The Pains of Endometriosis

Berkley, Karen J.; Rapkin, Andrea J.; Papka, Raymond E.

doi:10.1126/science.1111445

Cited by 411 publications

(277 citation statements)

References 18 publications

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“…Endometriosis is still found in 2-50% of asymptomatic women [4], confirming that the scientific research in this field remains a priority. The three most commonly suggested mechanisms for pain in endometriosis are the production of chemokines (growth factors and cytokines), the direct and indirect effects of active bleeding from endometriotic implants, and the irritation or direct invasion of pelvic floor nerves by infiltrating endometriotic lesions [10]. Central sensitization is also a mechanism involved in the pain process in patients with endometriosis.…”

Section: Discussionmentioning

confidence: 99%

Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study

et al. 2018

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Background: Forty percent of exploratory laparoscopies are performed for chronic pelvic pain (CPP). However, a final diagnosis is still unreported in 35% of the patients. We decided to evaluate the identification of pathological lesions and the improvement of painful symptoms in patients with CPP and normal physical examination and imaging and who are scheduled for exploratory laparoscopy. The prospective study was designed in a tertiary referral center for endometriosis. Forty-eight patients complaining of CPP and scheduled for exploratory laparoscopy were included. Pelvic pain intensity was assessed using the visual analogue pain scale (VAS), and at inclusion, negative clinical and imaging assessments were required. During exploratory laparoscopy, the recognized lesions were reported and different surgical treatment options were performed depending on the location of the lesion. Results: In 98% of the cases, exploratory laparoscopy demonstrated the presence of pelvic anomalies that had not been diagnosed at the time of clinical and imaging examination. After surgery, a significant improvement of CPP has been demonstrated in 24 (59%) patients with VAS < 5 postoperatively. Conclusions: Exploratory laparoscopy is reasonable in patients complaining of CPP, allowing a final diagnosis in a high percentage of patients and a significant improvement in pain symptom in 59% of the cases. This study was retrospectively registered by our local Ethics Committee on February 7, 2018 (B412201835729).

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Section: Discussionmentioning

confidence: 99%

Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study

et al. 2018

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“…Endometriosis is a common disease, characterized by the persistence and growth of vascularized endometrial tissue at ectopic sites, typically the pelvis, and associated with pelvic pain and infertility. [1][2][3] Endometriotic lesions possibly originate from shed endometrial tissue that reaches the abdominal cavity via the Fallopian tubes during menstruation. 4 This process, referred to as retrograde menstruation, occurs in most women during the fertile years.…”

mentioning

confidence: 99%

Macrophages Are Alternatively Activated in Patients with Endometriosis and Required for Growth and Vascularization of Lesions in a Mouse Model of Disease

Bacci

Capobianco

Monno

et al. 2009

The American Journal of Pathology

344

348

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The mechanisms that sustain endometrial tissues at ectopic sites in patients with endometriosis are poorly understood. Various leukocytes , including macrophages, infiltrate endometriotic lesions. In this study, we depleted mouse macrophages by means of either clodronate liposomes or monoclonal antibodies before the injection of syngeneic endometrial tissue. In the absence of macrophages, tissue fragments adhered and implanted into the peritoneal wall, but endometriotic lesions failed to organize and develop. When we depleted macrophages after the establishment of endometriotic lesions, blood vessels failed to reach the inner layers of the lesions, which stopped growing. Macrophages from patients with endometriosis and experimental mice, but not nonendometriotic patients who underwent surgery for uterine leiomyomas or control mice , expressed markers of alternative activation. These markers included high levels of scavenger receptors, CD163 and CD206, which are involved in both the scavenging of hemoglobin with iron transfer into macrophages and the silent clearance of inflammatory molecules. Macrophages in both inflammatory liquid and ectopic lesions were equally polarized, suggesting a critical role of environmental cues in the peritoneal cavity.Adoptively transferred, alternatively activated macrophages dramatically enhanced endometriotic lesion growth in mice. Inflammatory macrophages effectively protected mice from endometriosis. Therefore, endogenous macrophages involved in tissue remodeling appear as players in the natural history of endometriosis, required for effective vascularization and ectopic lesion growth.

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“…3 It causes pelvic pain, severe dysmenorrhea (painful periods) and subfertility. 4 The disease is defined by the presence of endometrial-like epithelium and stroma in the extra-uterine sites, most commonly the ovaries and peritoneum. The main pathological processes associated with endometriosis are peritoneal inflammation and fibrosis, and the formation of adhesions and endometriomas (benign ovarian cysts).…”

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confidence: 99%

Molecular genetic evidence that endometriosis is a precursor of ovarian cancer

Prowse

Manek

Varma

et al. 2006

Intl Journal of Cancer

146

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Histopathology and epidemiology studies have consistently demonstrated a strong link between endometriosis and endometriosisassociated ovarian cancers (EAOCs)-in particular, the endometrioid and clear cell subtypes. However, it is still unclear whether endometriosis is a precursor to EAOCs, or whether there is an indirect link because similar factors predispose to both diseases. In order to search for evidence of clonal progression, we analyzed 10 EAOCs (endometrioid 5 4; clear cell 5 6) with coexisting endometriosis for common molecular genetic alterations in both the carcinoma and corresponding endometriosis. We used 82 microsatellite markers spanning the genome to examine loss of heterozygosity (LOH) in the coexisting carcinoma and endometriosis samples. A total of 63 LOH events were detected in the carcinoma samples; twenty two of these were also detected in the corresponding endometriosis samples. In each case, the same allele was lost in the endometriosis and cancer samples. Interestingly, no marker showed LOH in the endometriosis alone. These data provide evidence that endometriosis is a precursor to EAOCs. ' 2006 Wiley-Liss, Inc.

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The Pains of Endometriosis

Cited by 411 publications

References 18 publications

Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study

Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study

Macrophages Are Alternatively Activated in Patients with Endometriosis and Required for Growth and Vascularization of Lesions in a Mouse Model of Disease

Molecular genetic evidence that endometriosis is a precursor of ovarian cancer

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