Ovarian endometrioma are found in up to 40% of women with endometriosis and 50% of infertile women. The best surgical approach for endometrioma and its impact on pregnancy rates is still controversial. Therefore, we conducted a literature review on surgical management of ovarian endometrioma and its impact on pregnancy rates and ovarian reserve, assessed by anti-Müllerian hormone (AMH) serum levels. Ovarian cystectomy is the preferred technique, as it is associated with lower recurrence and higher spontaneous pregnancy rate. However, ablative approaches and combined techniques are becoming more popular as ovarian reserve is less affected and there are slightly higher pregnancy rates. Preoperative AMH level might be useful to predict the occurrence of pregnancy. In conclusion, AMH should be included in the preoperative evaluation of reproductive aged women with endometriosis. The surgical options for ovarian endometrioma should be individualized. The endometrioma ablation procedure seems to be the most promising treatment.
EditorA 43-year-old woman came to our clinic with multiple painful erythematous papules and nodules of the scalp (Fig. 1). These cutaneous lesions had appeared about 6 months earlier and were resistant to many topical treatments, including corticosteroids. Routine laboratory tests including complete blood count were within normal range with a peripheral eosinophilia of 1.1%. Histological examination showed capillaries had increased in number and diameter throughout the dermis. These vessels were surrounded by moderately dense eosinophilic infiltrate. The endothelial cells were swollen and protruded into the lumen of each vessel. The diagnosis of angiolymphoid hyperplasia with eosinophilia (ALHE) was proposed. Based on the increased vascularity of this condition, we used an excited dye laser system. Our patient was treated on two separate occasions, 3 months apart, with a single pulse using a 5-mm circular spot size with 450-μ sec spot duration and 6 J/cm 2 for the first time and 6.5 J/cm 2 for the second time. The lesions flattened after the initial treatment and resolved after the second (Fig. 2). We were able to demonstrate a 70% clearance with total relief of pain. No recurrence was observed in a 1-year period of follow-up.ALHE is a rare vascular disorder of unknown pathogenesis, characterized by intradermal or subcutaneuos reddish-brown papules and/or nodules, typically occurring on the head and neck. Other cutaneous localizations have been found, including the lip, the literature, as well as pentoxifylline, cessation of oestrogen therapy, indometacin farnesyl, oral isotretinoin and intralesional interferon α 2a. 5 To date, patients undergoing laser treatment have experienced the most promising results. Pulsed dye laser with a 585-nm wavelength and a 450-μ sec pulse duration causes more specific destruction of the abnormal vessels and less scarring. Its main advantage is its selectivity in causing coagulation necrosis of blood vessels without any damage to the overlying epidermis. 6,7 In conclusion, the long-pulsed tunable dye laser seems to be the most effective treatment for ALHE. Reference 1 Zanchi M, Favot F, Bizzarini M, Piai M, Donini M, Sedona P. Botulinum toxin type-A for the treatment of inverse psoriasis.
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