Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications

Somigliana, Edgardo; Infantino, Mirco; Candiani, Massimo; Vignali, M; Chiodini, Annalisa; Busacca, Mauro; Vignali, Mario

doi:10.1093/humrep/deg513

Cited by 104 publications

(65 citation statements)

References 14 publications

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“…In the present study, an association was found between adenomyosis and deep endometriosis. It should be emphasized that it is the deep rather than the superficial endometriotic foci that resemble those found in adenomyosis [42].…”

Section: Discussionmentioning

confidence: 98%

Patients with adenomyosis are more likely to have deep endometriosis

et al. 2012

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This study seeks to analyze the association between adenomyosis diagnosed by magnetic resonance imaging (MRI) and endometriosis. This is a prospective study of consecutive patients. One hundred fifty-two patients with histologically confirmed endometriosis. Patients were submitted to MRI, then divided into Group A (with adenomyosis) and Group B (without adenomyosis). Thickness of the junctional zone and the presence of intramyometrial cysts were the principal criteria for diagnosis of adenomyosis. MRI data were correlated with clinical status, staging, sites affected, and histological classification of endometriosis. The prevalence of adenomyosis in endometriosis patients was 42.76 %. Patients with endometriosis and adenomyosis were more likely than those without adenomyosis to report severe or incapacitating dysmenorrhea (61.53 % in Group A; 44.83 % in Group B; p00.041) and deep dyspareunia (64.61 % in Group A; 41.38 % in Group B; p00.005), to have stage IV endometriosis (50.77 % in Group A; 33.34 % in Group B; p00.03), to have endometriosis of the rectosigmoid (49.23 % in Group A; 32.18 % in Group B; p00.033), and to have undifferentiated or mixed histological types of endometriosis (52.31 % in Group A; 34.48 % in Group B; p00.028). A correlation was found between adenomyosis and deep endometriosis with poorer prognosis, particularly endometriosis of the rectosigmoid.

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Section: Discussionmentioning

confidence: 98%

Patients with adenomyosis are more likely to have deep endometriosis

et al. 2012

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“…2 ). Moreover, various forms of peritoneal and ovarian disease are usually present in patients with vaginal endometriosis, suggesting that the pathogenesis may not be different [4] . This has also been confirmed by a recent epidemiologic study demonstrating that peritoneal, ovarian, rectal, and vaginal lesions share both protective and risk factors [22] .…”

Section: Pathogenesismentioning

confidence: 99%

Surgery for Deep Endometriosis: A Pathogenesis-Oriented Approach

Vercellini

Carmignani

Rubino

et al. 2009

Gynecol Obstet Invest

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Background: Deep endometriosis is usually associated with severe symptoms and constitutes a complex treatment challenge. Methods: The available evidence has been revisited with the aim of defining an effective diagnostic workup and a safe surgical strategy based on pathogenetic findings. Results: Vaginal, rectal, and bladder detrusor endometriosis appear to be caused by intraperitoneal seeding of regurgitated endometrial cells which implant in the posterior and anterior cul-de-sac and trigger an inflammatory process leading to adhesion of contiguous organs. Excision of posterior deep lesions implies removal of a fibrotic cast of the Douglas’s pouch which may involve the posterior vaginal fornix and the rectal muscular layer, with a not negligible risk of major complications. Removal of full-thickness bladder detrusor endometriosis entails excision of the bladder dome or posterior wall, generally well above the trigone. Transurethral resection is contraindicated. A radical approach to obstructive uropathy is suggested, with resection of the stenotic ureteral tract and reimplantation with antireflux vesicoureteral plasty. Conclusion: Infiltrating endometriotic lesions appear to originate intraperitoneally sharing common pathogenetic mechanisms. Involvement of the intestinal and urologic apparatuses should be identified before surgery, in order to schedule intraoperative consultation and to inform the woman about the type of intervention required and its potential sequelae.

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“…Since ovarian endometriomas are often an occasional ultra-sonographic finding it is very important to carefully evaluate the entity and the pathogenetic correlations of the associated pelvic pain before opting for a surgical indication [3,4].…”

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confidence: 99%