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Nonpigmented endometriosis; Clinical, laparoscopic, and pathologic definition
428
Citations fromthe Literature
acute pelvic inflammatory disease was laparoscopically confirmed. We developed a mathematical model that correctly predicted 87.0% of the cases of acute pelvic inflammatory disease and had an overall correct classification rate of 75.6@/0.Variables that were good predicators of acute pelvic inflammatory disease were purulent vaginal discharge. erythrocyte sedimentation rate 315 mm&r, positive gonorrhea result, adnexal swelling on bimanual examination, and rectal temperature >38”C. Furthermore, we developed ‘mixed model I’ and ‘mixed model II’. which combine simple clinical parameters and laparoscopy in varying degrees. In mixed model I the sensitivity, specificity, and overall classification values were 93%. 67.2%, and 84.50/r; in mixed mode1 II these values were MO%, 67.2%, and 89.2rlr. Use of relatively simple and reproducible clinical parameters can identify those women who would most benefit from laparoscopy to diagnose acute pelvic inflammatory disease. Nonpigmented endometrios& Clinkel, hparoucopk, and petbdogk definition Jansen RPS; Russel P Department of Obstetrics and Gynaecoio&v, University of Sydney, Sydney, Australia AM. J. OBSTET. GYNECOL.; M/6 (1154-1159) 1986 We describe the morphologic characteristics and clinical importance of peritoneal lesions that have the histologic fea-
Int J Gynaecol Obstet 25
tures of endometriosis but are devoid of the pigmented stigmas typical of this disease. A total of 137 laparoscopic biopsy specimens were taken of nonpigmented peritoneal lesions in 77 patients. among whom 70 were infertile. Seventythree biopsy specimens showed endometrium-like glands and stroma, and another 12 showed only endometrioid stroma; no such histologic features of endometriosis were present in 10 biopsy specimens of normal uterosacral ligament peritoneum@ = 0.005, Fisher’s test). Nonpigmented lesions that were commonly endometriotic were: (1) white opacified peritoneum (endometriosis in 81qo of n = 52 biopsy specimens), (2) red flamelike lesions (81% of n = 16). and (3) glandular lesions (resembling endometrium at hysteroscopy) (67% of n = 21). Lesions that were sometimes endometriotic were: (1) subovarian adhesions (50% of n = 4), (2) yellow-brown peritoneal patches (470/o of n = 19), and (3) circular peritoneal defects (458 of n = 11). However, thickened cribriform peritoneum usually was not endometriotic (Qqo of n = 11) and vesicular excrescences were in every case, reactions to oil-based salpingographic medium (n = 5). Si patients underwent another laparoscopy within 6 to 24 months and each had developed pigmented endometriotic lesions in previously nonpigmented but abnormal areas. Visualization of pigment is not necessary to diagnose endometriosis, and defhrition of its early, nonpigmented appearance keeps the clinical category of ‘unexplained infertility’ exclusive.
Citations fromthe Literature
acute pelvic inflammatory disease was laparoscopically confirmed. We developed a mathematical model that correctly predicted 87.0% of the cases of acute pelvic inflammatory disease and had an overall correct classification rate of 75.6@/0.Variables that were good predicators of acute pelvic inflammatory disease were purulent vaginal discharge. erythrocyte sedimentation rate 315 mm&r, positive gonorrhea result, adnexal swelling on bimanual examination, and rectal temperature >38”C. Furthermore, we developed ‘mixed model I’ and ‘mixed model II’. which combine simple clinical parameters and laparoscopy in varying degrees. In mixed model I the sensitivity, specificity, and overall classification values were 93%. 67.2%, and 84.50/r; in mixed mode1 II these values were MO%, 67.2%, and 89.2rlr. Use of relatively simple and reproducible clinical parameters can identify those women who would most benefit from laparoscopy to diagnose acute pelvic inflammatory disease. Nonpigmented endometrios& Clinkel, hparoucopk, and petbdogk definition Jansen RPS; Russel P Department of Obstetrics and Gynaecoio&v, University of Sydney, Sydney, Australia AM. J. OBSTET. GYNECOL.; M/6 (1154-1159) 1986 We describe the morphologic characteristics and clinical importance of peritoneal lesions that have the histologic fea-
Int J Gynaecol Obstet 25
tures of endometriosis but are devoid of the pigmented stigmas typical of this disease. A total of 137 laparoscopic biopsy specimens were taken of nonpigmented peritoneal lesions in 77 patients. among whom 70 were infertile. Seventythree biopsy specimens showed endometrium-like glands and stroma, and another 12 showed only endometrioid stroma; no such histologic features of endometriosis were present in 10 biopsy specimens of normal uterosacral ligament peritoneum@ = 0.005, Fisher’s test). Nonpigmented lesions that were commonly endometriotic were: (1) white opacified peritoneum (endometriosis in 81qo of n = 52 biopsy specimens), (2) red flamelike lesions (81% of n = 16). and (3) glandular lesions (resembling endometrium at hysteroscopy) (67% of n = 21). Lesions that were sometimes endometriotic were: (1) subovarian adhesions (50% of n = 4), (2) yellow-brown peritoneal patches (470/o of n = 19), and (3) circular peritoneal defects (458 of n = 11). However, thickened cribriform peritoneum usually was not endometriotic (Qqo of n = 11) and vesicular excrescences were in every case, reactions to oil-based salpingographic medium (n = 5). Si patients underwent another laparoscopy within 6 to 24 months and each had developed pigmented endometriotic lesions in previously nonpigmented but abnormal areas. Visualization of pigment is not necessary to diagnose endometriosis, and defhrition of its early, nonpigmented appearance keeps the clinical category of ‘unexplained infertility’ exclusive.