Thoracic Endometriosis presented as catamental hemoptysis: Fourteen Cases of a Rare Disease and the hormonal treatment management

Abstract

Background: Thoracic endometriosis syndrome (TES) is a rare disease in which a functioning endometrial tissue is observed in the pleura, lung parenchyma, airways, or diaphragm. The optimal management of this disease remains a matter of debate Methods: Retrospective study in one university based tertiary care hospital between 1997 to 2017. 14 women presented as CH diagnosed with thoracic endometriosis were included. The main outcome of measure was cessation or recurrence of the clinical manifestations of thoracic endometriosis. Baseline parameters were presented using descriptive statistics. For categorical variables, Pearson’s chi-square tests or Fisher’s exact tests was used as appropriate to describe the characteristic of thoracic endometriosis presented as CH, and the long-term prognosis after hormonal treatment. Results : The mean onset age of the 14 patients was 30.21±5.40 years. Catamenial hemoptysis (CH) was characteristic symptom of these patients, and most of patients (13/14, 92.9%) had regular menstruation and only 42.9% (6/14) of the patients complained of different degrees of dysmenorrhea. All patients underwent chest computed tomography (CT) scan during menstruation and 2 or 3 weeks after menstruation, which showed the obvious shrinking or disappearance of the lesions. No active bleeding on bronchial mucosa were observed in patients with CH, and the bronchoalveolar lavage (BAL) did not find the typical abnormality. All of patients were given GnRH-a for 3 to 6 months, eleven of them were administered with COCs cyclically after GnRH-a. All patients were followed up and the median follow-up duration was 24 months. Hemoptysis recurrence was observed in one patient. Conclusion: CH is a rare clinical entity of thoracic endometriosis, which has the typical cyclic manifestation with menstruation. The change of CT images during and after menstruation or the response to GnRHa were helpful for accurate diagnosis. Hormonal treatment with GnRH-a followed by COCs cyclically could be employed as a choice of therapy for efficient management of thoracic endometriosis.

Clinical Manifestations of Endometriosis in the Respiratory System - Available Diagnostic Methods

“…The presence of intrathoracic endometrial implants has not fully been explained. In many studies three main theories to explain occurrence of thoracic endometriosis are distinguished [18]. First is the theory of coelomic metaplasia, where pleural and peritoneal structures share a common mesothelial origin as endometrial tissue.…”

Associação entre os sintomas e a topografia das lesões da endometriose pélvica

“…Dois autores observaram relação entre lesões vaginais e dispareunia e profundidade(52,59). Em 1996, Vercellini et al(52) encontraram uma associação entre lesões vaginais e maior chance de dispareunia de profundidade (OR=2,55; IC 95% 1,21 -5,39).…”

“…Em 1996, Vercellini et al(52) encontraram uma associação entre lesões vaginais e maior chance de dispareunia de profundidade (OR=2,55; IC 95% 1,21 -5,39). Dai et al(59), em 2010, compararam os sintomas de pacientes com endometriose de compartimento posterior (n=176) e sem endometriose nesse compartimento (n=179) diagnosticadas por laparoscopia e encontraram uma maior incidência de dispareunia de profundidade naquelas com lesão de fórnice vaginal (p<0,05).Outros trabalhos associaram a presença desse sintoma com lesões de fundo de saco posterior e compartimento posterior da pelve(32,61).Vercellini et al, em 2007 (61), avaliaram uma amostra de 1.054 pacientes consecutivas que foram submetidas à cirurgia para tratamento de endometriose no período de 1996 e 2002.Os sintomas dismenorreia, dispareunia de profundidade e dor pélvica acíclica foram avaliados através de uma escala multidimensional categórica de 0 a 3 e também pela EVA de 0 a 10. Os sintomas intestinais e urinários não foram avaliados.…”

“…Mais recentemente, Montanari et al, em um trabalho retrospectivo publicado em 2019 (60), avaliaram os sintomas de 245 mulheres submetidas à cirurgia para endometriose profunda entre 2014 e 2018 através de EVA de 0 a 10 e encontraram uma associação entre lesões de ligamento uterossacro e paramétrio com dispareunia (p=0,002). O tamanho das lesões foi classificado em <1 cm, entre 1 e 3 cm e >3 cm e também foi observada uma associação entre o tamanho das lesões de ligamento uterossacro e paramétrio com a intensidade da dispareunia (p=0,046).A endometriose intestinal também tem sido frequentemente relacionada à presença de disquezia e sintomas intestinais cíclicos(31,54,59,60,62).Em 2012, Roman et al (62) realizaram estudo prospectivo comparativo entre três grupos de pacientes com endometriose: doença superficial isolada (n=21), doença profunda sem acometimento intestinal (n=42) e doença profunda com acometimento intestinal (n=53). Os sintomas intestinais foram avaliados no pré e pós-operatório através de questionários gastrointestinais padronizados e a presença de estenose intestinal foi verificada por meio de colonoscopia virtual baseada em tomografia computadorizada.…”