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2D and 3D Sonographic Features of Deep Endometriosis after Laparoscopic Bowel Resection and Correlation with Symptoms
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Study Objective: To determine whether and to what extent the two surgical procedures for endometrioma, cystectomy and laser vaporization, affect ovarian reserve. Recently, cystectomy has been questioned as an ideal surgical approach because it may involve excessive removal of ovarian tissue and the loss of follicles; laser vaporization has been proposed as a promising method to preserve ovarian function. Design: Prospective, multicentric, randomized (1:1) clinical trial. Setting: San Raffaele Scientific Institute, Milan; Collegium Medicum, Krakow, Poland. Patients: 40 patients undergoing surgery for symptomatic endometriomas larger than 3 cm. Intervention: Patients were randomly assigned to undergo either cystectomy (Group 1) or laser vaporization (Group 2). Patients of Group 1 have undergone a standardized laparoscopic stripping technique; patients of Group 2 have undergone drainage of the cyst content and vaporization of the internal wall with CO2 laser (Lumenis, AcuPulse Laser). Before, at 1- and 3-month follow-up, patients underwent pelvic ultrasound to determine the antral follicle count (AFC) and blood sample to determine AMH. Measurements and Main Results: Age and the mean size of endometriomas were similar between the two groups (Group 1 = 30.1 years, Group 2 = 31.9 years, p = .901; Group 1 = 4.9 cm, Group 2 = 4.5 cm, p = .141). AFC at 3-month follow-up was significantly higher compared to baseline in Group 2 (from 9.6 to 16.1, p = .010); AFC of the operated ovary was also found to be significantly higher after treatment in Group 2 (from 4.1 to 8.1, p = .011). In Group 1, AFC at 3-month follow-up and the AFC of the operated ovary did not differ from baseline (p = .121, p = .248). AMH at 3-month followup was not different from baseline in either group. Conclusion: CO2 laser vaporization for endometrioma yields an higher functional ovarian tissue, as determined by higher AFC count and no change in AMH, in comparison with cystectomy. These are preliminary data of an ongoing study, and the results need to be confirmed on a larger sample.
87
Open Communications 4 – Endometriosis and Adenomyosis (12:10 PM–1:10 PM) 12:56 PM – GROUP B
2D and 3D Sonographic Features of Deep Endometriosis after Laparoscopic Bowel Resection and Correlation with Symptoms Zupi E, Martire F, Morosetti G, Pietropolli A, Piccione E, Exacoustos C. Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Tor Vergata, Rome, Italy Study Objective: To evaluate the presence or absence of residual posterior disease and adhesions by 2D and 3D transvaginal sonography in patients who underwent segmental bowel resection for Deep Infiltrating Endometriosis (DIE). Furthermore the presence of residual pelvic endometriosis, adhesions and adenomyosis were correlated to symptoms and infertility. Design: Retrospective study. Setting: University Hospital. Patients: 50 premenopausal women (mean age 37.4 ± 5.2 yrs) with bowel DIE who underwent segmental bowel resection. Intervention: All patients underwent an accurate 2D, 3D and power Doppler transvaginal examination and mapping of the pelvic disease before and after surgery. All patients are assessed for pelvic pain by visual analog scale (VAS). The sonographic features of adenomyosis, adhesions, presence of ovarian, peritoneal and deep endometriosis were evaluated. A previous published mapping system to evaluate pelvic endometriosis was always performed. Measurements and Main Results: At the TVS scan performed within 6 month after surgery we found 14 patients (28%) with residual DIE, 38 patients (76%) with adhesions in the posterior compartment, 32 patients (64%) with sonographic features of adenomyosis. No patients showed ovarian endometriosis. Out of 25 women desiring pregnancy, 21 (84%) showed severe dysmenorrhea (vas >5), 13 (52%) had dyspareunia (vas >5) and 19 patients underwent to ART.
S35
Conclusion: DIE is a chronic disease that is not completely eradicable. After surgery painful symptomatology could be correlated to residual posterior disease and mostly to adhesions and adenomyosis. However surgery, when indicated, allows an improvement in painful symptomatology and quality of life. The spontaneous pregnancy rate in our study is not improved by surgery. 88
Open Communications 4 – Endometriosis and Adenomyosis (12:10 PM–1:10 PM) 1:03 PM – GROUP B
Immunohistochemical Characteristic of Stem Cells Markers in Foci of Nodular and Diffuse Adenomyosis Dzhamaludinova KM,1 Kozachenko IF,1 Shchegolev AI,1 Adamyan LV,1 Stepanian AA2. 1Department of Operative Gynecology, Federal Research Center for Obstetrics, Gynecology, and Perinatology Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation; 2 Academia of Women’s Health and Endoscopic Surgery, Atlanta, Georgia Study Objective: To study the features of the clinical course and expression of stem cell markers in ectopic and ectopic endometrium in patients with nodular and diffused adenomyosis. Design: Cross-sectional study. Setting: Federal Scientific Center of Obstetrics, Gynaecology and Perinatology, Moscow, Russia. Patients: Included are 150 women who underwent surgery between 2014 and 2016 for pre-operative diagnosis of adenomyosis, subsequently confirmed with histological examination. Intervention: Immunohistochemical study of expression of stem cell markers in nodular and diffuse adenomyosis cells and comparison with eutopic endometrium. Measurements and Main Results: Immunohistochemical analysis of endometrial tissue and adenomyosis showed that a positive reaction with Musashi-1 was observed in both nuclei and in the cytoplasm of glandular and stromal cells. The maximum values were found in the nuclei of epithelial cells, where they exceeded the analogous phase of secretion by 35%. The cytoplasmic level of expression of Musashi-1 in proliferating epithelium was 21.7% higher than the values of the secretion phase. For COX-2, a cytoplasmic reaction is characteristic. As a result of the quantitative analysis of the intensity of the reaction on COX-2, it was established that in the tissue of normal endometrium the highest level of expression was observed in epithelial cells during the proliferation phase. Positive immunohistochemical reaction with OCT4 was observed in the nuclei of epithelial and stromal cells. In the observations of nodular adenomyosis, such OCT4+ epithelial and stromal cells were more by 67.7% and 41.3%, respectively, than in the eutopic endometrium of the proliferation phase. In areas of diffuse adenomyosis, their number exceeded the same parameters by 123.2% and 90.4%, respectively (p < .05). Conclusion: Aberrant Musashi-1 expression of stem cells markers in adenomyosis may be involved in the pathogenesis and pathophysiology of adenomyosis.
TUESDAY, NOVEMBER 14, 2017
89
Open Communications 5 – Research & Science (2:15 PM–3:15 PM) 2:15 PM – GROUP A
CXCR4 Mediated to Epithelial-Mesenchymal Transition and Stemness in Epithelial Ovarian Carcinoma Zi D,1 Tan J,2 Shu L,3 He Z,3 Jin H4. 1Department of Obstetrics and Gynecology, Gui Zhou Medical Unversity, Gui Yang, Gui Zhou, China;
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Open Communications 4 – Endometriosis and Adenomyosis (12:10 PM–1:10 PM) 12:56 PM – GROUP B
2D and 3D Sonographic Features of Deep Endometriosis after Laparoscopic Bowel Resection and Correlation with Symptoms Zupi E, Martire F, Morosetti G, Pietropolli A, Piccione E, Exacoustos C. Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Tor Vergata, Rome, Italy Study Objective: To evaluate the presence or absence of residual posterior disease and adhesions by 2D and 3D transvaginal sonography in patients who underwent segmental bowel resection for Deep Infiltrating Endometriosis (DIE). Furthermore the presence of residual pelvic endometriosis, adhesions and adenomyosis were correlated to symptoms and infertility. Design: Retrospective study. Setting: University Hospital. Patients: 50 premenopausal women (mean age 37.4 ± 5.2 yrs) with bowel DIE who underwent segmental bowel resection. Intervention: All patients underwent an accurate 2D, 3D and power Doppler transvaginal examination and mapping of the pelvic disease before and after surgery. All patients are assessed for pelvic pain by visual analog scale (VAS). The sonographic features of adenomyosis, adhesions, presence of ovarian, peritoneal and deep endometriosis were evaluated. A previous published mapping system to evaluate pelvic endometriosis was always performed. Measurements and Main Results: At the TVS scan performed within 6 month after surgery we found 14 patients (28%) with residual DIE, 38 patients (76%) with adhesions in the posterior compartment, 32 patients (64%) with sonographic features of adenomyosis. No patients showed ovarian endometriosis. Out of 25 women desiring pregnancy, 21 (84%) showed severe dysmenorrhea (vas >5), 13 (52%) had dyspareunia (vas >5) and 19 patients underwent to ART.
S35
Conclusion: DIE is a chronic disease that is not completely eradicable. After surgery painful symptomatology could be correlated to residual posterior disease and mostly to adhesions and adenomyosis. However surgery, when indicated, allows an improvement in painful symptomatology and quality of life. The spontaneous pregnancy rate in our study is not improved by surgery. 88
Open Communications 4 – Endometriosis and Adenomyosis (12:10 PM–1:10 PM) 1:03 PM – GROUP B
Immunohistochemical Characteristic of Stem Cells Markers in Foci of Nodular and Diffuse Adenomyosis Dzhamaludinova KM,1 Kozachenko IF,1 Shchegolev AI,1 Adamyan LV,1 Stepanian AA2. 1Department of Operative Gynecology, Federal Research Center for Obstetrics, Gynecology, and Perinatology Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation; 2 Academia of Women’s Health and Endoscopic Surgery, Atlanta, Georgia Study Objective: To study the features of the clinical course and expression of stem cell markers in ectopic and ectopic endometrium in patients with nodular and diffused adenomyosis. Design: Cross-sectional study. Setting: Federal Scientific Center of Obstetrics, Gynaecology and Perinatology, Moscow, Russia. Patients: Included are 150 women who underwent surgery between 2014 and 2016 for pre-operative diagnosis of adenomyosis, subsequently confirmed with histological examination. Intervention: Immunohistochemical study of expression of stem cell markers in nodular and diffuse adenomyosis cells and comparison with eutopic endometrium. Measurements and Main Results: Immunohistochemical analysis of endometrial tissue and adenomyosis showed that a positive reaction with Musashi-1 was observed in both nuclei and in the cytoplasm of glandular and stromal cells. The maximum values were found in the nuclei of epithelial cells, where they exceeded the analogous phase of secretion by 35%. The cytoplasmic level of expression of Musashi-1 in proliferating epithelium was 21.7% higher than the values of the secretion phase. For COX-2, a cytoplasmic reaction is characteristic. As a result of the quantitative analysis of the intensity of the reaction on COX-2, it was established that in the tissue of normal endometrium the highest level of expression was observed in epithelial cells during the proliferation phase. Positive immunohistochemical reaction with OCT4 was observed in the nuclei of epithelial and stromal cells. In the observations of nodular adenomyosis, such OCT4+ epithelial and stromal cells were more by 67.7% and 41.3%, respectively, than in the eutopic endometrium of the proliferation phase. In areas of diffuse adenomyosis, their number exceeded the same parameters by 123.2% and 90.4%, respectively (p < .05). Conclusion: Aberrant Musashi-1 expression of stem cells markers in adenomyosis may be involved in the pathogenesis and pathophysiology of adenomyosis.
TUESDAY, NOVEMBER 14, 2017
89
Open Communications 5 – Research & Science (2:15 PM–3:15 PM) 2:15 PM – GROUP A
CXCR4 Mediated to Epithelial-Mesenchymal Transition and Stemness in Epithelial Ovarian Carcinoma Zi D,1 Tan J,2 Shu L,3 He Z,3 Jin H4. 1Department of Obstetrics and Gynecology, Gui Zhou Medical Unversity, Gui Yang, Gui Zhou, China;