Biomarkers of endometriosis

8 07 2013

To the Editor:

We would like to thank Dr. Fassbender et al. for their fine article (1). The aim of the review study was to show the diagnostic performance of noninvasive or semi-invasive tests for endometriosis. This article provides an overview of various markers and their place in early detection. We greatly appreciated this paper, but there are also some other biomarkers that should be discussed.

Stem cell theory opens the latest advanced avenue for the etiology of many diseases, including endometriosis. Stem progenitor cells may serve as early markers and also detect recurrence. The endometrium contains endometrial/stem progenitor cells, and these stem cells are present in the peritoneal cavity in women that have retrograde menstruation. Bone marrow is another origin. Bone marrow mesenchymal stem cells (MSC) circulate to the endometrium and reprogram into the endometrial MSC. Positive immunostaining for stem cell markers such as CD9, CD34, c-Kit, Oct-4, Musashi-1 was detected in isolated epithelial and stromal cells in eutopic and ectopic endometrium (2). It has been reported that Oct-4 may stimulate the migration activity of endometrial cells (3). Moreover, these markers may also identify the patients that carry the risk of developing ovarian cancer. Read the rest of this entry »


Comment on “Surgical treatment of ovarian endometriomas: state of the art?”

13 11 2012

To the Editor:

We read with interest the recent review conducted by Jadoul et al. (1) on the surgical treatment of ovarian endometriomas. The authors stress, as we do, that laparoscopic cystectomy for ovarian endometriomas may be difficult, and that a meticulous surgical technique should be used. The stripping technique, similar to that used for other benign cysts, cannot be used for this situation as it may induce severe bleeding and damage to the ovary (2, 3, 4). As we published before, the authors suggest that whenever the plane is adequately exposed, the surgeon may identify “arrows” on the surface of the cyst wall. These “arrows” help the surgeon to identify the correct cleavage plane. Indeed, a precise cut on the top of the arrow will present a safe and bloodless plane close to the cyst wall and away from the normal ovarian tissue, which should be preserved as much as possible. Read the rest of this entry »

Endometriosis: a consequence of varying injuries to pelvic autonomic nerves

2 10 2012

To the Editor:

Ectopic endometrium appears in the pelvis following injuries to uterotubal nerves that result in uterotubal dysmotility and retrograde menstruation (1). These neural injuries result from prolonged straining during defecation, difficult vaginal deliveries, excessive traction to the pregnant cervix at surgical evacuation of the uterus, and miscellaneous injuries yet to be fully described (2). Retrograde menstruation enables adhesion of endometrium to contemporary pelvic injuries (1). Some years later laparoscopic findings may include symmetric thickening of the uterosacral ligaments with fusion of the vagina to the rectum and extensive deposits of ectopic endometrium (recurrent straining at stool), asymmetric injuries to uterosacral ligaments with variable deposits (sporadic, difficult vaginal deliveries), minor deposits around the uterosacral insertions (excessive traction to the pregnant cervix), and endometriomas following injuries to the surface of the ovaries at ovulation (1), or combinations of these presentations. Aberrant reinnervation in the respective organs contributes to symptoms of dysmenorrhea (uterus), dyspareunia (cervix, vagina), chronic pelvic pain (uterus and uterosacral ligaments, and subfertility (uterus, fallopian tubes) (1, 2).

Endometriosis is no longer an enigma; it is, for the most part, a preventable condition caused by Western diets and lifestyles and obstetric and gynecologic interventions (3). No single view can account for each and every individual case, nevertheless, injuries to pelvic autonomic nerves may explain many clinical and laparoscopic presentations and failures of medical and surgical treatment. Autonomic denervation, with its remote and wide-ranging consequences, may account for many features of reproductive ill health, and in some cases, later systemic disease (4).

Martin Quinn, M.D.
Xin Mei Zhang, M.D., Ph.D.
Xiu Feng Huang, M.D.
Hong Xu, M.D., Ph.D.
Department of Gynecology, Women’s Hospital, School of Medicine, University of Zhejiang
Hangzhou, China


(1) Quinn M. Endometriosis- the consequence of uterine deneration-reinnervation. Arch Gynaecol Obstet 2011; 284:1423-9.

(2) Atwal GSS, Armstrong G, Duplessis D, Slade R, Quinn M. Differences in uterine innervation at hysterectomy for chronic pelvic pain with, or without, endometriosis. Am J Obstet Gynecol 2005; 193:1650-5.

(3) Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy. Fertil Steril 2012; 98: 509-10.

(4) Quinn MJ. Origins of Western Diseases. J R Soc Med 2011; 104: 449-56.

The authors declined to respond to this letter.

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2012.10.002

Does complete laparoscopic excision of endometriosis in teenagers really occur?

9 06 2011

To the Editor:

We read with great interest “Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary?” (1). The study evaluated 17 teens – aged 12-19 when they presented with pelvic pain – who underwent a laparoscopic procedure and were found to have biopsy-proven endometriosis. Seven of these patients (41.2%) had, in fact, been treated by ablation or fulguration previous to the “index” laparoscopy for this study, with a total of 13 of the 17 patients having at least one prior laparoscopy. The surgeons state that at this index laparoscopy “all” endometriosis was excised, and postoperatively the teens were not specifically asked to utilize suppressive hormonal therapy. However, 6 (35.1%) patients were on combination hormones and 1 was on GnRH agonist. Among the 17 patients, the study reports 47% return of pain to a level where subsequent laparoscopy was performed within an average of 23.1 months (maximum 66 months). We believe that this finding supports established data that with aggressive surgical therapy alone pain symptoms return (2). Read the rest of this entry »

Specificity of peritoneal blue staining

10 03 2011

To the Editor:

We read with interest and pleasure the technique proposed by Rauh-Hain and Laufer (1) to increase the diagnostic accuracy of laparoscopy in endometriosis. The diagnostis of superficial implants may be difficult, particularly the identification of the limits of the disease. Therefore a staining technique would be useful to identify abnormal peritoneal areas, helping the surgeons to decide the limits of the surgical treatment. We would like to propose three comments to this approach. Read the rest of this entry »

Transforming growth factor β1 gene -509 C/T polymorphism and endometriosis

10 06 2010

To the Editor:

We read with interest the article by Kim and co-workers (1) describing the analysis of the transforming growth factor beta 1 (TGF-beta 1) -509 C/T gene polymorphism among Korean patients with advanced-stage endometriosis and controls. Read the rest of this entry »

Re: Evaluation of high sensitivity C- reactive protein in comparison with C- reactive protein as biochemical serum markers in women with endometriosis

20 05 2010

To the Editor:

We read the article by Lermann et al. (1) with great interest. The aim of the study was to compare high-sensitivity C-reactive protein (hs-CRP) with CRP as a soluble serum marker for the diagnosis of women with endometriosis. There were no significant differences between hs-CRP and CRP levels in endometriosis, unknown endometriosis and non endometriosis. However, the authors reported that hs-CRP had positive correlations between CRP in endometriosis (also in all stages), unknown endometriosis and non endometriosis. Read the rest of this entry »