of endometriosis in humans.

Arch Gynecol Obstet. 2011 May;283(5):1075-9. doi: 10.1007/s00404-010-1505-2. Epub 2010 May 18. Tokmak A1, Ugur M, Tonguc E, Var T, Moraloğlu O, Ozaksit G. Abstract PURPOSES:  In this study, we sought to establish the value of a new molecule, urocortin (Ucn), in the diagnosis of endometrioma and compare with Ca-125 to identify superiority of urocortin. METHODS:  Of the patients operated on at our hospital with the initial diagnosis of adnexal mass, 88 patients whose pathology results were endometrioma and benign ovarian cyst were included in the study. As a result of the pathological examination, the patients were assessed in two groups. Group 1 consisted of 42 cases of endometrioma and Group 2 included 46 cases of benign ovarian cyst (control group). The serum Ucn and CA 125 levels of patients were measured from the blood samples drawn prior to the operation. RESULTS:  While the serum Ucn level was 4.8 ± 1.00 ng/ml in the endometrioma group, it was 4.5 ± 1.03 ng/ml in the control group (P = 0.21). The difference was statistically not meaningful. On the other hand, mean serum Ca-125 level was 43.8 U/l (11.7-251) in the endometrioma group, it was 16.5 U/l (4.3-121.1) in the control group. The difference was statistically meaningful (P = 0.001). When the cut-off point for Serum Ca-125 level was taken as 21.38, sensitivity and specificity levels were found to be 88.1 and 63%. When the cut-off point for Ucn was taken as 4.16, sensitivity was 76.2%, and specificity 45.7%. CONCLUSION:  Ucn was not found to be efficient in distinguishing endometrioma from other benign ovarian cysts or to be superior to CA125 in the diagnosis of endometrioma.

Genet Mol Res. 2010 Apr 6;9(2):629-36. doi: 10.4238/vol9-2gmr779. Attar R1, Cacina C, Sozen S, Attar E, Agachan B. Abstract Several polymorphisms in the DNA repair gene are thought to have significant effects on cancer risk. We investigated the association of polymorphisms in the DNA repair genes XRCC1 Arg399Gln, XRCC3 Thr241Met, XPD Lys751Gln, XPG Asp1104His, APE1 Asp148Glu, and HOGG1 Ser326Cys with endometriosis risk. Genotypes were determined by PCR-RFLP assays in 52 patients with endometriosis and 101 age-matched healthy controls. Although there were no significant (P > 0.05) differences in the frequencies of genotypes or alleles of APE1, XRCC1, XPD, XPG, and HOGG1 genes between patients and controls, the frequency of the XRCC3 Thr/Thr genotype was significantly greater in endometriosis patients compared with controls (P = 0.005). XRCC3 Thr/Met genotypes (P = 0.022), and the Met allele (P = 0.005) seem to have a protective role againstendometriosis. The distributions of genotypes and alleles of the genes APE1, XRCC1, XRCC3, XPD, XPG, and HOGG1 were not significantly associated with the different stages of endometriosis (P > 0.05). We conclude that the XRCC3 Thr/Thr genotype is associated with endometriosis in Turkish women.

Arch Gynecol Obstet. 2011 Apr;283(4):799-804. doi: 10.1007/s00404-010-1434-0. Epub 2010 Mar 24. Zulfikaroglu E1, Kılıc S, Islimye M, Aydin M, Zergeroglu S, Batioglu S. Abstract OBJECTIVE:  To show the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in an experimental model. DESIGN:  A randomized, placebo-controlled, blinded study using rat endometriosis model. SETTING:  Experimental research center of Ankara Education and Research Hospital. ANIMAL(S):  Twenty-two Wistar female rats. INTERVENTION(S):  After peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: control and etanercept-treated groups. After measuring implant volume, blood and peritoneal fluid samples were obtained. Vehicle treatments of 2 mL saline to rats in control and 0.4 mg/kg etanercept SC once weekly were administered in treatment group. Four weeks later, a third laparotomy was performed to remeasure implant volumes, blood, and peritoneal fluid samples. MAIN OUTCOME MEASURE(S):  To compare spherical volume, peritoneal fluid and serum levels of VEGF, IL-6, and TNF-α between groups. RESULT(S):  There was a significant difference in spherical volume between control [131.0 (60.3-501.2)] and treatment groups [72.8 (31.2-149.6)] (p < 0.025). In etanercept-treated group, a significant difference was found between peritoneal fluid and serum levels of VEGF, IL-6, and TNF-α (p < 0.01). CONCLUSION(S):  These results indicate that etanercept was found to effectively reduce the development of endometriosis

Eur J Obstet Gynecol Reprod Biol. 2010 May;150(1):84-7. doi: 10.1016/j.ejogrb.2010.02.004. Epub 2010 Feb 25. Altintas D1, Kokcu A, Kandemir B, Tosun M, Cetinkaya MB. Abstract OBJECTIVE:  To compare the efficacies of anastrozole and raloxifene on endometriosis. STUDY DESIGN:  A randomized, placebo-controlled, single-blind, experimental study was performed on 45 adult Wistar female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University in Turkey. Endometrial tissues were implanted on the abdominal peritoneum in 45 rats. Six weeks later, the implant volumes were measured (volume-1) by performing a second laparotomy. Rats were randomized to one of three equal study groups. Saline solution (0.1 cc/rat/week, subcutaneously) was administered to group 1 (control group), anastrozole (0.004 mg/rat/day, orally) to group 2 (anastrozole group), and raloxifene (0.24 mg/rat/day, orally) to group 3 (raloxifene group) for 8 weeks. At the end of administration, a third laparotomy was performed to remeasure implant volumes (volume-2), and implants were totally excised for histopathologic examination. Volume-1 and volume-2 within the groups, as well as stromal and glandular tissues between the groups, were compared. RESULT(S):  In the anastrozole and raloxifene groups, volume-2 values were significantly lower than those of volume-1. When compared to the control group, in both anastrozole and raloxifene groups, while glandular tissue scores were found significantly lower, stromal tissue scores were not different than that of the control group. There was no significant difference between both the GT and ST scores of the anastrozole and raloxifene groups. CONCLUSION(S):  Anastrozole and raloxifene were seen to have caused equally the regression of the experimental endometriosis statistically significantly.

Gynecol Endocrinol. 2010 Jun;26(6):468-72. doi: 10.3109/09513591003632134. Ercan CM1, Sakinci M, Duru NK, Alanbay I, Karasahin KE, Baser I. Abstract OBJECTIVE:  To evaluate whether a change takes place in antimullerian hormone (AMH) levels reflecting the ovarian reserve after laparoscopic endometrioma stripping surgery and to demonstrate if there is any correlation between AMH levels and the sizes of endometriomas. METHOD:  Fourty-seven women participated as the study group in this prospective controlled trial, 33 of whom (70.2%) had unilateral and 14 (29.7%) of whom had bilateral endometriomas. Pre- and post-operative serum AMH levels were measured and compared with 17 normo-ovulatory control cases and also correlated with endometrioma sizes. RESULT(S):  Mean pre-operative AMH levels of the study group and the normo-ovulatory control cases did not reveal a statistically significant difference (1.62 +/- 1.09 ng/ml and 2.06 +/- 0.51 ng/ml, P > 0.05). Mean level of post-operative serum AMH of the study group decreased from 1.62 +/- 1.09 to 1.39 +/- 1.16. However, this reduction was not statistically significant. (P > 0.05). Pre- and post-operative AMH levels do not reveal a correlation with the size of endometrioma in both group of patients with either unilateral or bilateral endometrioma. CONCLUSION(S):  The presence of the endometrioma does not impair the AMH levels. Laparoscopic endometrioma stripping surgery do not appear to cause a damage in the AMH secreting healthy ovarian tissue, in the short-term follow-up. Laparoscopic stripping surgery of endometriomas in experienced hands is currently a valid approach.

Hum Reprod. 2010 Apr;25(4):932-7. doi: 10.1093/humrep/deq016. Epub 2010 Feb 3. Oner G1, Ozcelik B, Ozgun MT, Serin IS, Ozturk F, Basbug M. Abstract BACKGROUND: Our aim was to investigate the effects of metformin and letrozole on experimentally induced endometriosis in a rat model. METHODS:  Endometriotic implants were surgically formed, and 38 rats were randomly divided into four groups. Group 1 (control group, 8 rats) was given no medication. Group 2 (metformin group, 10 rats) was given 100 mg/kg/day of oral metformin. Group 3 (metformin group, 10 rats) was given 200 mg/kg/day of oral metformin. Group 4 (letrozole group, 10 rats) was given 0.1 mg/kg/day of oral letrozole. All rats continued to receive the treatment for 4 weeks and then were sacrificed to assess the size of implants and scores of adhesions. The histopathologic scores of implants in excised endometriotic foci were examined by a pathologist. RESULTS:  The mean surface area of endometriotic implants was similar in all groups before the treatment. Although the area was not reduced in controls, it was found to be significantly reduced in all treatment groups (44.50 +/- 23.37, 5.90 +/- 2.37, 4.30 +/- 1.33, 6.90 +/- 3.72 mm(2), respectively; P < 0.05). The effect was comparable between the treatment groups. The histopathologic assessment revealed that the histopathologic score of implants was lowest after 100 mg/kg/day metformin. Additionally, metformin reduced the severity of adhesions. CONCLUSIONS:  Metformin and letrozole caused a statistically significant regression of endometriotic implants. The effects of metformin on endometriotic tissue were at least comparable to letrozole.

Reprod Biomed Online. 2010 Feb;20(2):291-9. doi: 10.1016/j.rbmo.2009.11.004. Epub 2009 Nov 26. Yilmaz B1, Ozat M, Kilic S, Gungor T, Aksoy Y, Lordlar N, Sut N, Aksakal O. Abstract Endometriotic implants were induced surgically in female Wistar albino rats, which were randomly divided into three groups. The rats in group I (n=10) and group II (n=9) were given 2.5 mg/kg/day intraperitoneal and oral atorvastatin, respectively, for 28 days. Group III (n=9) was given no medication (control). The mean volume and weight of explants in group I were significantly lower (both P < 0.05) compared with group III. Histopathological score of the implants was significantly lower in groups I and II, when compared with group III (P < 0.01 and P < 0.05, respectively). There were significant reductions in explant concentrations of vascular endothelial growth factor and matrix metalloproteinase 9 in group I (P < 0.01 and P < 0.001, respectively) and group II (both P < 0.01) compared with group III while staining due to tissue inhibitor of metalloproteinase 2 was significantly higher in group I (P < 0.01) and group II (P < 0.01) compared with group III. Moreover, explant concentration of superoxide dismutase was significantly increased in groups I and II compared with group III (both P < 0.05). In conclusion, atorvastatin causes significant regression of endometriotic implants in rats. Moreover, intraperitoneal atorvastatin seems to be more effective than oral atorvastatin.

Reprod Biomed Online. 2010 Feb;20(2):286-90. doi: 10.1016/j.rbmo.2009.11.007. Epub 2009 Nov 26. Bozdag G1, Alp A, Saribas Z, Tuncer S, Aksu T, Gurgan T. Abstract Endometriosis seems to be the result of a complex interaction between environmental factors and various genes. In this regard, the cytochrome subfamily 17 (CYP17) may play an important role by altering the biosynthesis of sex steroids. CYP2C19 is also an important member of the cytochrome P450 (CYP) family, and related mutations may result in an inability to fully metabolize environmental chemicals and cytokines, leading to several diseases. This study sought to determine whether there is a relationship between endometriosis and CYP17 T>C, CYP2C19 *2 and CYP2C19 *3 polymorphisms. When samples from 46 patients with endometriosis and 39 healthy controls were analysed, A2A2 type mutation of the CYP17 gene was observed to be more frequent in patients with endometriosis (34.8 versus 7.7%, P = 0.003). No association was found between the severity of endometriosis and CYP2C19 *2 or CYP2C19 *3 polymorphisms of the CYP2C19 gene. These results suggest that mutations related with sex steroid metabolism seem to have an important role in endometriosis. However, the relation between detoxification ability and endometriosisshould be examined in further studies with larger sample sizes.

Arch Gynecol Obstet. 2011 Feb;283(2):267-72. doi: 10.1007/s00404-009-1344-1. Epub 2009 Dec 30. Altinkaya SO1, Ugur M, Ceylaner G, Ozat M, Gungor T, Ceylaner S. Abstract OBJECTIVE:  Endometriosis is a chronic gynecological disease characterized by the growth of hormonally responsive, endometrial tissue outside the uterine cavity. The present study aims to analyze two vascular endothelial growth factor (VEGF) polymorphisms (-460 C/T and +405 C/G) in Turkish women with and without endometriosis. STUDY DESIGN:  A case-control study was undertaken at the Infertility Department of Zekai Tahir Burak Women's Health Care Education and Research Hospital. The single nucleotide polymorphisms, -460 C/T and +405 C/G, in the 5'-untranslated region of the VEGF gene were tested in 98 affected women and 94 women with no laparoscopic evidence of disease. Endometriosis was also confirmed histologically. Following genomic extraction of genomic DNA, genotyping of the -460 C/T and +405 C/G polymorphisms of the VEGF gene were performed by polymerase chain reaction and restriction fragment length polymorphism assay. Nominal data were evaluated by Pearson Chi-square or Fisher's Exact test, where applicable. Odds ratios and 95% confidence intervals were also calculated. A P value less than 0.05 was considered statistically significant. RESULTS:  Demographic data were similar among groups. The genotype and allele frequencies of the -460 C/T polymorphism did not differ significantly between cases and controls. In contrast, the genotype (P < 0.001) and allele frequencies (P < 0.001) of +405 C/G polymorphism showed a significant difference between cases and controls. Regardless of the early or advanced stage, women with endometriosis showed a higher incidence of the +405 GC genotype and +405G allele when compared with the controls. CONCLUSIONS:  These data suggest that VEGF +405 GC genotype and +405G allele may be associated with the risk of developing early and advanced stage endometriosis in the Turkish population.

Yilmaz B1, Sucak A, Kilic S, Aksakal O, Aksoy Y, Lortlar N, Sut N, Gungor T. Abstract OBJECTIVE:  We sought to test if metformin could regress endometriotic explants in rats. STUDY DESIGN:  After inducing endometriotic implants and randomization of female Wistar albino rats, they were given 25 and 50 mg/kg/day of oral metformin in group A (n = 9) and B (n = 8), respectively, for 28 days. Group C (n = 9) was given saline as placebo. RESULTS:  Mean volume, weight, and histologic score of implants in groups A (P < .01, P < .05, and P < .05, respectively) and B (P < .01, P < .05, and P < .05, respectively) were significantly lower than in group C. The activity of superoxide dismutase and tissue inhibitor of metalloproteinase-2 staining in groups A (P < .05 and P < .01, respectively) and B (P < .01 and P < .01, respectively) was significantly higher than in the control group. Moreover, there were more significant reductions in implant levels of vascular endothelial growth factor and matrix metalloproteinase-9 in groups A (both P < .001) and B (both P < .001) than in group C. CONCLUSION:  Metformin causes regression of endometriotic implants in rats.

Reprod Biomed Online. 2009 Dec;19(6):864-71. Cinar O1, Seval Y, Uz YH, Cakmak H, Ulukus M, Kayisli UA, Arici A. Abstract Protein kinase B (PKB/Akt), a serine/threonine kinase, regulates the function of many cellular proteins involved in apoptosis and proliferation. It was postulated that there is a higher Akt activity in endometriosis compared with normal endometrium, and that oestrogen may be one of the factors responsible for the high Akt activation in endometriotic cells. Phospho-Akt (pAkt) concentrations in normal, eutopic and ectopic endometrial tissues were compared by immunohistochemistry, and a higher pAkt immunoreactivity was revealed in eutopic and ectopic endometrium compared with normal endometrium, in vivo. Higher Akt phosphorylation in stromal cells from eutopic endometrium was observed, when compared with normal, in vitro (P < 0.05). Akt phosphorylation was rapidly (2-10 min) stimulated when endometrial stromal cells from normal and endometriosis patients were treated with 17 beta-oestradiol. In endometrial stromal cells from the endometriosis group, ICI 182,780 (ICI, a specific oestrogen receptor antagonist) failed to antagonize the effect of oestradiol when combined with oestradiol, and revealed a stimulatory effect on Akt phosphorylation when given alone (P < 0.05). In conclusion, since Akt affects cell survival, it is suggested that increased Akt phosphorylation may be related to the altered apoptosis/proliferation harmony in endometriosis, and therefore Akt may play a critical role in the pathogenesis of endometriosis.

Fertil Steril. 2010 Jul;94(2):775-6. doi: 10.1016/j.fertnstert.2009.09.056. Epub 2009 Nov 14. Ozerkan K1, Oral B, Uncu G. Abstract The serum concentrations of mannose-binding lectin in patients with or without endometriosis do not differ. Mannose-binding lectin could be involved in the modulation of inflammatory responses, but it does not seem to take part in endometriosis pathogenesis.

Fertil Steril. 2010 Mar 15;93(5):1722-4. doi: 10.1016/j.fertnstert.2009.09.028. Epub 2009 Nov 6. Yesildaglar N1, Yildirim G, Attar R, Karateke A, Ficicioglu C, Yilmaz B. Abstract The effects of water collected from an industrially polluted river in a rat model with surgically induced endometriosis were investigated in this preliminary study. Exposure to industrially polluted water resulted in regressed endometriotic lesions and enhanced adhesion formation.

Fertil Steril. 2010 Oct;94(5):1622-6. doi: 10.1016/j.fertnstert.2009.09.023. Epub 2009 Oct 29. Cayan F1, Ertunç D, Aras-Ateş N, Ayaz L, Akbay E, Karakaş S, Coban O, Dilek S. Abstract OBJECTIVE:  To investigate whether the insulin receptor substrate (IRS)-2 G1057D polymorphism is associated with the risk of endometriosis, and to evaluate potential correlation of IRS2 gene polymorphism with the stages of endometriosis. DESIGN:  Case-control study. SETTING:  Gynecology clinics in university hospital. PATIENT(S):  Women with (n = 135) or without (n = 135) endometriosis. Afterward, the women with endometriosis were divided into two groups according to the stage: group 1 included 63 women in stages I-II, and group 2 included 72 women in stages III-IV. INTERVENTION(S):  Genotyping by polymerase chain reaction-based restriction fragment-length polymorphism method. MAIN OUTCOME MEASURE(S):  Genotype distribution of the G1057D polymorphism in the IRS2 gene. RESULT(S):  The genotype distribution of the IRS2 G1057D polymorphism in the endometriosis group was significantly different from that of the control group (GG/GD/DD rates were 43.0%/39.3%/17.7% and 55.6%/36.3%/8.1% for the endometriosis and control groups, respectively). Further subgroup analyses according to the stage of endometriosis also revealed a positive association between the IRS2 DD genotype expression and stage III-IV endometriosis patients in the population studied. CONCLUSION(S):  These results suggest that the IRS2 G1057D polymorphism may be associated with an increased risk for endometriosis.

Fertil Steril. 2010 Apr;93(6):1787-92. doi: 10.1016/j.fertnstert.2009.09.021. Epub 2009 Oct 29. Yildirim G1, Attar R, Ozkan F, Kumbak B, Ficicioglu C, Yesildaglar N. Abstract OBJECTIVE:  To determine the effects of letrozole and melatonin on surgically induced endometriosis in a rat endometriosis model. DESIGN:  Prospective, randomized, controlled, experimental study. SETTING:  Experimental Research Center of Yeditepe University (YUDETAM). ANIMAL(S):  Thirty female, nonpregnant, nulligravid Wistar-Hannover albino rats. INTERVENTION(S):  Surgical induction of endometriosis, administration of estrogen for 2 weeks, and laparotomy; administration of letrozole or melatonin for 2 weeks after induction of endometriosis, and laparotomy; administration of estrogen for 2 weeks and necropsy. MAIN OUTCOME MEASURE(S):  The volume and histopathologic scores of endometriotic foci, and levels of superoxide dismutase, catalase, and malondialdehyde in the peritoneal fluid. RESULT(S):  The mean volumes of the endometriotic foci were 99.6 +/- 18.8 mm(3), 21.5 +/- 7.4 mm(3), and 29.2 +/- 17.5 mm(3), and histopathologic scores were 2.5 +/- 0.7, 2.0 +/- 0.8, and 1.7 +/- 0.9 in the melatonin group at the end of the second, fourth, and sixth weeks, respectively. The mean volumes of the endometriotic foci were 75.9 +/- 26.3 mm(3), 29.8 +/- 14.7 mm(3), and 121.2 +/- 35.1 mm(3) and the histopathologic scores were 2.5 +/- 0.5, 2.2 +/- 0.8, and 2.7 +/- 0.4 in the letrozole group at the end of the second, fourth, and sixth weeks, respectively. In the melatonin group, peritoneal fluid superoxide dismutase and catalase levels increased statistically significantly. CONCLUSION(S):  Melatonin caused more pronounced regression of endometriotic foci when compared with letrozole in a rat model. After the cessation of melatonin treatment, the recurrence rate was lower than that observed after the cessation of letrozole treatment.

Mol Biol Rep. 2010 Jan;37(1):369-74. doi: 10.1007/s11033-009-9800-3. Attar R1, Agachan B, Kucukhuseyin O, Toptas B, Attar E, Isbir T. Abstract Endometriosis is regarded as a complex trait, in which genetic and environmental factors contribute to the disease phenotype. We investigated whether the interleukin (IL) 1beta (+3953) polymorphism is associated with the severity of endometriosis. Diagnosis of endometriosis was made on the basis of laparoscopic findings. Stage of endometriosis was determined according to the Revised American Fertility Society classification. 118 women were enrolled in the study. 78 women did not have endometriosis, 6 women had stage I, 3 had stage II, 13 had stage III and 18 had stage IVendometriosis. Polymerase Chain Reaction (PCR), Restriction Fragment Length Polymorphism (RFLP), and agarose gel electrophoresis techniques were used to determine the IL 1beta (+3953) genotype. Frequencies of the IL-1beta (+3953) genotypes in the control group were: CC, 0.397; TT, 0.115; CT, 0.487. Frequencies of the IL-1beta (+3953) genotypes in cases were: CC, 0.375; TT, 0.225; CT, 0.400. We found a 2.22 fold increase in TT genotype in the endometriosis group. However, the difference was not statistically significant (P > 0.05). We also observed an increase in the frequency of IL-1beta (+3953) T allele in the endometriosis group. However, the difference was not statistically significant. We also investigated the association between IL-1beta (+3953) polymorphism and the severity of endometriosis. The frequencies of CC+CT genotypes in stage I, III and IVendometriosis patients were 83.3, 84/6 and 72.2%, respectively; and TT genotypes were 16.7, 15.4 and 27.8%, respectively. We observed a statistically insignificant increase in TT genotype in stage IV endometriosis (P > 0.05). We suggest that IL-1beta (+3953) polymorphism is not associated with endometriosis in Turkish women.

Fertil Steril. 2009 Oct;92(4):1496.e5-8. doi: 10.1016/j.fertnstert.2009.06.044. Epub 2009 Jul 31. Alatas E1, Oztekin O, Hacioglu SK. Abstract OBJECTIVE:  To present two cases of endometriosis in patients with Glanzmann's thrombasthenia (GT) and discuss the underlying pathophysiology of endometriosis. DESIGN:  Case report. SETTING:  Gynecology practice in a university teaching hospital. PATIENT(S):  Two sisters, aged 24 and 28 years, previously diagnosed as having GT. INTERVENTION(S):  Surgical exploration. MAIN OUTCOME MEASURE(S):  Pathologic examination of surgical specimens was performed. RESULT(S):  A diagnosis of endometriosis was confirmed pathologically for two sisters previously diagnosed as having GT. CONCLUSION(S):  Women with GT seem to represent an important human model of endometriosis from which important data on the pathophysiology of endometriosis can be acquired.

Fertil Steril. 2009 Nov;92(5):1761-3. doi: 10.1016/j.fertnstert.2009.05.022. Epub 2009 Jul 23. Kurdoglu Z1, Gursoy R, Kurdoglu M, Erdem M, Erdem O, Erdem A. Abstract Preoperative blood samples and intraoperative tissue specimens were obtained from 101 patients with endometriosis and 78 patients withoutendometriosis referred for benign gynecologic operations to investigate the clinical value of serum and tissue CA 19-9 levels in the diagnostic evaluation of endometriosis as compared to CA 125. Our prospective cohort study showed that serum CA 19-9 is a valuable marker in the diagnosis of endometriosis, and it may be used to predict the patients with severe endometriosis when used with CA 125.

Hernia. 2010 Apr;14(2):215-7. doi: 10.1007/s10029-009-0532-z. Epub 2009 Jul 10. Kiyak G1, Ergul E, Sarikaya SM, Yazgan A. Abstract Endometriosis is characterized by the presence of histological normal endometrial tissue outside the uterine cavity. It occurs in up to 15% of menstruating women and often goes undetected. Some cases of soft-tissue involvement have been reported, particularly in the skin and subjacent tissues of surgical scars. However, we came cross a 42-year-old female patient with millimetric focal lesions in a groin hernia sac. A case report and a review of the literature are presented. Although definitive diagnosis still requires biopsy, the patient's cyclic symptoms and history of previous uterine surgery should suggest the correct diagnosis.  

Fertil Steril. 2009 Dec;92(6):2100-2. doi: 10.1016/j.fertnstert.2009.05.065. Epub 2009 Jul 5. Onalan G1, Zeyneloglu HB, Bayraktar N. Abstract Fenofibrate -a peroxisome proliferator-activated receptor-a agonist- is an angiostatic agent that is commonly used in human liver diseases, therefore it may interfere with the angiogenetic process required for endometriosis. In a rat endometriosis model, we demonstrated that peritoneal implant areas and vascular endothelial growth factor levels in the peritoneal flud were significantly decreased in high dose or low dose finofibrate and luprolide acetate treated groups compared to control.

Gynecol Endocrinol. 2009 Aug;25(8):530-5. doi: 10.1080/09513590902972059. Cayan F1, Ayaz L, Aban M, Dilek S, Gümüş LT. Abstract AIM:  To investigate the association of CYP2C19 genotypes with endometriosis. METHODS:  The study included 100 women who underwent laparotomy or laparoscopy: 50 patients with endometriosis diagnosed with surgery and histopathology, and 50 control subjects who had no evidence of endometriosis during exploratory laparotomy or laparoscopy. Genomic DNA of subjects was extracted from the whole blood using High Pure PCR template preparation kit. Genotyping of CYP2C19 polymorphisms were detected by using a LightCycler CYP2C19 mutation detection kit in a real-time PCR, and were compared between the two groups. RESULTS:  Logistic regression analyses showed that the CYP2C19*2 heterozygote genotype was associated with a significantly increased risk ofendometriosis. The odds ratio of endometriosis for the CYP2C19*2 heterozygote genotype was 3.165 (p = 0.023) compared with the control group. CYP2C19*3 genotype was detected as wild in all subjects in the endometriosis and control groups. CONCLUSION:  Our results suggest that CYP2C19*2 heterozygote genotype has higher risk of developing endometriosis. Therefore, CYP2C19*2 allele gene polymorphisms may be associated with genetic susceptibility of endometriosis.

Fertil Steril. 2009 Jul;92(1):391.e5-7. doi: 10.1016/j.fertnstert.2009.04.013. Epub 2009 May 23. Dirim A1, Celikkaya S, Aygun C, Caylak B. Abstract OBJECTIVE:  To describe a case of renal subcapsular hematoma due to renal endometriosis. DESIGN:  Case report. SETTING:  Departments of Urology and Pathology, Baskent University Faculty of Medicine, Ankara, Turkey. PATIENT(S):  A 46-year-old premenopausal woman was admitted with a left lumbar pain and mass. Ultrasonography and computerized tomography revealed a giant-sized renal subcapsular hematoma. INTERVENTION(S):  Computerized tomography, percutaneous drainage catheter placement, surgical exploration, and excision of renal capsule. MAIN OUTCOME MEASURE(S):  None. RESULT(S):  Histopathologic examination revealed endometriosis located beneath the fibrous renal capsule. CONCLUSION(S):  Renal capsular endometriosis should be kept in mind among the causes of renal subcapsular hematoma.

Hum Reprod. 2009 Aug;24(8):1900-8. doi: 10.1093/humrep/dep106. Epub 2009 Apr 28. Akkaya P1, Onalan G, Haberal N, Bayraktar N, Mülayim B, Zeyneloglu HB. Abstract BACKGROUND:  Doxycycline (Dox) has a number of non-antibiotic properties. One of them is the inhibition of matrix metalloproteinase (MMP) activity. The aim of this study was to assess the effects of Dox in a rat endometriosis model. METHODS:  Endometriosis was surgically induced in 40 rats by transplanting of endometrial tissue. After 3 weeks, repeat laparotomies were performed to check the implants and the animals were randomized into four groups: Group I, low-dose Dox (5 mg/kg/day); Group II, high-dose Dox (40 mg/kg/day); Group III, leuprolide acetate 1 mg/kg single dose, s.c.; and Group VI (controls), no medication. The treatment, initiated on the day of surgery and continuing for 3 weeks, was administered to the study groups. Three weeks later, the rats were euthanized and the implants were evaluated morphologically and histologically for immunoreactivity of MMP-2 and -9, and interleukin-6 (IL-6) concentration in the peritoneal fluid was assayed. RESULTS:  Treatment with leuprolide acetate, or high-dose or low-dose Dox caused significant decreases in the implant areas compared with the controls (P = 0.03, P = 0.006, and P = 0.001, respectively). IL-6 levels in peritoneal fluid decreased in Group I (P = 0.02) and Group III (P < 0.05). MMP H scores were significantly lower in the group that received low-dose Dox in both epithelial and stromal MMP-2 and -9 immunostaining when compared with the control group [P = 0.048, P = 0.002, P = 0.007 and P = 0.002, respectively, MMP-2 (epithelia), MMP-2 (stroma), MMP-9 (epithelia) and MMP-9 (stroma)]. CONCLUSIONS:  Low-dose Dox caused regression of endometriosis in this experimental rat model.

Arch Gynecol Obstet. 2009 Dec;280(6):1011-4. doi: 10.1007/s00404-009-1020-5. Epub 2009 Mar 24. Aydin Y1, Atis A, Ercan E, Donmez M. Abstract INTRODUCTION:  The aetiology of endometriosis remains unknown. The clinical presentation of endometriosis can be highly variable, occurring in numerous potential locations outside the abdomen and associated with distinct complaints. Recurrence is common, though we present a very rare case of recurrence and complication. CASE PRESENTATION:  A 42-year-old caucasian woman was admitted to our unite with monthly vaginal bleeding lasting 3-5 days, beginning from 6 months after previous hysterectomy and right salpingo-oophorectomy surgery for myoma and endometrioma. We suspected of endometrioma of the left ovarium upon transvaginal ultrasonography, and diagnosed vault fistula from the endometriosis cyst to the vagina. We re-operated the patient using Pfannenstiel incision, and performed left-oophorectomy and fistula repairment. The Pouch of Douglas was obliterated and many bowel adhesions were present, indicating a stage IV endometriosis. According to our assessment, stage IV endometriosis had been present in the previous surgery. CONCLUSIONS:  Considering that the short-term endometriosis recurrence is higher in premenopausal age and in advanced stage of endometriosis, bilateral oophorectomy together with hysterectomy may be a better operational choice for these patients.

Arch Gynecol Obstet. 2009 Sep;280(3):495-7. doi: 10.1007/s00404-008-0922-y. Epub 2009 Jan 24. Akbulut S1, Dursun P, Kocbiyik A, Harman A, Sevmis S. Abstract While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Involvement at this site may present as acute appendicitis and be diagnosed only upon postoperative histopathologic examination. We report such an occurrence of appendiceal endometriosis in a 40-year-old woman who presented with acute perforated appendicitis

J Turk Ger Gynecol Assoc. 2009 Dec 1;10(4):199-204. eCollection 2009. Yıldırım G1, Attar R1, Fıçıcıoğlu C2, Karateke A1, Ozkan F3, Kılıç E4, Yılmaz B5, Yeşildağlar N1. Abstract OBJECTIVE:  To determine the effects of the combination of letrozole and melatonin on surgically induced endometriosis. MATERIAL AND METHODS:  This prospective, randomized, controlled, experimental study was carried out at Yeditepe University Experimental Research Center (YUDETAM). Female non-pregnant, 17 nulligravid Wistar - Hannover albino rats with surgically induced endometriosis were used in this study. Endometriosis was induced by using homologous uterine horn transplantation in the rats. Four operations were performed on each rat. The induction of endometriosis was performed in the first operation. After two weeks of estradiol treatment the second operation was performed and endometriotic lesions were evaluated. Estrogen was then discontinued and in the study groups medications were started. During two weeks the rats were given medications and the third operation was performed for the assessment of the effects of the medications on the endometriotic foci. Then all the medications were stopped and estrogen was started again. Two weeks later all the rats were euthanized and recurrence of endometriosis was evaluated. RESULTS:  The sum of the lesion volumes in the control group was 93.6±31.7 mm(3) at the end of the second week. After the cessation of estradiol it decreased to 85.0±23.8 mm(3) (P=0.31) and increased to 119.7±29.4 mm(3) at the sixth week (P=0.02). A significant reduction in histopathologic scores were seen after cessation of the estradiol (p=0.04). At the end of the sixth week, histopathological scores reached the pretreatment values. In the letrozole and melatonin group the sum of the lesion volumes decreased significantly after the treatment (82.8±21.0 mm(3) and 15.7±8.0 mm(3) respectively). At the end of the sixth week, the mean volume was calculated as 43.9±31.8 mm(3) (p=0.002). Histopathologic scores were 2.3±0.1, 2.0±0.2 and 2.2±0.3 at the end of the second, fourth and sixth weeks, respectively, in the letrozole and melatonin group. CONCLUSIONS:  Letrozole and melatonin caused a significant regression in lesion volumes; however, histopathological scores of endometriotic lesions did not change significantly.

BMJ Case Rep. 2009;2009. pii: bcr04.2009.1820. doi: 10.1136/bcr.04.2009.1820. Epub 2009 Jun 28. Yetkin G1, Uludağ M, Citgez B, Polat N. Abstract As with other types of endometriosis in the intestinal tract, endometriosis of the appendix is generally asymptomatic and is usually discovered incidentally during laparotomy in patients with pelvic endometriosis. When it presents with symptoms they are difficult to differentiate from acute appendicitis. Appendiceal endometriosis may not only cause symptoms of acute appendicitis, but may also present as cyclic and chronic right lower quadrant pain, melena, lower intestinal haemorrhage and caecal intussusception. We report a case of appendiceal endometriosis clinically presenting as acute appendicitis, where the definitive diagnosis was established by histopathological examination of the appendix.

Arch Gynecol Obstet. 2009 Aug;280(2):195-9. doi: 10.1007/s00404-008-0895-x. Epub 2008 Dec 27. Hassa H1, Tanir HM, Tekin B, Artan S, Dundar E, Kirilmaz SD, Sahin Mutlu F. Abstract OBJECTIVE:  To assess the apoptosis rate in eutopic and ectopic endometrial stromal and glandular cells, normal peritoneum and adhesions in women with endometriosis. METHODS:  A total number of 97 women with (n:60) and without (n:37) histopathologically confirmed endometriosis who underwent laparoscopy or laparotomy in the early follicular phase of the menstrual cycles for pain and infertility were included in this study. Stage I/II and stage III/IV were categorized as early staged and late-staged endometriosis. The endometrial samples were obtained with a Novack cannula from the corpus of the uterus. Normal-looking peritoneum, peritoneal implants and adhesions were sampled and fixed in formaldehyde for immunohistochemical staining with Bcl-2 and Bax. Tissue samples were fixed in formaldehyde for the assessment of apoptosis via terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) and M30 cytoDEATH antibody. RESULTS:  The intensity of Bax staining of normal-looking peritoneum in early staged endometriosis was higher, compared to women with late-staged and women without endometriosis (P = 0.03). However, degree of Bcl-2 staining did not differ among early and late-staged endometriosis and women without endometriosis (P = 0.1). In terms of Bcl-2 and Bax staining in the stromal and glandular parts of the eutopic endometria, no significant differences were detected among three groups. In cases with early- and late-staged endometriosis the intensity of Bax and Bcl-2 stainings did not differ in both stromal and glandular parts of ectopic endometria. Number of cells with positive apoptotic signals assessed via TUNEL (P = 1.0) and M30 cytoDEATH antibody (P = 0.59) in normal-looking peritoneum did not differ between three groups. In addition, no difference in term of numbers of apoptotic cells obtained from adhesions was observed between three groups (for TUNEL, P = 0.29, for M30, P = 0.19). CONCLUSIONS:  Apoptosis patterns did not differ in the eutopic and ectopic endometria as well as adhesions of women with or withoutendometriosis.

Arch Gynecol Obstet. 2009 Jun;279(6):891-5. doi: 10.1007/s00404-008-0844-8. Epub 2008 Nov 21. Hassa H1, Tanir HM, Tekin B, Kirilmaz SD, Sahin Mutlu F. Abstract OBJECTIVE:  To investigate the level of cytokines and immune cells in the peripheral blood (PB) and peritoneal fluid (PF) of different stages ofendometriosis. METHODS:  A prospective study was conducted to include 97 women with (n 60) and without (n 37) histopathologically confirmed endometriosis. Based on rASRM classification, stage I/II and stage III/IV were categorized as early-and late-staged endometriosis. Prior to surgery, 10 ml of blood was withdrawn from antecubital vein and serum was obtained. Aliquots were made and stored at -70 degrees C until assayed for cytokines. PF was aspirated from the pouch of Douglas. Peripheral and PF samples were analyzed by ELISA in terms of IL-2, IL-4, IL-10 and IFN-gamma. Determinations of T helper, T suppressor, NK, and B cells were assessed by using cluster determinant-3 (CD-3), CD4, CD8, CD25, CD28, CD45, CD16, CD23 and antibodies against early T cell activation antigens such as CD45RA/CD45RO, CD-69 and late activation antigens such as HLA-DR. A multiparameter flow cytometry was applied to detect the cell activation antigen expression. RESULTS:  In terms of cytokine levels in PB and PF's of control group and early- and late-staged endometriosis cases, no significant difference was depicted in the cytokine levels (p > 0.05). Levels of immune cells did not differ between three groups (p > 0.05). CONCLUSIONS:  The result of this study did not show any significant difference in PB and PF cytokine and lymphocyte subgroups between normal and early- and late-staged endometriosis.

J Obstet Gynaecol Res. 2008 Dec;34(6):1014-9. doi: 10.1111/j.1447-0756.2008.00807.x. Altintas D1, Kokcu A, Tosun M, Cetinkaya MB, Kandemir B. Abstract AIM:  In the present study, we aimed to compare the effects of cetrorelix and leuprolide on endometriosis. METHODS:  This randomized, placebo-controlled, single-blind, experimental study was performed on 45 Wistar adult female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University. After the peritoneal implantation of endometrial tissue, rats were randomized to three equal intervention groups: (i) control group, (ii) leuprolide group, and (iii) cetrorelix group. Six weeks later, following implant volume measurements (volume-1) by performing a second laparotomy, saline (0.1 cc/rat) was administered subcutaneously to the control group once a week, leuprolide (0.075 mg/kg) subcutaneously to the leuprolide group twice at 4-week intervals and cetrorelix (0.001 mg/rat/day) subcutaneously to the cetrorelix group for 8 weeks. At the end of the treatment, by performing a third laparotomy, implant volumes were remeasured (volume-2) and implants were totally excised for histopathological examination. The volume-1 and volume-2 values within the groups, and stromal and glandular tissue scores between the groups were compared. RESULTS:  In both the leuprolide group and the cetrorelix group, volume-2 as compared to volume-1 had significantly reduced (P < 0.01, P < 0.01 respectively), while there was no significant volume change in the control group (P > 0.05). In this group, when compared with the control group, glandular and stromal tissues had significantly lessened (P < 0.01, P < 0.01 respectively). CONCLUSION:  Leuprolide and cetrorelix were found to have similar efficacy in the regression of both the size and the histological structure of experimental endometriotic implants.

Gynecol Obstet Invest. 2009;67(2):81-91. doi: 10.1159/000163071. Epub 2008 Oct 16. Ozkan S1, Arici A. Abstract Endometriosis, defined as the presence of endometrial tissue outside the uterus, is a challenging condition associated with substantial morbidity. Management of endometriosis must be individualized according to the desired treatment outcome, whether it is relief of pain, improvement of fertility, or the prevention of recurrence. For alleviation of endometriosis-associated pain, medical treatment is generally successful, with no medical agent being more efficacious than another in spite of significantly differing side-effect profiles. Surgical therapy has also been demonstrated to reduce pain scores in comparison with expectant management, although conservative surgery has been frequently associated with recurrence. The efficacy of combination therapies still remains to be clarified. For treatment of endometriosis-associated infertility, suppressive medical treatment has been proven to be detrimental to fertility and should be discouraged, while surgery is probably efficacious for all stages. Controlled ovarian hyperstimulation with intrauterine insemination is recommended in early-stage and surgically corrected endometriosis. Combined surgery with GnRH analog treatment has been proposed to be first-line therapy, followed by IVF as second-line therapy in advanced cases. More rigorously designed randomized clinical trials focusing on the endocrinological, immunological, and genetic aspects of endometriosis are necessary to refine conclusions regarding the etiopathogenesis and therapeutic innovations of this perplexing disease.

Saudi Med J. 2008 Sep;29(9):1340-1. Balci O1, Karatayli R, Capar M. Abstract In this case report, a Mayer-Rokitansky-Kuster-Hauser syndrome with pelvic ectopic kidney and a perirenal cyst with endometrial tissue inside is demonstrated. A 17 year old patient admitted with primary amenorrhea. Pubertal stages were completed. In pelvic ultrasonography; uterus could not be detected, a 6 x 11 cm sized cystic lesion was seen on the right adnexal area. A centrally located 5.5 x 9 cm sized ectopic pelvic kidney was detected. Hormones and tumor markers were normal. Laparoscopy was planned. In the laparoscopic observation, uterus and both tubes could not be detected, ovaries were normal. There was a 6 x 7 cm sized cyst located in the retroperitoneal area, the origin of the cyst could not be identified. Laparatomy was considered, retroperitoneal space was entered, an 8 x 11 cm sized smooth contoured perirenal cyst adjacent to the pelvic kidney was detected. Cyst was extirpated. The pathology result was reported to include endometrial tissue and hemorrhage inside.

Clin Exp Obstet Gynecol. 2008;35(3):231-2. Canda MT1, Demir N, Sezer O, Doganay L. Abstract We present the case of a patient with advanced endometriosis who presented with chronic pelvic pain, bilateral unruptured ovarian endometrioma, massive peritoneal implants and extremely elevated CA 125, and also elevated CA 15-3 levels. Laparoscopy revealed bilateral unruptured ovarian endometrioma and diffuse peritoneal endometriotic implants. Increased association of elevated levels of CA 125 and CA 15-3 is not so common in advanced endometriosis. The case was successfully treated with laparoscopy and combined low-dose oral contraceptive with one year of follow-up. To the best of our knowledge among the reported cases this is the highest CA 15-3 level ever reported with an extremely elevated CA 125 level.

Hum Reprod. 2008 Nov;23(11):2458-65. doi: 10.1093/humrep/den246. Epub 2008 Aug 2. Celik O1, Hascalik S, Elter K, Tagluk ME, Gurates B, Aydin NE. Abstract BACKGROUND:  The objective of this study is to investigate the effect of pyrrolidine dithiocarbamate [PDTC; a nuclear factor-kappaB (NF-kappaB) inhibitor] and bortezomib (Velcade; a proteasome inhibitor) on the development of experimental endometriotic implants in rats. METHODS:  Endometriosis was surgically induced in 30 rats using the method of Vernon and Wilson. Three weeks later the viability and volume of the implants were recorded and classified. Afterwards, rats were put into three groups with equal numbers. The groups were labelled as the control, the PDTC and the bortezomib groups. Seven days after treatment, a third laparotomy was done and the volume of implants was measured again. The animals were then sacrificed, and the implants were stained with Ki67, proliferating cell nuclear antigen (PCNA), CD34, CD31 and Masson's trichrome histochemical staining. RESULTS:  In 80% of the implanted rats, vesicles at the suture region were observed, and the rats graded according to average vesicle diameter (D) as: Grade 1 (no vesicle, 20% of rats), Grade 2 (D < 2 mm, 33.3% of rats), Grade 3 (2 mm<D > 4.5 mm, 26.7% of rats) and Grade 4 (D > 4.5 mm, 20% of rats). After treatment with PDTC or bortezomib, these percentages were decreased for Grades 3 and 4, and increased in Grade 1. The post-treatment implant volumes were decreased in the PDTC and bortezomib groups (P < 0.002 and P < 0.001), and slightly increased in the control group (P = 0.279). In the PDTC and bortezomib groups, CD34, CD31, PCNA and Ki67 expression levels were similar but were significantly reduced compared with the control group. CONCLUSIONS:  PDTC and bortezomib may represent a novel therapeutic strategy for treatment of endometriosis.

Acta Histochem. 2009;111(1):61-7. doi: 10.1016/j.acthis.2008.04.005. Epub 2008 Jun 16. Tuncay G1, Kilic S, Yuksel B, Elmas C, Lortlar N, Erdogan D, Ozogul C. Abstract The aim of the research was to reveal vascular endothelial growth factor (VEGF) immunolocalization in endometrioma cysts and endometrial tissues. The study group (group1) included 15 patients laparoscopically operated on for endometrioma and the control group (group 2) included 13 patients prepared for diagnostic laparoscopy for primary infertility. Biopsies from endometrioma cyst capsules, disease-free peritoneum and pipelle biopsies from the endometrium were taken from group 1. Biopsies from parietal peritoneum and endometrium were taken from group 2. Results showed VEGF immunoreactivity of peritoneal biopsies of group 1 was more intense than that of the control biopsies. A positive correlation was seen between the diameter of cyst capsules and VEGF labeling intensity and as the size of cyst enlarged, the appearance of non-homogeneous distribution of VEGF immunolocalization became more frequent. We conclude that the variation of VEGF immunolocalization in endometrioma cysts may be attributed to other possible angiogenic molecules in the pathogenesis and may cause unexpected responses to anti-angiogenic therapies.

Ann N Y Acad Sci. 2008 Apr;1127:92-100. doi: 10.1196/annals.1434.007. Ozkan S1, Murk W, Arici A. Abstract Endometriosis is an estrogen-dependent disorder defined as the presence of endometrial tissue outside of the uterine cavity. A leading cause of infertility, endometriosis has a prevalence of 0.5-5% in fertile and 25-40% in infertile women. The optimal choice of management for endometriosis-associated infertility remains obscure. Removal or suppression of endometrial deposits by medical or surgical means constitutes the basis ofendometriosis management. Current evidence indicates that suppressive medical treatment of endometriosis does not benefit fertility and should not be used for this indication alone. Surgery is probably efficacious for all stages of the disease. Controlled ovarian hyperstimulation with intrauterine insemination is recommended in early-stage and surgically corrected endometriosis when pelvic anatomy is normal. In advanced cases, in vitro fertilization is a treatment of choice, and its success may be augmented with prolonged gonadotropin-releasing hormone analog treatment. Further randomized clinical trials focusing on diverse etiopathogenic mechanisms and therapeutic innovation are necessary to find more conclusive, evidence-based answers regarding this enigmatic disease.

Clin Exp Obstet Gynecol. 2008;35(1):48-53. Cirpan T1, Yeniel O, Ulukus M, Ozbal A, Gundem G, Ozsener S, Mete Itil I, Zekioglu O. Abstract OBJECTIVE:  The purpose of this study was to compare the clinical symptoms and histopathological findings in subjects with adenomyosis uteri. METHOD:  Infiltration depth and spread of adenomyotic foci together with clinical symptoms and findings were compared in a total of 103 subjects who had undergone hysterectomy and were diagnosed with adenomyosis uteri through histopathological examinations. RESULTS:  The spread of adenomyotic foci in myometrial tissues was observed to significantly increase as the depth of myometrial infiltration increased in subjects with adenomyosis (p < 0.05). It was observed that there was significantly higher myometrial infiltration depth in subjects with dysmenorrhea and severe anemia, and diffuse adenomyotic foci in subjects with menometrorrhagia (p < 0.05). CONCLUSION:  Increased infiltration depth and spread of adenomyotic foci in myometrial tissues in subjects with adenomyosis uteri were studied. When clinical symptoms and findings in subjects with adenomyosis, such as dysmenorrhea, anemia and menometrorrhagia are compared with these histopathological findings, infiltration depth and spread of adenomyotic foci appear to determine the clinical severity of adenomyosis.

Arch Gynecol Obstet. 2008 Dec;278(6):593-5. doi: 10.1007/s00404-008-0618-3. Epub 2008 Mar 12. Dogan E1, Gode F, Saatli B, Seçil M. Abstract Cystic adenomyosis is a rare form of adenomyosis mostly seen in middle aged women. We report a case of cystic adenomyosis in a juvenile patient presenting with severe dysmenorrhea refractory to any given medication. The patient initially was diagnosed as uterus bicornis with an obstructed rudimentary horn. Surgical exploration and excision of the cystic mass relieved the symptoms of the patient.

Fertil Steril. 2009 Mar;91(3):687-93. doi: 10.1016/j.fertnstert.2007.12.067. Epub 2008 Mar 7. Ulukus M1, Ulukus EC, Tavmergen Goker EN, Tavmergen E, Zheng W, Arici A. Abstract OBJECTIVE:  To investigate the expression and localization of interleukin-8 (IL-8) and monocyte chemotactic protein 1 (MCP-1) in women with and without endometriosis. DESIGN:  Comparative immunohistochemical study. SETTING:  Academic medical center. PATIENT(S):  Ectopic (n = 24) and homologous eutopic endometrium (n = 24) from women with endometriosis and endometrium from women withoutendometriosis (n = 27) were used for immunohistochemical analysis of IL-8 and MCP-1. INTERVENTION(S):  Tissue sections were immunostained with antihuman IL-8 and MCP-1 antibodies. MAIN OUTCOME MEASURE(S):  Microscopic evaluation to assess the presence and localization of IL-8 and MCP-1 throughout the menstrual cycle in both eutopic endometrial and endometriotic tissues of women with endometriosis and comparison with normal endometrium. RESULT(S):  In normal endometrium, secretory phase samples expressed higher levels of epithelial IL-8 than in proliferative phase samples. Epithelial MCP-1 expression was similar in both proliferative and secretory phases. Proliferative phase samples showed higher epithelial IL-8 and MCP-1 expressions in eutopic endometrium of women with endometriosis compared with that of normal women. Immunoreactivities of both chemokines were significantly increased in the epithelial cells of ectopic endometrial tissues compared with those of normal endometrium. CONCLUSION(S):  These findings suggest that IL-8 and MCP-1 may be involved in the pathogenesis of endometriosis.

Arch Gynecol Obstet. 2008 Sep;278(3):273-5. doi: 10.1007/s00404-008-0570-2. Epub 2008 Jan 31. Uncu H1, Taner D. Abstract The incidence of appendiceal endometriosis is lower than 1% among pathologies of pelvic endometriosis. They may occur with findings such as acute appendicitis, invagination, colic or melena, though they are mostly seen with an asymptomatic character. Diagnosis can be made only after a histopathological examination following the operation. We present here two appendiceal endometriosis cases, which were operated on for a prediagnosis of acute appendicitis, but postoperatively diagnosed as appendiceal endometriosis.

Clin Exp Obstet Gynecol. 2007;34(4):215-8. Cirpan T1, Akercan F, Tavmergen Goker EN, Ozyurek E, Levi R, Tavmergen E. Abstract OBJECTIVE:  To evaluate the effect of the management modality of ovarian endometriomas on ovarian response to COH (controlled ovarian hyperstimulation) and ART (assisted reproductive technology) treatment outcome. DESIGN:  Retrospective case control study. SETTING:  Ege University Infertility-Family Planning Research and Treatment Center. PATIENTS:  115 cycles of 84 patients who underwent ICSI-ET (intracytoplasmic sperm injection-embryo transfer) with ejaculated sperm were enrolled in the study. The endometrioma resection group (Group I) was comprised of 36 cycles in 29 patients who were treated with laparoscopic endometrioma cyst resection prior to treatment; endometrioma aspiration (Group II) was comprised of 26 cycles in 15 patients whose endometriomas were aspirated prior to treatment; and the control group (Group III) was comprised of 53 cycles in 40 patients for whom the only infertility cause was the tubal factor. INTERVENTIONS:  ICSI-ET treatment, laparascopic ovarian endometrioma cyst resection, transvaginal ultrasonography-guided endometrioma cyst aspiration. MAIN OUTCOMES MEASURES:  COH results and ICSI-ET treatment outcomes. RESULTS:  The groups were similar in all characteristics except for the mean age of the patients in group II being older than those in group I. Gonadotropin consumption was higher, peak estradiol level lower, and the number of oocytes less in the laparascopic resection group (Group I) with respect to the control group. The number of follicles was lower in the cyst aspiration group (Group II) with respect to the control group. The number of follicles larger than 15 mm, number of metaphase II oocytes, the fertilization, pregnancy and implantation rates were similar in all three groups. CONCLUSION:  Interventions (laparascopic endometrioma resection, transvaginal ultrasound-guided endometrioma cyst aspiration) performed on endometriomas prior to ART treatment do not worsen the treatment outcome.

Ophthal Plast Reconstr Surg. 2008 Jan-Feb;24(1):47-8. doi: 10.1097/IOP.0b013e31815c9053. Türkçüoğlu I1, Türkçüoğlu P, Kurt J, Yildirim H. Abstract A 13-year-old girl was admitted with a complaint of cyclic bleeding from the left inferior punctum with menstruation. Crusted hemorrhage was noticed in the tear meniscus of the left eye and just inferior to the left caruncle. With gradient-echo magnetic resonance imaging, the hemorrhagic tissue in the nasolacrimal canal was demonstrated and the diagnosis of nasolacrimal endometriosis was made. Nasolacrimal endometriosis is a rare ocular condition. Its management and histologic diagnosis remain challenging.

Cardiovasc Intervent Radiol. 2008 Jul-Aug;31(4):824-7. doi: 10.1007/s00270-007-9284-2. Epub 2008 Jan 15. Kervancioglu S1, Andic C, Bayram N, Telli C, Sarica A, Sirikci A. Abstract Pulmonary parenchymal endometriosis is extremely rare and usually manifests itself with a recurrent hemoptysis associated with the menstrual cycle. The therapies proposed for women with endometriosis consist of medical treatments and surgery. Bronchial artery embolization has become a well-established and minimally invasive treatment modality for hemoptysis, and to the best of our knowledge, it has not been reported in pulmonaryendometriosis. We report a case of pulmonary parenchymal endometriosis treated with embolotheraphy for hemoptysis.

World J Gastroenterol. 2008 Jan 7;14(1):146-51. Teke Z1, Aytekin FO, Atalay AO, Demirkan NC. Abstract We report a 31-year-old woman with Crohn's disease complicated by multiple stenoses and internal fistulas clinically misdiagnosed as small bowelendometriosis, due to the patient's perimenstrual symptoms of mechanical subileus for 3 years; at first monthly, but later continuous, and gradually increasing in severity. We performed an exploratory laparotomy for small bowel obstruction, and found multiple ileal strictures and internal enteric fistulas. Because intraoperative findings were thought to indicate Crohn's disease, a right hemicolectomy and partial distal ileum resection were performed for obstructive Crohn's ileitis. Histopathology of the resected specimen revealed Crohn's disease without endometrial tissue. The patient made an uneventful recovery from this procedure and was discharged home 10 d post-operatively. The differential diagnosis of Crohn's disease with intestinal endometriosis may be difficult pre-operatively. The two entities share many overlapping clinical, radiological and pathological features. Nevertheless, when it is difficult to identify the cause of intestinal obstruction in a woman of child-bearing age with cyclical symptoms suggestive of small bowel endometriosis, Crohn's disease should be included in the differential diagnosis.

Gynecol Obstet Invest. 2008;65(3):212-6. Epub 2007 Dec 10. Kumbak B1, Kahraman S, Karlikaya G, Lacin S, Guney A. Abstract OBJECTIVE:  To investigate whether the space-occupying effect of an endometrioma, rather than endometriosis itself, affects results in in vitro fertilization (IVF) using women with simple ovarian cysts as the control group. METHODS:  85 normoresponder patients with endometriomas of 10-50 mm who underwent IVF treatment directly without initial removal were compared with 83 normoresponder patients with simple ovarian cysts of 10-35 mm detected at the beginning of stimulation and initiated treatment without aspiration. RESULTS:  Gonadotropin consumption was higher in the endometrioma group (3,013 vs. 2,451 IU; p = 0.001), although significantly fewer numbers of oocytes were retrieved (13.9 vs. 16.4; p = 0.03). However, oocyte maturation rates were similar. The transferred grade I embryos ratio was evaluated and found to be better in the cyst group (79.7 vs. 70.7%; p = 0.03). Consequently, the implantation rate was found to be significantly higher in the cyst group (28 vs. 19%; p = 0.02), although pregnancy and ongoing pregnancy rates were similar. CONCLUSION:  The presence of an endometriotic cyst during the IVF cycle was demonstrated to be associated with a lower embryo quality and implantation rate, although pregnancy success was unaffected. This adverse effect is suggested to be the result of the disease itself, not the presence of a cystic mass.

Fertil Steril. 2008 Oct;90(4):988-93. Epub 2007 Dec 3. Ceyhan ST1, Onguru O, Baser I, Gunhan O. Abstract OBJECTIVE:  To investigate the expression of cyclooxygenase-2 (Cox-2) and vascular endothelial growth factor (VEGF) in ovarian endometriotic cysts and assess their relation with angiogenesis. DESIGN:  Experimental clinical study. SETTING:  University hospital. PATIENT(S):  Fifty patients with ovarian endometriotic cysts. INTERVENTION(S):  Surgical excision of 50 ovarian endometriotic cysts. MAIN OUTCOME MEASURE(S):  Microvessel density and the expression of Cox-2 and VEGF were analyzed immunohistochemically. RESULT(S):  Cyclooxygenase-2 immunoreactivity was mainly cytoplasmic in glandular epithelial cells in all of the ovarian endometriotic cysts, with low expression in 12 cases (24%), moderate expression in 21 (42%), and high expression in 17 (34%). Vascular endothelial growth factor immunoreactivity was mainly cytoplasmic in stromal cells in 46 (92%) of the ovarian endometriotic cysts, with low expression in 12 cases (24%), moderate expression in 18 (36%), and high expression in 16 (32%). No immunoreactivity was present in 4 cases (8%). Both Cox-2 (r = 0.728) and VEGF (r = 0.670) were closely, statistically significantly related with microvessel density in ovarian endometriotic cysts. Cyclooxygenase-2 and VEGF also were highly statistically significantly correlated (r = 0.777) with each other. CONCLUSION(S):  We observed Cox-2 expression mostly in glandular epithelial cells of ovarian endometriotic cysts, whereas VEGF expression was observed mainly in stromal cells. Cyclooxygenase-2 and VEGF were closely correlated with each other, and both of them appear to play a role in the angiogenesis of ovarian endometriosis.

Hum Reprod. 2008 Jan;23(1):100-4. Epub 2007 Nov 13. Verit FF1, Erel O, Celik N. Abstract BACKGROUND:  There is increasing evidence that oxidative stress may play a role in the pathophysiology of endometriosis. Serum paraoxonase-1 (PON-1) is a high-density lipoprotein (HDL) associated enzyme that prevents oxidative modification of low-density lipoprotein (LDL). The aims of the study were to (i) compare the serum PON-1 activity in women with endometriosis versus controls and (ii) assess whether PON-1 activity can be used as a diagnostic test for endometriosis. METHODS:  A total of 87 women who underwent laparoscopy or laparotomy were divided into groups by visual diagnosis at surgery: control patients (n = 40) with no pathologic findings; endometriosis sufferers with minimal to mild (n = 24) and moderate to severe (n = 23) stage. Serum PON-1 activity was measured spectrophotometrically. Lipid hydroperoxide (LOOH) levels were measured by iodometric assay. Serum triglyceride (TG), total cholesterol (TC), HDL and LDL levels were also determined. RESULTS:  PON-1 activity was significantly lower whereas LOOH levels were significantly higher in women with moderate to severe endometriosisthan in women with minimal to mild endometriosis and controls, and in women with minimal to mild endometriosis compared with control groups (P < 0.0001, for all). A significant negative correlation was found between PON-1 activity and stage of the disease (r=-0.74, P < 0.0001). PON-1 activity and HDL levels were decreased whereas LOOH, TG, TC and LDL levels increased in all women with endometriosis versus controls (all P < 0.0001). CONCLUSIONS:  Reduced serum PON-1 activity and increased LOOH might contribute to the increased susceptibility for the development of atherosclerosis. PON-1 activity can be used as a diagnostic test to detect endometriosis.

Fertil Steril. 2008 Aug;90(2):401-5. Epub 2007 Nov 5. Altintas D1, Kokcu A, Kandemir B, Cetinkaya MB, Tosun M. Abstract OBJECTIVE:  To investigate the efficacy of imiquimod on endometriosis. DESIGN:  Randomized, placebo-controlled, single-blind, experimental study. SETTING:  Experimental surgery laboratory at a university in Turkey. ANIMAL(S):  Thirty Wistar female rats. INTERVENTION(S):  After the peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: [1] the control group and [2] the imiquimod group. Six weeks later, after implant volume was measured (volume 1) by performing a second laparotomy, imiquimod (10 mg intraperitoneally per rat, 2 times per wk) was administered to the imiquimod group, and saline solution (0.1 mL SC, once per wk), to the control group, for 8 weeks. At the end of the treatment, a third laparotomy was performed to remeasure implant volumes (volume 2), and implants were totally excised for histopathologic examination. MAIN OUTCOME MEASURE(S):  To compare volume 1 and volume 2 within the groups, as well as stromal and glandular tissues between the groups. RESULT(S):  In the imiquimod group, volume 2 was statistically significantly reduced compared with volume 1, whereas there was no significant volume change in the control group. In the imiquimod group, when compared with the control group, both glandular and stromal tissues had statistically significantly lessened. CONCLUSION(S):  Imiquimod was seen to regress significantly both the size and the histological structure of endometriotic implants.

Eur J Obstet Gynecol Reprod Biol. 2008 Jul;139(1):95-9. Epub 2007 Oct 24. Altintas D1, Kokcu A, Tosun M, Cetinkaya MB, Kandemir B. Abstract OBJECTIVE:  To investigate the efficacy of recombinant human interferon alpha-2b on endometriosis. STUDY DESIGN:  The randomized, placebo-controlled, single-blind, experimental study was performed on 30 Wistar female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University in Turkey. After the peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: (1) the control group and (2) the interferon group. Six weeks later, after implant volume was measured (volume-1) by performing a second laparotomy, interferon alpha-2b (100,000 IU subcutaneously per rat, three times at 48 h intervals) was administered to the interferon group, and saline solution (0.1 ml SC, once per week), to the control group, for 8 weeks. At the end of the treatment, a third laparotomy was performed to remeasure implant volumes (volume-2), and implants were totally excised for histopathologic examination. Volume-1 and volume-2 within the groups, as well as stromal and glandular tissues between the groups were compared. RESULTS:  In the interferon group, volume-2 was statistically significantly reduced compared with volume-1, whereas there was no significant volume change in the control group. In the interferon group, when compared with the control group, both stromal and glandular tissues had statistically significantly lessened. CONCLUSIONS:  Interferon alpha-2b was seen to regress significantly both the size and the histological structure of endometriotic implants.

J Reprod Med. 2007 Sep;52(9):805-9. Duru NK1, Dede M, Acikel CH, Keskin U, Fidan U, Baser I. Abstract OBJECTIVE:  To add further data on in vitro fertilization (IVF) outcome and ovarian response after endometrioma stripping via either laparoscopy or laparotomy. STUDY DESIGN:  IVF outcome and ovarian response parameters in patients who had undergone unilateral endometrioma stripping at laparoscopy (n=28) or laparotomy (n=10) before IVF were retrospectively compared. RESULTS:  Fertilization rates, number of embryos transferred and pregnancy rates did not differ between the groups. Significantly more recombinant FSH was used to induce folliculogenesis, and fewer metaphase II oocytes were retrieved in the laparotomy group. The laparotomy-postcystectomy ovaries were significantly smaller and malpositioned. In both stripping groups, significantly smaller operated-on ovaries with lower numbers of antral and mature follicles were observed as compared to intact ovaries. CONCLUSION:  A higher amount of FSH is needed to achieve an acceptable IVF outcome after unilateral endometrioma surgery. Indications for surgical treatment of patients having larger and bilateral cysts with an expectation for future fertility should be cautiously reviewed

Clin Exp Obstet Gynecol. 2007;34(3):163-7. Yeniel O1, Cirpan T, Ulukus M, Ozbal A, Gundem G, Ozsener S, Zekioglu O, Yilmaz H. Abstract OBJECTIVE:  This prospective study investigated the prevalence of adenomyosis in histopathological examinations of patients who had undergone hysterectomy due to various indications in our clinic. Epidemiological characteristics, predisposing risk factors, symptoms and clinical findings of adenomyosis were evaluated. METHOD:  A total of 298 subjects who had undergone abdominal, vaginal or laparoscopic hysterectomy with/without salpingooophorectomy between October 2003 and April 2004 in our clinic were included. Uterine specimens obtained through hysterectomy were weighed and histopathologically examined in the Pathology Department of Ege University. The study group (n = 103), cases with adenomyosis, was compared with the control group (n=195), cases without adenomyosis, with respect to the epidemiological, clinical and histopathological characteristics. RESULTS:  The prevalence of adenomyosis in 298 subjects was 36.2% (103). Duration of the reproductive period in patients with adenomyosis was found to be significantly longer than for those in the control group (p < 0.05). Prevalence of pelvic pain, dysmenorrhea and dyspareunia was also significantly higher in the study group (p < 0.05). Moreover, the number of cases requiring blood transfusion before the operation was significantly higher in the study group (p < 0.05) as were the rates of smoking, previous uterine surgery and nulliparity (p < 0.05). The most common gynecological condition accompanying adenomyosis was found to be uterine myoma in both groups, but the difference was not significant. CONCLUSION:  Adenomyosis is not a rare histopathological finding. Due to diagnostic and therapeutic methods which are being developed as an alternative to hysterectomy, the clinical effects of adenomyosis and its association with other gynecological conditions, adenomyosis appears to be an issue which will be more intensively investigated in the future.

J Reprod Med. 2007 Aug;52(8):715-21. Aban M1, Ertunc D, Tok EC, Tamer L, Arslan M, Dilek S. Abstract OBJECTIVE:  To evaluate the interaction of glutathione-S-transferase (GST) gene polymorphisms and smoking as a risk factor for endometriosis. STUDY DESIGN:  The study group consisted of 150 women who were diagnosed by means of surgery and histopathology as having endometriosis. The control group consisted of 150 women who displayed no evidence of endometriosis during exploratory laparotomy or laparoscopy. We assessed the interaction of smoking and GSTM1 and GSTT1 polymorphisms in these patients. RESULTS:  Logistic regression analyses showed that the GSTM1-null allele was associated with a significantly increased risk of endometriosis and smoking with a decreased risk of endometriosis separately. There was no association between endometriosis and the GSTT1-null allele. The interaction of smoking and GST polymorphisms showed a joint effect. We found that the GSTM1-null allele was more prevalent in active smokingendometriosis patients (63.4%) than in the controls (35.0%), and the difference was statistically significant. A similar tendency was also observed in the GSTT1 allele distribution. CONCLUSION:  Genetic factors could modify the response to environmental pollutants in endometriosis.

Reprod Biomed Online. 2007 Sep;15(3):316-20. Kilic S1, Evsen M, Tasdemir N, Yilmaz N, Yuksel B, Dogan M, Batioglu S. Abstract The aim of this study was to investigate follicular fluid vascular endothelial growth factor (VEGF) and tumour necrosis factor alpha (TNFalpha) concentrations in endometriosis, and their effect on the outcome of intracytoplasmic sperm injection (ICSI). A prospective study was performed among patients who had either a laparoscopic diagnosis of endometriosis (n = 48) or who had normal laparoscopic findings with unexplained infertility (n = 43). The number of gonadotrophin units, peak oestradiol concentrations, number of oocytes retrieved, fertilization, cleavage and pregnancy rates, and number of embryos transferred, were the main outcome measurements. There was no difference in these parameters between the two study groups. Significantly higher concentrations of VEGF were found in the endometriosis group (P = 0.031), but there was no difference in TNFalpha concentrations. No relationship was found between VEGF and TNFalpha concentrations and ICSI outcome. Despite a higher concentration of intrafollicular VEGF in the endometriosis group, it was concluded that this parameter had no predictive value with respect to ICSI outcome. In addition, intrafollicular TNFalpha concentrations were not different in the endometriosis group and there was no relationship between VEGF or TNFalpha concentrations and the outcomes measured.

Eur J Gynaecol Oncol. 2007;28(4):278-81. Cirpan T1, Aygul S, Terek MC, Kazandi M, Dikmen Y, Zekioglu O, Sagol S. Abstract OBJECTIVE:  The aim of this study was to investigate the role of MMAC1 protein in the relationship between ovarian endometriosis and clear cell and endometrioid-type ovarian adenocarcinomas. METHODS:  A total of 63 subjects who underwent surgery for a pelvic tumoral mass, 30 of whom were diagnosed with grade 1 to 3 ovarian adenocarcinoma and 33 of whom were diagnosed with grade 1 to 4 endometriosis during histopathological examination were included in this study. The mean age for subjects with ovarian endometrioid type adenocarcinoma was 51.8 +/- 12.4, whereas the mean age for subjects with ovarian clear cell type adenocarcinoma was 59.5 +/- 13.7. Ovarian carcinomas were graded in accordance with the FIGO 1989 grading system. The mean age for subjects with endometriosis was 37 +/- 11.9. New sections were obtained from paraffin blocks in the archives of Ege University, School of Medicine, Department of Pathology onto lysinated slides and immunohistochemical staining by using mouse monoclonal antibody (MMAC1, 28H6 clone, Novocastra, UK) as MMAC antibody was applied in order to determine MMAC1 protein. Brown staining on the nucleus was considered as positive immunoreactivity. Immunoreactive staining was evaluated as percentage staining over the whole preparative. RESULTS:  Of the 63 subjects included in the immunohistochemical study, ovarian endometrioid adenocarcinoma was identified in 18 subjects, while 12 subjects were diagnosed with ovarian clear cell adenocarcinoma and 33 subjects with ovarian endometriosis. No significant relationships were observed between age and MMAC immune staining in the ovarian endometrioid adenocarcinoma (r = -0.41, p = 0.08) and ovarian endometriosis (r = 0.12, p = 0.50) groups, whereas a significant relationship was observed in the ovarian clear cell adenocarcinoma group (r = 0.631, p = 0.02). No significant relationships were observed between CA125 levels and MMAC immune staining in the ovarian endometrioide adenocarcinoma (r = 0.056, p = 0.82), ovarian endometriosis (r = 0.21, p = 0.36) and ovarian clear cell adenocarcinoma (r = 0.363, p = 0.24) groups. No correlations were observed between endometriosis stages and the MMAC immune staining (r = -0.17, p = 0.92). There was no correlation between mean diameter of endometrioma and MMAC immune staining (r = -0.230, p = 198). Mean endometrioma diameter was 5.7 +/- 3.5 (1-15.5). No correlations were detected between MMAC immune staining and ovarian endometrioide adenocarcinoma or ovarian clear cell adenocarcinoma stage (r = -0.22, p = 0.37; r = 0.44, p = 0.14, respectively). No significant relationships with respect to MMAC immune staining were detected between the endometriosisand ovarian clear cell adenocarcinoma groups (p = 0.05) and between the ovarian clear cell adenocarcinoma and ovarian endometrioid adenocarcinoma groups (p = 0.27). A significant relationship with respect to MMAC immune staining was observed between ovarian endometrioide adenocarcinoma and endometriosis groups (p = 0.001). CONCLUSION:  Immunohistochemical determination of MMAC defective protein expressions could be considered for utilization as a new, simple and useful technique in determination of endometriosis patients with increased risk of malignant transformation, patients where early surgical treatment would be necessary and patients that should be subjected to follow-up controls with a higher frequency.  

Int J Gynaecol Obstet. 2007 Oct;99(1):38-42. Epub 2007 Aug 3. Ocal G1, Kokcu A, Cetinkaya MB, Tosun M, Kefeli M, Kandemir B. Abstract OBJECTIVE:  To investigate the efficacy of levamisole on experimental endometriosis. METHODS:  After the implantation of endometrial tissue on abdominal peritoneum, 40 rats were randomized to 1 of 4 equal intervention groups. Levamisole (2 mg/rat) was applied subcutaneously to group "L" once a week. Depot medroxyprogesterone acetate (3 mg/kg) was applied intramuscularly to group "M" twice at 4-week intervals. Leuprolide (0.075 mg/kg) was applied subcutaneously to group "G" twice at 4-week intervals. Saline (0.1 cm(3)/rat) was applied subcutaneously to group "C" once a week for 8 weeks. The efficacy of levamisole was determined by volume measurement and characterizing the histological structure of the implants. RESULT:  Volume increase of the implants in group C (P<0.05), and volume decrease in groups M, G, and L was found (P<0.05, P<0.01, and P<0.01, respectively.) Stromal tissue and glandular activity were not different between groups L and G. CONCLUSION:  Levamisole was found to be as effective as leuprolide in regression of the volume of endometriotic implants.

Fertil Steril. 2008 Jul;90(1):209-13. Epub 2007 Jul 26. Hascalik S1, Celik O, Kekilli E, Elter K, Karakas HM, Aydin NE. Abstract In this experimental study on endometriosis, the majority of the implants were successfully detected with technetium-(99mTc) labeled red blood cell scintigraphy.

Ultrasound Obstet Gynecol. 2007 Sep;30(3):341-5. Kepkep K1, Tuncay YA, Göynümer G, Tutal E. Abstract OBJECTIVES:  To evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis. METHODS:  In this prospective study, 70 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography. If at least one of the following sonographic features was present, a diagnosis of adenomyosis was made: heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial-myometrial junction. The sonographic features were compared with the histopathological results. RESULTS:  The prevalence of adenomyosis was 37.1% (26/70 patients). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 80.8%, 61.4%, 55.3%, 84.4% and 68.6%, respectively. We found that a regularly enlarged uterus with a globular appearance, subendometrial echogenic linear striations and myometrial cysts had the highest accuracy for the diagnosis of adenomyosis. Of all findings evaluated, heterogeneous myometrium was the most common in patients with adenomyosis (21/26 patients), but it had a poor specificity. The presence of subendometrial linear striations was the most specific sonographic feature (95.5%) and it had the highest PPV (80.0%) for the diagnosis of adenomyosis. CONCLUSIONS:  The presence of subendometrial echogenic linear striations, a globular configuration and myometrial cysts on transvaginal ultrasound supports the diagnosis of adenomyosis. Among the transvaginal ultrasound diagnostic findings of adenomyosis, subendometrial linear striations have the highest diagnostic accuracy.

Aust N Z J Obstet Gynaecol. 2007 Aug;47(4):321-5. Aytan H1, Caliskan AC, Demirturk F, Aytan P, Koseoglu DR. Abstract BACKGROUND:  The effect of rosiglitazone, an activator of peroxisome proliferator-activated receptor-gamma, on the growth of ectopic uterine tissue was assessed. METHODS:  Endometriosis was surgically induced in 28 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Four weeks later, rats were randomly grouped and a second laparatomy was performed. The length, width, height and volume of the explants were measured. Rosiglitazone at 0.2 mg/kg/day was orally administered to one group, while vehicle treatment was given to the control group. Four weeks later, rats were sacrificed and ectopic uterine tissues were re-evaluated morphologically and histologically. Scoring system was used to evaluate the preservation of epithelia. RESULTS:  One rat in the study group and two rats in the control group died as a result of complications related to surgery. There was a significant difference in post-treatment length, width, height, and spherical volumes between control and rosiglitazone-treated groups. The epithelia were found to be preserved significantly better in the control group when compared with the rosiglitazone-treated group. CONCLUSION:  Rosiglitazone was found to cause regression of experimental endometriosis in rats

J Reprod Med. 2007 May;52(5):422-4. Haberal A1, Kayikcioglu F, Caglar GS, Cavusoglu D. Abstract BACKGROUND:  Leiomyomatosis peritonealis disseminata is a benign disease of women of reproductive age. Female gonadal steroids play the major role in pathogenesis, but reported cases in postmenopausal women suggests other factors. A few cases in the literature with coexistingendometriosis confirm the hypothesis that both originate in submesothelial multipotential mesenchymal cells. The clinical behavior can be life threatening due to extension through the pelvic veins. CASE:  A 46-year-old woman with endometriosis diagnosed at laparotomy 3 years earlier presented with a huge pelvic mass. Postoperative histologic examination of the peritoneal nodules confirmed the diagnosis. Magnetic resonance angiography performed postoperatively revealed intravenous leiomyomatosis. Surgical castration was satisfactory after 2 years of follow-up. CONCLUSION:  Although malignant transformation of the disease is known, intravascular extension of the tumor increases the risk of mortality. Close follow-up by clinical examination and radiologic evaluations is required.

Fertil Steril. 2008 Apr;89(4):934-42. Epub 2007 Jun 19. Güney M1, Oral B, Karahan N, Mungan T. Abstract OBJECTIVE:  To determine the antioxidant, antiinflammatory, and immunomodulatory effects of melatonin on endometrial explants, the distribution of cyclooxygenase-2 (COX-2), the activity of antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT), and levels of malondialdehyde (MDA) in the rat endometriosis model. DESIGN: Prospective, placebo-controlled experimental study. SETTING:  Experimental surgery laboratory in a university department. ANIMAL(S):  Twenty-five rats with experimentally induced endometriosis. INTERVENTION(S):  Endometriosis was surgically induced in 25 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Four weeks later, three rats were killed and the remaining 22 rats given second-look laparotomies to identify and measure ectopic uterine tissue in three dimensions. After the second laparotomy, 4 weeks of vehicle and melatonin treatment were administered, then all of the rats were given a third laparotomy and killed. MAIN OUTCOME MEASURE(S):  The volume and weight of the implants were measured. The remaining rats were randomly divided into two groups. In control group (group 1; n = 11) no medication was given. To the rats in melatonin-treated group (group 2; n = 11), 10 mg/kg a day of melatonin was administered intraperitoneally. Four weeks later, after the second laparotomy, the endometrial explants were reevaluated morphologically, and COX-2 expression was evaluated immunohistochemically and histologically. In addition, endometrial explants were analyzed for the antioxidant enzymes SOD, CAT, and MDA, a marker of lipid peroxidation. A scoring system was used to evaluate expression of COX-2 and preservation of epithelia. RESULT(S):  The pretreatment and posttreatment volumes within the control group were 135.9 +/- 31.5 and 129.4 +/- 28.7, respectively. The mean explant volume was 141.4 +/- 34.4 within the melatonin group before the treatment and 42.9 +/- 14.0 after 4 weeks of treatment. There was a statistically significant difference in spherical volumes (129.4 +/- 28.7 versus 42.9 +/- 14.0 mm(3)) of explant weights (155.8 +/- 27.1 versus 49.6 +/- 19.5 mg) and COX-2 positivity (91% versus 18.1%) between groups after the third laparotomy. In the melatonin-treated group, the endometrial explant levels of MDA statistically significantly decreased and activities of SOD and CAT significantly increased when compared with the control group. The epithelia showed statistically significantly better preservation in the control group when compared with the melatonin-treated group (2.54 +/- 0.52 versus 0.63 +/- 0.50). CONCLUSION(S):  Melatonin causes regression and atrophy of the endometriotic lesions in rats.

Fertil Steril. 2007 Oct;88(4 Suppl):1129-34. Epub 2007 Jun 7. Yavuz E1, Oktem M, Esinler I, Toru SA, Zeyneloglu HB. Abstract OBJECTIVE:  To determine the effects of raloxifene and genistein on experimentally induced endometriosis in a rat model. DESIGN:  Prospective, randomized animal study. SETTING:  Animal surgery laboratory in a university hospital. ANIMAL(S):  Thirty-three adult, mature female Wistar-Albino rats in which endometriotic implants were induced by transplanting autologous uterine tissue to ectopic sites on the peritoneum. INTERVENTION(S):  After the endometriotic implants were formed surgically, the 33 rats were randomly divided into three groups. Group 1 (genistein group, 10 rats) were given 500 mg/kg per day of oral genistein. Group 2 (raloxifene group, 10 rats) were given 10 mg/kg per day of oral raloxifene. Group 3 were given no medication and served as controls (13 rats). All the rats continued to receive treatment for 21 days, and then were killed to assess the implants' size and for histologic examination. MAIN OUTCOME MEASURE(S):  The surface area of the endometriotic implants and the score of histologic analysis. RESULT(S):  At the beginning of the medical treatment, the mean surface areas of the endometriotic implants were comparable in all three groups. At the end of the medical treatment, the mean surface area of implants in groups 1 and 2 was smaller than that of implants in the control group. The decrease in the surface area of the endometriotic implants was greater in group 1 and group 2 than found in the control group. The histologic assessment revealed that the mean of the histopathologic score of the implants at the end of the treatment was lower in groups 1 and 2 when compared with the control group. CONCLUSION(S):  Genistein caused a statistically significant regression of endometriotic implants.

Fertil Steril. 2007 Oct;88(4):968.e15-7. Epub 2007 Jun 4. Kahraman K1, Ozguven I, Gungor M, Atabekoglu CS. Abstract OBJECTIVE:  To present a case of a unilateral endometrioma with extremely elevated serum CA-125 levels. DESIGN:  Case report. SETTING:  University hospital. PATIENT(S):  A 25-year-old woman with left adnexal mass and extremely elevated serum CA-125 level, 7,900 U/mL, underwent laparoscopy. There were unilateral endometrioma and stage IV endometriosis. INTERVENTION(S):  Laparoscopic excision of the endometrioma, unilateral salpingectomy, adhesiolysis, ablation of endometriotic foci, and partial omentectomy were performed, and histopathologic results confirmed the diagnosis of endometriosis. MAIN OUTCOME MEASURE(S):  Extremely elevated serum CA-125 levels and unruptured ovarian endometrioma. RESULT(S):  On the second, sixth, and 13th days of the menstrual period, serum CA-125 levels were 7,900 U/mL, 1,577 U/mL, and 627 U/mL, respectively. On the third postoperative day serum CA-125 level was 56 U/mL. CONCLUSION(S):  Ovarian endometrioma and advanced endometriosis may be associated with extremely elevated serum CA-125 levels. For this reason ovarian endometrioma should be considered with respect to differential diagnosis of reproductive-age women presenting with an ovarian mass even if it resembles an ovarian malignancy.

Curr Opin Obstet Gynecol. 2007 Jun;19(3):284-8. Tavmergen E1, Ulukus M, Goker EN. Abstract PURPOSE OF REVIEW:  To discuss the relationship between endometriosis and infertility, the impact of endometriosis on assisted reproductive techniques and also the benefits of prolonged use of gonadotropin-releasing hormone analogue before IVF in women with endometriosis. RECENT FINDINGS:  The available evidence suggests that endometriosis is strongly associated with infertility. Many studies indicate lower pregnancy and implantation rates even in assisted reproductive cycles in women with endometriosis. It is well known that medical suppression ofendometriosis does not appear to be warranted for endometriosis-associated infertility. Prolonged pretreatment with gonadotropin-releasing hormone analogue before IVF has been reported to improve clinical pregnancy rates in infertile women with endometriosis. SUMMARY:  Based on the recently published data, infertile women with endometriosis may benefit from long-term pretreatment of gonadotropin-releasing hormone analogue prior to IVF.

Fertil Steril. 2007 Oct;88(4):832-9. Epub 2007 Apr 10. Pabuccu R1, Onalan G, Kaya C. Abstract OBJECTIVE:  To investigate the outcomes of intracytoplasmic sperm injection (ICSI) cycles after controlled ovarian hyperstimulation (COH) with GnRH antagonist or GnRH agonist (GnRH-a) in mild-to-moderate endometriosis and endometrioma. DESIGN:  Prospective randomize trial. SETTING:  A private IVF center. PATIENT(S):  A total of 246 ICSI cycles in 246 patients were divided into three groups: women with mild-to-moderate endometriosis (n = 98); women who had ovarian surgery for endometrioma (n = 81); women with endometrioma and no history of previous surgery (n = 67). INTERVENTION(S):  Patients in each group were randomized to COH with either triptrolein or cetrorelix. MAIN OUTCOME MEASURE(S):  Clinical parameters, characteristics of COH, and ICSI results were analyzed. RESULT(S):  Outcomes of COH with both GnRH antagonist and GnRH-a were similar in patients with mild-to-moderate endometriosis. Implantation rates were 15.9% vs. 22.6% and clinical pregnancy rates were 27.5% vs. 39% with GnRH antagonist and GnRH-a protocols, respectively, in patients who had ovarian surgery for endometrioma. Implantation rates were 12.5% vs. 14.8% and clinical pregnancy rates were 20.5% vs. 24.2% with GnRH antagonist and GnRH-a protocols, respectively, in patients with endometrioma and no history of ovarian surgery. CONCLUSION(S):  Considering the implantation and clinical pregnancy rates, COH with both GnRH antagonist and GnRH-a protocols may be equally effective in patients with mild-to-moderate endometriosis and endometrioma who did and did not undergo ovarian surgery.

Abdom Imaging. 2007 Jul-Aug;32(4):451-6. Epub 2007 Apr 10. Onbas O1, Kantarci M, Alper F, Kumtepe Y, Durur I, Ingec M, Gursan N, Okur A. Abstract PURPOSE:  In this study we aimed to investigate the value of contrast enhanced dynamic MR imaging (DMI) in the diagnosis of nodular abdominalendometriosis. SUBJECTS AND METHODS:  Fourteen patients with surgically and pathologically proven endometriosis were examined with DMI. The patients were 22-54 years old (mean age 30.8 years). The dynamic MR studies of these patients were retrospectively reviewed by two radiologists who were aware of the clinical data. Nodular masses showing enhancement were evaluated for size, margins, and signal intensity on T1- and T2-weighted MR sequences. The protocol was tailored to selectively determine the diagnostic utility of signal intensity time course analysis for the behavior of nodularendometriosis and endometrial tissue, in DMI. Contrast-enhanced DMI was performed and the time-intensity curves of the lesions and the uterine endometrial tissue of each patient were compared. Mean enhancement values were calculated. Each DMI was evaluated for signal intensity value. RESULTS:  In 8 (57%) of 14 patients, we found endometriosis in the abdominal wall. All patients with abdominal wall endometriosis had pelvic surgical operation history. Diameter of nodular endometriosis determined in the abdominus muscle ranged between 3 and 40 mm. Of eight cases, five had only one lesion and three had multiple lesions. Remaining 6 (43%) cases had deep pelvic endometriosis located in the uterosacral ligaments (n = 3), rectosigmoid (n = 2), and rectovaginal septum (n = 1). Diameter of pelvic endometriosis ranged between 9 and 53 mm. Noncontrast mean signal intensity of endometriosis and endometrial tissue were 280 +/- 73 and 216 +/- 20, respectively. The mean values of both endometriosis and normal endometrial tissue were calculated for each patient examined with five-slice DMI. All of the curves showed significant correlation. The lesion showed significant enhancement in the course of time similar to the endometrial tissue in all patients. CONCLUSION:  Our study was inspired from the fact that endometriosis is the ectopic endometrial tissue and we thought that endometrial tissue and endometriomas should have similar vascularity. In this way imaging with MR, getting the time-intensity curves and experiencing the correlation between the endometriosis and endometrial tissue may support the diagnosis in the cases with suspected endometriosis. This first study shows that the ectopic nodular endometriosis can easily be identified with dynamic MRI. It may be used to differentiate nodular endometriosis from the other pathologic conditions of abdominal wall and pelvis.

Acta Chir Belg. 2006 Nov-Dec;106(6):712-3. Tumay V1, Ozturk E, Ozturk H, Yilmazlar T. Abstract Appendiceal endometriosis is a rare and usually asymptomatic condition. The authors report a case of a 24-year old woman, admitted for periumbilical pain. Physical examination revealed rebound tenderness in the right iliac fossa. Her white blood cell count was 23300/mm3. We performed appendicectomy. The histopathological result was endometriosis of the appendix vermiformis.

Hum Reprod. 2007 May;22(5):1474-80. Epub 2007 Jan 18. Oktem M1, Esinler I, Eroglu D, Haberal N, Bayraktar N, Zeyneloglu HB. Abstract BACKGROUND:  This prospective randomized-controlled animal study was designed to determine the effects of atorvastatin on experimentally induced endometriosis in a rat model. METHODS:  Thirty-seven Wistar-Albino rats in which endometriotic implants were induced were randomly divided into four groups. Group I (Low-dose atorvastatin group, eight rats) were given 0.5 mg kg(-1) day(-1) oral atorvastatin. Group II (High-dose atorvastatin group, 10 rats) were given 2.5 mg kg(-1) day(-1) oral atorvastatin. Group III were given a single dose of 1 mg kg(-1) s.c. leuprolide acetate (GnRH agonist group, nine rats). Group IV were given no medication and served as controls (10 rats). All rats received the treatment for 21 days and were then euthanized to assess the implants' size, vascular endothelial growth factor (VEGF) level in peritoneal fluid and histological score. RESULTS:  At the end of the treatment, the mean areas of implants were smaller and VEGF levels in peritoneal fluid were lower in Groups II and III than those in Group I and the control group (all P < 0.05). The mean areas of implants decreased from 41.2 +/- 13.9 to 22.7 +/- 13.9 mm(2) after medication in Group II and decreased from 41.2 +/- 18.1 to 13.1 +/- 13.8 mm(2) in Group III (both P < 0.05), whereas in Group I, the mean area increased from 43.0 +/- 12.7 to 50.5 +/- 13.9 mm(2) (P < 0.05). CONCLUSIONS:  High-dose atorvastatin caused a significant regression of endometriotic implants.

J Obstet Gynaecol Res. 2006 Dec;32(6):613-4. Imir G1, Arici S, Cetin M, Kivanc F. Abstract A 30-year-old woman with a history of endometriosis and chronic pelvic pain had right-sided pain and sonographic evaluation demonstrated a right ovarian cyst 5 cm in diameter. Laparotomy revealed a right ovarian cystic mass and the cystic mass was found on the sigmoid colon. After excision, histopathologic study revealed endometrioma for the ovarian cyst and a supernumerary ovary for the cystic mass on the sigmoid colon.

Langenbecks Arch Surg. 2007 Jan;392(1):105-9. Epub 2006 Oct 17. Aydin O1. Abstract INTRODUCTION:  Scar endometriosis develops in and is adjacent to surgical scars at the site of previous abdominal operations. The most frequent clinical presentation of the disease is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain and swelling during menses. Endometriosis of the surgical scar is often referred to the general surgeons because the clinical presentation suggests an incisional hernia or other conditions related to the general surgery. Cyclical symptoms such as pain and swelling, in relation to surgical scars, which worsen at the time of menstruation, are nearly pathognomonic of scar endometriosis. However, often the diagnosis of endometriosis is not suggested until after histology has been performed. CASE REPORT:  We present two cases of cutaneous endometriosis that has occurred on the site of previous cesarean section scar area.

Ophthalmic Res. 2006;38(5):313-4. Epub 2006 Sep 15. Oner A1, Karakucuk S, Serin S. Abstract Endometriosis is the presence of endometrial tissue outside of the uterine cavity. In this paper, we present a patient with nasolacrimal systemendometriosis which is a rare clinical condition.

Reprod Biomed Online. 2006 May;12(5):639-43. Demirol A1, Guven S, Baykal C, Gurgan T. Abstract The study was conducted to investigate the effect of conservative surgery of ovarian endometriomas before an ICSI cycle. Ninety-nine patients with endometriomas who were referred to an intracytoplasmic sperm injection (ICSI) cycle were enrolled in the study. The patients were prospectively randomized into two groups; group I (49 patients) underwent conservative ovarian surgery before the ICSI cycle and group II (50 patients) underwent the ICSI cycle directly. The stimulation was started 3 months after the operation in group I and directly in group II. In the ovarian surgery group, stimulation was significantly longer (14.0 days in group I and 10.8 days in group II; P = 0.001), total recombinant FSH dose was significantly higher (4575 IU in group I and 3675 IU in group II; P = 0.001), and mean number of mature oocytes was significantly lower (7.8 in group I and 8.6 in group II; P = 0.032). There was no difference in terms of fertilization (86% in group I and 88% in group II), implantation (16.5 % in group I and 18.5% in group II) and pregnancy rates (34% in group I and 38% in group II). Ovarian surgery resulted in longer stimulation, higher FSH requirement and lower oocyte number, but fertilization, pregnancy and implantation rates did not differ between the groups.

J Soc Gynecol Investig. 2006 Jul;13(5):378-83. Epub 2006 May 19. Uygur D1, Aytan H, Zergeroglu S, Batioglu S. Abstract OBJECTIVE:  To test if leflunomide, an immunomodulator, could impede the growth of an ectopic uterine tissue. METHODS:  Endometriosis was surgically induced in 26 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Four weeks later two rats were killed. The volume and weight of the implants were measured. The remaining rats were randomly grouped, and in group 1 no medication was given. To the rats in group 2, 35 mg/kg/d of leflunomide was administered orally. Four weeks later, rats were killed and ectopic uterine tissues were reevaluated morphologically and histologically. A scoring system was used to evaluate preservation of epithelia. RESULTS:  Two rats in the control group died 5 weeks after surgery. There was a significant difference in post-treatment spherical volumes (139.1 +/- 92.8 versus 33.5 +/- 12.5 mm3) and explant weights (156.3 +/- 105.6 versus 38.6 +/- 12.6 mg) between the control and leflunomide-treated groups. The epithelia were found to be preserved significantly better in the control group when compared with the leflunomide-treated group (median 2.5 [interquartile range, 1.25] versus median 1.00 [interquartile range, 1.5]). CONCLUSION:  Leflunomide appeared to cause regression of experimental endometriosis in rats.

Fertil Steril. 2006 Jun;85(6):1730-5. Epub 2006 May 11. Esinler I1, Bozdag G, Aybar F, Bayar U, Yarali H. Abstract OBJECTIVE:  To assess the impact of prior unilateral or bilateral endometrioma cystectomy on controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection (ICSI) outcome. DESIGN:  Retrospective case-control study. SETTING:  Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey. PATIENT(S):  Fifty-seven consecutive infertile patients were enrolled who had previously undergone unilateral (n = 34) or bilateral (n = 23) laparoscopic cystectomy for endometriomas more than 3 cm in diameter and underwent ICSI. The control group consisted of 99 patients with tubal factor infertility. INTERVENTION(S):  Controlled ovarian hyperstimulation and ICSI. MAIN OUTCOME MEASURE(S):  Cycle cancellation rate, number of oocytes, fertilization rate, embryo quality, clinical pregnancy rate (PR), and implantation rate. RESULT(S):  The mean number of oocytes, metaphase II oocytes, and two-pronucleated oocytes were significantly lower in the bilateral cystectomy group compared to the unilateral cystectomy and control groups. However, all other parameters, including fertilization rate, the mean number of embryos transferred, the mean number of grade 1 embryos transferred, the clinical PR per embryo transfer, and implantation rate, were comparable among the three groups. Within the unilateral cystectomy group, the mean number of oocyte retrieved from the operated site was significantly less than in the contralateral nonoperated site. CONCLUSION(S):  Laparoscopic endometrioma cystectomy does reduce the ovarian reserve. However, diminished ovarian reserve does not translate into impaired pregnancy outcome.

Respirology. 2006 May;11(3):348-50. Ozvaran MK1, Baran R, Soğukpmar O, Uzman O, Sahin K, Kocadelioglu I, Aksoy F, Altun S. Abstract The authors present a case of endobronchial endometriosis with catamenial haemoptysis. The lesion was diagnosed as endobronchial endometriosisbased on histopathological examination of a bronchial biopsy from the right second carina. Fibreoptic bronchoscopic examination revealed a tiny hyperaemic submucosal area with bleeding and a brown-coloured diverticulum at bottom of this lesion encompassing a 2-cm2 area at the right second carina. Multiplanar reconstructions of a spiral CT scan revealed a 0.5-cm lesion that looked like a diverticulum at the right second carina. The patient was treated with argon laser at bronchoscopy. Following treatment, the patient has been asymptomatic with no recurrence of haemoptysis.

J Minim Invasive Gynecol. 2006 Mar-Apr;13(2):145- Ceyhan T1, Atay V, Gungor S, Karateke A, Oral O, Baser I. Abstract STUDY OBJECTIVE:  To investigate the usefulness and effectiveness of the extracorporeal surgical technique in the treatment of endometriomas. DESIGN:  Retrospective evaluation (Canadian Task Force Classification II-2). SETTING:  Department of gynecology in a tertiary care faculty hospital and training hospital. PATIENTS:  Of 89 patients with endometrioma, 53 had laparoscopic stripping, and 36 had laparoscopically-assisted extracorporeal cystectomy. INTERVENTIONS:  Laparoscopic stripping and laparoscopically-assisted extracorporeal cystectomy were performed for the treatment of endometriomas diagnosed laparoscopically. MEASUREMENTS AND MAIN RESULTS:  The size of the endometrioma diagnosed by the ultrasonographic examination was not statistically related to the severity of the endometriosis (p = .42). Conversion to extracorporeal technique was required in 17 of 58 cases with moderate endometriosisand 14 of 31 cases with severe endometriosis (p = .04). Operation time, visual analogue pain score, and hospitalization periods were similar between the 2 techniques. Among 53 specimens obtained with laparoscopic stripping, 29 (55%) had no ovarian tissue, and 24 (45%) had ovarian tissue with follicles. Of 36 specimens obtained with extracorporeal technique, 19 (52%) had no ovarian tissue, and 17 (48%) had ovarian tissue with follicles. Preservation of the ovarian tissue was not significantly different between both surgical techniques. CONCLUSIONS:  Extracorporeal technique with laparoscopically-assisted minilaparotomy is a valuable alternative for laparoscopic stripping in selected cases.

Fertil Steril. 2006 Mar;85(3):758-60. Dilek U1, Pata O, Tataroglu C, Aban M, Dilek S. Abstract Management of ovarian cysts is still controversial especially when dealing with endometriomas. Cyst excision was accepted surgical method by many centers; however, relationship between the excision and the loss of functional ovarian tissue is still uncertain.

Aust N Z J Obstet Gynaecol. 2006 Feb;46(1):38-41. Itil IM1, Cirpan T, Akercan F, Gamaa A, Kazandi M, Kazandi AC, Yildiz PS, Askar N. Abstract OBJECTIVE:  To investigate the effect of Bacillus Calmette-Guerin (BCG) vaccine on peritoneal implantation of endometrial tissue in rats. METHODS:  Forty sexually mature virgin Wistar albino rats weighing 190-200 g were randomly assigned (double blind) to two groups. The rats in the first group were vaccinated with 0.1 mL BCG and those in the second group were injected with 0.1 mL saline into the tail, intracutaneously. All the rats underwent median laparotomy after 4 weeks of vaccination or injection. The right uterine horn was excised, and the two samples of endometrial tissue dissected from myometrium were implanted on each side of peritoneum at the 2 cm lateral line of the median laparotomy incision. The implanted peritoneal segments were excised after 8 weeks of laparotomy. The tissue samples were accepted, histologically, as endometriosis when both glands and stroma of endometrial tissue were seen in sections. RESULTS:  Thirty-six implants from the study group and 34 implants from the control group were obtained. Ten and 23 implants were accepted asendometriosis in the study and control group, respectively. The number of endometriotic foci were significantly lower in the study group than in the control group (P = 0.01). CONCLUSIONS:  Stimulation of the cellular immune response with BCG vaccine could exert an inhibitory effect on ectopic endometriotic implants.

J Soc Gynecol Investig. 2006 Jan;13(1):58-62. Demirturk F1, Aytan H, Caliskan AC, Aytan P, Koseoglu DR. Abstract OBJECTIVE:  To assess the effect of the peroxisome proliferator-activated receptor (PPAR)-gamma agonist rosiglitazone on the induction ofendometriosis in a rat model. METHODS:  Endometriosis was surgically induced in 28 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Group I was assigned as control and no medication was administered. Starting 3 days before the operation and continuing for 4 weeks, 0.2 mg/kg/d rosiglitazone was administered to the study group orally. Four weeks later rats were killed and ectopic uterine tissues were evaluated morphologically and histologically. Scoring systems were used to evaluate preservation of epithelia. RESULTS:  Four rats in the study group and one rat in the control group died of complications related to surgery. There was a significant difference in post-treatment spherical volumes (64.00 mm3 [interquartile range (IQR): 354.42] vs 41.60 mm3 [IQR: 37.87], P = .018) and explant weights (77.97 mg [IQR: 431.27] vs 47.24 mg [IQR: 43.01], P = .005) between control and rosiglitazone-treated groups. The epithelia were found to be preserved significantly better in the control group when compared with the roziglitazone-treated group (2.00 [IQR:2.00] vs 0.00 [IQR:2.25], P = .014). CONCLUSIONS:  Rosiglitazone was found to affect the induction of endometriosis negatively in this experimental rat model and seemed to interfere with the growth and maintenance of the uterine explant.

MedGenMed. 2005 Apr 7;7(2):64. Ata B1, Ates U, Usta T, Attar E. Abstract Cervix uteri is regarded as an infrequent localization for endometriosis. With widespread use of invasive cervical procedures, however, an increased incidence can be expected. Limited awareness of the clinical appearance of the disease may account for its apparent rarity. This presentation aims to refocus attention to the disease by reviewing the case of a woman who presented to us with minimal metrorrhagia, which is a rare symptom of cervical endometriosis.

Mt Sinai J Med. 2005 Nov;72(6):405-8. Paksoy M1, Karabiçak I, Ayan F, Aydoğan F. Abstract We report a case of a premenopausal woman with severe constipation causing intermittent obstruction. Colonoscopy revealed a tight rectal stricture; however, mucosal biopsies were normal. Exploratory surgery revealed an intense fibrotic reaction involving the rectum and uterus, necessitating a simultaneous low anterior resection and hysterectomy. Pathology established a diagnosis of endometriosis. Preoperative diagnosis of rectalendometriosis can be difficult to establish. Endometrial deposits do not invade the mucosa; therefore, colonoscopy with biopsies are frequently non-diagnostic. Surgery may be the only definitive way to obtain a certain diagnosis. In cases involving rectal strictures of unknown etiology in premenopausal women, rectal endometriosis must be included in the differential diagnosis.

Turk J Gastroenterol. 2005 Mar;16(1):48-51. Yildirim S1, Nursal TZ, Tarim A, Torer N, Bal N, Yildirim T. Abstract Although endometriosis is a common disease in women of childbearing age, intestinal endometriosis is unusual and may cause clinically significant complications. We report a 46-year-old woman with rectal endometriosis who presented with intestinal obstruction. She was operated on with a preoperative diagnosis of malignancy. The diagnosis of endometriosis was made only after histological examination of the resected specimen. Intestinal endometriosis has a diverse clinical spectrum, with nonspecific features in many patients. In female patients who have unexplained digestive complaints, endometriosis should also be considered in the differential diagnosis.

Med Princ Pract. 2005 Nov-Dec;14(6):434-7. Kocakusak A1, Arpinar E, Arikan S, Demirbag N, Tarlaci A, Kabaca C. Abstract OBJECTIVE:  To report 3 cases of endometriosis of the abdominal wall, a disease which is unfamiliar to general surgeons because of the potential pitfalls in its diagnosis. CLINICAL PRESENTATION AND INTERVENTION:  Three patients were referred to our general surgery clinic for abdominal masses. Incisional hernia and an abdominal mass were initially suspected in 2 patients, while a preoperative diagnosis of a rectus abdominis hematoma was made in the third because she had no history of previous surgery. Pain was a remarkable complaint in only one of the present cases. Abdominal wallendometriosis was diagnosed only upon histological examination postoperatively. In all cases, ultrasonography revealed hypoechogenic masses, and computed tomography showed that these masses had spiculations, and macroscopic views of the resected masses revealed well-demarcated margins without peritoneal involvement. All patients were treated with wide radical resections followed by polytetrafluoroethylene patch grafting. They were discharged from hospital on either the 2nd or the 3rd postoperative day uneventfully, and during follow-up there were no signs of pelvicendometriosis, as confirmed by ultrasonography, CA 125 measurement, gynecological consultation and examination. CONCLUSION:  Since the diagnosis of scar endometrioma is rarely established prior to surgery, endometriosis should be included in the differential diagnosis of masses on the abdominal wall.

J Obstet Gynaecol Res. 2005 Oct;31(5):471-5. Gunes M1, Kayikcioglu F, Ozturkoglu E, Haberal A. Abstract AIM:  To report 11 cases of incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. The diagnostic approaches and therapies for incisional endometriosis are also evaluated. METHODS:  Eleven patients who presented with a painful nodule that was increasing in size during menstruation on the scar of a previous gynecologic procedure were examined retrospectively. RESULTS:  All patients presented with a palpable painful lesion, located on the cesarean section incision, perineal episiotomy incision or the vaginal cuff after hysterectomy. All masses were increasing during menstruation and all patients had been having cyclical pain that worsened during menstrual periods. The mean age of the patients was 28.2 years. The onset of symptoms was referred at variable intervals after surgery ranging between 2 and 11 years (mean: 5.72 years). Ultrasound examination confirmed hypoechoic mass septated with cystic and solid components in the abdomen without intra-abdominal communications. All endometriotic masses were completely excised under general anesthesia. The excised masses were sent for microscopic examination which confirmed the diagnosis of endometriosis. CONCLUSION:  Incisional endometriosis seems to be common in women who have had a cesarean section, although it does occur after other procedures and de novo. It is suggested that caution is exercised during gynecologic procedures to avoid transplantation of endometrium to the anterior abdominal wall. The preferred management is to excise the lesion completely even if this necessitates fascial excision.

Minerva Ginecol. 2005 Jun;57(3):237-48. Ulukus M1, Arici A. Abstract Endometriosis is classically described as the presence of both endometrial glandular and stromal cells outside the uterine cavity, mainly in the pelvis. The pathogenesis of this enigmatic disorder still remains controversial despite extensive research. Although multiple theories have been put forth to explain the pathophysiology and pathogenesis of endometriosis, the retrograde menstruation theory of Sampson is the most widely accepted. However, since retrograde menstruation occurs in most of the reproductive age women, it is clear that there must be other factors which may contribute to the implantation of endometrial cells and their subsequent development into endometriotic disease. There is substantial evidence to support that the alterations in both cell-mediated and humoral immunity contribute to the pathogenesis of endometriosis. Increased number and activation of peritoneal macrophages, decreased T cell and natural killer (NK) cell cytotoxicities are the alterations in cellular immunity and result in inadequate removal of ectopic endometrial cells from the peritoneal cavity. Moreover, increased levels of several cytokines and growth factors which are secreted by either immune and endometrial cells seem to promote implantation and growth of ectopic endometrium by inducing proliferation and angiogenesis. In addition to the impaired capacity of the immune cells to mediate endometrial cell removal, inherent resistance of the ectopic endometrial cells against immune cells is another interesting concept in the pathogenesis of endometriosis. Endometriosis has also been considered to be an autoimmune disease, since it is often associated with the presence of autoantibodies, other autoimmune diseases, and possibly with recurrent immune-mediated abortion.

Hum Reprod. 2005 Sep;20(9):2546-9. Epub 2005 May 19. Nadir Ciray H1, Bener F, Karagenç L, Ulug U, Bahçeci M. Abstract BACKGROUND:  Assisted hatching can improve the implantation rate in cycles with poor outcome. The impact of assisted hatching in embryos from women with endometriosis is not known. Therefore, the hypothesis that the implantation potential of embryos obtained from women withendometriosis can be improved with assisted hatching was tested. METHODS:  In a prospective randomized study, transfer embryos obtained from 60 women with endometriosis were hatched using a laser system and compared to embryos obtained from patients with the same diagnosis which were left intact (n = 30). RESULTS:  The characteristics of cycles were similar between groups. The pregnancy (40% zona intact, 28.3% assisted hatching), and implantation rates (19.4% zona intact, 17.8% assisted hatching) did not differ in endometriosis cycles regardless of assisted hatching. CONCLUSION:  Assisted hatching does not improve outcome in women with endometriosis undergoing assisted reproduction

Hum Reprod. 2005 Aug;20(8):2157-61. Epub 2005 May 5. Ertunc D1, Aban M, Tok EC, Tamer L, Arslan M, Dilek S. Abstract BACKGROUND:  Glutathione-S-tranferase (GST) is the part of the key phase II detoxifying enzyme system. Many studies have investigated the role of GSTM1 and GSTT1 gene polymorphisms in endometriosis. Although GSTP1 was found to be one of the most abundant types of GST in genital system, there are insufficient data about the importance of the role of GSTP1 gene polymorphism in endometriosis. METHODS:  This case-control study involved 150 patients with endometriosis and 150 controls. The frequency of GSTP1 single nucleotide polymorphisms was evaluated using PCR and melting curve analysis. RESULTS:  The proportion of GSTP1 ile/ile tended to be higher in patients with endometriosis than control group, although the difference was not significant [odds ratio (OR)=1.53; 95% confidence interval (CI)=0.95-2.46]. In contrast, GSTP1 val/val was significantly higher in control patients and seems protective for endometriosis (OR=0.10; 95% CI=0.02-0.42). CONCLUSION:  The results of this study suggest that GSTP1 polymorphism might modulate the risk of endometriosis with significantly decreased risk for GSTP1 val/val and marginally increased risk for GSTP1 ile/ile. Further studies on not only the disease processes but also normal distribution of the enzyme in female genital tract may provide better understanding about the role of GST types and their polymorphs in endometriosis.

J Reprod Med. 2005 Mar;50(3):198-202. Kaya H1, Sezik M, Ozkaya O, Sahiner H, Ozbaşar D. Abstract OBJECTIVE:  To correlate ovarian endometrioma diameter with the extent of pelvic adhesions. STUDY DESIGN:  Forty women with unilateral ovarian cysts thought to be endometriomas were prospectively recruited. The interventions were transvaginal ultrasound to measure the size of the ovarian endometrioma and a laparoscopic surgical procedure, including detailed pelvic assessment. Main outcome measures were pelvic adhesion scores using the American Fertility Society revised classification of endometriosis. RESULTS:  Thirty-two women met the inclusion criteria. Twelve had an endometrioma < 3 cm in diameter; 12, 3-5 cm; and 8, > 5 cm. Adhesion scores from various anatomic areas did not differ across these 3 groups. No correlation between the size of the endometrioma and associated pelvic adhesions was found using multiple regression analysis. CONCLUSION:  The size of an endometrioma measured by transvaginal ultrasound does not correlate with the extent of adhesive disease. Small (< 3 cm) endometriomas may be associated with a considerable degree of pelvic adhesions.

Eur J Obstet Gynecol Reprod Biol. 2005 Mar 1;119(1):82-6. Hassa H1, Tanir HM, Uray M. Abstract OBJECTIVE:  To evaluate endometriosis patients' symptoms and relate them to different stages and locations of endometriosis and also to fertility/infertility of the patients. STUDY DESIGN:  Sixty-eight patients diagnosed with endometriosis constituted the population investigated in this cross-sectional observational study, 55 and 13 of whom were diagnosed from the visual findings recorded during laparoscopy and laparotomy, respectively. All cases were categorised as early- (stages I and II) or late (stages III and IV)-stage endometriosis and as fertile or infertile endometriosis. The extent ofendometriosis was further divided into peritoneal, ovarian, and ovarian and peritoneal. Symptoms of dysmenorrhoea, deep dyspareunia, dyschesia and dysuria and also depressive mood state were analysed and compared among those different groups. RESULTS:  Cyclic chronic pelvic pain was more relevant in late-stage endometriosis (P = 0.04). Deep dyspareunia, painful defecation, dysuria, infertility, and depressive state did not differ with stages of endometriosis or fertility status. Admission for pelvic pain of any duration was more prevalent among fertile patients with endometriosis (P = 0.008). Chronic noncyclic pelvic pain was more frequently observed in patients with fertile than in those with infertile endometriosis (P = 0.01). More cases in the fertile group experienced noncyclic pelvic pain (P = 0.04). More patients admitted with cyclic pelvic pain had ovarian or ovarian and peritoneal endometriosis than peritoneal endometriosis only (P = 0.03). Infertility was more prevalent among peritoneal endometriosis cases than among those with ovarian or peritoneal and ovarian involvement (P = 0.008). CONCLUSION:  Symptoms of endometriosis may predict the stage and localisation of the disease to some extent.

Fertil Steril. 2004 Oct;82 Suppl 3:1115-20. Dogan E1, Saygili U, Posaci C, Tuna B, Caliskan S, Altunyurt S, Saatli B. Abstract OBJECTIVE:  To investigate the effects of cyclooxygenase-2 (COX-2) inhibitor rofecoxib on endometrial explants and on peritoneal vascular endothelial growth factor (VEGF) levels in the rat endometriosis model. DESIGN:  Prospective, placebo-controlled study. SETTING:  Laboratory at Dokuz Eylül University. ANIMAL(S):  Twenty-six rats with experimentally induced endometriosis. INTERVENTION(S):  Rats were treated for 3 weeks with oral rofecoxib (3 mg/kg per day; n = 9); single subcutaneous injection of depot leuprolide acetate (1 mg/kg; n = 9); or vehicle (control; n = 8). MAIN OUTCOME MEASURE(S):  Change in explant area and histologic examination by semiquantitative analysis of endometriotic explants and measurement of peritoneal VEGF levels. RESULT(S):  Three weeks of treatment with rofecoxib statistically significantly decreased the implant size (62.4%) compared with control (16.6%), and this effect was comparable with the decrease in leuprolide (64.3%). Histologic examination of the explants indicated mostly atrophy and regression in treatment groups, and semiquantitative analysis showed statistically significantly lower scores in rats treated with rofecoxib and leuprolide compared with controls. Both rofecoxib and leuprolide statistically significantly decreased VEGF levels compared with controls. CONCLUSION(S):  Rofecoxib causes regression and atrophy of the endometriotic lesions and is as effective as a GnRH agonist with an accompanying decrease in the VEGF levels.

Fertil Steril. 2004 Sep;82(3):705-11. Pabuccu R1, Onalan G, Goktolga U, Kucuk T, Orhon E, Ceyhan T. Abstract OBJECTIVE:  To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation (COH) improves intracytoplasmic sperm injection (ICSI) outcomes. DESIGN:  Prospective study. SETTING:  University hospital. PATIENT(S):  A prospective analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups: aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery (n = 41) (group 1); nonaspirated endometriomas (n = 40) (group 2); history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH (n = 44) (group 3); and tubal factor infertility (n = 46) (control group 4). INTERVENTION(S):  Aspiration of endometriomas. MAIN OUTCOME MEASURE(S):  Clinical parameters, characteristics of COH, and ICSI results were analyzed. RESULT(S):  We observed higher levels of E(2) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas. When we compared all endometriomas and tubal factor (control) groups, we observed a lower number of total follicles (>17 mm) and metaphase II (MII) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group. Implantation and clinical pregnancy rates were similar among all groups. CONCLUSION(S):  In the current study, all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility. We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles >17 mm, the number of MII oocytes retrieved, the implantation rates, or the clinical pregnancy rates. Resection of small endometriomas (1-6 cm) may not present any additional benefits to the IVF-ICSI cycle outcomes.

Eur J Obstet Gynecol Reprod Biol. 2004 Sep 10;116(1):85-8. Kafali H1, Artuc H, Demir N. Abstract OBJECTIVE:  To elucidate whether endometriosis can be diagnosed clinically by assessing the differences between serum CA125 levels during menstruation and during the rest of the menstrual cycle. METHODS:  The study was performed in 28 patients who underwent laparoscopy to check for pelvic causes of infertility. Patients with endometriosiswere selected as the study group, and patients with normal laparoscopic findings functioned as the control group. Blood specimens were taken for CA125 determination during menstruation and during the rest of the menstrual cycle. Mean serum CA125 concentrations were compared by the two-sample t-test for between-group comparisons and the paired t-test for within-group comparisons. The receiver operating characteristic curve was applied to assess the usefulness of CA125 level changes during the menstrual cycle in the clinical diagnosis of endometriosis. RESULTS:  The mean CA125 concentrations of healthy women during menstruation and during the rest of the menstrual cycle were 12.2 and 10 U ml(-1), respectively. In this group, the mean CA125 concentration was an average of 22% higher during menstruation than during the rest of the menstrual cycle (P < 0.001). The patients with endometriosis showed a similar pattern to that of normal women, but the levels differed by 198.3% in these patients (P < 0.001). Mean CA125 concentrations of these patients during menstruation and in the rest of the cycle were 35.8 and 12 U ml(-1), respectively. The mean CA125 concentration during menstruation was significantly higher in patients with endometriosis than in normal women (P < 0.001), but CA125 concentrations at other points in the menstrual cycle were found to be similar in both groups (P > 0.05). ROC curve analyses set a cutoff of 83% (percentage increment of CA125 level during menstruation compared with that on days without menstrual bleeding), which gives a sensitivity of 93% and specificity of 92%, with a corresponding likelihood ratio of 11.3. CONCLUSIONS:  It may be possible to diagnose endometriosis clinically by assessment of the differences in CA125 level during menstruation as against the remainder of the menstrual cycle.

Eur J Gynaecol Oncol. 2004;25(3):389-90. Karateke A1, Kir G, Gurbuz A, Aker F. Abstract We present a case of microscopic adenocarcinoma arising in the right fallopian tube, which was incidentally found in 74-year-old woman undergoing total abdominal hysterectomy with salpingo-oophorectomy for uterine myoma, hematometra and bilateral hydrosalpinx. A small focus of endometrioid adenocarcinoma confined within the endosalpingeal mucosa of the right fallopian tube associated with endometriosis was fortuitously found during histological examination. Our case seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and an adjoining focus of microscopic carcinoma. This is the second case report of a microscopic endometrioid carcinoma associated with endosalpingealendometriosis.

Arch Gynecol Obstet. 2005 Jan;271(1):76-8. Epub 2004 May 20. Kapan M1, Kapan S, Durgun AV, Goksoy E. Abstract INTRODUCTION:  Extrapelvic endometriosis is a rarely seen condition and it is occasionally presented to the general surgeons. It is often diagnosed incidentally. CASE REPORT:  In this report we presented three cases of inguinal endometriosis all of which were thought to be inguinal hernia preoperatively. They were diagnosed during the operation for inguinal hernia repair and treated with simple excision of the lesions with a part of the round ligament

Eur J Obstet Gynecol Reprod Biol. 2004 May 10;114(1):110-1. Gocmen A1, Inaloz HS, Sari I, Inaloz SS. Abstract A case of endometriosis infiltrating the Bartholin gland is presented. The initial diagnosis was a Bartholin gland cyst. The clinical diagnosis was made during the operation when chocolate-colored fluid poured into operation field. Laparoscopy was done during the same operation and minimalendometriosis was found. The presence of endometriosis may be considered as a diagnosis in cases with cystic mass in the Bartholin gland and laparoscopy might be performed to rule out the presence of intraperitoneal endometriosis if a woman is infertile.

Gynecol Obstet Invest. 2004;57(4):214-7. Epub 2004 Feb 11. Oner-Iyidoğan Y1, Koçak H, Gürdöl F, Korkmaz D, Buyru F. Abstract This study was designed to determine the activities of superoxide dismutase and glutathione peroxidase and some of the lipid peroxidation indices (malondialdehyde and total sulfhydryl groups) in eutopic and ectopic endometria of patients with endometriosis. Ectopic endometrial tissues (ovarian cysts; n = 22) were obtained laparoscopically during the preovulatory period. Statistical analyses were made using the Wilcoxon signed-rank test. The levels of malondialdehyde and total sulfhydryl groups were similar in the eutopic and ectopic endometria, whereas the superoxide dismutase activity was found to be significantly higher in the latter (1,893 +/- 780 vs. 3,512 +/- 1,502 U/g protein; p = 0.002). Although the glutathione peroxidase activity was slightly lower in the ectopic than in the eutopic tissues, the difference was not found to be statistically significant. The malondialdehyde levels were positively correlated with the plasma 17beta-estradiol concentrations in the ectopic endometria (r = 0.683, p = 0.001). No such correlation was seen in the eutopic tissue. It is suggested that various factors, such as cytokines released by activated macrophages in the peritoneal fluid and 17beta-estradiol itself synthesized by the ovaries, may locally affect the oxidant status of ectopic endometria.

Skeletal Radiol. 2004 Mar;33(3):165-8. Epub 2004 Jan 23. Yekeler E1, Kumbasar B, Tunaci A, Barman A, Bengisu E, Yavuz E, Tunaci M. Abstract Endometriosis, an important gynecological disorder of reproductive women, affects most commonly the ovaries and less frequently the gastrointestinal tract, chest, urinary tract, and soft tissues. Endometriosis classically appears on MRI as a mass with a large cystic component and variable signal intensities on T1- and T2-weighted images due to the presence of variable degradation of hemorrhagic products. Endometriosis in an atypical location, an infiltrative appearance and without cystic-hemorrhagic components has rarely been described. We report on a 33-year-old woman with cyclic sciatica due to histologically documented infiltrative endometriosis involving the area of the left sciatic notch.

Hum Reprod. 2004 Jan;19(1):160-7. Soysal S1, Soysal ME, Ozer S, Gul N, Gezgin T. Abstract BACKGROUND:  Among patients using GnRH analogues for endometriosis it has been postulated that peripheral and inflammation-induced in-situ aromatization of adrenal androgens are probably the main reasons for the high rates of failure during follow-up. We hypothesized that in cases with premenopausal severe endometriosis, use of a combination of anastrozole and goserelin to achieve almost maximal endocrine blockade of estrogen synthesis after conservative surgery may increase the pain-free interval and reduce the recurrence rates as compared to goserelin alone. METHODS:  In a prospective randomized trial, we evaluated the efficacy of using either a combination of anastrozole and goserelin for 6 months or goserelin alone for 6 months after conservative surgery for severe endometriosis. The primary outcome measures were the symptom recurrence rates and the impact of treatment on endometriosis-related multidimensional score. The secondary outcome measures were the impact of allocated treatment regimens on menopausal quality of life and on lumbar spine bone mineral density (BMD). RESULTS:  When we analyzed the Kaplan-Meier survival curves, we detected a statistically significant advantage of goserelin plus anastrozole as compared to goserelin only, in terms of the median time to detect symptom recurrence (>2.4 versus 1.7 months; log-rank test; P=0.0089). This statistically significant advantage occurred with a relative risk of 4.3 [95% confidence interval (CI) 1.3-9.8]. Three cases out of 40 recurred in the goserelin plus anastrozole arm (7.5%), whereas we detected recurrences in 14 cases out of 40 cases in the goserelin-only arm (35%) during the follow-up period of 24 months. Based on these data, the interpretation of Kaplan-Meier curves indicates that at the end of follow-up, 54.7 versus 10.4%, respectively, of the patients were free of recurrence. The mean of the differences in terms of Deltabaseline-24 months post-medical therapy multidimensional score were statistically significant in favour of goserelin and anastrozole (9.2 +/- 2.1 versus 6.7 +/- 2.8; paired t-test; P<0.0001; 95% CI 1.5-4.0). We observed a statistically significant difference in suppression of estradiol concentrations and a significantly greater BMD loss at the end of treatment in the goserelin and anastrozole arm as compared to goserelin-only arm. However, this did not elicit deterioration in menopausal quality of life and the observed bone loss was not significant in terms of DeltaBMD between the groups at 2 years of treatment withdrawal. CONCLUSIONS:  Six months of treatment with anastrozole and goserelin as compared to goserelin alone increased the pain-free interval and decreased symptom recurrence rates in patients following surgery for severe endometriosis. Furthermore, menopausal quality of life and BMD at 2 years after medical therapy remained unaffected.

Eur J Gynaecol Oncol. 2003;24(5):445-6. Göçmen A1, Karaca M, Tarakçioğlu M. Abstract A 24-year-old single woman was referred to our department due to intermittent abdominal pain. Because her serum CA 125 concentration was extremely elevated an ovarian malignancy was suspected. At the laparoscopic examination, it was determined to be a ruptured endometrioma and serum CA 125 concentrations rapidly decreased after surgery.

Infect Dis Obstet Gynecol. 2003;11(1):59-64. Erguvan R1, Meydanli MM, Alkan A, Edali MN, Gokce H, Kafkasli A. Abstract BACKGROUND:  Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems. CASE:  A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 x 85 mm leiomyoma-like lesion including a 53 x 43 mm cystic space and 9 x 6 mm papillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful. CONCLUSION:  The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.

Eur J Obstet Gynecol Reprod Biol. 2003 Jul 1;109(1):97-101. Oral E1, Ilvan S, Tustas E, Korbeyli B, Bese T, Demirkiran F, Arvas M, Kosebay D. Abstract OBJECTIVE:  To determine the prevalence of ovarian endometriosis in malignant epithelial ovarian tumours. STUDY DESIGN:  A retrospective analysis of 160 malignant and 23 borderline ovarian tumours during the period 1995-2001. RESULTS:  Fourteen (7.7%) of the tumours contained endometriosis. This affected 22% of the endometrioid and 10.8% of the mixed adenocarcinomas. The mean age of the ovarian endometriosis patients was 43+/-13 range 26-70 years. The incidence in borderline tumours 13% (3/23) was higher than that in ovarian cancer 6.9% (11/160) (P>0.05). Eight (57%) of cases were classified as atypical and six (43%) as typicalendometriosis. Nine cases were FIGO (International Federation of Gynaecology and Obstetrics) stage I and 5 stage III. CONCLUSIONS:  Both malignant and borderline ovarian tumours are associated with ovarian endometriosis. In addition, atypical endometriosis was found associated with endometrioid and mixed epithelial ovarian tumours.

Eur J Obstet Gynecol Reprod Biol. 2003 Jul 1;109(1):97-101. Oral E1, Ilvan S, Tustas E, Korbeyli B, Bese T, Demirkiran F, Arvas M, Kosebay D. Abstract OBJECTIVE:  To determine the prevalence of ovarian endometriosis in malignant epithelial ovarian tumours. STUDY DESIGN:  A retrospective analysis of 160 malignant and 23 borderline ovarian tumours during the period 1995-2001. RESULTS:  Fourteen (7.7%) of the tumours contained endometriosis. This affected 22% of the endometrioid and 10.8% of the mixed adenocarcinomas. The mean age of the ovarian endometriosis patients was 43+/-13 range 26-70 years. The incidence in borderline tumours 13% (3/23) was higher than that in ovarian cancer 6.9% (11/160) (P>0.05). Eight (57%) of cases were classified as atypical and six (43%) as typicalendometriosis. Nine cases were FIGO (International Federation of Gynaecology and Obstetrics) stage I and 5 stage III. CONCLUSIONS:  Both malignant and borderline ovarian tumours are associated with ovarian endometriosis. In addition, atypical endometriosis was found associated with endometrioid and mixed epithelial ovarian tumours.

Gynecol Endocrinol. 2003 Apr;17(2):143-50. Inan S1, Kuscu NK, Vatansever S, Ozbilgin K, Koyuncu F, Sayhan S. Abstract Our goal in this study was to investigate the presence of angiogenesis-related factors in endometriomas by evaluating their vascular surface densities. Thirty ovarian samples were included in the study. Of these, ten were histologically confirmed endometriomas, ten were ovarian specimens in the follicular phase and ten were ovarian specimens in the luteal phase, serving as controls. Histological specimens were immunostained for von Willebrand factor (vWF: factor VIII-related antigen) and CD34. The area with the highest microvessel density in endometriosisand in the normal ovary was evaluated by using an intercept grid. All microvessels in a specific field (x 100 magnification) were counted and vascular surface density was measured, as 164.01 +/- 21.26 vs. 125.15 +/- 11.28 and 117.44 +/- 9.27 by using vWF, and as 172.97 +/- 25.64 vs. 138.65 +/- 32.21 and 120.34 +/- 18.40 by using CD34 in endometriotic, follicular and luteal ovarian samples, respectively (p < 0.001). The mean vascular surface density was significantly higher in endometriosis than in the ovarian samples of the follicular phase or the luteal phase. No significant difference was seen between normal ovarian samples. Endometriosis was associated with angiogenic properties. Having demonstrated elevated angiogenic factors in endometriotic samples, we concluded that activation of angiogenesis might be a key factor in the pathogenesis ofendometriosis.

Hum Reprod. 2003 Mar;18(3):588-92. Soysal ME1, Soysal S, Gurses E, Ozer S. Abstract BACKGROUND:  Some patients with endometriosis are candidates for sympathectomy of the superior hypogastric plexus. The objective of this paper is to describe our technique of laparoscopic presacral neurolysis for sympathectomy and to report 1 year results of the first 15 cases. METHODS:  To achieve this objective in a prospective observational study of 1 year follow-up; we performed laparoscopic presacral chemical neurolysis with phenol in 15 patients with pelvic pain and minimal-moderate endometriosis. The main outcome measures were: the impact of treatment on pelvic symptom resolution, non-opioid analgesic consumption during menses, sexual performance and observed complications and side effects during 1 year follow-up. RESULTS:  We noted a significant reduction in total pelvic symptom score as compared with baseline mean (SD) of 9.04 (1.2). The mean difference [95% confidence interval (CI)] of reduction was 5.7 (4.9-6.5), 5.8 (5.0-6.6) and 5.8 (4.9-6.6) from the baseline at the 3rd, 6th and 12th postoperative month (P < 0.001). We observed a significant improvement in Sabbatberg Sexual Rating Scale as compared with baseline mean (SD) of 30.9 (4.3). The mean difference (95% CI) of increase was 33.4 (30.3-36.4), 33.2 (30.1-36.2) and 33.2 (30.1-36.3) from the baseline at the 3rd, 6th and 12th postoperative month. We observed a significant reduction in analgesic consumption during menses in terms of total naproxen sodium tablets as compared with baseline mean (SD) of 8.9 (1.1). The mean difference (95% CI) of reduction in the total number of naproxen sodium 250 mg tablets was 6.5 (5.5-7.5), 6.7 (5.7-7.7) and 6.6 (5.6-7.6) from the baseline at the 3rd, 6th and 12th postoperative month. The most common side effect was constipation. CONCLUSION:  Laparoscopic presacral neurolysis is feasible and simple. More data is needed to support its efficacy and safety.

Clin Exp Obstet Gynecol. 2002;29(3):217-8. Karakök M1, Balat O, Sari I, Kocer NE, Erdogan R. Abstract Intramural pregnancy is the rarest type of ectopic pregnancy and almost always is diagnosed intraoperatively. It constitutes less than 1% of ectopic pregnancies and the world literature contains only 33 cases. We present an additional case of an uncomplicated intramural pregnancy in a patient with extensive adenomyosis, which is the earliest preoperatively diagnosed (sixth week of gestation) case in the literature.

J Reprod Med. 2002 Nov;47(11):955-8. Erbayraktar S1, Acar B, Saygili U, Kargi A, Acar U. Abstract BACKGROUND:  Few data exist on treating spinal cord endometriosis. CASE:  Total excision of the endometriotic lesion, followed by a bilateral oophorectomy and aromatase inhibitor therapy, led to a clinical improvement. CONCLUSION:  Attempts at total removal of spinal cord endometriosis may be safer after achieving pharmacologic control.

Acta Radiol. 2002 Mar;43(2):164-6. Kiyan E1, Kilicaslan Z, Caglar E, Yilmazbayhan D, Tabak L, Gürgan M. Abstract Thoracic endometriosis is an uncommon disorder. In most cases, the diagnosis is based on history alone and radiographic findings depend on the menstrual cycle. CT findings include ill-defined or well-defined opacities, nodular lesions, cavities, cystic changes and bullous formation. We report a case of pulmonary parenchymal endometriosis with an unusual radiographic finding.

Arch Gynecol Obstet. 2002 Jan;266(1):21-4. Göker EN1, Ozçakir HT, Terek MC, Levi R, Adakan S, Tavmergen E. Abstract OBJECTIVE:  To evaluate the efficacy of controlled ovarian hyperstimulation and intrauterine insemination for infertility associated withendometriosis. MATERIAL AND METHODS:  A retrospective analysis of 260 patients with the only diagnosis of endometriosis, or male factor, or tubal factor, or unexplained infertility were performed: a total of 56 patients with different stages of endometriosis, a control group consisting of 38 patients with male factor infertility, a group of 26 patients with tubal factor infertility and a group of 140 patients with others (unexplained infertility, ovulation disorders, cervical factor). Pregnancy rate, hormone levels, endometrial thickness and number of follicles were analyzed. RESULTS:  Clinical pregnancy rates per patient were similar between endometriosis, male factor, tubal factor, and others including unexplained infertility, ovulation disorders and cervical factor groups (10.7%, 5.4%, 11.5%, 17.9%, respectively; p>0.05). Clinical pregnancy rates per patient were not effected between the 2 subgroups of endometriosis as minimal to mild and moderate to severe [5.1% (2/39) versus 23.5% (4/17), p=0.19]. CONCLUSION:  Endometriosis did not affect the clinical pregnancy rate per patient compared to the other infertility factors. Endometriosis of various stages have no effect on the success of controlled ovarian hyperstimulation combined with intrauterine insemination.

Eur J Obstet Gynecol Reprod Biol. 2001 Oct;98(2):209-12. Gül A1, Yaşar T, Uğraş S. Abstract To investigate whether BCG vaccination can prevent endometrial implantation in a rat model. Forty sexually mature virgin Wistar-Albino rats weighing 185-215g were randomly assigned (double-blind) to two groups. The first group (n=20) were injected with BCG 3 weeks before endometrial implantation to the eye. The second group (n=20) with BCG not injected before endometrial implantation was the control. Photobiomicroscopy observation was done weekly and 6 weeks post endometrial implantation all eyes were investigated histologically.Five implants grew in the anterior surface of the iris of the first (vaccinated) group and 17 in the second (control) group. The difference was statistically significant. Systemic prophylaxis with BCG can exert an inhibitory effect on endometrial transplantation.

Pathol Oncol Res. 2001;7(1):33-8. Bayramoğlu H1, Düzcan E. Abstract It has been reported that cases of ovarian endometriosis those with epithelial cytological atypia have potential for malignant transformation. This study was planned to determine the incidence of atypical endometriosis and its cytological criteria, to evaluate the malignant potential of atypicalendometriosis via immunohistochemical methods (p53). In this study we evaluated 140 samples obtained from 120 cases of ovarian endometriosisand 10 ovarian endometrioid carcinomas that have been previously diagnosed histopathologically. We re-evaluated endometriosis cases with respect to their epithelial and stromal features, existence of acute or chronic inflammatory cells in endometriotic epithelium or stroma and other accompanying histological findings. We observed atypia in 7 (5.8%) cases; reactive atypia in 37 (30.8%) cases, no atypia in 76 (63.4%) cases. We evaluated immunohistochemical p53 expression in 7 atypical cases, 37 reactive atypical cases, and in 10 of those without atypia and in 10 endometrioid carcinoma cases. We noted no staining in cases with atypia, reactive atypia and without atypia while 3 cases of endometrioid carcinoma had positive staining for p53. We concluded that prominent nucleolus and angulation of nuclear contour could be added to criteria of atypia that were mentioned before in the literature. In our study, even though p53 expression could not be shown with immunohistochemical methods in atypical endometriotic cases; it can not be determined that atypical endometriosis lesions are not premalignant. Still, endometriosis cases should be evaluated carefully by the pathologist for foci of cytological atypia and it should be kept in mind that malignant transformation might occur in these atypical endometriosis cases.

Eur J Obstet Gynecol Reprod Biol. 2001 May;96(1):102-7. Bukulmez O1, Yarali H, Gurgan T. Abstract OBJECTIVE:  To assess the impact of endometriosis on the outcome of intracytoplasmic sperm injection (ICSI) outcome. STUDY DESIGN:  Retrospective case-control study which enrolled 1280 consecutive cycles of 834 couples of ICSI with ejaculated sperm. Among them, 973 cycles of 632 couples had resulted in embryo transfer (ET). The presence of endometriosis was noted in 110 consecutive cycles of 45 patients among which 78 cycles of 44 patients had resulted in ET. Data from endometriosis group were analyzed in subgroups of minimal-mild (49 ET cycles of 25 patients) and moderate-severe (29 ET cycles of 19 patients). The controls consisted of 1170 consecutive cycles of age-matched 771 couples. Of the controls, 588 couples had 895 cycles of ET. Main outcome measures were implantation and clinical pregnancy rates. RESULTS:  There were no differences in cycle and ET cancellation rates between control and endometriosis groups. The number of oocytes retrieved, fertilization and cleavage rates and the number and quality of embryos developed and transferred were similar among the groups. The implantation and clinical pregnancy rates were also comparable. CONCLUSION:  The presence and extent of endometriosis do not affect implantation and clinical pregnancy rates in patients undergoing ICSI.

Clin Nephrol. 1999 Sep;52(3):179-82. Akçay A1, Altun B, Usalan C, Ulusoy S, Erdem Y, Yasavul U, Turgan C, Caglar S. Abstract Endometriosis is a common disease but ureteral involvement is relatively rare. Ureteric endometriosis is mostly unilateral. Endometriotic ureteral obstruction is a serious event commonly diagnosed late and therefore associated with a major risk of hydronephrotic renal atrophy. We present the cyclical acute renal failure associated with menstruation in a patient who developed severe bilateral ureteral obstruction due to endometriosis. Physicians should be aware of this uncommon but serious manifestation of endometriosis, especially if the clinical presentation is cyclical acute renal dysfunction in a premenopausal woman.

Gynecol Obstet Invest. 1999;48(2):123-6. Kaya H1, Oral B. Abstract OBJECTIVE:  When we review the current literature on endometriosis and luteinized unruptured follicle (LUF), we see that most of the studies deal with only the association between LUF frequency and the severity of endometriosis. Our purpose was to evaluate the effect of ovarian involvement on LUF frequency in endometriosis and assess the relationship between endometriosis and LUF in infertile women. STUDY DESIGN:  This study is a prospective analysis covering a total of 126 infertile women between 22 and 35 years of age who underwent diagnostic laparoscopy from September 1995 to August 1997 in the Department of Obstetrics and Gynecology at Süleyman Demirel University, Isparta, Turkey. Endometriosis was diagnosed in 58 of these patients. All had received a revised American Fertility Society staging score at the time of the laparoscopic diagnosis. Diagnosis of LUF was made when the following criteria were fulfilled: absence of ultrasonic signs of ovulation, and absence of an ovulation ostium on the follicle by laparoscopy, despite increased serum progesterone. Statistical evaluation was performed using chi2 test and Fisher's exact test where appropriate. RESULTS:  The prevalence of LUF in mild, moderate and severe endometriosis cases was 13.3, 41.2 and 72.7%, respectively. The LUF frequencies were 45.9% in 37 endometriosis patients with ovarian involvement, 9.5% in 21 cases without ovarian involvement, and 5.9% in 68 cases withoutendometriosis. A statistically significant difference was observed between the LUF rate in the group with ovarian involvement and that without involvement (chi(2) = 8.06, p < 0.001). CONCLUSION:  In summary, in this study we noted a significant increase in LUF frequency in endometriosis patients with ovarian involvement.

J Reprod Med. 1999 May;44(5):450-4. Gurgan T1, Bukulmez O, Yarali H, Tanir M, Akyildiz S. Abstract OBJECTIVE:  To examine whether insulinlike growth factor I (IGF I), IGF II and IGF binding protein 3 (IGFBP 3) in serum and peritoneal fluid (PF) correlate with the presence and severity of endometriosis. STUDY DESIGN:  Case-control study including 29 patients with endometriosis and 15 controls. The revised American Fertility Society classification stages of I and II were pooled as early-stage (n = 15), and stages III and IV were taken as late stage (n = 14). Simultaneous sampling of blood and PF was performed during laparoscopy, and IGF I, IGF II and IGFBP 3 levels were determined by immunoradiometric assay. RESULTS:  The serum levels of all three proteins were higher than PF levels except for a reversed IGF I PF: serum ratio in the early stage. There were no significant differences in IGF II and IGFBP 3 levels among the groups. The mean serum IGF I levels of controls and early-stage patients were significantly lower than those in the late stage. Also, mean PF IGF I levels in controls were significantly lower than in the late stage. CONCLUSION:  IGF I may be an important mediator in the development and/or maintenance of endometriosis or progression to late-stage disease.

Int J Fertil Womens Med. 1999 Jan-Feb;44(1):38-42. Karabacak O1, Kambic R, Gursoy R, Ozeren S. Abstract OBJECTIVE:  To determine the effectiveness of ovulation induction after laparoscopic treatment of endometriosis in an infertile population. DESIGN:  An observational prospective study in which infertility cases were treated with laparoscopic surgery was followed up (mean 11 months), either by treatment (ovulation induction) or no further treatment (expectant management) and the outcomes recorded. In both groups pregnancies were compared by Cox's regression survival model. SETTING:  Gazi University Hospital, Department of Obstetric and Gynecology, Ankara, Turkey. PATIENTS:  Infertile women with different stages of endometriosis who were treated by laparoscopic surgery, with a mean duration of infertility of 80.7 (+/-50 [SD]) months. INTERVENTIONS:  Patients were treated by cauterization of the foci, adhesiolysis, endometrioma stripping, and distal tubal reconstruction according to their lesions. Postoperatively, patients had either ovulation induction (clomiphene, hMG) therapy or no further treatment. MAIN OUTCOME MEASURE:  Cumulative pregnancy rate of infertile women after laparoscopic treatment of endometriosis with or without ovulation induction. RESULTS:  A total of 36 out of 128 patients became pregnant after laparoscopy, with a 34% cumulative pregnancy rate. In the ovulation induction group, relative risk (chance) of pregnancy was 1.42 (1.02-2.05, 95 % CI) when the duration of infertility was less than 5 years. In this lower risk group, the overall cumulative pregnancy rate was 46%--56% and 27% for the ovulation induction and expectant management groups, respectively. In the expectant management group, per cycle fecundity was 0.021, whereas it was 0.066 and 0.174 (p = 0.001) in the clomiphene citrate- and hMG-treated patients, respectively. Expectant management significantly increased the likelihood of pregnancy compared to ovulation induction in previous pregnancy, stage 1 or 2 endometriosis, and no male infertility groups (p = 0.04-0.009). CONCLUSION:  After laparoscopic treatment of endometriosis, ovulation induction has a positive effect only if done with hMG and the duration of infertility was less than 5 years (P<.05).

Fertil Steril. 1997 Jan;67(1):40-5. Taskin O1, Yalcinoglu AI, Kucuk S, Uryan I, Buhur A, Burak F. Abstract OBJECTIVE:  To investigate the efficacy and safety of tibolone on hypoestrogenic vasomotor symptoms and bone parameters in patients treated with goserelin acetate. DESIGN:  Prospective, randomized placebo controlled double-blind study. SETTING:  Human volunteers in a university-based fertility clinic. PATIENT(S):  Twenty-nine women of mean age 29.2 +/- 4.8 years with mild to severe endometriosis undergoing 6 months of treatment with 3.6 mg goserelin acetate in an SC depot formulation were studied. INTERVENTION(S):  The patients were allocated randomly to either 2.5 mg/d tibolone (n = 15) or an iron pill (n = 14) in a double-blinded fashion beginning in the third cycle. MAIN OUTCOME MEASURE(S):  Frequency and severity of hot flushes, sweating, irritability, loss of libido, nervousness, and sleeplessness were assessed by the patients using 0 to 6 point scoring system and compared. Samples of urine were obtained for calcium and creatinine (Ca:Cr) ratios at the start of treatment and monthly there after. The vasomotor scoring for each symptom and Ca:Cr ratios before the treatment and at the end of 6th month were analyzed by parametric and nonparametric tests. RESULT(S):  The mean age, weight, vasomotor scores, pelvic scores, and urine Ca:Cr ratios were similar in both placebo and tibolone group (28.7 +/- 4.8 versus 27.6 +/- 6.3 years, 50.9 +/- 5.3 versus 53.1 +/- 7.1 kg, 4.7 +/- 1.1 versus 4.2 +/- 0.8, and 0.056 +/- 0.008 versus 0.059 +/- 0.006, respectively). The decreases in vasomotor scoring as regards to hot flushing, sweating, and other associated symptoms were statistically significant in tibolone group compared with placebo (10.4 +/- 1.6 versus 24.6 +/- 4.9). During the study significant reductions in urine Ca:Cr ratio was obtained in the tibolone patients compared with placebo (0.031 +/- 0.006 versus 0.0055 +/- 0.007). The incidence of side effects (weight change, vaginal bleeding) was low and did not differ from the placebo group. CONCLUSION(S):  Considering the beneficial effects of tibolone on vasomotor symptoms and bone loss, our data suggest that this synthetic steroid is an effective and safe option in relieving symptoms induced by GnRH-analogue.

Eur J Obstet Gynecol Reprod Biol. 1996 Sep;68(1-2):155-8. Ugur M1, Senöz S, Gökmen O. Abstract In this preliminary study, the safety and efficacy of a combined GnRHa and low-dose danazol regimen was evaluated in patients with advanced stage endometriosis. Five patients with stage IV endometriosis were administered triptorelin 3.75 mg intramuscularly with monthly intervals in combination with oral danazol 100 mg/day for 6 months. Laparoscopy was performed before and after therapy to assess the change in endometriotic lesions. During controls, patients were evaluated for the change in hormonal and biochemical parameters and the side effects of the treatment. In 4 patients with ovarian endometriomas, cysts were drained during initial laparoscopy. None of the endometriomas persisted after therapy. Total scores, according to the revised American Fertility Society classification of endometriosis were, 54.8 +/- 10.9 before treatment and decreased to 31.6 +/- 10.3 (P < 0.05), whereas, endometriotic implants scores changed from an initial value of 22.8 +/- 12.1 to 1.2 +/- 1.1 (P < 0.05). No adverse effect was observed on lipid and liver metabolism. Estrogen deprivation symptoms and oily skin were the most prominent complaints and one patient had a weight gain of 6 kg. Based on these results we conclude that a combination of GnRHa and low dose danazol is an effective alternative treatment modality in the treatment of severe endometriosis without any serious side effect. J Am Assoc Gynecol Laparosc. 1996 Aug;3(4, Supplement):S51-2.

J Am Assoc Gynecol Laparosc. 1996 Aug;3(4, Supplement):S51-2. Uryan I I1, Taskin O, Erden F, Buhur A, Burak F, Ozekici U, Wheeler JM. Abstract Gonadotropin-releasing hormone (GnRH) agonists are widely administered to treat endometriosis, but generally are not prescribed for more than 6 months since they are associated with vasomotor symptoms and bone loss. A GnRH agonist and steroid add-back therapy can be given for longer times without flare-up or significant hypoestrogenic symptoms. We examined the efficacy and safety of a weak estrogenic steroid, OD14, with prolonged goserelin treatment in seven regularly menstruating women (age 26-33 yrs) with laparoscopically diagnosed, symptomatic endometriosis. The women received goserelin 3.65 mg subcutaneously/month and 2.5 mg OD14 2.5 mg/day beginning in the fourth cycle for 18 to 20 months. The frequency and severity of hot flushes, sweating, irritability, loss of libido, nervousness, and sleeplessness were scored by the women on a scale of 0 to 6 and compared. Samples of blood and urine were obtained to measure serum estradiol (E2) levels, lipids, and urinary calcium:creatinine (Ca:Cr) ratios at the start of treatment and monthly thereafter. The vasomotor scores, serum E2 levels, and urine Ca:Cr ratios were consistent with the hypoestrogenism induced by goserelin (24.2 &plusmn; 3.1, 18.5 &plusmn; 7.2 pg/ml, and 0.063 &plusmn; 0.008, respectively). The decreases in vasomotor scoring with regard to hot flushing, sweating, and urinary Ca:Cr ratios were significant after adding OD14 (14.8 &plusmn; 2.2, 0.031 &plusmn; 0.005, p <0.05), whereas E2 levels remained below 40 pg/ml (23.1 &plusmn; 8.2 pg/ml, p >0.05) throughout therapy. The increased low-density:high-density lipoprotein ratio with goserelin improved with OD14, remaining at the lower limit of normal. Thus, OD14 add-back to GnRH agonist therapy enabled us to extend medical therapy of endometriosis longer than 6 months, preventing hypoestrogenic side effects, and with adequate suppression endometriosis symptoms.

J Am Assoc Gynecol Laparosc. 1996 Aug;3(4, Supplement):S49. Taskin O1, Erden F, Uryan I I, Atmaca R, Ozekici U, Wheeler JM. Abstract We evaluated the effects of low-dose oral contraceptive (Desolett) in the management of pelvic pain, and its sensitivity in differentiating organic disorders such as endometriosis, in 96 women who were followed for at least 4 to 6 months. The 67 who still complained of pelvic pain with no improvement in severity, or who reported increase in symptoms after 4 to 6 months were examined by laparoscopy. All patients underwent laparoscopy in the follicular phase, under general anesthesia with the three-puncture technique. Fifty-six women (83.6%) were diagnosed as havingendometriosis, 19 stage 1, 31 stage 2, and 6 stage 3 disease (American Fertility Society classification). Six (9%) had moderate to severe pelvic adhesions (2 Fitz-Hugh-Curtis syndrome) with no endometriotic implants. One (1.5%) had Taylor syndrome, and the others (6%) were free of disease. Unresponsiveness to low-dose oral contraceptives at the end of 4 to 6 months was highly sensitive and predictive of organic pelvic disorders such as endometriosis as the cause of pelvic pain. Therefore, we conclude that this therapy is effective in evaluating and treating women with obscure findings for particular disorders. In addition to managing mild to moderate endometriosis, it is effective in reducing the severity of midline pelvic pain of uterine origin, which may be of further benefit in pelvic pain of obscure etiology. Finally, a trial of oral contraceptives may be used as initial screening in women with chronic pelvic pain to reduce the number of unnecessary diagnostic and surgical interventions.

J Am Assoc Gynecol Laparosc. 1996 Aug;3(4, Supplement):S17. Gurgan T1, Yarali H. Abstract Unilateral or bilateral cystectomy for endometriomas was performed in 90 infertile women. Using a multipuncture technique, a cortical incision was made on the medial aspect of the ovary with sharp-tipped unipolar coagulation. Cystectomy was performed by stripping the cyst capsule from the normal ovarian cortex with the aid of atraumatic grasping forceps. If the capsule removal was incomplete due to technical difficulties, the remaining capsular fragments were vaporized with the carbon dioxide laser. Endometriosis implants elsewhere in the pelvis were vaporized and adhesions, if present, were lysed. The ovarian cortex was closed with a few interrupted 6-0 polyglactin sutures using extracorporeal knot technique. A second-look laparoscopy was performed in 25 patients to evaluate adhesion formation, reformation, postoperative crude pregnancy rates, and factors that would predict conception.

J Am Assoc Gynecol Laparosc. 1996 May;3(3):389-92. Gurgan T1, Urman B, Yarali H. Abstract STUDY OBJECTIVE:  To evaluate the extent of adhesion formation after laparoscopic removal of endometriomas. DESIGN:  Prospective case series. SETTING:  A university hospital. PATIENTS:  Nineteen infertile women with ovarian endometriomas. INTERVENTIONS:  All patients underwent laparoscopic cystectomy with total stripping of the cyst capsule when possible. A second-look laparoscopy was performed after 3 months of postoperative treatment with a gonadotropin-releasing hormone analog. MEASUREMENTS AND MAIN RESULTS:  The extent of adhesion reformation was dependent on the extent and severity of adhesions at initial laparoscopy. One (5.2%) woman had a residual ovarian endometrioma at second-look laparoscopy. De novo adhesion formation was not seen. Nine women (42.8%) conceived during the postoperative follow-up period (range 11-22 mo). CONCLUSIONS:  Laparoscopic removal of endometriomas is effective in eradicating the disease. Adhesions at second-look laparoscopy depend on adhesions at the initial laparoscopy. Crude pregnancy rates are satisfactory in infertile women.

Int J Gynaecol Obstet. 1996 Feb;52(2):145-9. Dogan MM1, Ugur M, Soysal SK, Soysal ME, Ekici E, Gokmen O. Abstract OBJECTIVE:  To assess the efficacy of transvaginal sonography (TVS) in differentiating endometriomas from other adnexal masses. METHODS:  One thousand thirty-five adnexal masses undergoing laparoscopy or laparotomy were evaluated prospectively using TVS. Masses diagnosed as endometrioma according to their sonographic appearance were divided into two groups: those with a round shape, regular margins, thick walls and homogeneous, low-level echoes (group A); or those with irregular margins, internal septations and an anechoic appearance (group B). RESULTS:  The sensitivity of TVS in diagnosing endometriomas was 86.50% and the specificity 99.11%. The positive predictive value (PPV) and the negative predictive value of the test were calculated to be 91.45% and 98.14%, respectively. By using the criteria determining group A, the PPV of the test increased to 97%, whereas group B had a lower PPV (70.85%). CONCLUSION:  We propose that the accuracy of TVS in diagnosing endometriomas may be beneficial in various clinical conditions. J Pak Med Assoc. 1996 Feb;46(2):30-2.  

J Pak Med Assoc. 1996 Feb;46(2):30-2. Batioglu S1, Celikkanat H, Ugur M, Mollamahmutoglu L, Yesilyurt H, Kundakci M. Abstract To assess the efficacy of GnRH-agonist therapy in the treatment of endometriomas with or without surgical intervention, 26 women with laparoscopically proven endometriomas larger than 3 cm were recruited to the study. Fourteen women with 19 endometriomas (5 bilateral), had drainage of endometrioma at initial laparoscopy. After the procedure, ovarian suppression was done with GnRH-a therapy for 6 months. The second group which consisted of 12 women, had 17 endometriomas. No surgical procedure was performed. They received only GnRH-a therapy for 6 months. On repeat laparoscopy, in the first group, the rates of decrease in ovarian AFS scores of endometriomas and complete resolution were found as 100% and 37% respectively. In the second group the response was only 18% (p < 0.0001). It was concluded that drainage of the cyst (surgical therapy) combined with postoperative GnRH-a suppression is a better treatment modality than the use of GnRH-a (medical therapy) alone for endometriomas.

Int J Gynaecol Obstet. 1995 Sep;50(3):269-73. Ozakşit G1, Cağlar T, Ciçek N, Kuşçu E, Batioğlu S, Gökmen O. Abstract OBJECTIVES:  The aim of this study was to assess the treatment of endometriosis with a gonadotropin-releasing hormone (GnRH) agonist in terms of changes to the extent of disease and to CA 125 levels as well as to recurrence during follow-up. METHODS:  The levels of serum CA 125 were evaluated in 66 patients with endometriosis diagnosed and staged by laparoscopy according to the revised American Fertility. Society classification, who received a 6-month course of a GnRH agonist. Serum CA 125 levels were measured before, during (3 and 6 months after the initiation of therapy) and 6 months after cessation of therapy. RESULTS:  Patients with minimal and mild endometriosis had significantly higher mean pretreatment values than control subjects in the luteal phase of the cycle or than postmenopausal women (P < 0.05), but the overall mean value was still below 35 U/ml. Levels of CA 125 fell during treatment to those found in normal controls, but rose again after the end of treatment. The sensitivity and specificity of CA 125 were 75% and 83.3%, respectively, and its positive predictive value as a marker of recurrence was 46.36%. CONCLUSION:  These data suggest that CA 125 may be a reliable indicator for monitoring the efficacy of GnRH agonist treatment of endometriosis, but its value as a predictor of recurrence is low, probably due to the suppression of all CA 125 sources such as endometrium, ovaries and implants.

Hum Reprod. 1995 Sep;10(9):2419-22. Tasdemir M1, Tasdemir I, Kodama H, Tanaka T. Abstract The effect of peritoneal fluid (PF) from endometriosis patients was studied in spontaneous and stimulus-induced (Ca-ionophore; A23187) acrosome reactions. PF samples were obtained from 21 infertile women with endometriosis and five normal women (controls). Sperm acrosomes were examined by staining with Pisum sativum agglutinin labelled with fluorescein isothiocyanate. The incidence of spontaneous acrosome reaction after 1 and 6 h of incubation (6.7 +/- 1.6 and 6.9 +/- 1.4 respectively) was significantly (P < 0.001) lower when the incubation was performed with PF fromendometriosis patients in comparison with spermatozoa incubated in PF from the control group (12.8 +/- 1.1 and 12.8 +/- 0.8). Similarly, the incidence of A23187-induced acrosome reaction after 1 and 6 h of incubation (19.8 +/- 2.7 and 20.0 +/- 2.4) was significantly (P < 0.001) lower when spermatozoa were incubated with PF from endometriosis patients in comparison with spermatozoa incubated with PF from the control group (34.6 +/- 9.8 and 34.4 +/- 1.1). The incidence of A23187-inducible acrosome reaction was also significantly (P < 0.001) lower when the incubation was performed with PF from endometriosis patients (13.1 +/- 2.8 and 13.1 +/- 2.4) when compared with that from the control group (21.8 +/- 2.6 and 21.6 +/- 1.5). No relationship was found between the stage of endometriosis and the incidence of acrosome loss. In conclusion, the PF fromendometriosis patients decreased both spontaneous and stimulus-induced acrosome reaction. This may represent a mechanism for the detrimental effect of the PF from endometriosis patients on the spermatozoa-oocyte interaction and partially explain the aetiology of infertility in patients withendometriosis.

Acta Eur Fertil. 1995 Mar-Apr;26(2):75-9. Fiçicioğlu C1, Tekin HI, Arioğlu PF, Okar I. Abstract OBJECTIVE:  The aim of this study was to investigate whether fluoxetine given to castrated and noncastrated rats caused hyperprolactinemia and its effects with respect to adenomyosis. DESIGN:  Fluoxetine, a serotonin reuptake inhibitor, was given to Wistar Albino rats for 98 days to produce hyperprolactinemia. The drug was given to two groups consisting of castrated and noncastrated rats and compared to two groups of castrated and noncastrated controls. Prolactin levels were measured and the uteri of the rats were removed for histopathological analysis at the end of 98 days. SETTING:  Marmara University School of Medicine, Department of Histology and Embryology, Zeynep Kamil Women and Children's Hospital. MAIN OUTCOME MEASURES:  Serum prolactin levels, uterine histopathology. RESULTS:  The prolactin levels of castrated and noncastrated groups treated with fluoxetine were statistically significantly higher when compared to their respective control groups. Histological studies revealed 11 cases of adenomyosis, all within the noncastrated group receiving fluoxetine. CONCLUSION:  It was suggested that high serum prolactin levels cause degeneration of myometrial cells in the presence of ovarian steroids that results in a myometrial invasion by endometrial stroma. This invasion eventually progresses to adenomyosis.

1995;40(4):261-4 Uğur M1, Turan C, Mungan T, Kuşçu E, Senöz S, Ağiş HT, Gökmen O. Abstract There have been many theories proposed regarding etiology and pathogenesis of endometriosis. The theories of retrograde menstruation, celomic metaplasia, and müllerian remnants are among these. In order to find out whether a higher prevalence exists in patients with müllerian anomalies and to test these theories, we reviewed the case records of our reproductive endocrinology clinic set up between 1989 and 1994. The study group included patients with müllerian anomalies (n =186) whereas the control group consisted of patients without müllerian anomalies (n = 3,240). The frequency of endometriosis was 37 of 186 (19.8%) in the study group as compared with 619 of 3,240 (19.1%) in the controls (p > 0.05). In 1 patient without functioning endometrium endometriosis was demonstrated. Obstructive anomalies were associated more with endometriosis as compared with nonobstructive anomalies (p < 0.001). The nonobstructive anomalies did not present a higher prevalence as compared with controls (p > 0.05). These results show that endometriosis is not more frequent in patients with müllerian anomalies as a whole, but outflow obstruction is an important contributing factor. Evaluating patients with müllerian anomalies contributes proof in favor of the theories of retrograde menstruation and celomic metaplasia, but against a possible relation of a developmental defect of differentiation or migration of the müllerian duct system during embryogenesis.

J Am Assoc Gynecol Laparosc. 1994 Aug;1(4, Part 2):S13. Gurgan T1, Urman B, Yarali H, Aksu T, Kisnisci HA. Abstract Despite widespread use of operative laparoscopy for removal of endometriomata, there are inadequate data regarding subsequent adhesion formation. We performed second look laparoscopy (SLL) within 6 months of laparoscopic endometriosis cystectomy in 21 infertile women. Mean age and mean duration of infertility were 30.5 &plusmn; 4.4 and 7.1 &plusmn; 4.9 years respectively. Cysts were removed with the following technique: incision of the ovarian cortex, cystoscopy (biopsy when necessary), and total stripping of the cyst capsule. All patients received postoperative suppressive therapy for 3 months. Total AFS score decreased significantly in all patients (34.1 &plusmn; 14.7 vs 12.3 &plusmn; 10.7; P<0.001). The adhesion score assessed at SLL improved in 3 (14.3%) remained the same in 13 (61.9%) and worsened in 5 (23.8%). Mean adhesion score at SLL was significantly less compared with adhesion score during cystectomy (7.1 &plusmn; 5.2 vs 8.7 &plusmn; 6.4; P=0.038). None of the patients had de novo adhesions. Adhesion scores were similar in women where ovarian cortical defect was left open or suture closed. Of the 21 women, 4 (19%) conceived within six months of SLL. In conclusion, laparoscopic removal of ovarian endometriomata was not associated with increased adhesion formation at SLL. Adhesions at SLL were mainly dependent upon adhesions at laparoscopic cystectomy.

Gynecol Obstet Invest. 1994;38(4):249-52. Cetin T1, Vardar MA, Demir C, Burgut R. Abstract Fifty-six patients with pelvic endometriosis were treated with a buserelin dosage of 200 micrograms/day s.c. for 6 months. Scoring of the American Fertility Society (AFS) for endometriosis was performed by laparoscopy in all cases before and at the end of therapy. Serum CA-125 and estradiol levels were determined before the treatment, and monthly during therapy and follow-up (6 months; respectively). A slight positive correlation was found between serum CA-125 concentrations before treatment and AFS scores for adhesions only. Before treatment, serum CA-125 values also correlated slightly with total AFS scores of patients with adhesions. At the end of the 6-month therapy, no correlation was found between CA-125 concentrations and second-look AFS scores for implants and/or adhesions. Serum CA-125 and estradiol values were closely parallel to each other during and after therapy with the gonadotrophin-releasing hormone agonist buserelin. In conclusion, (1) adhesions may play a role in the elevation of serum CA-125 levels in endometriosis, and (2) a significant decrease in serum CA-125 values during the buserelin therapy may result from a rather different mechanism, such as ovarian suppression, other than the therapeutic effect of this agent.

Gynecol Obstet Invest. 1990;30(2):105-8. Gürgan T1, Kişnişçi H, Yarali H, Aksu T, Zeyneloğlu H, Develioğlu O. Abstract Serum and peritoneal fluid (PF) CA-125 levels were assayed using the immunoradiometric assay in 17 women with minimal endometriosis and 21 control women at the time of laparoscopy. Serum levels of CA-125 were not significantly higher in women with minimal endometriosis. Minimalendometriosis was diagnosed with a 70.6% rate of sensitivity and a 71.4% rate of specificity with 16 U/ml as the upper limit of normal. PF CA-125 levels were significantly higher than serum levels but showed no significant difference between control and endometriosis patients.