Wang Ping, Meng Zhilan, Li Yakun, Xu Zuojun
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Front Med (Lausanne). 2021 Mar 30;8:631048. doi: 10.3389/fmed.2021.631048. eCollection 2021.
Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with endometriosis-related PE remain unknown. We present a case of endometriosis-related PE diagnosed on pleural fluid cytology. A systematic review of all endometriosis-related PE cases in literature was conducted to elucidate the clinical characteristics, explore the diagnostic yield of pathological examinations, and to summarize the outcomes of therapeutic approaches in this disease. A case of endometriosis-related PE diagnosed in study hospital was reported. PubMed, Web of Science, and EMBASE were searched for publications pertaining to cases of endometriosis-related PE using predefined search terms. This case and those identified from PubMed, Web of Science, and EMBASE were analyzed. A total of 67 patients were included. Catamential symptoms were presented in 30 (44.8%) patients. Dyspnea was presented in 50 patients (74.6%), followed by right chest/shoulder pain in 34 (50.7%) and cough in 18 (26.9%). 82.8% of the patients had concomitant pelvic endometriosis and 76.7% was infertile or nulliparous. The diagnostic yield of pleural fluid cytological examination, percutaneous pleural biopsy, and surgical biopsy was 9.0, 45.5, and 78.7%, respectively. The patients who received surgery-based therapy had a significantly longer time to relapse than those who received progestational agents or GnRH analogs alone ( = 0.025) or hysterectomy and bilateral salpingoophorectomy (HBSO) ( = 0.040). High clinical awareness of pleural endometriosis is essential in all female with hemorrhagic PE, especially in young females who have infertility and/or pelvic endometriosis. Plerual fluid cytology might be a simple minimally invasive and cost-effective modality in the diagnosis of endometriosis-related PE. Treatment is challenging due to high recurrence and the optimal management of endometriosis-related PE needs further evaluation. The combined approach by surgery and hormonal therapy may achieve the best relapse-free survival.
子宫内膜异位症相关胸腔积液（PE）是血性胸腔积液相对罕见但可治疗的病因。子宫内膜异位症相关胸腔积液患者的临床特征及预后仍不明确。我们报告一例经胸腔积液细胞学诊断的子宫内膜异位症相关胸腔积液病例。对文献中所有子宫内膜异位症相关胸腔积液病例进行系统回顾，以阐明其临床特征，探讨病理检查的诊断率，并总结该疾病的治疗方法的结果。报告了在研究医院诊断的一例子宫内膜异位症相关胸腔积液病例。使用预定义的检索词在PubMed、科学网及EMBASE中检索与子宫内膜异位症相关胸腔积液病例有关的出版物。对该病例以及从上述数据库中识别的病例进行分析。共纳入67例患者。30例（44.8%）患者出现经前症状。50例（74.6%）患者出现呼吸困难，其次是34例（50.7%）出现右胸/肩痛，18例（26.9%）出现咳嗽。82.8%的患者伴有盆腔子宫内膜异位症，76.7%的患者不孕或未生育。胸腔积液细胞学检查、经皮胸膜活检及手术活检的诊断率分别为9.0%、45.5%及78.7%。接受手术为主治疗的患者复发时间显著长于单纯接受孕激素或促性腺激素释放激素类似物治疗的患者（P = 0.025）或接受子宫切除术及双侧输卵管卵巢切除术（HBSO）的患者（P = 0.040）。对于所有患有出血性胸腔积液的女性，尤其是患有不孕和/或盆腔子宫内膜异位症的年轻女性，对胸膜子宫内膜异位症有较高的临床认识至关重要。胸腔积液细胞学检查可能是诊断子宫内膜异位症相关胸腔积液的一种简单、微创且经济有效的方法。由于复发率高，治疗具有挑战性，子宫内膜异位症相关胸腔积液的最佳管理需要进一步评估。手术与激素治疗相结合的方法可能实现最佳的无复发生存。
