To conduct a systematic review of the literature on patients with extrapelvic deep endometriosis. Data Sources: A thorough search of the PubMed/Medline, Embase, and Cochrane databases was performed. Methods of Study Selection: Studies in the last 20 years that reported on primary extrapelvic endometriosis were included (PROSPERO registration number CRD42019125370). Tabulation, Integration, and Results: The initial search identified 5465 articles, and 179 articles, mostly case reports and series, were included. A total of 230 parietal (PE), 43 visceral (VE), 628 thoracic (TE), 6 central nerve system, 12 extrapelvic muscle or nerve, and 1 nasal endometriosis articles were identified. Abdominal endometriosis was divided into PE and VE. PE lesions involved primary lesions of the abdominal wall, groin, and perineum. When present, symptoms included a palpable mass (99%), cyclic pain (71%) and cyclic bleeding (48%). Preoperative clinical suspicion was low, the use of tissue diagnosis was indeterminate (25%), and a few (8%) malignancies were suspected. Surgical treatment for PE included wide local excision (97%), with 5% recurrence and no complications. Patients with VE involving abdominal organs − kidneys, liver, pancreas, and biliary tract − were treated surgically (86%) with both conservative (51%) and radical resection (49%), with 15% recurrence and 2 major complications reported. In patients with TE involving the diaphragm, pleura, and lung, isolated and concomitant lesions occurred and favored the right side (80%). Patients with TE presented with the triad of catamenial pain, pneumothorax, and hemoptysis. Thoracoscopy with resection followed by pleurodesis was the most common procedure performed, with 29% recurrence. Adjuvant medical therapy with gonadotropin-releasing hormone was administered in 15% of cases. Preoperative magnetic resonance imaging was performed in all cases of nonthoracic and nonabdominal endometriosis. Common symptoms were paresthesia and cyclic pain with radiation. Surgical resection was reported in 84%, with improvement of symptoms. Conclusion: Extrapelvic endometriosis, traditionally thought to be rare, has been reported in a considerable number of cases. Heightened awareness and clinical suspicion of the disease and a multidisciplinary approach are recommended to achieve a prompt diagnosis and optimize patient outcomes. Currently, there are no comparative studies to provide recommendations regarding optimal diagnostic methods, treatment options, and outcomes for endometriosis involving extrapelvic sites.

Oxidative stress plays an important role in the pathogenesis and progression of endometriosis.

Problem To evaluate CD4+CD25highFoxp3+ cells and IL‐6, IL‐10, IL‐17, and TGF‐β in the peritoneal fluid of women with endometriosis. Method of study A total of ninety‐eight patients were studied: endometriosis (n = 70) and control (n = 28). First, peritoneal fluid lymphocytes were isolated, and CD4+CD25high cells were identified using flow cytometry. Then, RT‐PCR was performed to verify Foxp3 expression in these cells. Also, IL‐6, IL‐10, IL‐17, and TGF‐β concentration was determined. Results Of all the lymphocytes in the peritoneal fluid of women with endometriosis, 36.5% (median) were CD4+CD25high compared to only 1.15% (median) in the control group (P < 0.001). Foxp3 expression was similarly elevated in patients with the disease compared to those without (median, 50 versus 5; P < 0.001). IL‐6 and TGF‐β were higher in endometriosis group (IL‐6: 327.5 pg/mL versus 195.5 pg/mL; TGF‐β: 340 pg/mL versus 171.5 pg/mL; both P < 0.001). IL‐10 and IL‐17 showed no significant differences between the two groups. Conclusion The peritoneal fluid of patients with endometriosis had a higher percentage of CD4+CD25highFoxp3+ cells and also higher levels of IL‐6 and TGF‐β compared to women without the disease. These findings suggest that CD4+CD25highFoxp3+ cells may play a role in the pathogenesis of endometriosis.

Endometriosis negatively affects QoL. A consensus must be reached as to which QoL instrument should be used to make studies comparable.

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Lung transplantation is a well-established treatment for patients with advanced lung disease. The evaluation of a candidate for transplantation is a complex task and involves a multidisciplinary team that follows the patient beyond the postoperative period. Currently, the mean time on the waiting list for lung transplantation in the state of São Paulo, Brazil, is approximately 18 months. For Brazil as a whole, data from the Brazilian Organ Transplant Association show that, in 2014, there were 67 lung transplants and 204 patients on the waiting list for lung transplantation. Lung transplantation is most often indicated in cases of COPD, cystic fibrosis, interstitial lung disease, non-cystic fibrosis bronchiectasis, and pulmonary hypertension. This comprehensive review aimed to address the major aspects of lung transplantation: indications, contraindications, evaluation of transplant candidates, evaluation of donor candidates, management of transplant recipients, and major complications. To that end, we based our research on the International Society for Heart and Lung Transplantation guidelines and on the protocols used by our Lung Transplant Group in the city of São Paulo, Brazil.

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