자궁내막증 환자의 복강액내 IGF가 자궁내막 기질세포 증식에 미치는 영향

김정구,서창석,김석현,최영민,문신용,이진용,Kim, Jung-Gu,Suh, Chang-Seok,Kim, Seok-Hyun,Choi, Young-Min,Moon, Shin-Yong,Lee, Jin-Yong 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.3

The purposes of this study were to evaluate the effects of insulin-like growth factor (IGF)s in peritoneal fluid (PF) from patients with and without endometriosis on the proliferation of endometrial stromal cells and to investigate the effects of type I IGF receptor antibody on the response of endometrial stromal cells to PF from patients with endometriosis. IGFs in PF from patients with endometriosis (n=14) and without endometriosis (n=10) were measured by immunoradiometric assay and PF samples were divided into low IGF-I PF group (less than 85 ng/ml) and high IGF-I PF group (more than 85 ng/ml). Endometrial stromal cells from patients without endometriosis were cultured in serum free media in the presence or absence of 1 % PF and thymidine incorporation test were used to evaluate the proliferation of endometrial stromal cells. Also cultures were incubated with type I IGF receptor monoclonal antibody (${\alpha}IR_3$) before adding PF. PF from patients with endometriosis and without endometriosis increased thymidine incorporation in endometrial stromal cells. In patients with endometriosis, high IGF-I PF group had high IGF-II levels and resulted in higher thymidine incorporation than low IGF-I PF group but no significant difference in increase in thymidine incorporation between high IGF-I and low IGF-I PF group was noted in patients without endometriosis. There was not a significant correlation between increase in thymidine incorporation and IGF-I levels in PF from patients without endometriosis but in PF from patients with endometriosis. Preincubation with ${\alpha}IR_3$ significantly inhibited the mitogenic response of endometrial stromal cells to PF. Our data indicate that IGF-I in PF may be involved in the growth of ectopic endometrium in patients with endometriosis.

Intestinal Endometriosis: Clinicopathologic Analysis of 15 Cases Including a Case of Endometrioid Adenocarcinoma

이희진,김규래 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.2

Background : Since many patients with intestinal endometriosis present with gastrointestinal symptoms without a history of endometriosis, endoscopic examination of the intestinal tract is initially performed, often leading to a misdiagnosis. Methods : We reviewed the clinicopathologic findings of 18 samples from 15 patients with intestinal endometriosis who underwent endoscopic biopsy and/or surgical resection to identify diagnostically helpful findings. Results : All 7 biopsy specimens displayed relatively well-defined submucosal lesions, with non-mucinous glands lined by ciliated epithelium and surrounding cellular stroma containing spiral arteriolelike blood vessels. The stroma was immunopositive for CD10 in all cases. All but one specimen exhibited immunopositivity for ER and PR in both glandular and stromal components. In contrast to the overlying normal colonic mucosa, glandular epithelium with endometriosis was immunopositive for cytokeratin (CK) 7, but immunonegative for CK20 in all cases. Three cases were associated with adenocarcinoma in the same or different segments; specifically, two primary rectal adenocarcinomas and one endometrioid adenocarcinoma arising from endometriosis. Conclusions : The characteristic features of endometrial glands and stroma, including nonmucinous glands without goblet cells, ciliated columnar epithelium, and cellular stroma with spiral arterioles, facilitate the accurate diagnosis of intestinal endometriosis, which can be confirmed by immunohistochemical staining. Background : Since many patients with intestinal endometriosis present with gastrointestinal symptoms without a history of endometriosis, endoscopic examination of the intestinal tract is initially performed, often leading to a misdiagnosis. Methods : We reviewed the clinicopathologic findings of 18 samples from 15 patients with intestinal endometriosis who underwent endoscopic biopsy and/or surgical resection to identify diagnostically helpful findings. Results : All 7 biopsy specimens displayed relatively well-defined submucosal lesions, with non-mucinous glands lined by ciliated epithelium and surrounding cellular stroma containing spiral arteriolelike blood vessels. The stroma was immunopositive for CD10 in all cases. All but one specimen exhibited immunopositivity for ER and PR in both glandular and stromal components. In contrast to the overlying normal colonic mucosa, glandular epithelium with endometriosis was immunopositive for cytokeratin (CK) 7, but immunonegative for CK20 in all cases. Three cases were associated with adenocarcinoma in the same or different segments; specifically, two primary rectal adenocarcinomas and one endometrioid adenocarcinoma arising from endometriosis. Conclusions : The characteristic features of endometrial glands and stroma, including nonmucinous glands without goblet cells, ciliated columnar epithelium, and cellular stroma with spiral arterioles, facilitate the accurate diagnosis of intestinal endometriosis, which can be confirmed by immunohistochemical staining.

자궁내막증 병변에서의 Cytokine mRNA의 발현 양상

이택후(Taek Hoo Lee),김광수(Gwang Soo Kim),김일규(Il Gyu Kim),전상식(Sang Sik Chun),조영래(Young Lae Cho) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

목적: 자궁내막증은 최근에 그 빈도가 급격하게 증가되고 있으나 아직까지 병인과 치료법이 확실하게 정립되지 못하고 있는 부인과 내분비의 대표적인 질환이다. 최근 들어서 자궁내막증 환자의 불임의 원인으로 cytokine이 밀접하게 관여됨이 밝혀지고 있고 자궁내막증의 병인으로 복강내로 역류된 월경혈에 의한 복강내의 국소적 염증에 대한 개체의 반응정도와 면역체계의 변화가 중요하게 인정되고 있으나 아직까지 정확한 기전은 밝혀져 있지 않기 때문에 이에 저자는 자궁내막증 환자의 복수 내에서의 cytokine의 정량측정과 골반내 자궁내막증 병변조직에서의 cytokine mRNA의 발현 양상을 조사하여 자궁내막증 환자의 병인분석을 시도하였다. 연구방법: 자궁내막증 진단을 받고 복강경 혹은 개복 수술을 받은 30명의 환자에서 총 60개의 자궁내막증 병변이라고 의심되는 조직을 채취하여 이를 RT-PCR법을 이용하여 Cytokine 유전자의 발현양상을 조사하였다. 또한 7례의 정상대조군과 23례의 자궁내막증 환자의 복수를 ELISA법을 이용하여 정량분석을 시도하였다. 결과: 자궁내막증 환자의 복수내에서 IL-6와 IL-10의 농도는 자궁내막증의 임상적 중증도에 따라서 의미있게 증가되어 있었으나 IFN-γ, TNF-α, IL-1β, 그리고 IL-5의 농도는 정상 대조군에 비해서 변화가 없었다. 모든 예의 심부 자궁내막증 병변조직과 표재성 자궁내막증 병변조직에서 IL-1β cytokine mRNA의 발현을 볼 수 있었다. IL-5와 IL-6은 표재성 병변 12개 중에서 각각 2개의 black lesion에서만 발현을 볼 수 있었으며 IL-10은 표재성 병변에서는 12개중 2개에서 그리고 심부성 병변에서는 8개중 1개의 조직에서만 발현되었다. IFN-γ는 표재성 병변에서는 전혀 발현이 없었으나 심부성 병변에서는 8개중 4개의 조직에서 발현이 되었으며 TNF-α는 표재성 병변에서는 red 및 black 병변에서 각각 1개의 조직에서만 발현이 되었으나 심부성 병변에서는 역시 8개중 4개의 조직에서 발현이 되었다. 결론: 표재성 병변이 골반강내에 착상하여 염증성 반응이 일어날 수 있는 원인이 제공되면 IL-1β 혹은 TNF-α같은 염증성 cytokine이 분비가 되며 이로 인해 생성되는 단핵세포의 chemotactic factor에 의해 대식세포의 증가와 활성화가 이루어지고 이어서 복강내에 IL-6 등의 cytokine이 증가되며 마지막으로 여러 가지 증가된 cytokine에 대한 반대 반응으로 IL-10이 증가됨을 추정할 수가 있겠으며 이러한 가정은 앞으로 cytokine을 이용한 치료적 응용의 기초적인 연구로서 중요한 의미를 제공할 수 있다고 하겠다. Objective: The pathogenesis of endometriosis is generally accepted that retrograde menstruation and alterations in the local pelvic immune environment. This study was performed to help elucidate what kind of role various cytokines might play in the pathogenesis of endometriosis. Method: Concentrations of peritoneal fluid cytokines were compared in 7 women with normal pelvic finding and 23 women with endometriosis by enzyme-linked immunosorbent assay(ELISA). The patterns of cytokine mRNA expression in 8 ovarian endometrioma and 12 superficial pelvic endometriosis lesions were investigated by reverse transcription-polymerase chain reaction(RT-PCR) amplification method. Result: Both IL-6 and IL-10 levels in peritoneal fluid specimens with endometriosis tended to be higher than normal. However, there were no significant differences between peritoneal fluid concentrations of IFN-γ, TNF-α, IL-1β, and IL-5 of women with and without endometriosis. The levels of IL-6 and IL-10 were significantly higher in peritoneal fluid of women with severe endometriosis compared to women with mild endometriosis. IL-1β mRNA was expressed in all of 8 deep and 12 superficial endometriosis lesions. IL-5 and IL-6 mRNA were expressed in only two black lesions respectively, however, both were not expressed in the all deep lesions. Expressions of IL-10 mRNA occurred in one red and one black lesion while this was expressed in only one of the deep lesions. TNF-α mRNA was expressed in one red and one black lesion of 12 superficial lesions compared with four of the deep lesions. There was the difference between kinds of increased cytokines in the peritoneal fluid and those of expressed cytokines in the endometriotic lesions of patients with endometriosis. Conclusion: This study supports the concept that local immunologic factors may be important in the pathogenesis and pathophysiology of endometriosis. The pattern of cytokine mRNA expression of endometriotic lesions would seem to indicate that proinflammatory cytokines such as IL-1β and TNF-α are responsible for the development or progression of endometriosis.

Prognostic importance of atypical endometriosis with architectural hyperplasia versus cytologic atypia in endometriosis-associated ovarian cancer

Isabel Ñiguez Sevilla,Francisco Machado Linde,Maria del Pilar Marín Sánchez,Julián Jesús Arense,Amparo Torroba,Anibal Nieto Díaz,Maria Luisa Sánchez Ferrer 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.4

Objective: Patients with endometriosis are at increased risk of ovarian cancer. It has been suggested that atypical endometriosis is a precursor lesion of endometriosis-associated ovarian cancer (EAOC). The aim of this study is to evaluate if cytologic (cellular) atypia and architectural atypia (hyperplasia), histologic findings described as atypical endometriosis, play a different role in patients with EAOC. Methods: A prospective study was conducted between January 2014 and April 2017 at our institution with patients undergoing surgery with a histologic diagnosis of endometriosis, ovarian cancer, or EAOC. The prevalence and immunohistologic study (Ki-67, BAF250a, COX-2) of cases of cellular and architectural atypia in endometriosis were analyzed. Results: Two hundred and sixty-six patients were included: the diagnosis was endometriosis alone in 159 cases, ovarian cancer in 81, and EAOC in 26. Atypical endometriosis was reported in 23 cases (12.43%), 39.13% of them found in patients with EAOC. Endometriosis with cellular atypia was found mainly in patients without neoplasm (71.4%), and endometriosis with architectural atypia was seen in patients with ovarian cancer (88.9%) (p=0.009). Ki-67 was significantly higher in endometriosis patients with architectural atypia than those with cellular atypia. Conclusion: The diagnosis of endometriosis with architectural atypia is important because it may be a precursor lesion of ovarian cancer; therefore, pathologists finding endometriosis should carefully examine the surgical specimen to identify any patients with hyperplasia-type endometriosis, as they may be at higher risk of developing EAOC.

자궁절제술 환자의 자궁내막증 유병률

김미연 ( Mi Yeon Kim ),최민혜 ( Min Hye Choi ),배진영 ( Jin Young Bae ),김미주 ( Mi Ju Kim ),조영래 ( Young Lae Cho ),박일수 ( Il Soo Park ),이윤순 ( Yoon Soon Lee ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.10

목적: 전자궁절제술을 시행받은 환자를 대상으로 수술방식, 나이, 분만력, 비만도 및 병리학적 진단과 자궁내막증의 유병률과의 관련성을 알아보고자 하였다. 방법: 1999년부터 2006년까지 경북대학교병원 산부인과에서 복식 전자궁절제술, 질식 전자궁절제술, 복강경식 전자궁절제술을 시행받은 환자를 대상으로 하여 임상 기록 및 병리 보고서를 바탕으로 하여 후향적으로 검토하였다. 나이(35세 미만, 35~45세, 45세 초과), 분만력(무분만력, 초산, 다산), 비만도(18.5 미만, 18.5~24.9, 25 초과) 및 진단과 자궁내막증의 유병률과의 관련성을 조사하였다. 진단 분류는 병리학적 진단을 바탕으로 하였다. 자궁내막증의 해부학적 부위와 수술 방법과의 관련성도 조사하였다. 통계는 SPSS version 12.0의 Chi-square test을 이용하였다. 결과: 최근 7년간 본원에서 시행한 전자궁절제술은 총 4,830예였다. 이 중 자궁내막증은 125예(2.5%)에서 동반되었고, 수술별로 보면, 복식 전자궁절제술 2,260예 중 76예(3.3%), 질식 전자궁절제술 1,589예 중 31예(1.95%), 복강경식 전자궁절제술 981예 중 18예(1.83%)에서 동반되었다. 복식 전자궁절제술이나 질식 전자궁절제술보다는, 복강경식 전자궁절제술과 자궁내막증 유병률의 관련성이 통계적으로 유의하게 높았다 (P<0.05). 자궁내막증을 해부학적 부위별로 살펴보면, 총 125예 중 난소 109예(87.2%), 자궁천골인대 7예(5.6 %), 복막 4예(3.2%), 더글라스와 3예(2.4%), 난소 오목(ovarian fossa)에서 3예(2.4%), 복벽, 직장벽, 질벽, 소장유착부위에서 각각 1예(0.8%)로 발견되었다. 나이, 분만력, 비만도, 병리학적 진단과 자궁내막증의 유병률은 통계적 유의성이 없었다 (P>0.05). 결론: 대상군 중 자궁내막증의 유병률은 2.5%로 낮았으나, 복강경식 전자궁절제술에서 자궁내막증의 유병률이 더 높았다. 이는 자궁내막증이 의심되는 부위를 주의깊게 살펴보고 수술했기 때문이다. 복강경식 전자궁절제술의 확대 시야에서는, 다른 자궁절제술 방식보다 더욱 선명히 자궁내막증 의심 병변을 확인할 수 있다고 생각된다. Objective: We investigated whether surgical methods, age, parity and obesity were correlated to endometriosis in patients who had hysterectomy. Methods: This research was surveyed and reviewed of patients who underwent total abdominal hysterectomy, laparoscopic hysterectomy and vaginal hysterectomy in Kyungpook National University Hospital from 1999 to 2006, based on clinical recordings and pathologic reports. Based on these data, we investigated whether age, parity, obesity and pathologic diagnosis were correlated to prevalence rate of endometriosis. Also we investigated the correlations with anatomic lesion of endometriosis and surgical methods. SPSS version 12.0 chi-square test was conducted as the statistical data. Results: The total 4,830 cases of hysterectomy were undergone. Out of these, endometriosis was found at 125 cases (2.5%). Among them, 76 cases of endometriosis were found at 2,260 cases of abdominal hysterectomy (3.3%). 31 cases of endometriosis were found at 1,589 cases of vaginal hysterectomy (1.95%), and 18 cases of endometriosis were found at 981 cases of laparoscopic hysterectomy (1.83%). The correlation with laparoscopic hysterectomy and endometriosis had the statistically significant high rate (P<0.005). For anatomic site of endometriosis, 109 cases were found at ovary (87.2%), 7 cases were found at uterosacral ligament (5.6%), 4 cases were found at peritoneum (3.2%), 3 cases were found at cul-de-sac (2.4%), 3 cases were found at ovarian fossa (2.4%), 1 case was found at abdominal wall, rectal wall, vaginal wall and small intestine (0.8%), respectively. Age, parity, patologic diagnosis and obesity did not show the significant correlation with the prevalence rate of endometriosis (P>0.05). Conclusion: Even the prevalence of endometriosis was low (2.5%) in total cases of hysterectomy, laparoscopic hysterectomy had more prevalence rate of endometriosis than other types of hysterectomy. because suspicious lesions were inspected carefully, Magnified laparoscopic view make us to identify suspicious endometriotic lesion more clearly than other type of hysterectomy.

자궁내막증 환자에서 복강내의 IL-6와 IL-10의 변화양상에 관한 연구

이경석(Kyung Suk Lee),강정배(Jeong Bae Kang),김홍배(Hong Bae Kim),이근영(Keun Young Lee),강성원(Sung Won Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11

목적: 자궁내막증과 이로 인한 불임의 원인으로 여겨지고 있는 면역학적 인자 중 세포 매개성 면역계의 변화양상을 규명하기 위하여 자궁내막증 환자와 정상인의 복강액을 채취하여 면역세포의 분포양상을 비교분석하고자 IL-6와 IL-10을 측정하였다. 연구방법: 1997년 10월부터 1998년 10월까지 한림대학교 산부인과를 방문하여 불임검사, 불임시술 또는 양성 골반 질환의 진단 및 치료를 목적으로 복강경 또는 개복술을 시행한 여성 57명을 대상으로 이들 중 육안적 또는 조직검사로 자궁내막증으로 확진된 29명을 연구군으로 나머지 자궁내막증의 증상과 소견이 없는 28명을 대조군으로 하였다. 두군의 복강액에서 IL-6와 IL-10을 ELISA 방법으로 측정하였다. 결과: 복강액의 IL-6의 농도는 자궁내막증군에서는 1320.3121pg/ml로 대조군의 1017113 pg/ml보다 유의하게 증가하였고 (p=0.03) IL-10의 농도도 자궁내막증군에서 1.090.04 pg/ml로 대조군의 2.190.03 pg/ml보다 유의하게 감소하였다 (p=0.03). 자궁내막증 여성의 생리주기별 농도변화는 IL-6는 증식기보다 분비기에 유의하게 증가한 반면 (p=0.02) IL-10은 차이가 없었다. 자궁내막증군 중에서도 IL-6는 가임여성보다 불임여성에서 유의하게 증가하였고 (p=0.03) IL-10은 두 군 간에 유의한 차이는 없었다. 자궁내막증의 병기에 따른 IL-6와 IL-10의 농도를 각각 비교한 결과 통계학적으로 유의한 변화는 없었다. 결론: 자궁내막증 환자의 복강액에서 세포매개성 면역변화로 IL-6가 증가하고 IL-10은 감소하며 이러한 사이토카인의 변화가 자궁내막증의 생성과 진행, 증상발현에 관여하며 기계적폐쇄로 인한 배란장애와 난소이동의 장애, 수정력 감소, 착상장애로 불임이 유발되는 것으로 생각되며 이들 면역계통의 변화에 대한 더 많은 연구가 필요하리라 여겨진다. Objective: Endometriosis is a disease affecting a large population of women all over the world. A local sterile inflammation occurs in the peritonel cavity of patients with endometriosis. It suggests that immunological events play a major role in the pathogenesis of endometriosis. We have studied the levels of serveral T cell and monocyte derived cytokines, especially IL-6 (promoter of immune response) and IL-10 (inhibitor of immune response), in the peritoneal fluid of patients with endometriosis to characterize the change of immune response that occurs at the site of endometriosis. Method: This study was performed in Hallym university hospital from October, 1997 to October 1998 and enrolled 29 women with gross or microscopic findings of minimal to severe endometriosis in case group, and 28 women without visual evidence of pelvic endometriosis and with benign gynecologic disease in control group. IL-6 and IL-10 levels in the peritoneal fluid were determined using commercial ELISA and compared between endometriosis and controls and between fertile and infertile women with endometriosis and according to the revised American Fertility Society classification. Result: IL-6 was higher and IL-10 was lower in the peritoneal fluid of endometriosis group than of control group. Cyclic variations in the IL-6 concentrations were seen in endometriosis group : the concentrations in the secretory phase were significantly higher than those in the proliferative phase. In endometriosis group, IL-6 concentrations of infertile women were higher than fertile women. Both IL-6 and IL-10 in the peritoneal fluid of endomtriosis group did not show significant correlation according to r-AFS stages. Conclusion: Increased IL-6 and decreased IL-10 levels in the peritoneal fluid may be related to infertility and pathogenesis in the endometriosis, suggesting that partially contribute to the disturbed immune regulation observed in endometriosis.

자궁내막증과 동반된 불임환자의 보조생식술을 이용한 치료

문신용,이경순,노재숙,서창석,김석현,최영민,신창재,김정구,이진용,장윤석,Moon, Shin-Yong,Lee, Kyung-Soon,Roh, Jae-Sook,Suh, Chang-Suk,Kim, Seok-Hyun,Choi, Young-Min,Shin, Chang-Jae,Kim, Jung-Gu,Lee, Jin-Young,Chang, Yoon-Seok 대한생식의학회 1995 Clinical and Experimental Reproductive Medicine Vol.22 No.2

Though the endometriosis is not always related with infertility, endometriosis causes infertility in some patients. There are many treatment modalities of infertile patients who have endometriosis. In recent years, Assisted Reproductive Technology(ART) have been widely accepted as being a useful tool for the treatment of infertile endometriotic patients. The objective of this study was to evaluate the outcome of ART in infertile endometriotic patients who have been carried out IVF-ET from Jan, 1992 to Dec, 1994 and to compare the results between COH/IUI and IVF-ET in the patients with endometriosis stage I. Tubal disease only patients were grouped(308 patient, 956 cycles) as a control. Endometriosis group was subdivided into 4 groups according to American Fertility Society classification; endometriosis stage I (45 patients, 61 cycles), stage II (26 patients, 39 cycles), stage III (26 pateitns, 37 cycles), stage IV (33 patients, 50 cycles). The outcomes of IVF-ET in endometriosis patients were as follows; The oocyte recovery rates were significantly lower in stage III, IV endometriosis. In case of stage III endometriosis, the fertilization rate was significantly lower than other stages of endometriosis. Clinical pregnancy rates per cycle were not different between the tubal group(22%) and the endometriosis group(25%). According to endometriosis stage, the implantation rate and clinical pregnancy rate were significantly lower in stage IV (5.6%, 16%) compared with other stages (I; 10.0%, 26%, II;9.8%, 31%, III;12.6%, 32%). It suggests that some factor like autoantibodies may inhibit implantation of embryos in stage IV endometriosis. To evaluate the possibility that simply increasing the number of gametes at the site of fertilization might account for pregnancies attributed to IVF-ET, the authors retrospectively analyzed the outcome of couples undergoing IUI during hMG cycles and CC cycles between 1992 and 1994 in the women with endometriosis stage 1. In case of stage I endometriosis, though the COH/IUI group showed lower FSH level and lesser age profile than IVF-ET group, IUI group has resulted in lower pregnancy rates(19.2%) compared with the IVF-ET group(26.2%). In conclusion, endometriotic infertile patients can get comparable pregnancy rates with the tubal factor infertility patients during IVF-ET program. Moreover even in stage I endometriosis, IVF-ET may be an more effective treatment modality than COH/IUI.

Women with Endometriosis, Especially Those Who Conceived with Assisted Reproductive Technology, Have Increased Risk of Placenta Previa: Meta-analyses

전혜지,민지원,김덕경,서희경,김선경,김윤숙 대한의학회 2018 Journal of Korean medical science Vol.33 No.34

Background: Many women with endometriosis have become pregnant through assisted reproductive technology (ART), and have often experienced placenta previa (PP) during pregnancy. The objective of this study was to assess the association between women with endometriosis, especially those who conceived with ART, and the risk of PP. Methods: Two reviewers independently determined studies that were considered suitable for meta-analyses published in various medicine-related databases from March 1, 2004 through July 31, 2017 without language restrictions. Eight studies met the inclusion criteria, with a combined sample size of 21,930 women. Of these 21,930 pregnancies, 6,256 had endometriosis (endometriosis) and 15,674 had no endometriosis. Four of these studies included 8,161 women who conceived with ART, 1,640 of whom had endometriosis (endometriosis + ART), and 6,521 of whom did not have endometriosis. Meta-analyses were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. Results: These meta-analyses showed women with endometriosis (endometriosis) have an increased risk of PP (OR, 4.038; 95% CI, 2.291–7.116; P = 0.000). These results showed women who conceived with ART (endometriosis + ART), have a substantially increased risk of PP (OR, 5.543; 95% CI, 1.659–18.523; P = 0.005). Conclusion: These meta-analyses demonstrate women with endometriosis have an increased risk of PP.

Primary Cutaneous Endometriosis of Umbilicus

( Seung-hee Loh ),( Bark-lynn Lew ),( Woo-young Sim ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.5

Cutaneous endometriosis is defined by the presence of endometrial glands and/or stroma in skin and represents less than 1% of all ectopic endometrium. Cutaneous endometriosis is classified as primary and secondary. Primary cutaneous endometriosis appears without a prior surgical history and secondary cutaneous endometriosis mostly occurs at surgical scar tissue after abdominal operations. The most widely accepted pathogenesis of secondary endometriosis is the iatrogenic implantation of endometrial cells after surgery, such as laparoscopic procedures. However, the pathogenesis of primary endometriosis is still unknown. Umbilical endometriosis is composed only 0.4% to 4.0% of all endometriosis, however, umbilicus is the most common site of primary cutaneous endometriosis. A 38-year-old women presented with solitary 2.5×2.0-cm-sized purple to brown colored painful nodule on the umbilicus since 2 years ago. The patient had no history of surgical procedures. The skin lesion became swollen with spontaneous bleeding during menstruation. The skin lesion was diagnosed as a keloid at private hospital and has been treated with lesional injection of steroid for several times but there was no improvement. Imaging studies showed an enhancing umbilical mass without connection to internal organs. Biopsy specimen showed the several dilated glandular structures in dermis. They were surrounded by endometrial- type stroma and perivascular infiltration of lymphocytes. The patient was diagnosed as primary cutaneous endometriosis and skin lesion was removed by complete wide excision without recurrence. We report an interesting and rare case of primary umbilical endometriosis mistaken for a keloid and review the literatures. (Ann Dermatol 29(5) 621∼625, 2017)

Evaluation of the Pathogenesis of Tumor Development from Endometriosis by Estrogen Receptor, P53 and Bcl-2 Immunohistochemical Staining

Esmaili, Haidarali,Vahedi, Amir,Mohajeri, Shiva,Mostafidi, Elmira,Azimpouran, Mahzad,Behzad, Mohammad Naghavi Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.12

Objective: Endometriosis, one of the most common estrogen dependent gynecological disorders, can present as both benign and malignant disease. The prevalence of tumoral transformation is 0.7-1.6% and the most common tumors are clear cell and endometrioid carcinomas. Unfortunately, the pathogenesis of transformation is unknown. For this purpose, we examined molecular alterations in ovarian endometriosis and endometriosis-associated tumors. Methods: Using the data bank of Alzahra hospital pathology department and paraffin blocks from appropriate cases were identified. Sections were cut and stained for 3 markers: estrogen receptor, P53 and bcl2. Correlations between findings were investigated. Results: Nineteen cases of endometriosis-associated tumor and 19 cases of endometriosis were identified. Staining for bcl2 was documented in 14 of 19 (73.7%) of endometriosis-associated tumor cases and also 7 of 19 (36.8%) endometriosis cases (P=0.02). Only 3 of the 19 (15.8%) endometriosis-associated tumors exhibited positive staining for estrogen receptors, compared with 14 of 19 (73.7%) endometriosis cases (P<0.001). Positive staining for P53 was noted in 5 of 19 (31.6%) endometriosis-associated ovarian tumor samples but was absent in endometriosis samples (0%), (P =0.008). Conclusions: Endometriosis-associated tumors appear to be associated with overexpression of bcl2 and P53 and reduced expression of Estrogen receptor. These finding may help to diagnose tumoral transformation with a background of endometriosis.