Endometriose e saúde sexual feminina ­ desafios, tratamento, perfil epidemiológico e impactos biopsicossociais: uma revisão integrativa / Endometriosis and female sexual health ­challenges, treatment, epidemiological profile and biopsychosocial impacts: an integrative review / Endometriosis y salud sexual femenina ­desafíos, tratamiento, perfil epidemiológico e impactos biopsicosociales: una revisión integradora

Introdução:A endometriose consiste em uma patologia ginecológica bastante prevalente emmulheres de múltiplas faixas etárias, consistindo em um desafio constante para a fertilidade, sexualidade e demais aspectos da qualidade de vida.Objetivo:Avaliar o perfil epidemiológico, formas de tratamento e os aspectos biopsicossociais associados à saúde sexual das mulheres com endometriose. Metodologia:Esta é uma revisão integrativa da literatura cujapergunta norteadorafoi "Como a endometriose influencia nos aspectos biopsicossociais inerentes ao comportamento sexual feminino?". Foi aplicada a estratégia de busca "Endometriose AND Dispareunia AND Qualidade de Vida" na Biblioteca Virtual em Saúde (BVS) e sua versão em inglês "EndometriosisAND DyspareuniaAND Quality of Life" na base de dados PubMed, com ofiltro"últimos10anos"aplicadoemambasasplataformas.Critérios de inclusão: estudos que abordassem mulheres cisgênero, em idade fértil,com vida sexual ativa, diagnóstico prévio de endometriose pélvica ou profunda e distúrbios ou queixas sexuais. Critério de exclusão: artigos que contemplassem mulheres em uso de psicofármacos. Resultados:Inicialmente,foram obtidos 227 artigos. Apósanálise primária, 189 estudos foram excluídos, seguindo para a etapa seguinte apenas 38. Destes, somente 15 atenderam aos critérios e foram considerados válidos para compor o presente estudo.No âmbito sexual, a endometriose pode acarretar aredução da frequência das relações, sangramentos durante ou após o coito, desinteresse em preliminares, desconforto em certas posições, términos de relacionamentos, conflitos conjugais, e, sobretudo, dispareunia.Conclusões:Diante dos prejuízos em diversos âmbitos da vida e bem-estar feminino causados pela endometriose, faz-se indispensável maior qualificação dos serviços de saúde para o diagnóstico precoce e intervenções efetivas, bem como apoio, acolhimento e acompanhamento multiprofissional contínuo. Além disso, a adaptação, compreensão e solicitude dos parceiros são fundamentais para que as mulheres sejam capazes de melhor gerenciar tais desafios (AU).

Introduction:Endometriosis is a gynecological pathology that is quite prevalent among women of multiple age groups, representing a constant challenge to fertility, sexuality, and other aspects of quality of life.Objective:To evaluate the epidemiological profile, forms of treatment and biopsychosocial aspects associated with the sexual health of women with endometriosis.Methodology:This is an integrative review of the literature whose guiding question was "How does endometriosis influence the biopsychosocial aspects inherent to female sexual behavior?". The search strategy "Endometriosis AND Dyspareunia AND Quality of Life" was applied in the Biblioteca Virtual em Saúde (BVS) and in the PubMed database, with the "last 10 years" filter applied on both platforms. Inclusion criteria: studies that addressed cisgender women, of childbearing age, with active sexual life, previous diagnosis of pelvic or deep endometriosis and sexual disorders or complaints. Exclusion criteria: articles that included women using psychotropic drugs. Results:Initially, 227 articles were obtained. After primary analysis, 189 studies were excluded, only 38 going on to the next stage. Of these, only 15 met the criteria and were considered valid to be part of the present study. In the sexual sphere, endometriosis can lead to a reduction in the frequency of intercourse, bleeding during or after coitus, lack of interest in foreplay, discomfort in certain positions, relationship endings, marital conflicts, and, above all, dyspareunia.Conclusions:Given the damage to various areas of life and female well-being caused by endometriosis, it is essential to improve the quality of health services for early diagnosis and effective interventions, as well as support, reception, and continuous multidisciplinary monitoring. Furthermore, adaptation, understanding and concern from partners are fundamental for women to be able to better manage such challenges (AU).

Introducción:La endometriosis esuna patología ginecológica bastante prevalente en mujeres de múltiples grupos etarios, que supone un reto constante para la fertilidad, la sexualidad y otros aspectos de la calidad de vida.Objetivo:Evaluar elperfil epidemiológico, las formas de tratamiento y los aspectos biopsicosociales asociados a la salud sexual de las mujeres con endometriosis.Metodología:Se trata de una revisión integradora cuya pregunta orientadora fue "¿Cómo influye la endometriosis en los aspectos biopsicosociales inherentes a la conducta sexual femenina?".Se aplicó la estrategia de búsqueda "Endometriosis AND Dispareunia AND Calidad de Vida" en la Biblioteca Virtual en Salud (BVS) y su versión en inglés en PubMed, con el filtro "últimos 10 años" enambas plataformas. Criterios de inclusión: estudios dirigidos a mujeres cisgénero en edad fértil, con vida sexual activa, diagnóstico previo de endometriosis pélvica o profunda, y trastornos o quejas sexuales. Criteriode exclusión: artículos que incluían mujeres usuarias de psicofármacos.Resultados:Inicialmente se obtuvieron 227 artículos. Después del análisis primario, se excluyeron 189 estudios y solo 38 pasaran a la siguiente etapa. De estos, solo 15 cumplieron con los criterios y seconsideraron válidos para el presente estudio. En el ámbito sexual, la endometriosis puede provocar reducción de la frecuencia de relaciones sexuales, sangrado durante o después de las relaciones sexuales, falta de interés por los juegos previos, molestias en determinadas posiciones, rupturas, conflictos matrimoniales y, sobre todo, dispareunia.Conclusiones:Ante los daños causados por la endometriosis en diversos ámbitos de la vida y el bienestar de las mujeres, es indispensable mejorar la calidad de losservicios de salud para el diagnóstico precoz y las intervenciones efectivas, así como apoyo, acogida y seguimiento multidisciplinar continuo. Además, la adaptación, comprensión y solicitud de las parejas son fundamentales para que las mujeres puedan gestionar mejor estos desafíos (AU).

Upregulation of h-TERT and Ki-67 in ectopic endometrium is associated with recurrence of endometriosis / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

At present, endometriosis remains a worldwide health burden, with the main symptoms of dysmenorrhea, chronic pelvic pain, and infertility, markedly reducing the quality of life (de Ziegler et al., 2010). Although there is no proof that the disease is associated with high mortality, this disorder can significantly contribute to the deterioration of women's general well-being (McPeak et al., 2018). The main current treatment for endometriosis is surgery to remove endometriotic lesions; however, the recurrence rate following surgical treatment is as high as 21.5% at two years and 40.0%‍-‍50.0% at five years post-surgery (Koga et al., 2015). To prevent recurrence, adjuvant treatment with drugs after surgery is recommended to prolong relapse-free intervals. However, it is inconvenient for patients to continuously use such medications in terms of adverse effects and cost (Turk, 2002).

Endometriosis umbilical primaria: reporte de dos casos / Primary umbilical endometriosis: two case reports

INTRODUCCIÓN: La endometriosis es una patología benigna, dependiente de estrógenos, en la que el tejido que normalmente crece dentro del útero aparece fuera de este. Su localización habitual es en la pelvis, pero en ocasiones puede aparecer en otras áreas, como es el caso de la endometriosis umbilical. OBJETIVO: Familiarizar al ginecólogo con esta patología y entregar una serie de herramientas para diagnosticar, tratar y seguir a las pacientes que la presentan. CASOS CLÍNICOS: Se presentan dos casos clínicos de endometriosis umbilical primaria diagnosticados en el Hospital La Paz, en Madrid (España), entre los años 2018 y 2019. Las pacientes, de 30 y 34 años, consultaron por dolor o sangrado umbilical durante la menstruación. Ninguna tenía antecedentes de patología ginecológica ni cirugía abdominal previa. Tras una exhaustiva exploración física y una ecografía de alta resolución, se decidió extirpar la lesión con la colaboración del servicio de cirugía plástica. En ambos casos, el estudio anatomopatológico confirmó que se trataba de tejido endometriósico. Las dos pacientes presentaron una buena evolución posquirúrgica, sin recidivas hasta la fecha. CONCLUSIONES: La endometriosis umbilical primaria es una patología infrecuente, pero es necesario incluirla en el diagnóstico diferencial de una mujer con un nódulo umbilical. Siempre deben realizarse una exploración física exhaustiva y una ecografía ginecológica, para descartar posibles patologías concomitantes. El tratamiento de elección es la extirpación quirúrgica de la lesión y el diagnóstico final se establece con el estudio anatomopatológico.

INTRODUCTION: Endometriosis is an estrogen-dependent benign pathology in which endometrial tissue develops outside the uterus. Its most frequent location is the pelvis, although it can appear in other areas such as the umbilicum. OBJECTIVE: To familiarize the gynecologist with this pathology and provide a series of tools to diagnose, treat and provide continued care to these patients. CASE REPORTS: Retrospective study of two clinical cases of primary umbilical endometriosis diagnosed at La Paz University Hospital, in Madrid (Spain), between 2018 and 2019. Both patients (30 and 34 years old respectively) presented with pain and/or bleeding around the umbilical area during menstruation. Neither of them had any previous gynecologic conditions or abdominal surgeries. After exhaustive physical examination and a high-resolution ultrasound, lesions were surgically removed in collaboration with the plastic surgery department. In both cases, histology confirmed the presence of endometrial tissue. Both patients made a full recovery after surgery and havent had a recurrence of said lesions. CONCLUSIONS: Primary umbilical endometriosis is an infrequent disease. However, it must be included in the differential diagnosis of umbilical nodes in women. Exhaustive physical examination and gynecologic ultrasound should always be performed to rule out any other pathologies. Surgical removal of the nodes is the preferred treatment, and the final diagnosis is reached through histology.

Resección intestinal por endometriosis severa, diagnóstico y tratamiento luego de la introducción de la Unidad de Endometriosis: revisión de 18 años en el Hospital Clínico de la Universidad de Chile / Bowel resection for severe endometriosis, diagnosis and treatment after the introduction of Endometriosis Unit: 18 years review, Clinical Hospital of the University of Chile

INTRODUCCIÓN: La endometriosis intestinal afecta en gran medida la calidad de vida de una mujer joven y habitualmente requiere un tratamiento quirúrgico con resección intestinal. Esta cirugía es técnicamente compleja por las adherencias firmes del intestino a la vagina, el útero y los ovarios. OBJETIVO: Describir y analizar los resultados quirúrgicos e histopatológicos de las resecciones intestinales por endometriosis grave durante los últimos 18 años en el Hospital Clínico de la Universidad de Chile, en relación con la introducción de la unidad multidisciplinaria de endometriosis, a partir del año 2011, y las experiencias publicadas en la literatura chilena y extranjera. MÉTODO: Trabajo retrospectivo realizado en un hospital terciario desde el año 2001 hasta el año 2019. Las pacientes se asignaron a dos grupos según el período de cirugía: grupo 2001-2010 y grupo 2011-2019, luego de la introducción de la unidad de endometriosis. Se recopilaron todas las pacientes a las que se realizó una resección intestinal (discoidal o segmentaria) por endometriosis, por laparotomía o laparoscopía. Los datos distribuidos normalmente se presentan como promedio ± DE y los datos no paramétricos como mediana (rango). Las comparaciones demográficas de variables continuas se hicieron con la prueba t de Student y las de las variables categóricas con las pruebas de ji al cuadrado o de Fisher. La significación estadística se estableció en p < 0,05. RESULTADOS: Se recopilaron 52 casos. El 94,2% de las cirugías fueron electivas. El 5,8% fueron de urgencia por obstrucción intestinal (todas entre 2001 y 2010). Un 75% de las cirugías fueron laparoscópicas. Se realizó resección segmentaria en el 67,3%, resección discoidal simple en el 28,8%, resección discoidal doble en el 1,9% y resección segmentaria y una discoidal en el 1,9%. La histopatología demostró compromiso de la lesión hasta la mucosa intestinal en un 7,7%. Hubo franca disminución del dolor en el seguimiento de las pacientes. El 24% de las pacientes con deseo de embarazo y endometriosis intestinal lograron un parto de término mediante fecundación in vitro o espontáneamente. Hubo cuatro complicaciones posoperatorias, tres de ellas de categoría II según la clasificación de Clavien-Dindo y una de categoría IV A con reintervención a las 72 horas. Al comparar ambos periodos, en 2001-2010 los exámenes diagnósticos utilizados fueron ecografía transvaginal (0%), enema baritado (60%), tomografía computarizada de abdomen y pelvis (45%) y resonancia magnética pelviana (20%), mientras que en 2011-2019 fueron ecografía transvaginal (100%), enema baritado (3%), tomografía computarizada (3%) y resonancia magnética pelviana (66%). En 2001-2010, las lesiones fueron más más infiltrativas (mayor compromiso mucoso y submucoso) (75 vs. 16% de las resecciones intestinales; p < 0,05), estenóticas (cirugías de urgencia por obstrucción), con mayor porcentaje de resecciones segmentarias (100 vs. 46,9%; p < 0,05) y más días de hospitalización (5,8 ± 2,3 vs. 4,1 ± 0,9 días) que en 2011-2019. CONCLUSIONES: A nuestro entender, esta es la serie más grande publicada en Chile de resecciones intestinales por endometriosis. Estos hallazgos demuestran cómo la introducción de la unidad multidisciplinaria de endometriosis permite un diagnóstico precoz y un tratamiento quirúrgico eficaz y oportuno, tal como se decribe en la literatura.

INTRODUCTION: Bowel endometriosis severely affects a young woman's quality of life and often requires surgical treatment with bowel resection. This surgery is technically complex due to the tight adhesions of the intestine to the vagina, uterus, and ovaries. The objective of this work is to describe and analyze the surgical and histopathological results of intestinal resections for severe endometriosis during the last 18 years at the Clinical Hospital University of Chile, in relation to the implementation of the multidisciplinary endometriosis unit, based on the year 2011 and the experiences published in Chilean and foreign literature. METHOD: Retrospective work carried out in a tertiary hospital from 2001 to 2019. The patients were assigned to two groups according to the surgery period: group 2001-2010 and group 2011-2019, after endometriosis unit formation. All patients who underwent bowel resection (discoidal or segmental) for endometriosis by laparotomy or laparoscopy were collected. Normally distributed data are presented as mean ± SD and nonparametric data as median (range). Demographic comparisons of continuous variables are compared using Student's t test and categorical variables using chi squared or Fisher's test. Statistical significance was established at p < 0.05. RESULTS: 52 cases were collected. 94.2% of the surgeries were elective. 5.8% were urgent due to intestinal obstruction (all between 2001 and 2010). 75% of the surgeries were laparoscopic. Segmental resection 67.3%, simple discoidal resection 28.8%, double discoidal resection 1.9% and segmental resection and a discoidal resection 1.9%. Histopathology showed involvement of the lesion up to the intestinal mucosa in 7.7%. A marked decrease in pain in the follow-up of the patients. 24% of the patients with a desire for pregnancy and intestinal endometriosis achieved a full-term delivery by IVF or spontaneously. There were four postoperative complications, three of them category II according to the Clavien-Dindo classification, and one category IV A complication with reoperation at 72 h. When comparing both periods, between 2001-2010 the diagnostic tests used were: transvaginal ultrasound (ECO TV) (0%), barium enema (BE) (60%), abdomen pelvis CT (45%) and pelvic resonance (MRI) (20%). Between 2011 and 2019 ECO TV (100%), EB (3%), TAC (3%) RM (66%). In the period 2001 to 2010, the lesions were more infiltrative (greater mucosal and submucosal involvement) (75% vs 16% of intestinal resections (P <0.05)), stenotic (urgent surgery for obstruction), with a higher percentage of resections segmental (100% vs 46.9% (P <0.05) and more days of hospitalization (5.8 ± 2.3 SD vs 4.1 ± 0.9 SD) than in the period from 2011 to 2019. CONCLUSIONS: To our knowledge, this is the largest series published in Chile of intestinal resections for endometriosis. These findings demonstrate how the introduction of the multidisciplinary endometriosis unit allows early diagnosis and effective and timely surgical treatment as described in the literature.

Quality of life in women with deep endometriosis: A cross-sectional study / Qualidade de vida de mulheres com endometriose profunda: Estudo de corte transversal

Abstract Objective To describe clinical and sociodemographic characteristics of women with deep infiltrating endometriosis (DIE) and assess their quality of life (QOL) during 6 months of medical treatment. Methods A descriptive cross-sectional study of 60 women diagnosed with DIE either by surgery or image methods (ultrasound or magnetic resonance), who received clinical treatment for at least 6 months in the Universidade de Campinas, Campinas, state of São Paulo, Brazil. Both the SF-36 and the EHP-30 questionnaires were used to assess the quality of life. Results The mean age of the patients was 37.7 ± 6.0 years old, with 50% presenting dysmenorrhea; 57% dyspareunia; and 50% chronic pelvic pain. The SF-36 and the EHP-30 revealed impaired quality of life. In the SF-36, the worst domains were limitation due to emotional aspects (40.2 ± 43.1) and self-esteem and disposition (46.1 ± 24.8), whereas in the EHP-30 they were social well-being (50.3 ± 30.6); infertility (48.0 ± 36.3); and sexual intercourse (54.0 ± 32.1). Conclusion Although clinically treated, women with deep endometriosis present impairment in different domains of quality of life regardless of the questionnaire used for evaluation.

Resumo Objetivo Descrever características clínicas e sociodemográficas de mulheres com endometriose profunda infiltrativa e avaliar sua qualidade de vida dentro de 6 meses de tratamento clínico. Métodos Estudo de corte transversal descritivo com 60 mulheres em seguimento ambulatorial na Universidade de Campinas, Campinas, SP, Brasil, com endometriose profunda infiltrativa diagnosticada por cirurgia ou métodos de imagem (ultrassonografia ou ressonância magnética), em tratamento clínico há pelo menos 6 meses. Para avaliar a qualidade de vida, foram utilizados os questionários SF-36 e EHP-30. Resultados A média etária das mulheres foi de 37,7 ± 6,0 anos; 50% delas apresentaram dismenorreia, 57% dispareunia e 50% dor pélvica crônica. O SF-36 e o EHP-30 mostraram comprometimento da qualidade de vida destas mulheres. No SF-36, os piores domínios foram os aspectos emocionais (40,2 ± 43,1) e a autoestima e disposição (46,1 ± 24,8), enquanto que no EHP-30 foram o bem-estar social (50,3 ± 30,6), a infertilidade (48,0 ± 36,3) e as relações sexuais (54,0 ± 32,1). Conclusão Embora tratadas clinicamente, as mulheres com endometriose profunda apresentaram comprometimento em diferentes domínios da qualidade de vida independente do questionário utilizado para avaliação.

Regulatory T cells isolated from endometriotic peritoneal fluid express a different number of Toll-like receptors / Células T reguladoras isoladas do fluido peritoneal de mulheres com endometriose expressam um número diferente de receptores do tipo Toll

ABSTRACT Objective To analyze and compare the expression of Toll-like receptors by regulatory T cells present in the peritoneal fluid of patients with and without endometriosis. Methods Regulatory T cells were isolated from peritoneal fluid of women with and without endometriosis, collected during surgery, and mRNA was extracted for analysis of Toll-like receptors expression by reverse-transcriptase polymerase chain reaction. Results Patients with endometriosis presented regulatory T cells expressing a larger number and variety of Toll-like receptors when compared to regulatory T cells from patients in the Control Group. Toll-like receptor-1 and Toll-like receptor-2 in regulatory T cells were expressed in both groups. All other expressed Toll-like receptors types were only found in regulatory T cells from the Endometriosis Group. Conclusion Patients with endometriosis had peritoneal regulatory T cells expressing various Toll-like receptors types.

RESUMO Objetivo Analisar e comparar a expressão de receptores do tipo Toll por células T reguladoras presentes no líquido peritoneal de pacientes com endometriose. Métodos Células T reguladoras foram isoladas do líquido peritoneal de mulheres com e sem endometriose, coletadas durante a cirurgia, e o RNAm foi extraído para análise da expressão de receptores do tipo Toll por reação em cadeia da polimerase com transcriptase reversa. Resultados Pacientes com endometriose apresentaram células T reguladoras expressando maior número e variedade de Toll por células quando comparadas com T reguladoras de pacientes do Grupo Controle. Receptores do tipo Toll-1 e receptores do tipo Toll-2 foram expressos em ambos os grupos. Todos os outros tipos de receptores Toll foram encontrados expressos apenas em células T reguladoras do grupo com endometriose. Conclusão Pacientes com endometriose apresentaram células T reguladoras peritoneais expressando vários tipos de receptores tipo Toll.

Advances in Post-translational Modifications and Endometriosis / 中国医学科学院学报

Proteins exert their roles in life activities via post-translational modifications(PTMs),which include phosphorylation,acetylation,ubiquitination,glycosylation,and methylation.These modifications can change the functions of proteins and play key roles in a variety of diseases.Endometriosis is a common disease in women of childbearing age,although its molecular mechanisms remain unclear.Recent studies have shown that PTMs may be involved in the pathogenesis of endometriosis.Here we review the roles of PTMs in the occurrence and development of endometriosis and the potential medical treatments.

Thalidomide reduces cell proliferation in endometriosis experimentally induced in rats / A talidomida induz diminuição da proliferação celular em endometriose experimentalmente induzida em ratas

Abstract Objective To analyze the effect of thalidomide on the progression of endometriotic lesions experimentally induced in rats and to characterize the pattern of cell proliferation by immunohistochemical Proliferating Cell Nuclear Antigen (PCNA) labeling of eutopic and ectopic endometrium. Methods Fifteen female Wistar rats underwent laparotomy for endometriosis induction by resection of one uterine horn, isolation of the endometrium and fixation of a tissue segment to the pelvic peritoneum. Four weeks after, the animals were divided into 3 groups: control (I), 10mg/kg/day (II) and 1mg/kg/day (III) intraperitoneal thalidomide for 10 days. The lesion was excised together with the opposite uterine horn for endometrial gland and stroma analysis. Eutopic and ectopic endometrial tissue was submitted to immunohistochemistry for analysis of cell proliferation by PCNA labeling and the cell proliferation index (CPI) was calculated as the number of labeled cells per 1,000 cells. Results Group I showed a mean CPI of 0.248 ± 0.0513 in the gland and of 0.178 ± 0.046 in the stroma. In contrast, Groups II and III showed a significantly lower CPI, that is, 0.088 ± 0.009 and 0.080 ± 0.021 for the gland (p < 0.001) and 0.0945 ± 0.0066 and 0.075 ± 0.018 for the stroma (p < 0.001), respectively. Also, the mean lesion area of Group I was 69.2mm2, a significantly higher value compared with Group II (49.4mm2, p = 0.023) and Group III (48.6mm2, p = 0.006). No significant difference was observed between Groups II and III. Conclusion Thalidomide proved to be effective in reducing the lesion area and CPI of the experimental endometriosis implants both at the dose of 1mg/kg/day and at the dose of 10 mg/kg/day.

Resumo Objetivo Analisar o efeito da talidomida na progressão de lesões endometrióticas induzidas experimentalmente em ratas e caracterizar o padrão de proliferação celular pela marcação imunohistoquímica de Antígeno Nuclear de Célula Proliferativa (PCNA) no endométrio eutópico e ectópico. Métodos Quinze ratas Wistar foram submetidas a laparotomia para indução de endometriose por ressecção de um corno uterino, isolamento do endométrio e fixação de um segmento do tecido ao peritônio pélvico. Após quatro semanas, os animais foram divididos em 3 grupos: controle (I), 10 mg/kg/dia (II) e 1 mg/kg/dia (III) de talidomida intraperitoneal por um período de 10 dias. As lesões foram resseccionadas juntamente com o corno uterino oposto para análise da glândula endometrial e do estroma. O tecido endometrial eutópico e ectópico foi submetido à imunohistoquímica para análise da proliferação celular por marcação com PCNA e o índice de proliferação celular (CPI) foi calculado como o número de células marcadas por 1.000 células. Resultados O grupo I apresentou média de CPI de 0,248 ± 0,0513 na glândula e de 0,178 ± 0,046 no estroma. Em contraste, os grupos II e III apresentaram CPI significativamentemenor, isto é, 0,088 ± 0,009 e 0,080 ± 0,021 para a glândula (p < 0,001) e 0,0945 ± 0,0066 e 0,075 ± 0,018 para o estroma (p < 0,001), respectivamente. Além disso, a área de lesãomédia do Grupo I foi de 69,2mm2, valor significativamentemaior em relação ao Grupo II (49,4mm2, p = 0,023) e Grupo III (48,6mm2, p = 0,006). Não houve diferença estatisticamente significante entre os Grupos II e III. Conclusão A talidomida mostrou-se eficaz na redução da área da lesão e CPI dos implantes de endometriose experimental tanto na dose de 1mg/kg/dia quanto na dose de 10 mg/kg/dia.

Elevación de los marcadores de estrés oxidativo en pacientes con endometriosis / Elevation of oxidative stress biomarkers in patients with endometriosis

RESUMEN Introducción y objetivos: La endometriosis es una de las principales patologías ginecológicas que afecta a mujeres en edad reproductiva. Existen muchas teorías en cuanto a su fisiopatología destacando las alteraciones genéticas y epigenéticas, los desbalances hormonales y otros factores como la inflamación crónica y el estrés oxidativo; pero en realidad, su origen continúa siendo desconocido. Estudios recientes han implicado al estrés oxidativo y la consecuente generación de radicales libres de oxígeno en la fisiopatología de la entidad mediante la generación de inflamación crónica pélvica. El objetivo de este estudio es corroborar que existen vías de estrés oxidativo que se encuentran alteradas en estas pacientes. Métodos: Se realizará un análisis de marcadores de estrés oxidativo en plasma sanguíneo, entre ellos los niveles de proteínas carboniladas y el cociente glutatión oxidado/glutatión reducido (GSSG/GSH), comparando los resultados en pacientes con endometriosis (n=19) versus un grupo control (n=11). Resultados: existe un incremento de las proteínas carboniladas en las pacientes con endometriosis (p < 0,041). No se obtuvieron diferencias estadísticamente significativas en relación al cociente GSSG/GSH o a los niveles de GSH. Conclusión: existe evidencia para relacionar al estrés oxidativo con la fisiopatología de la endometriosis, sin poder determinar a día de hoy que vías de oxidación están implicadas.

ABSTRACT Introduction and objectives: Endometriosis is one of the main gynecological pathologies that affects women of reproductive age. There are many theories regarding its physiopathology highlighting genetic and epigenetic alterations, hormonal imbalances and other factors such as chronic inflammation and oxidative stress; but actually, its origin continues to be unknown. Recent studies have implicated oxidative stress and the consequent generation of oxygen free radicals in the physiopathology of the entity through the generation of chronic pelvic inflammation. The objective of this study is to corroborate that there are oxidative stress pathways that are altered in these patients. Methods: An analysis of oxidative stress biomarkers in blood plasma will be carried out, including carbonylated protein levels and the oxidized/reduced glutathione ratio (GSSG / GSH), comparing the results in patients with endometriosis (n = 19) versus a control group (n = 11). Results: there is an increase of carbonylated proteins in patients with endometriosis (p <0.041). There were no statistically significant differences in relation to the GSSG/GSH ratio or GSH levels. Conclusion: there is evidence to relate oxidative stress to the pathophysiology of endometriosis, without being able to determine to date which oxidation pathways are involved.

Angiomixoma pélvico asociado a endometriosis infiltrativa profunda: reporte de un caso / Pelvic angiomyxoma associated to deep infiltrative endometriosis: case report

El angiomixoma de la pelvis es un tumor mesenquimal inusual; que dado su alto potencial de recidiva es relevante que la exéresis quirúrgica sea lo más radical posible. Por su parte, la endometriosis infiltrativa profunda, es otra entidad poco frecuente que requiere de tratamientos complejos. La co-existencia de ambas patologías representa una situación absolutamente infrecuente; de los que hay muy pocos casos reportado en la literatura occidental. Se presenta el caso de una mujer de 41 años de edad que desarrolló ambas entidades nosológicas de forma concomitante y que fue tratada quirúrgicamente con buenos resultados.

Angiomyxoma of the pelvis is an unusual mesenchymal tumor; that given its high potential for recurrence, it is relevant that the surgical resection be as radical as possible. For its part, to deep infiltrative endometriosis is another rare entity that requires complex treatments. The co-existence of both pathologies represents an absolutely infrequent situation; of which there are very few cases reported in western literature. We present the case of a 41-year-old woman who developed both clinical entities concomitantly and who was treated surgically with good results.

Tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal / Surgical treatment of deep pelvic endometriosis with colorectal involvement

INTRODUCCIÓN: En la endometriosis el compromiso intestinal afecta hasta al 12% de las pacientes, comprometiendo al recto y a la unión rectosigmoidea en el 90% de los casos. OBJETIVO: Describir la experiencia del equipo de Coloproctología y Ginecología de Clínica Alemana de Santiago en el tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal. MATERIAL Y MÉTODOS: Estudio retrospectivo a partir de la base de datos de pacientes con endometriosis tratados entre enero del año 2015 y abril de 2018. Los criterios de inclusión fueron pacientes con clínica de endometriosis pélvica profunda, que tuviesen compromiso colorrectal y hayan sido tratados con shaving rectal, resección discoide o resección segmentaria. Se revisaron fichas clínicas electrónicas, protocolos operatorios y biopsias definitivas. RESULTADOS: Se reclutaron 25 pacientes con una mediana de edad de 35 años. El síntoma principal de consulta fue dismenorrea y el síntoma digestivo más frecuente fue disquecia. En 8 pacientes se realizó un shaving rectal, en 7 una sigmoidectomía, en 9 una resección discoide y en 1 paciente una tiflectomía. La complicación posoperatoria reportada fue la hemorragia digestiva baja en 4 pacientes (Clavien-Dindo I y IIIa). Con una mediana de seguimiento de 13 meses, a la fecha 3 pacientes se les ha diagnosticado algún tipo de recidiva. CONCLUSIÓN: Es importante que la cirugía a realizar, garantice una morbilidad y recurrencia baja. Los resultados en nuestro centro son alentadores, lo que nos hace creer que el tratamiento quirúrgico podría ser una buena alternativa en la endometriosis pélvica profunda con compromiso colorrectal.

INTRODUCTION: In endometriosis, intestinal involvement affects up to 12% of patients, compromising the rectum and the rectosigmoid junction in 90% of cases. AIM: Describe the experience of the Coloproctolgy and Gynecology Team of the Clínica Alemana de Santiago in the surgical treatment of deep pelvic endometriosis with colorectal involvement. MATERIAL AND METHODS: Retrospective study based on the database of patients with endometriosis treated between January 2015 and April 2018. The inclusion criteria were patients with deep pelvic endometriosis clinic, who had colorectal involvement and who had been treated with rectal shaving, discoid resection or segmental resection. Electronic clinical records, operative protocols and definitive biopsies were reviewed. RESULTS: Twenty-five patients with a median age of 35 years were recruited. The main symptom of consultation was dysmenorrhoea and the most frequent digestive symptom was dyschezia. In 8 patients a rectal shaving was performed, in 7 a sigmoidectomy, in 9 a discoid resection and in 1 patient a tiflectomy. The only reported post-operative complication was low gastrointestinal bleeding in 4 of the 25 patients (Clavien-Dindo I and IIIa). A median follow-up of 13 months was achieved, to date 3 patients have been diagnosed with some type of recurrence. CONCLUSION: It is important that the surgery to be performed guarantees low morbidity and recurrence. The results in our center are encouraging, which makes us believe that surgical treatment could be a good alternative in deep pelvic endometriosis with colorectal involvement.

Endosalpingiosis como causa de dolor pélvico crónico: reporte de un caso / Endosalpingiosis as a cause of chronic pelvic pain: a case report

RESUMEN La endosalpingiosis es una patología benigna de origen embriológico caracterizada por la presencia de epitelio tubárico en una localización ectópica; la cual debe ser considerada ante la presencia de dolor pélvico crónico. Su etiología no está clara, y su diagnóstico suele ser un hallazgo incidental durante estudios imagenológicos, laparotomía o laparoscopia, y solo es confirmado por el estudio histopatológico. Se presenta el caso de una paciente de 43 años con antecedente de esterilización quirúrgica y resección de pólipo endocervical, quien consulta por dolor pélvico crónico de 6 años de evolución, localizado en fosa iliaca derecha. Se realiza laparoscopia exploratoria con hallazgos quirúrgicos sugestivos de endosalpingiosis.

ABSTRACT Endosalpingiosis is a benign pathology of embryological origin characterized by the presence of tubal epithelium in an ectopic location; it must be considered in the presence of chronic pelvic pain. Its etiology is not clear, and its diagnosis is usually an incidental finding during imaging studies or during laparotomy or laparoscopy, and is only confirmed by the histopathological studies. We present the case of a 43-year-old patient with a history of surgical sterilization and endocervical polyp resection, who consulted for chronic pelvic pain of 6 years of evolution, located in the right iliac fossa. Exploratory laparoscopy was performed with surgical findings suggestive of endosalpingiosis

Effects of omega-6/3 and omega-9/6 nutraceuticals on pain and fertility in peritoneal endometriosis in rats

Abstract Purpose: To evaluate the effects of the nutraceuticals omega-6/3 and omega-9/6 on endometriosis-associated infertility and pain. Methods: Controlled experimental study, with each group composed of eight female rats. Fertility groups: sham-operated control (0.9% saline solution); control with endometriosis (0.9% saline); omega-6/3 (1.2 g/kg/day); omega-9/6 (1.2 g/kg/day); and meloxicam (0.8 mg/kg/day). Pain groups: sham-operated control (0.9% saline); control with endometriosis (0.9% saline); omega-6/3 (1.2 g/kg/day); omega-9/6 (1.2 g/kg/day); medroxyprogesterone acetate (5 mg/kg/every 3 days); and meloxicam (0.8 mg/kg/day). Peritoneal endometriosis was surgically induced. Pain was evaluated with the writhing test. Fertility was evaluated by counting the number of embryos in the left hemi-uterus. Results: The mean number of writhings was as follows: sham-operated, 11.1 ± 2.9; control with endometriosis, 49.3 ± 4.4; omega-6/3, 31.5 ± 2.7; omega-9/6, 34.1 ± 4.5; medroxyprogesterone acetate, 2.1 ± 0.8; meloxicam, 1 ± 0.3. There was a significant difference between both controls and all drugs used for treatment. Regarding fertility, the mean values were as follows: sham-operated, 6.8 ± 0.6; control with endometriosis, 4.2 ± 0.7; omega-6/3, 4.7 ± 1; omega-9/6, 3.8 ± 0.9; and meloxicam, 1.8 ± 0.9. Conclusions: The omega-6/3 and omega-9/6 nutraceuticals decreased pain compared to the controls. There was no improvement in fertility in any of the tested groups.

Manejo laparoscópico multidisciplinario de la endometriosis profunda del 2010 al 2017: estudio de cohorte retrospectivo / Multidisciplinary laparoscopic management of deep infiltrating endometriosis from 2010 to 2017: A retrospective cohort study

INTRODUCCIÓN La laparoscopía es actualmente el estándar en el manejo de la endometriosis profunda. Sin embargo, requiere de un entrenamiento específico e involucra la realización de procedimientos complejos y asociados a una alta tasa de complicaciones. Por lo anterior en Chile y Latinoamérica, la endometriosis profunda es frecuentemente manejada de manera inadecuada. OBJETIVO Describir nuestra experiencia en el enfrentamiento clínico y manejo quirúrgico laparoscópico de la endometriosis profunda, durante los últimos siete años. MÉTODOS Estudio de cohorte retrospectivo de 137 pacientes consecutivas operadas y con confirmación histológica de endometriosis profunda. Se recolectaron los datos demográficos, datos quirúrgicos, complicaciones, resultados reproductivos y seguimiento. RESULTADOS Todas las cirugías fueron completadas por laparoscopía, sin conversión. La dismenorrea y la dispareunia fueron los síntomas más frecuentes en 85,4 y 56,9%, respectivamente. La localización más frecuente de endometriosis profunda fueron los ligamentos úterosacros, coexistiendo un endometrioma en 48,9% de los casos. La mediana de tiempo operatorio fue de 140 minutos, siendo significativamente más prolongado en casos con compromiso intestinal (p < 0,0001). Quince pacientes (10,9%) presentaron complicaciones. El seguimiento medio fue de 24,5 meses. La tasa de embarazo fue de 58,1% y 90% de las pacientes reportó una mejoría significativa de su sintomatología. CONCLUSIONES El manejo laparoscópico de la endometriosis profunda es efectivo y seguro, pero debe reservarse a centros especializados y con disponibilidad de equipo multidisciplinario.

BACKGROUND Laparoscopy has become the standard of care in the surgical management of deep infiltrating endometriosis (DIE). However, it is a challenging procedure with a high complication rate. Despite the benefits of the minimally invasive approach, DIE resection is often performed by surgeons without adequate training, especially in developing countries like Chile. OBJECTIVE To asses our experience in the diagnosis and laparoscopic management of DIE during seven years. METHODS A retrospective cohort study of data including 137 patients with pathology-proven DIE. Surgical and fertility outcomes were evaluated. RESULTS All procedures were performed laparoscopically without conversion. Dysmenorrhea and dyspareunia were the most common symptoms in 85.4% and 56.9%, respectively. Uterosacral ligaments were the most common DIE location. Endometrioma was present in 48.9% of cases. Median operative time was 140 minutes; however, it was longer in cases requiring bowel surgery (p < 0.0001). The complication rate was 10.9%. Median follow-up was 24.5 months. The pregnancy rate was 58.1% and 90% of patients reported significant symptom relief after surgery. CONCLUSION Laparoscopic surgical management of DIE is effective and safe but it must be performed in tertiary centers with the availability of multidisciplinary teams.

Increased expression levels of metalloprotease, tissue inhibitor of metalloprotease, metallothionein, and p63 in ectopic endometrium: an animal experimental study / Aumento nos níveis de expressão de metaloprotease, inibidor tecidual das metaloproteases, metalotioneina e p63 em endométrio ectópico: um estudo experimental animal

Abstract Objective To characterize the patterns of cell differentiation, proliferation, and tissue invasion in eutopic and ectopic endometrium of rabbits with induced endometriotic lesions via a well- known experimental model, 4 and 8 weeks after the endometrial implantation procedure. Methods Twenty-nine female New Zealand rabbits underwent laparotomy for endometriosis induction through the resection of one uterine horn, isolation of the endometrium, and fixation of tissue segment to the pelvic peritoneum. Two groups of animals (one with 14 animals, and the other with15) were sacrificed 4 and 8 weeks after endometriosis induction. The lesion was excised along with the opposite uterine horn for endometrial gland and stroma determination. Immunohistochemical reactions were performed in eutopic and ectopic endometrial tissues for analysis of the following markers: metalloprotease (MMP-9) and tissue inhibitor of metalloprotease (TIMP-2), which are involved in the invasive capacity of the endometrial tissue; and metallothionein (MT) and p63, which are involved in cell differentiation and proliferation. Results The intensity of the immunostaining for MMP9, TIMP-2, MT, and p63 was higher in ectopic endometria than in eutopic endometria. 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 eutopic endometria, demonstrating a potentially invasive, progressive, and heterogeneous presentation of endometriosis.

Resumo Objetivo Caracterizar o padrão de diferenciação celular, proliferação e invasão tecidual em endométrio eutópico e ectópico de coelhas com lesões de endometriose induzidas por um modelo experimental 4 e 8 semanas após o procedimento de implantação endometrial. Métodos Vinte e nove coelhas fêmeas Nova Zelândia foram submetidas a laparotomia para indução de endometriose através da ressecção de um dos cornos uterinos, isolamento do endométrio e fixação do tecido no peritônio pélvico. Dois grupos de animais (14 animais em um grupo e 15 animais no outro) foram sacrificados 4 e 8 semanas após a indução da endometriose. A lesão foi excisada junto com o corno uterino contralateral para determinação da presença de glândulas e de estroma endometrial. Reações de imunohistoquímica foram realizadas no tecido endometrial eutópico e ectópico para análise dos seguintes marcadores: metaloprotease (MMP9) e inibidor tecidual da metaloprotease 2 (TIMP-2), os quais estão envolvidos na capacidade de invasão do tecido endometrial; e metalotioneina (MT) e p63, os quais estão envolvidos na diferenciação e proliferação celular. Resultados A intensidade da imunomarcação para MMP9, TIMP-2, MT e p63 foi mais alta nos endométrios ectópicos do que nos endométrios eutópicos. Contudo, quando as lesões foram comparadas entre 4 e 8 semanas, nenhuma diferença foi observada, com exceção do marcador p63, o qual foi mais evidente depois de 8 semanas de evolução do tecido endometrial ectópico. Conclusão Lesões endometriais ectópicas parecem expressar maior poder de diferenciação celular e de invasão tecidual comparadas com endométrios eutópicos, demonstrando o potencial de invasão, de progressão e de apresentação heterogênea da endometriose.

The apoptotic, angiogenic and cell proliferation genes CD63, S100A6 e GNB2L1 are altered in patients with endometriosis / Os genes apoptóticos, angiogênicos e de proliferação celular CD63, S100A6 e GNB2L1 estão alterados em pacientes com endometriose

Abstract Objective The aim of the present study was to analyze the expression of the CD63, S100A6, and GNB2L1genes, which participate in mechanisms related to the complex pathophysiology of endometriosis. Methods A case-control study was conducted with 40 women who were diagnosed with endometriosis, and 15 fertile and healthy women. Paired samples of eutopic endometrium and endometriotic lesions (peritoneal and ovarian endometriotic implants) were obtained from the women with endometriosis in the proliferative (n = 20) or secretory phases (n = 20) of the menstrual cycle. As controls, paired endometrial biopsy samples were collected from the healthy women in the proliferative (n = 15) and secretory (n = 15) phases of the samemenstrual cycle.We analyzed the expression levels of the CD63, S100A6, and GNB2L1 genes by real-time polymerase chain reaction. Results An increase in CD63, S100A6, and GNB2L1 gene transcript levels was observed in the ectopic implants compared with the eutopic endometrium of the women with and without endometriosis, regardless of the phase of the menstrual cycle. Conclusion These findings suggest that the CD63, S100A6, and GNB2L1 genesmay be involved in the pathogenesis of endometriosis, since they participate in mechanisms such as inhibition of apoptosis, angiogenesis and cell proliferation, which lead to the loss of cell homeostasis in the ectopic endometrium, thus contributing to the implantation and survival of the tissue in the extrauterine environment.

Resumo Objetivo O objetivo do presente estudo foi analisar a expressão dos genes CD63, S100A6 e GNB2L1, que participam em mecanismos relacionados à complexa fisiopatologia da endometriose. Métodos Um estudo caso-controle foi realizado com 40 mulheres diagnosticadas com endometriose e 15 mulheres férteis e saudáveis. Amostras pareadas de endométrio eutópico e de lesões endometrióticas (implantes endometrióticos peritoneais e ovarianos) foram obtidas de mulheres com endometriose nas fases proliferativa (n = 20) ou secretora (n = 20) do ciclo menstrual. Como controle, amostras pareadas de biópsia endometrial foram coletadas de mulheres saudáveis nas fases proliferativa (n = 15) e secretora (n = 15) nomesmo ciclomenstrual. Foram analisados os níveis de expressão dos genes CD63, S100A6 e GNB2L1 por reação em cadeia da polimerase em tempo real. Resultados Foi observado um aumento nos níveis de transcritos dos genes CD63, S100A6 e GNB2L1 em implantes ectópicos quando comparado ao endométrio eutópico de mulheres com e sem endometriose, independente da fase do ciclo menstrual. Conclusão Estes achados sugerem que os genes CD63, S100A6 e GNB2L1 podem estar envolvidos na patogênese da endometriose, pois participam de mecanismos como inibição de apoptose, angiogênese e proliferação celular, os quais levam à perda da homeostase celular no endométrio ectópico e, portanto, contribuem para o implante e a sobrevivência do tecido no ambiente extrauterino.

Female Sexual Function in Women with Suspected Deep Infiltrating Endometriosis / Função sexual feminina em mulheres com suspeita de endometriose infiltrativa profunda

Abstract Objective To evaluate the quality of the sexual function of women with suspected deep infiltrating endometriosis. Methods A cross-sectional, observational and prospective study was conducted between May 2015 and August 2016, in which 67 patients with deep infiltrating endometriosis, suspected or diagnosed, were assessed for epidemiological and clinical characteristics, such as pain level through a visual analog scale (VAS), features of deep infiltrating endometriosis lesions and score on the Female Sexual Function Index (FSFI) before the onset of treatment. The statistical analysis was performed using the software STATA version 12.0 (StataCorp LLC, College Station, TX, USA) to compare the variables through multiple regression analysis. Results The average age of the patients was 39.2 years old; most patients were symptomatic (92.5%); and the predominant location of the deep infiltrating lesions was on the rectosigmoid colon (50%), closely followed by the retrocervical region (48.3%). The medianoverallscoreontheFSFIwas23.4;in67.2%of thecasesthescorewas26.5(cutoff point for sexualdysfunction). Deepdyspareunia(p = 0.000,confidenceinterval [CI]:0.64- 0.83) and rectosigmoid endometriosis lesions (p = 0.008, CI: 0.72-0.95) showed significant correlation with lower FSFI scores, adjusted by bladder lesion, patients' ageand size of lesions. Deep dyspareunia (p = 0.003, CI: 0.49-0.86) also exhibited significant correlation with FSFI pain domain, adjusted by cyclic bowel pain, vaginal lesion and use of gonadotropin-releasing hormone (GnRH) analog. These results reflect the influence of deep dyspareunia on the sexual dysfunction of the analyzed population. Conclusion Most patients exhibited sexual dysfunction, and deep dyspareunia was the pelvic painful symptom that showed correlation with sexual dysfunction.

Resumo Objetivo Avaliar a qualidade da função sexual em pacientes com suspeita de endometriose profunda infiltrativa. Métodos Foi realizado um estudo observacional transversal prospectivo entre maio de 2015 e agosto de 2016, no qual foram analisados os dados clínicos e epidemiológicos de 67 pacientes com endometriose profunda presuntiva ou diagnosticada, níveis de dor através de escala visual analógica (EVA) e Índice de Função Sexual Feminina (questionário IFSF) antes do início do tratamento. A análise estatística foi realizada utilizando o programa estatístico STATA, na versão 12.0 (StataCorp LLC, College Station, TX, USA), para comparar as variáveis por meio de regressão múltipla. Resultados A idade média foi de 39,2 anos; houve predominância de mulheres sintomáticas (92,5%) e da localização de lesões de endometriose profunda em retossigmoide (50%) seguida pela topografia retrocervical (48,3%). A pontuação total no IFSF mostrou uma mediana de 23,4, e em 67,2% das mulheres a pontuação foi 26,55 (cut-off que indica disfunção sexual). Dispareunia (p = 0.000, intervalo de confiança [IC]: 0.64-0.83) e lesão endometriótica em retossigmoide (p = 0.008, IC: 0.72-0.95) exibiram uma relação estatisticamente significante com valores baixos de pontuação no IFSF, ajustados por lesão em bexiga, idade da paciente e tamanho da lesão. A dispareunia de profundidade também mostrou correlação significante com o domínio dor do IFSFajustado por dor cíclica intestinal, lesão vaginal e uso de análogo de hormônio liberador de gonadotrofina (GnRH). Os resultados refletem a influência da dispareunia de profundidade na disfunção sexual da população do estudo. Conclusão A maioria das pacientes apresentava disfunção sexual e o sintoma mais relacionado a esta disfunção foi dispareunia de profundidade.

Ultrasonographic findings in primary umbilical endometriosis

Abstract: Primary cutaneous endometriosis is a rare condition. It appears without a prior history of surgical procedure and the umbilicus is the most frequently involved area. Primary umbilical endometriosis, or Villar's nodule, usually presents as a painful nodule. Its differential diagnosis may be challenging. Although histopathological assessment represents the gold standard for diagnosis, cutaneous ultrasonography may be useful in guiding the surgical treatment. Ultrasonographic features of cutaneous endometriosis have not yet been fully explored in the literature. Hence, we report peculiar ultrasonographic findings of primary umbilical endometriosis

Endometriosis / Endometriosis

Resumen La endometriosis es una enfermedad inflamatoria benigna, dependiente de estrógeno, que se caracteriza por la presencia de glándulas y estroma endometrial en un sitio distinto a la cavidad uterina. Las principales teorías sobre su patogénesis involucran la menstruación retrograda, La metaplasia del epitelio germinal, y la diseminación metastásica. Las lesiones típicamente se localizan en la pelvis; en ovarios, ligamentos uterosacros y saco de Douglas, sin embargo también pueden encontrarse fuera de esta. La enfermedad ocasiona un cuadro clínico variado que involucra dismenorrea, dispareunia, dolor pélvico e infertilidad. Su diagnóstico definitivo ES quirúrgico. El tratamiento médico es solo sintomático y no curativo, mientras que el quirúrgico pese a ser curativo, presenta variables tasas de recurrencia. Las técnicas de reproducción asistida mejoran significativamente las tasas de nacimientos en caso de infertilidad asociada a la enfermedad.

Abstract Endometriosis is a benign, estrogen dependent, inflammatory disease, which is characterized by the presence of endometrial glands and stroma in a site different from the uterine cavity. The main theories about it's pathogenesis involve retrograde menstruation, metaplasia of the germinal epithelium, and metastatic spread. The lesions are typically located in the pelvis; in ovaries, utero sacral ligaments and Douglas pouch, but can also have an extra pelvic location. This disease has a variable clinical presentation that involves dysmenorrhea, dyspareunia, pelvic pain and infertility. It's definitive diagnosis is surgical. Medical treatment is only symptomatic and non-curative, while the surgical treatment despite being curative has important recurrence rates. Assisted reproduction techniques are very useful to improve birth rates in case of infertility associated with the disease.

Primary umbilical endometriosis / Endometriose umbilical primária

ABSTRACT Objective: to report the characteristics, evolution and outcome of patients with primary umbilical endometriosis. Methods: an observational and descriptive study of patients with primary umbilical endometriosis diagnosed between 2014 and 2017. The clinical variables evaluated were age, clinical picture, lesion characteristics, diagnostic methods, treatment and recurrence. Results: six patients diagnosed with primary umbilical endometriosis aged 28 to 45 years were operated on during the study period. They had lesions ranging from one to 2.5cm in diameter, violet in five patients and erythematous-violaceous in one. The duration of the symptoms until diagnosis ranged from one to three years and in all the cases studied the diagnosis was made through the clinical manifestations and confirmed by histopathological analysis. No case was associated with neoplastic alterations. All patients evaluated had pain and umbilical bleeding in the menstrual period. Conclusion: umbilical endometriosis is an uncommon disease and should be included in the differential diagnosis of women as umbilical nodules. The treatment of choice is the total exeresis of the lesion.

RESUMO Objetivo: relatar as características, evolução e desfecho de pacientes portadoras de endometriose umbilical primária. Métodos: estudo observacional e descritivo de pacientes portadoras de endometriose umbilical primária diagnosticada entre 2014 e 2017. As variáveis clínicas avaliadas foram: idade, quadro clínico, características das lesões, métodos diagnósticos, tratamento e recidiva. Resultados: seis pacientes com diagnóstico de endometriose umbilical primária, com idades entre 28 e 45 anos foram operadas no período do estudo. Elas apresentavam lesões que variavam de 1,0cm a 2,5cm de diâmetro, de cor violácea em cinco pacientes e eritemato-violácea em uma. O tempo de duração dos sintomas até o diagnóstico variou de um a três anos e em todos os casos estudados o diagnóstico foi feito por meio das manifestações clínicas e confirmado por meio da análise histopatológica. Nenhum caso foi associado com alterações neoplásicas. Todas as pacientes avaliadas apresentavam como manifestação clínica dor e sangramento umbilical no período menstrual. Conclusão: a endometriose umbilical é uma doença pouco frequente e deve ser incluída no diagnostico diferencial de mulheres como nódulo umbilical. O tratamento de eleição é a exérese total da lesão.