Dynamics of thoracic endometriosis in the pleural cavity

Abstract

Background Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis. Methods In total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively. Results The cohort median age was 41 (range 22–53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6–1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively. Conclusions Visceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence.

Diaphragmatic Endometriosis—A Single-Center Retrospective Analysis of the Patients’ Demographics, Symptomatology, and Long-Term Treatment Outcomes

“…Diaphragmatic endometriosis as visualized by laparoscopy was present in 89% of patients with catamenial pneumothorax [21], which is supposed to be a direct sign of the thoracic endometriosis syndrome. It should be noted that diaphragmatic pleural involvement was noted in 100% of patients with thoracic endometriosis [40]. Wetzel et al [24] reported better treatment outcomes in patients who received Video-Assisted Thoracoscopy (VATs).…”

Thoracic Endometriosis Syndrome (TES) in Martinique, a French West Indies Island

“…They reported 11,599 women (13-53 years), of whom 4501 (38%) were referred for surgery, but only 813 with catamenial pneumothorax, and an annual person-base incidence of 0.22/100,000 population, despite their female specific peak around 40 years. Nevertheless, Ochi et al [28] published a histopathological study collected from a single-center cohort in Tokyo. Among 435 women (15-55 years) operated on for SP, they diagnosed 160 (38%) with proven TES, which is similar to Alifano's findings.…”

“…The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/jcm12175578/s1, Table S1: Estimated annual incidence of SP and TES in France, England and Japan. References [19,[25][26][27][28] are cited in Supplementary Materials.…”