Special Issue "Clinical Manifestations and Treatment of Endometriosis"

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: 1 December 2021.

Special Issue Editor

Dr. Valerio Gaetano Vellone
E-Mail Website
Guest Editor
1. Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy;
2. Anatomic Pathology University Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Interests: surgical pathology; molecular pathology; gynecologic pathology; fetal pathology; placenta; endometriosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Endometriosis represents a real social scourge all over the world.

The disease is as frequent as it is poorly recognized; the prevalence of endometriosis varies from 2% to 10% of the female population, rising to more than 50% in women with infertility. For some authors, the prevalence of active disease is around 33% in women who complain of chronic pelvic pain, while it varies from 30% to 45% in women suffering from infertility.

Numerous pathogenetic theories and hypotheses have been proposed over the decades, but there is still no unifying theory. It is believed that the onset of the disease depends not on a single factor but on a series of events including genetic predisposition, immune system abnormalities, and anatomical factors.

Unfortunately, the symptoms are often vague and nonspecific, and the patients often reach a definitive diagnosis only after years of ailments and dysfunctions.

For a such disabling disease, the establishment of multidisciplinary teams for diagnosis and treatment including various professional figures such as gynecologists, radiologists, pathologists, and general surgeons is particularly necessary for structuring individualized, effective, and better-tolerated treatment protocols.

The aim of the current Issue is to present the most recent evidence in the diagnosis and treatment of endometriosis, with a particular emphasis on the cellular and molecular pathogenesis.

Dr. Valerio Gaetano Vellone
Guest Editor

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Keywords

  • Endometriosis
  • Imaging
  • Surgery
  • Medical Treatment
  • Pathology

Published Papers (6 papers)

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Research

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Article
Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment
Medicina 2021, 57(10), 1003; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101003 - 23 Sep 2021
Viewed by 411
Abstract
Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with [...] Read more.
Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79–14.06) than the others of being identified postoperatively with more advanced lesions. Full article
(This article belongs to the Special Issue Clinical Manifestations and Treatment of Endometriosis)
Article
Analysis of the Impact of Comorbidities on Endometrial Lesions Using the Charlson Comorbidity Index in Western Romania
Medicina 2021, 57(9), 945; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57090945 - 08 Sep 2021
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Abstract
Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing [...] Read more.
Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing the patient’s probability of survival in relation to the underlying disease and the existing comorbidities. Materials and Methods: During 2015–2019, 594 cases hospitalized for vaginal bleeding outside of pregnancy were included in the research. For all cases, the frequency of comorbidities was calculated, applying the Cox proportional hazard model, considering the hospitalizations (from the following year after the first outpatient or hospital assessment) as a dependent variable; age and comorbidities were considered as independent variables. Results: Analysis of variance (ANOVA) for mean age of patients enrolled after diagnosis and multiple comparisons (via the Tukey post-hoc test) indicate significant differences (p < 0.05) between the average age for endometrial cancer (EC) and that for the typical endometrial hyperplasia or other diagnoses. The most common comorbidities were hypertension (62.28%), obesity (35.01%), and diabetes (22.89%), followed by cardiovascular disease. An intensely negative correlation (r = −0.715281634) was obtained between the percentage values of comorbidities present in EC and other endometrial lesions. The lowest chances of survival were calculated for 88 (14.81% of the total) patients over 50 years (the probability of survival in the next 10 years being between 0 and 21%). The chances of survival at 10 years are moderately negatively correlated with age (sample size = 594, r = −0.6706, p < 0.0001, 95% confidence interval (CI) for r having values from −0.7126 to −0.6238) and strongly negatively correlated with the CCI (r = −0.9359, p < 0.0001, 95% CI for r being in the range −0.9452 to −0.9251). Conclusions: Using CCI in endometrial lesions is necessary to compare the estimated risk of EC mortality with other medical conditions. Full article
(This article belongs to the Special Issue Clinical Manifestations and Treatment of Endometriosis)
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Article
Clinical and Pathological Significance of Cellular Atypia in Endometriosis
Medicina 2021, 57(5), 453; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57050453 - 07 May 2021
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Abstract
Objective: To highlight the most frequent localization of ovarian endometriosis, the presence of atypical endometriosis, and recurrences. Retrospective review of 259 patients diagnosed with ovarian endometriosis treated at Tîrgu-Mures Emergency County Hospital, Obstetric Gynecology Clinic, between January 2014 and December 2018. Methods [...] Read more.
Objective: To highlight the most frequent localization of ovarian endometriosis, the presence of atypical endometriosis, and recurrences. Retrospective review of 259 patients diagnosed with ovarian endometriosis treated at Tîrgu-Mures Emergency County Hospital, Obstetric Gynecology Clinic, between January 2014 and December 2018. Methods: Data were collected and analyzed for demographics, size of ovarian endometriotic cyst, and recurrences. Results: Out of 259 patients, 51 patients presented atypia, 20 on the right, 24 on the left, and seven patients were diagnosed with endometriosis with bilateral atypia. Higher susceptibility for left localization was noted. Thirty-nine patients (15.1%) presented recurrence. A statistically significant correlation (p = 0.006) was noted between patients with recurrence and atypia compared with those without atypia and endometriotic cysts larger than 7 cm. Patients with relapse under the age of 40 were noted to have mainly atypia with localization on the right (p = 0.025, OD = 4.107). Conclusions: The presence of endometrioma was not statistically significant correlated with left or right sided localization; recurrent endometriomas larger than 7 cm represents a risk for atypical endometriosis development. Recurrence and atypia appear more often in patients under the age of 40 and are right-sided. The total removal of the endometriomas can prevent the recurrence and subsequently the appearance of atypia and secondary neoplastic conditions. Full article
(This article belongs to the Special Issue Clinical Manifestations and Treatment of Endometriosis)
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Review

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Review
Maternal–Fetal Outcomes in Women with Endometriosis and Shared Pathogenic Mechanisms
Medicina 2021, 57(11), 1258; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111258 - 17 Nov 2021
Viewed by 167
Abstract
The connection between endometriosis and pregnancy outcomes is trending among the research topics. Until recently, endometriosis and its painful symptomatology were considered to be alleviated by pregnancy. However, these beliefs have shifted, as emerging literature has demonstrated the role of this condition in [...] Read more.
The connection between endometriosis and pregnancy outcomes is trending among the research topics. Until recently, endometriosis and its painful symptomatology were considered to be alleviated by pregnancy. However, these beliefs have shifted, as emerging literature has demonstrated the role of this condition in affecting pregnancy evolution. The underlying pathogenesis of endometriosis is still poorly understood, all the more when pregnancy complications are involved. Debatable opinions on endometriosis associated with obstetric complications exist because of the potential bias resulting from the heterogeneity of preceding evidence. This review aims to evaluate the connection between endometriosis and adverse pregnancy outcomes and their shared pathogenic mechanisms. We searched PubMed and EMBASE and focused on the studies that include placenta praevia, premature rupture of membranes, spontaneous preterm birth, gestational hypertension, preeclampsia, obstetric hemorrhages (ante- and postpartum bleeding, abruptio placentae), miscarriage, stillbirth, neonatal death, gestational diabetes mellitus, gestational cholestasis, small for gestational age, and their association with endometriosis. Not only the risks of emergence were highlighted, but also the pathogenic connections. Epigenetic alterations of some genes were found to be mirrored both in endometriosis and obstetric complications. This review issues a warning for providing increased attention to pregnant women with endometriosis and newborns as higher risks of preeclampsia, placental issues, and preterm deliveries are associated. Full article
(This article belongs to the Special Issue Clinical Manifestations and Treatment of Endometriosis)
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Other

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Case Report
A Huge Hemorrhagic Epidermoid Cyst of the Perineum with Hypoechoic Semisolid Ultrasonographic Feature Mimicking Scar Endometriosis
Medicina 2021, 57(3), 276; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030276 - 17 Mar 2021
Cited by 1 | Viewed by 443
Abstract
Epidermoid cysts are small, solitary, and slow-growing lesions that rarely appear in the perineum and mostly arise because of trauma. This study examined a huge perineal epidermoid cyst that slowly grew over eight years in a premenopausal woman. Ultrasonography showed that the hemorrhage [...] Read more.
Epidermoid cysts are small, solitary, and slow-growing lesions that rarely appear in the perineum and mostly arise because of trauma. This study examined a huge perineal epidermoid cyst that slowly grew over eight years in a premenopausal woman. Ultrasonography showed that the hemorrhage in the cyst was a semisolid hypoechoic mass, which mimicked endometrioma, and was tentatively diagnosed as scar endometriosis in the perineum after vaginal delivery. This case study highlights the importance of wide surgical excision and histopathologic diagnosis, even with typical ultrasonography and surgical findings. Full article
(This article belongs to the Special Issue Clinical Manifestations and Treatment of Endometriosis)
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Case Report
Abdominal Wall Endometriosis: Two Case Reports and Literature Review
Medicina 2020, 56(12), 727; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120727 - 21 Dec 2020
Viewed by 1503
Abstract
Background and objectives: Abdominal wall endometriosis, also known as scar endometriosis, is a rare condition that is becoming increasingly common. The recent rise in incidence is attributed primarily to the surge of cesarean births, figures that could be influenced in a positive manner [...] Read more.
Background and objectives: Abdominal wall endometriosis, also known as scar endometriosis, is a rare condition that is becoming increasingly common. The recent rise in incidence is attributed primarily to the surge of cesarean births, figures that could be influenced in a positive manner considering the improvements brought towards the ultrasound diagnostic methods that have been made in recent years. Materials and Methods: Here we report the cases of two Caucasian women of 38- (G2P2) and 36-years old (G1P1), both subjected to an ultrasound examination due to a specific symptomatic panel reported during anamnesis. Independently of the current status, in the first patient, there were no reported symptom-specific associations with endometriosis, but she had a known history of mild hereditary thrombophilia; the second woman suffered from two conditions positively associated with endometriosis. Results: In both cases, abnormal structures were revealed, with the diagnostic(s) of endometriosis being histologically confirmed based on a set of features observed during the investigation. Conclusions: This paper aims to highlight the importance of reducing cesarean births and to consider the diagnosis of scar endometriosis in women with a history of obstetric or gynaecological surgeries who present with cyclic, recurrent abdominal pain. Full article
(This article belongs to the Special Issue Clinical Manifestations and Treatment of Endometriosis)
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