Endometriosis with its estimated incidence rate of ∼7-10% of women of reproductive age is a disease with the wide spectrum of symptoms depending on form and localization of endometrial foci. One clinical form of endometriosis is deep infiltrating endometriosis (DIE), most difficult to manage and generating a lot of direct and indirect treatment costs. We search the literature from PubMed database to establish the role of conservative treatment of DIE. Randomised controlled trials are lacking but in experts opinion hormonal treatment should be the first-line treatment in DIE. After evaluation of pain or other symptoms, second-line therapy with GnRH analogs or danazol should be offered or minimally invasive surgery. Consensus is not made whether surgery is the best therapeutic treatment for affected patients. Strong depending on surgeon's experience conservative surgery should be offered if the total excision of DIE foci is possible, which is essential for a successful outcome. If available treatment options do not release pain associated with DIE, experimental treatment in clinical trials should be discussed with patients.
Endometrium pacjentek z endometriozą charakteryzuje się inną ekspresją cytokin, czynników angiogennych i hormonalnych niż u kobiet zdrowych. Endometrioza występuje głównie u kobiet w wieku reprodukcyjnym, z częstością około 7-10%. Mimo wielu badań i hipotez dotyczących patogenezy nie wykryto dotychczas swoistego markera dla endometriozy. Złotym standardem diagnostycznym, zwłaszcza w przypadku postaci otrzewnowej, której nie udaje się uwidocznić w badaniu ultrasonograficznym, pozostaje laparoskopia. Inne formy endometriozy-jajnikową (torbiele czekoladowe) i głęboko naciekającą-można rozpoznać w badaniu ultrasonograficznym. Obecnie poszukuje się markerów, które w określonej kombinacji zapewniłyby maksymalną czułość i swoistość nieinwazyjnego wykrywania endometriozy, nawet we wczesnych stadiach. Czułość oznaczeń wykonywanych z krwi nie jest niestety satysfakcjonująca w odniesieniu do otrzewnowej postaci choroby. W artykule zaprezentowano potencjalne cele diagnostyczne-wybrane czynniki wykrywane w endometrium, czyli interleukinę 8, czynnik wzrostu śródbłonka naczyniowego, płytkopochodny czynnik wzrostu i czynnik wzrostu nerwów. Pobranie endometrium do badań jest łatwe i może być wykonywane ambulatoryjnie. Diagnozowanie z poziomu endometrium ułatwiłoby rozpoznawanie endometriozy i znacząco zmniejszyło koszty związane z koniecznością przeprowadzania laparoskopii.
Endometriosis is defined as the presence of viable endometrial glands and stroma outside of the uterus. Endometrial foci may give rise to malignant tumours, it is estimated at 0,7-1,0%. Women with endometriosis have a two-to threefold increase in absolute risk of developing epithelial ovarian cancer, especially clear cell and endometrioid subtypes, seromucinous tumours known as endometriosis-associated ovarian carcinoma (EAOC). We present a case of 44 years old patient hospitalised in case of surgical treatment of ovarian cancer at the I Department of Gynecology and Obstetrics. During medical interview the patient reported short menstrual cycles, periodic abdominal pain and infertility, diagnosis of endometriosis has never been confirmed. The result of CA 125 was elevated (156.0 U/ml). Furthermore, during ultrasound, an ovarian mass sized 6 cm was detected and hypoechogenic infiltration with rich vascularisation was recognised in the middle of the cervix. Cytology of the cervix which was performed in Clinic-without abnormalities. During the operation a full oncological protocol for ovarian cancer was performed-in the intraoperative histopathological examination: malignant lesion. After the excision of the uterus the infiltration was confirmed, the iliac lymph nodes were collected on both sides. In diagnostic material ovarian cancer endometrioid subtypes was diagnosed, additionally endometrioma was described in which probably cancer progression had occurred. What's more synchronous endometrial cancer of an identical structure to ovarian tumour was diagnosed. There is potential correlation between occurrence of endometriosis and risk of developing malignant tumours. CA 125 antigen can help as an alert marker and prognostic factor. We should seek to eliminate the risk factors for ovarian and endometrial cancer in patients with diagnosed endometriosis, they should be under permanent gynecological care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.