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

Abstract

Introduction: Endometriosis is a female disease that affects 5–10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation. Objective: The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique. Patients and Methods: We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020. Results: During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy (p = 0.03). Conclusions: We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.

Catamenial pneumothorax: a rare condition

“…First reported in 1958, CP is a rare recurrent entity (incidence around 1 case per 100,000 inhabitants and year). CP affects females in childbearing age; it associates with endometriosis and can be controlled by hormone therapy or surgery [1][2][3][4][5][6][7][8][9][10] . While CP occurs between 24 h before and 72 h after the onset of the menses, the pneumothorax occurring out of the menstrual period in patients with pelvic or thoracic endometriosis is named endometriosis-related non-catamenial pneumothorax (ER non-CP).…”

“…A 43-year-old patient with recurrent right-sided chest pain and dyspnea by CP presented pleural effusion, ascites, and left ovarian cyst; thoracoscopy showed hemorrhagic pleural fluid, cysts, nodules and gunshot lesions due to pleural endometriosis 2 . She underwent hysterectomy and salpingo-oophorectomy with confirmed endometriosis in the ovary 3 .…”

“…In Martinique, 479 cases of pneumothorax from January 2004 to 31 December 2020 were reviewed; 44% of the 212 cases in women were CP, while thoracic endometriosis syndrome (TES) was confirmed in 71 cases including 49 pneumothorax, 14 hemopneumothorax and 8 hemothorax; the incidence of TES was 1.1 cases/100,000 inhabitants/year; mean age at CP diagnosis was 36 ± 6 years, 32 had prior abdominopelvic surgery 2 . Among 71 patients with TES, 69 underwent surgery, 44 (62%) had recurrences in a mean time of 20 ± 33 months; the rates were 84.2% in exclusive medical therapy, 64.7% in only surgery, and 51.8% in patients treated by surgery and medical therapy 2 .…”