Endometriosis represents a major medical concern in women of reproductive age. One of the major hurdles in successful treatment of endometriosis that remains is the limitation in the process of timely disease diagnosis. A simple blood test for endometriosis-specific biomarkers would offer a timelier, accurate diagnosis for the disease allowing earlier treatment intervention. While there have been considerable efforts to identify such biomarkers, no clear choice for such non-invasive diagnostic tools have been identified. MicroRNAs are small non-coding RNAs which have been intensively evaluated as biomarkers for several diseases and may hold promise for endometriosis diagnosis. In this review, we highlight the need for non-invasive testing for endometriosis, discuss the potential use of miRNAs as diagnostic tools for this disease, and consider potential limitations in the use of these small RNA molecules as diagnostic markers for endometriosis.

Uterine fibroids (UFs) are benign smooth muscle neoplasms affecting up to 70% of reproductive age women. Treatment of symptomatic UFs places a significant economic burden on the US health-care system. Several specific genetic abnormalities have been described as etiologic factors of UFs, suggesting that a low DNA damage repair capacity may be involved in the formation of UF. In this study, we used human fibroid and adjacent myometrial tissues, as well as an in vitro cell culture model, to evaluate the expression of MutS homolog 2 (MSH2), which encodes a protein belongs to the mismatch repair system. In addition, we deciphered the mechanism by which polycomb repressive complex 2 protein, EZH2, deregulates MSH2 in UFs. The RNA expression analysis demonstrated the deregulation of MSH2 expression in UF tissues in comparison to its adjacent myometrium. Notably, protein levels of MSH2 were upregulated in 90% of fibroid tissues (9 of 10) as compared to matched adjacent myometrial tissues. Human fibroid primary cells treated with 3-deazaneplanocin A (DZNep), chemical inhibitor of EZH2, exhibited a significant increase in MSH2 expression (P < .05). Overexpression of EZH2 using an adenoviral vector approach significantly downregulated the expression of MSH2 (P < .05). Chromatin immunoprecipitation assay demonstrated that enrichment of H3K27me3 in promoter regions of MSH2 was significantly decreased in DZNep-treated fibroid cells as compared to vehicle control. These data suggest that EZH2-H3K27me3 regulatory mechanism dynamically changes the expression levels of DNA mismatch repair gene MSH2, through epigenetic mark H3K27me3. MSH2 may be considered as a marker for early detection of UFs.

Endometriosis continues to be a major primary gynecologic etiology of chronic pelvic pain. The symptom profile, which includes cyclic pelvic pain, dysmenorrhea, and dyspareunia or dyschezia, is nonspecific and does not correlate with the extent or severity of disease. Trans-vaginal or trans-rectal ultrasound, as well as magnetic resonance imaging, can help visualize endometriomas and deeply infiltrating endometriosis. Additionally, there have been no serum marker tests available so far. However, even intraoperatively, the diagnosis may be missed, leading to under diagnosis and delayed or noninitiation of treatment. There are thought to be three distinct endometriotic lesions of the pelvis that are seen laparoscopically. The first is that which is visible on the pelvic peritoneal surface or the surface of the ovary, which is commonly termed peritoneal endometriosis. Second, endometriotic lesions that occur within the ovary and form cysts that are often lined with endometrioid mucosa are termed endometriomas. Lastly, rectovaginal endometriomas are endometriotic lesions that contain a mixture of adipose and fibrous tissue located between the rectum and vagina. All of these lesions can be singular or multiple and the pelvis may contain one or all three types of lesions. The shared histologic feature with all three lesions is the presence of endometrial epithelial cells or endometrial stroma. During a diagnostic procedure, the da-Vinci robot and its firefly mode allow for three dimensional visualization and seven degrees of instrument articulation for meticulous dissection of fibrotic areas of peritoneum that may contain deep infiltrating lesions of endometriosis. This case report describes a relatively new and innovative technique for effectively diagnosing and successfully treating endometriosis when other less invasive methods have failed.

The benefits of laparoscopic surgery over conventional abdominal surgery have been well documented. Reducing postoperative pain, decreasing postoperative morbidity, hospital stay duration, and postoperative recovery time have all been demonstrated in recent peer-review literature. Robotic laparoscopy provides the added dimension of increased fine mobility and surgical control. With new single port surgical techniques, we have the added benefit of minimally invasive surgery and greater patient aesthetic satisfaction, as well as all the other benefits laparoscopic surgery offers. In this paper, we report a successful single port robotic hysterectomy and the simple process by which this technique is performed.

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dysfunctional venous valves, retrograde blood flow, and progressive venous dilation in susceptible females (3). The true prevalence of PCS is unclear as it is a frequently overlooked diagnosis (4). However, it is a syndrome that cannot be diagnosed by imaging alone as many women will have pelvic vein varicosities without the accompanying pelvic pain to create the syndrome (5, 6). From case series reports, it is believed that women with PCS are typically multiparous and still in their child-bearing years. It is well known that ovarian veins increase in size after pregnancy, which suggests that PCS may be unusual in nulliparous women. Other risk factors include hormonal fluxes, polycystic ovarian syndrome, and the presence of varicose veins in the vulva, buttocks, thighs, or legs. Soysal et al (7), after an extensive work-up of symptomatic women, found that 31% of patients with chronic pelvic pain had PCS as the sole cause of their pain. Symptoms of PCS include a dull ache or pain typically in the pelvis or less commonly in the back, dyspareunia, irritable bladder, dysmenorrhea, vaginal discharge, and sometimes gastrointestinal

Cystic lesions located in the paravaginal region are rare. When present, paravaginal cysts are typically benign and are incidentally found on routine gynecological exams; however, rarely they can be malignant. Treatment options for paravaginal cancers are not well studied and early diagnosis may help improve prognosis in these patients. Our case describes a 55-year-old female with a recurrent paravaginal cyst that was remarkable for serous papillary adenocarcinoma despite biopsy and fluid cytology negative for malignancy. This case demonstrates that malignancy should be considered highly with a recurrent paravaginal cyst, especially when present over a short interval.