Usta Akin, Turan Gulay, Altun Eren, Hocaoglu Meryem, Bulbul Cagla Bahar, Adali Ertan
1 Department of Obstetrics and Gynecology, School of Medicine, Balıkesir University, Balıkesir, Turkey.
2 Department of Pathology, School of Medicine, Balıkesir University, Balıkesir, Turkey.
Reprod Sci. 2019 Feb;26(2):269-277. doi: 10.1177/1933719118768697. Epub 2018 Apr 11.
Endometriosis is an estrogen-dependent inflammatory disease that causes infertility and chronic pelvic pain. Ovarian endometrioma is the most common form of endometriosis, and conservative surgery is the main preferred therapeutic approach for endometrioma-associated symptoms. The aim of this study was to investigate the persistence of cyclic and noncyclic pelvic pain (NCPP) after endometrioma excision and their relationship to clinical and histopathological findings. In this prospective observational study, 41 symptomatic patients were evaluated for the presence of pain symptoms 3 to 6 months after endometrioma excision. Tissue specimens of endometrioma were collected during the operation and embedded in paraffin. The persistence of pain was 41.4%. Surgical excision of endometrioma significantly decreased NCPP and dysmenorrhea, but not dyspareunia ( P < .0001, P = .0001, and P = .25, respectively). Histopathological changes, including depth of endometriosis penetration into the cyst wall, the presence of macrophage infiltration, and vascularity of endometrioma cyst walls were significantly higher in patients with pain persistence than in patients without pain persistence ( P = .0034, P = .0042, and P = .0007, respectively). Moreover, proliferating cell nuclear antigen (PCNA) and CD34 immunoreactivity in both glandular and stromal cells and vascular endothelium were significantly higher in patients with pain persistence ( P = .0079 and P = .0025, respectively). Additionally, these histopathological changes and PCNA and CD34 immunoreactivity were significantly correlated with the persistence of NCPP and dysmenorrhea. The discovered differences in patients with endometrioma with or without pain persistence may indicate a possible relationship between endometrioma-associated pain and histopathological variability of endometrioma.
子宫内膜异位症是一种雌激素依赖性炎症性疾病，可导致不孕和慢性盆腔疼痛。卵巢子宫内膜异位囊肿是子宫内膜异位症最常见的形式，保守手术是治疗子宫内膜异位囊肿相关症状的主要首选治疗方法。本研究的目的是调查子宫内膜异位囊肿切除术后周期性和非周期性盆腔疼痛（NCPP）的持续情况及其与临床和组织病理学发现的关系。在这项前瞻性观察研究中，对41例有症状的患者在子宫内膜异位囊肿切除术后3至6个月评估疼痛症状的存在情况。手术期间收集子宫内膜异位囊肿的组织标本并石蜡包埋。疼痛持续率为41.4%。子宫内膜异位囊肿的手术切除显著降低了NCPP和痛经，但性交困难未降低（分别为P <.0001、P =.0001和P =.25）。与无疼痛持续的患者相比，疼痛持续的患者组织病理学变化，包括子宫内膜异位症侵入囊肿壁的深度、巨噬细胞浸润的存在以及子宫内膜异位囊肿壁的血管形成显著更高（分别为P =.0034、P =.0042和P =.0007）。此外，疼痛持续的患者腺细胞、基质细胞和血管内皮中的增殖细胞核抗原（PCNA）和CD34免疫反应性显著更高（分别为P =.0079和P =.0025）。此外，这些组织病理学变化以及PCNA和CD34免疫反应性与NCPP和痛经的持续显著相关。有或无疼痛持续的子宫内膜异位囊肿患者中发现的差异可能表明子宫内膜异位囊肿相关疼痛与子宫内膜异位囊肿的组织病理学变异性之间存在可能的关系。
