Magnetic Resonance Imaging and Endometriosis: Deeply Infiltrating Endometriosis Does Not Originate from the Rectovaginal Septum

Chapron, Charles; Liaras, Etienne; Fayet, P; Hoeffel, Christine; Fauconnier, Arnaud; Vieira, Marco; Barakat, Habib; Dousset, B.; Legmann, P.; Bonnin, A; Dubuisson, Jean

doi:10.1159/000064562

Cited by 62 publications

(32 citation statements)

References 18 publications

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“…Firstly, in rectovaginal endometriotic nodules (rectovaginal ‘septum’ endometriosis is a very rare condition [31]), we previously demonstrated that in patients with a high pain score, most of the endometriotic lesions showed perineurial invasion or endoneurial invasion by endometriotic stromal cells [5]. Peri- and intraneural invasions by benign or malignant cells represent nerve lesions and are mainly observed in very painful conditions such as chronic pancreatitis, pancreatic carcinoma or in adenoid cystic carcinoma of the Bartholin gland [32].…”

Section: Discussionmentioning

confidence: 99%

Increased Nerve Density in Deep Infiltrating Endometriotic Nodules

Anaf¹,

Nakadi

Moor

et al. 2010

Gynecol Obstet Invest

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Background/Aims: Deep infiltrating endometriosis is a very painful condition and the mechanism of pain is still poorly understood. Pain and hyperalgesia can partly be explained by an increased number of nerve structures in the painful lesion. In order to clarify this issue, we assessed the nerve density in deep infiltrating endometriotic nodules of the posterior vagina and in the adjacent healthy vaginal tissue of the same patient. Methods: A prospective clinical and pathological study of 31 cases of deep infiltrating vaginal endometriotic nodules was conducted. Fifteen patients were in the proliferative phase and 16 in the secretory phase. The nerve density was studied by immunohistochemistry with the monoclonal antibody NF against neurofilaments in deep infiltrating endometriosis and in the adjacent unaffected vaginal tissue in the proliferative and in the secretory phases. Neurofilaments constitute the main structural elements of neuronal axons and dendrites. Results: The nerve density was significantly different in the endometriotic nodule than in the adjacent unaffected vaginal tissue (p = 0.0013). The same significant difference was found between endometriotic nodules and the unaffected vagina in the proliferative phase (p = 0.009) and in the secretory phase (p = 0.04). This difference was not significant between the proliferative and the secretory phases in the endometriotic lesions and in the controls. Conclusions: We hypothesize that the significantly increased number of nerve structures in the endometriotic nodules may contribute to the occurrence of severe and neuropathic pain that characterizes these lesions

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Section: Discussionmentioning

confidence: 99%

Increased Nerve Density in Deep Infiltrating Endometriotic Nodules

Anaf¹,

Nakadi

Moor

et al. 2010

Gynecol Obstet Invest

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“…However, the vast majority of these fibrotic plaques are found in the retrocervical area [16][17][18] . The rectovaginal septum is located caudally with respect to the posterior vaginal fornix and, based on normal anatomy, may not be the real site of deep nodular endometriosis.…”

Section: Pathogenesismentioning

confidence: 99%

“…Transvaginal and transrectal ultrasonography as well as MRI have been proposed to define the limits and degree of infiltration of these lesions [18,[35][36][37][38] . Bazot et al [39] reported an extremely high overall accuracy of transvaginal sonography in the diagnosis of rectosigmoid endometriosis in 30 patients.…”

Section: Diagnosismentioning

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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“…Torus uterinus is anatomically defined as a small, transverse thickening that binds the insertion of both uterosacral ligaments at the posterior uterus and is therefore treated together with lesion of the uterosacral ligaments [11]. Vaginal endometriosis belongs to posterior endometriosis and is located either in the upper portion of the posterior vaginal wall, the rectovaginal pouch, or the posterior vaginal fornix [12]. Ureteral endometriosis and bowel endometriosis (with invasion of the muscularis propria) are less frequent locations of posterior endometriosis (Table 1).…”

Section: Anatomic Location and Distribution Of Endometriosismentioning

confidence: 99%

Diagnosis of endometriosis with imaging: a review

et al. 2005

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Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed.

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Magnetic Resonance Imaging and Endometriosis: Deeply Infiltrating Endometriosis Does Not Originate from the Rectovaginal Septum

Cited by 62 publications

References 18 publications

Increased Nerve Density in Deep Infiltrating Endometriotic Nodules

Increased Nerve Density in Deep Infiltrating Endometriotic Nodules

Surgery for Deep Endometriosis: A Pathogenesis-Oriented Approach

Diagnosis of endometriosis with imaging: a review

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