Increased Expression Levels of Metalloprotease, Tissue Inhibitor of Metalloprotease, Metallothionein, and p63 in Ectopic Endometrium

Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 607 Two Cases of Endometriosis Presenting with Catamenial Pneumothorax and Umbilical Lesions McDonough AL, Zeisler J. Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut Patients: Two cases of catamenial pneumothorax and associated endometriotic lesions of the umbilicus presented to the same general gynecology practice within two years. The first case was a 30-year-old nulliparous female referred to the gynecologist for evaluation and management of endometriosis with recurrent pneumothorax, status post wedge resection of the right lung. The patient complained of cyclical umbilical pain, which worsened with menses. She underwent a resection of the umbilical endometrioma and diagnostic laparoscopy, which revealed extensive pelvic endometriosis. Postoperatively she was started on Lupron with good improvement of symptoms. The patient has been offered definitive therapy with hysterectomy and bilateral salpingooophorectomy once she no longer desires fertility preservation. The second case is a 28-year-old nulliparous female referred to the gynecologist by her cardiothoracic surgeon’ for a chief complaint of chest pain associated with her menses for the past four years. The patient had experienced two pneumothoraces over the prior 6 months, status post lysis of apical adhesions and pleurodesis. About three months after she initially presented to the gynecologist she began complaining of pain in her umbilicus. On examination she had a 1-2cm nodular area in the umbilicus, which on ultrasound showed a complex fluid accumulation. She underwent an umbilical mass excision and diagnostic laparoscopy with excisional biopsy of a left ovarian mass. Conclusion: Literature review resulted in two case reports of prior catamenial pneumothorax with associated umbilical lesions. Umbilical lesions are a particularly rare manifestation of endometriosis in patients without prior surgery. Based on the limited literature available hysterectomy with bilateral salpingo-oopherectomy should be offered as definitive therapy in these patients once they no longer desire preservation of fertility.

608 Complications During Pregnancy in Patients With Deep Infiltrating Endometriosis (DIE) Exacoustos C,1 Lauriola I,2 De Felice G,3 Frusca T,2 Zupi E.3 1 Department of Obstetrics and Gynecology, Universit
a degli studi di Roma ‘Tor Vergata,’ Roma, Italy; 2Department of Obstetrics and Gynecology, Universit
a degli Studi di Parma, Parma, Italy; 3Dipartimento Di Medicina Molecolare E Dello Sviluppo, Universit
a degli Studi di Siena, Siena, Italy Study Objective: to analyze the outcome and complications during pregnancy and delivery in patients with deep endometriosis diagnosed at laparoscopy and at ultrasound examination prior to pregnancy.

S169

Design: Retrospective study with follow up interviews. Setting: University hospitals. Patients: the criteria of inclusion patients with posterior DIE; less than 40 years age; desiring pregnancy. All the included patients showed on Transvaginal scan (TVS) DIE nodule of more than 2 cm. Endometriosis was confirmed on laparoscopy and histology. Intervention: Pregnancy outcome and complications of all included patients were collected from medical charts and by phone interviews. Measurements and Main Results: Out of 101 patients included in this study, 52 obtained a pregnant. We observed 13 cases of spontaneous abortion in the first trimester and 41 cases of term and preterm pregnancies. Of the 52 patient, 18 patients conceived by ART (assisted reproductive therapy). During the pregnancy 7 patients were hospitalized for abdominal pain, 6 had a placenta previa, 13 delivered before 37 weeks. Observed complication at delivery during C-section were: 2 hysterectomies, 1 bowel resection, 2 bladder lesions, 4 extended adhesiolysis with 2 salpingectomies. Following a vaginal delivery, 1 vaginal laceration that caused a severe post-partum hemorrhage. Conclusion: Patients with posterior DIE show a high infertility and complications rate during pregnancy and delivery. These complications were often not correlated to DIE and probably under-reported. This study suggests that pregnancy does not improve DIE condition. This suggests that the endocrine environment of pregnancy does not prevent activation of the disease.

609 Size of Rectosigmoid Endometriotic Nodule and Dyschezia: What’s the Novelty? Di Donato N, Costantino C, Montanari G, Facchini C, Zanello M, Seracchioli R. Minimally Invasive Gynaecological Surgery Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Study Objective: Purpose of this study was to evaluate the relationship between the severity of dyschezia with size of endometriotic rectosigmoid lesion. Design: Retrospective analysis of 82 patients with rectosigmoid endometriosis. Setting: Tertiary care university hospital. Patients: Patients with rectosigmoid endometriosis were grouped by preoperative severe dyschezia (VAS R8) and intra-operative diameter and volume of rectosigmoid endometriotic nodule were assessed. Other symptoms (dysmenorrhea, dyspareunia, dysuria and chronic pelvic pain) and presence of ovarian endometriosis, medical therapy and history of previous surgery for endometriosis were also recorded. Intervention: Laparoscopic intestinal shaving, preoperative scoring of dyschezia using 10-point verbal analog scale (VAS). Measurements and Main Results: Patients with severe dyschezia presented significantly smaller rectosigmoid nodule in size than those without dyschezia (mean major diameter 24.65.57 versus 34.1210.53 and mean volume 11.51.85 versus 14.713.51) (p\0.0001). Moreover, mean lesion diameter and volume in patients with severe dyspareunia (VASR8) was 26.67.97 and 12.22.65 mm versus 32.010.4 and 14.03.48 mm in patients without severe dyspareunia (p:0.04). There was a negative Spearman rank correlation between lesion major diameter and severity of dyschezia (Rho: -.259; p: .009). Conclusion: Severe dyschezia was significantly associated with smaller rectosigmoid endometriotic nodule. There was a negative correlation between severity of dyschezia and lesion diameter and volume.

610 Increased Expression Levels of Metalloprotease, Tissue Inhibitor of Metalloprotease, Metallothionein, and p63 in Ectopic Endometrium Rosa-e-Silva JC, Brandao VC, Meola J, Troncon JK, Poli-Neto OB. Gynecology and Obstetrics, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil

S170

Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253

Study Objective: To characterize the patterns of cell differentiation and tissue invasion in topic and ectopic endometria of rabbits with induced endometriotic lesions via a well-known experimental model, 4 and 8 weeks after the endometrial implantation procedure. Evaluation of lesions in two stages aims to confirm the presence of tissue modification during the evolution of the lesions and the growth of the same. Design: Animal experimental study. Setting: Experimental surgery sector. Patients: New Zealand rabbits. Intervention: Twenty-nine female New Zealand rabbits underwent laparotomy for endometriosis induction through resection of one uterine horn, isolation of the endometrium, and fixation of tissue segment to the pelvic peritoneum. Two groups of animals (14 and 15 animals in each group) were sacrificed 4 and 8 weeks after endometriosis induction. The lesion was excised together with the opposite uterine horn for endometrial gland and stroma determination. Measurements and Main Results: Immunohistochemical reactions were performed in topic and ectopic endometrial tissues for analysis of the following markers: metalloprotease (MMP-9) and tissue inhibitor of metalloprotease (TIMP-2), which is involved in the invasive capacity of the endometrial tissue; and metallothionein and p63, which are involved in cell differentiation and proliferation. The intensity of the immunostaining for MMP 9, TIMP-2, metallothionein, and p63 was higher in the ectopic endometrium than in the topic endometrium. However, when the ectopic lesions were compared at 4 and 8 weeks, no significant difference was observed, with the exception of the marker p63, which was more evident after 8 weeks of evolution of the ectopic endometrial tissue. Conclusion: Ectopic endometrial lesions seem to express greater power for cell differentiation and tissue invasion, compared with topic endometrial lesions, demonstrating a potentially invasive, progressive, and heterogeneous presentation of endometriosis.

611 The Comparison Between 2mg Dienogest and High-Dose Medroxyprogesterone Acetate on Oral Treatment of Endometriosis Oh S-T. Obstetrics & Gynecology, Chonnam University Medical School, Gwangju, GJ, Korea Study Objective: The new oral dienogest 2mg is developed to treatment for pain of endometriosis. Therefore, its effect was compared to high-dose (3060mg) medroxyprogesterone acetate (ProveraⓇ, MPA) treatment that had been used for pain of endometriosis. Design: The effectiveness for pain of endometriosis was compared, and their side-effects was compared. Setting: Retrospective study in Chonnam University Hospital. Patients: The study was performed in 98 patients of oral dienogest treatment for 6 months, and in 120 patients of 30-60mg oral MPA treatment. Intervention: The statistics was measured by SPSS 10.0 program. Measurements and Main Results: The disapperanece of pain is more than decrease of pain (VAS >3) in dienogest treatment group (67/98, 29/98) compared to 30-60mg MPA treatment group (42/120, 78/120) (p,0.01). (1) Irregular bleedding is significantly more in dienogest group than MPA group ( p\0.05). (2) Amenorrhea is significantly more in MPA group than dienogest group (p\0.01). (3) Weight gain is significantly more in MPA group than dienogest group (p\0.01). (4) Breast tenderness is significantly more in MPA group than dienogest group ( p\0.01). (5) Alopecia is in only dienogest group (4/98). (6) Headache is significantly more in dienogest group than MPA group. (7) Depression is in only MPA group (63/120). Conclusion: Therefore, Dienogest is the higher effective than MPA for pain of endometriosis. Howerver different side-effect is present in dienogest

group (e.g. alopecia, jeadache and general aching), high-dose MPA also useful in that cases.

612 Deep Infiltrating Endometriosis of the Bowels – Experience of a Multidisciplinary Team With 179 Patients Submitted to Intestinal Resections Queiroz CE,1 Medeiros BA,1 Furtado SP,1 Araujo MT,1 Pinto PJ,2 Castro NM.2 1NEC - Nucleo de Endometriose do Ceara, Hospital Regional Unimed, Fortaleza, CE, Brazil; 2IPADE - Instituto para Desenvolvimento da Educac¸~ao, Centro Universitario Christus - Campus Parque Ecologico, Fortaleza, CE, Brazil Study Objective: To present the experience of a multidisciplinary team of gynaecologists and surgeons in the treatment of deep infiltrating endometriosis involving the bowel (rectum, appendix, terminal ileum and right colon). Design: Patients who presented to our clinic with deep infiltrating endometriosis involving the rectum and were operated by our team. Data concerning age, size of the rectum nodule, surgical techniques, complication rates and hospital stay were recorded. Setting: Private hospital with a multicultural patient profile. Patients: 179 patients with deep infiltrating endometriosis of the rectum, identified in US mapping with bowel preparation. Intervention: Laparoscopic surgery, using these techniques: rectal shaving, disc excision, segmental resection, linear resection, appendectomy and ileocecal resection. Measurements and Main Results: 179 patients were submitted to laparoscopic surgery. The mean age was 35,4y (21y-61y). Size of the nodules varied between 1,0cm and 9,6cm. Shaving was performed in 16 patients (8,93%). Linear resection was performed in 4 patients (2,2%). 59 patients were submitted to discoid resection (32,9%). Segmental resection was performed in 100 patients (55,8%). In 16 patients (8,9%), resection of the cecum and terminal ileum was performed in association with the rectal procedure, mainly because of commitment of the ileocecal valve. 18 patients (10,05%) were submitted to appendectomy. 2 patients developed anastomotic leak, presenting in the 5th post-operative day. 3 patients had late stenosis of the colorectal anastomosis. 1 patient had a rectovaginal fistula. The mean hospital stay was 2,2 days (1d-9d). Conclusion: Deep Infiltrating Endometriosis of the bowels is a complex disease, involving multiple organs and segments of the digestive tract. Familiarity with all the techniques is fundamental to the adequate treatment of these patients.

613 Concentration of IL-1b and IL-8 in Blood Plasma and in Peritoneal Fluid of Women With External Genital Endometriosis Ovakimyan AS, Adamyan LV, Kozachenko IF, Vanko L, Vtorushina V, Krechetova L. Operative Gynecology, Russian Scientific Center for Obstetrics, Gynecology and Perinatology Named After V.I. Kulakov, Moscow, Russian Federation Study Objective: The purpose of the present study was to assess the levels of IL-1b and IL-8 in blood plasma and in peritoneal fluid of women with external genital endometriosis, in relation to the degree of diffusion of endometriosis and its severity, as well as on the intensity of the pain syndrome. Design: Prospective study. Setting: Department of operative gynecology. Patients: The main study group included 62 women with external genital endometriosis. The control group consisted of 24 women (with uterine