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Clinical profile of a Portuguese infertile population with endometriosis
pasa Medical Faculty Dept Obs & Gyn, Istanbul, Turkey; 2Cerrahpasa Medical Faculty Dept of Pathology, Istanbul, Turkey. Objective: The objective of this study was to examine the occurence of ovarian endometriosis in malignant epithelial ovarian tumors in our population. Design: Retrospective analysis. Materials/Methods: The presence of ovarian endometriosis was determined by reviewing the sections of resected specimens in 183 malignant epithelial tumors of ovary (160 malignant and 23 borderline) during the period 1995 to 2001. Results: The mean age of the 183 patients was 43.4 years (range, 26 –70 years). Fourteen (7.65%) of the 183 malignant ovarian epithelial tumors were associated with ovarian endometriosis and being more frequently associated with endometriod (22.2%) and mixed (10.8%) adenocarcinomas than with other histological types (Table 1). The incidence of ovarian endometriosis in borderline tumors 13% (3/23) was higher than that in ovarian cancer 6.9% (11/160) (p ⬎ 0.05). On the histological review, 8 (57.1%) cases were classified as atypical endometriosis and 6 (42.9%) cases were typical endometriosis. Atypical endometriosis was found in 3 endometrioid adenocarcinomas and 3 mixed adenocarcinomas (Table). These 14 cases were classified as FIGO (International Federation of Gynecology and Obstetrics) stage I (n: 9, 64.3%), and stage III (n:5, 35.7%). Ovarian malignant epithelial tumours and endometriosis. No. of patients with endometriosis Histological type (n:) Serous (70)* Mucinous (35)* Endometrioid (18)** Clear cell (11) Mixed (37) Others (12) Total
Typical
Atypical
Total (%)
2 1 1 1 1 0 6
1 1 3 0 3 0 8
3 (4.3) 2 (5.7) 4 (22.2) 1 (9.1) 4 (10.8) 0 14 (7.65)
* Malignant and borderline tumours. ** There was significant difference between endometrioid and serous tumours (p ⬍ 0.05). Conclusions: Malignant ovarian epithelial tumors, including borderline tumors, especially endometriod adenocarcinomas were associated with ovarian endometriosis. In addition, atypical endometriosis was found associated with endometroid and mixed epithelial ovarian tumors. Supported By: No support.
P-27 Quality of life for women with severe endometriosis and its alteration following radical conservative surgery. J. T. Wright1, J. Ogden2, C. Maker2. 1Ctr for Endometriosis and Pelvic Pain, Woking, UK; 2Kings, Guys, St Thomas’s Joint Medical Sch, London, UK. Objective: To evaluate psychological morbidity in women presenting with endometriosis to a specialist pelvic pain clinic. Design: 192 women attending a specialist tertiary referral pelvic pain clinic in the NHS and private sectors are invited to complete the ‘general health questionnaire,’ ‘perceived stress scale,’ and ‘significant others A and B’ (2). The data were correlated to severity of symptoms on a five point ranked ordinal scale. Materials/Methods: As above. Results: Laparoscopic excisional surgery for endometriosis is associated with a reduction in symptoms such as pelvic pain, dysmenorrhoea and dyschezia 1 but this is not consistent, some women gaining little symptomatic relief. 92 women completed baseline questionnaires on symptoms and psychological state (2), repeating the questionnaire on symptoms at a follow up appointment. Greater improvement in symptoms was associated with women who smoked, took prescribed drugs and had heavier periods. The pre-operative use of ‘alternative remedies’ such as aromatherapy were predictive of a poor surgical outcome. Conclusions: The relief of symptoms following radical conservative
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Abstracts
surgery is associated with improved quality of life, but with little improvement in mental health which reflects the serious psychological morbidity associated with this condition (1). This preliminary data will be presented in more detail at the meeting, however laparoscopic surgical excision is effective but variants in women’s outcomes relate to both medical and behavioural baseline variables. 1. Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG: an International Journal of Obstetrics & Gynaecology 2000;107:44 –54. 2. Johnston M, Wright S, Weinman J. Measures in Health Psychology: A Users Portfolio: NFER-NELSON Publishing, Windsor, Berks. Supported By: No support. P-28 Clinical profile of a Portuguese infertile population with endometriosis. C. Calhaz-Jorge, L. Tuna, A. Costa. Dept Obstetrics and Gynecology— Hosp de Santa Maria, Lisboa, Portugal. Objective: The importance of genetic and environmental factors in the development of endometriosis is generally accepted. As a consequence, it is conceivable that different populations show non-coincident prevalence and/or clinical characteristics. This study was undertaken to evaluate the demographic, menstrual, contraceptive and symptomatic characteristics of an infertile population with and without endometriosis. Design: Prospective, populational study. Materials/Methods: 828 consecutive infertile patients answered a standard questionnaire, by personal interview, within a few days before a diagnostic or therapeutic laparoscopy was performed in our Unit. 363 showed to have endometriosis (endo group) and 465 were free from the disorder (controls) which represents a 43.8% prevalence of endometriosis. According to the ASRM classification, 279 patients (77.1%) had minimal/ mild endometriosis and 83 (22.9%) had a moderate/severe situation. Results: No difference in age and duration of infertility where found between endo and controls but endo patients had more frequently primary infertility (73.6% vs 60.2%; p ⬍ 0.0001; rr ⫽ 1.429). Exercise, physical stress at work, smoking duration, intensity and age of beginning were similar in the two groups. Endo patients had lower frequency of BMI ⱖ 25 (26.6% vs 33%; P ⫽ 0.0329; rr ⫽ 0.8237). Fewer cases of irregular long menstrual cycles were found in the endo group (13.6% vs 21.4%; P ⫽ 0.0044; rr ⫽ 0.719). No difference was found in prevalence of either short menstrual cycles or long duration and/or greater intensity of menstrual flow. Fewer cases of menarche after 14 years were detected in the endo group (4.2% vs 11.0%; P ⫽ 0.0004; rr ⫽ 0.719;). The proportion of never users of oral contraceptives were 20.8% in endo group and 30.5% in the controls (P ⫽ 0.0018; rr ⫽ 0.736) and for users the duration of use and time since stopping smoking were not different. IUD users were too few for analysis. A significantly higher prevalence of dysmenorrhea was found in the endo patients (77.7% vs 69.2%; P ⫽ 0.0073; rr ⫽ 1.291) and those with menstrual pain showed a higher frequency of moderate/severe pain (59.1% vs 45.0%; P ⫽ 0.0078; rr ⫽ 1.355). The proportion of primary and secondary dysmenorrhea were similar. Dyspareunia, pain after coitus, pain at defecation or other pelvic pain were not different in endo and controls. Patients with endometriosis III/IV had more frequently pelvic pain not related to either menstruation or intercourse than those with endo I/II (22.9% vs 6.4%; P ⫽ 0.0001; rr ⫽ 2.608) and controls (22.9% vs 12.2%; P ⫽ 0.015; rr ⫽ 1.844). Conclusions: Patients with endometriosis showed more primary infertility, fewer long cycles, fewer cases of late menarche and lower frequency of never-users of oral contraceptives, all potential contributors for a greater menstrual reflux to the pelvic cavity. Dysmenorrhea was more frequent and of greater intensity in endo group but other type of pelvic pain was significantly more found only in women with endo III/IV. Supported By: No support. P-29 Recurrence of ovarian endometrioma after laparoscopic excision. Y. Osuga, K. Koga, O. Yoshino, Y. Hirota, O. Tsutsumi, Y. Taketani. Univ of Tokyo, Tokyo, Japan. Objective: To investigate the recurrence of ovarian endometrioma after laparoscopic excision.
Vol. 77, No. 2, Suppl. 1, February 2002
Typical
Atypical
Total (%)
2 1 1 1 1 0 6
1 1 3 0 3 0 8
3 (4.3) 2 (5.7) 4 (22.2) 1 (9.1) 4 (10.8) 0 14 (7.65)
* Malignant and borderline tumours. ** There was significant difference between endometrioid and serous tumours (p ⬍ 0.05). Conclusions: Malignant ovarian epithelial tumors, including borderline tumors, especially endometriod adenocarcinomas were associated with ovarian endometriosis. In addition, atypical endometriosis was found associated with endometroid and mixed epithelial ovarian tumors. Supported By: No support.
P-27 Quality of life for women with severe endometriosis and its alteration following radical conservative surgery. J. T. Wright1, J. Ogden2, C. Maker2. 1Ctr for Endometriosis and Pelvic Pain, Woking, UK; 2Kings, Guys, St Thomas’s Joint Medical Sch, London, UK. Objective: To evaluate psychological morbidity in women presenting with endometriosis to a specialist pelvic pain clinic. Design: 192 women attending a specialist tertiary referral pelvic pain clinic in the NHS and private sectors are invited to complete the ‘general health questionnaire,’ ‘perceived stress scale,’ and ‘significant others A and B’ (2). The data were correlated to severity of symptoms on a five point ranked ordinal scale. Materials/Methods: As above. Results: Laparoscopic excisional surgery for endometriosis is associated with a reduction in symptoms such as pelvic pain, dysmenorrhoea and dyschezia 1 but this is not consistent, some women gaining little symptomatic relief. 92 women completed baseline questionnaires on symptoms and psychological state (2), repeating the questionnaire on symptoms at a follow up appointment. Greater improvement in symptoms was associated with women who smoked, took prescribed drugs and had heavier periods. The pre-operative use of ‘alternative remedies’ such as aromatherapy were predictive of a poor surgical outcome. Conclusions: The relief of symptoms following radical conservative
S34
Abstracts
surgery is associated with improved quality of life, but with little improvement in mental health which reflects the serious psychological morbidity associated with this condition (1). This preliminary data will be presented in more detail at the meeting, however laparoscopic surgical excision is effective but variants in women’s outcomes relate to both medical and behavioural baseline variables. 1. Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG: an International Journal of Obstetrics & Gynaecology 2000;107:44 –54. 2. Johnston M, Wright S, Weinman J. Measures in Health Psychology: A Users Portfolio: NFER-NELSON Publishing, Windsor, Berks. Supported By: No support. P-28 Clinical profile of a Portuguese infertile population with endometriosis. C. Calhaz-Jorge, L. Tuna, A. Costa. Dept Obstetrics and Gynecology— Hosp de Santa Maria, Lisboa, Portugal. Objective: The importance of genetic and environmental factors in the development of endometriosis is generally accepted. As a consequence, it is conceivable that different populations show non-coincident prevalence and/or clinical characteristics. This study was undertaken to evaluate the demographic, menstrual, contraceptive and symptomatic characteristics of an infertile population with and without endometriosis. Design: Prospective, populational study. Materials/Methods: 828 consecutive infertile patients answered a standard questionnaire, by personal interview, within a few days before a diagnostic or therapeutic laparoscopy was performed in our Unit. 363 showed to have endometriosis (endo group) and 465 were free from the disorder (controls) which represents a 43.8% prevalence of endometriosis. According to the ASRM classification, 279 patients (77.1%) had minimal/ mild endometriosis and 83 (22.9%) had a moderate/severe situation. Results: No difference in age and duration of infertility where found between endo and controls but endo patients had more frequently primary infertility (73.6% vs 60.2%; p ⬍ 0.0001; rr ⫽ 1.429). Exercise, physical stress at work, smoking duration, intensity and age of beginning were similar in the two groups. Endo patients had lower frequency of BMI ⱖ 25 (26.6% vs 33%; P ⫽ 0.0329; rr ⫽ 0.8237). Fewer cases of irregular long menstrual cycles were found in the endo group (13.6% vs 21.4%; P ⫽ 0.0044; rr ⫽ 0.719). No difference was found in prevalence of either short menstrual cycles or long duration and/or greater intensity of menstrual flow. Fewer cases of menarche after 14 years were detected in the endo group (4.2% vs 11.0%; P ⫽ 0.0004; rr ⫽ 0.719;). The proportion of never users of oral contraceptives were 20.8% in endo group and 30.5% in the controls (P ⫽ 0.0018; rr ⫽ 0.736) and for users the duration of use and time since stopping smoking were not different. IUD users were too few for analysis. A significantly higher prevalence of dysmenorrhea was found in the endo patients (77.7% vs 69.2%; P ⫽ 0.0073; rr ⫽ 1.291) and those with menstrual pain showed a higher frequency of moderate/severe pain (59.1% vs 45.0%; P ⫽ 0.0078; rr ⫽ 1.355). The proportion of primary and secondary dysmenorrhea were similar. Dyspareunia, pain after coitus, pain at defecation or other pelvic pain were not different in endo and controls. Patients with endometriosis III/IV had more frequently pelvic pain not related to either menstruation or intercourse than those with endo I/II (22.9% vs 6.4%; P ⫽ 0.0001; rr ⫽ 2.608) and controls (22.9% vs 12.2%; P ⫽ 0.015; rr ⫽ 1.844). Conclusions: Patients with endometriosis showed more primary infertility, fewer long cycles, fewer cases of late menarche and lower frequency of never-users of oral contraceptives, all potential contributors for a greater menstrual reflux to the pelvic cavity. Dysmenorrhea was more frequent and of greater intensity in endo group but other type of pelvic pain was significantly more found only in women with endo III/IV. Supported By: No support. P-29 Recurrence of ovarian endometrioma after laparoscopic excision. Y. Osuga, K. Koga, O. Yoshino, Y. Hirota, O. Tsutsumi, Y. Taketani. Univ of Tokyo, Tokyo, Japan. Objective: To investigate the recurrence of ovarian endometrioma after laparoscopic excision.
Vol. 77, No. 2, Suppl. 1, February 2002