Dye diffusion during laparoscopic tubal patency tests may suggest a lymphatic contribution to dissemination in endometriosis: A prospective, observational study
Autoři:
Marco Scioscia aff001; Anna Pesci aff003; Arnaldo Scardapane aff004; Marco Noventa aff002; Gloria Bonaccorsi aff005; Pantaleo Greco aff005; Giuseppe Zamboni aff003
Působiště autorů:
Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
aff001; Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
aff002; Department of Pathology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
aff003; Interdisciplinary Department of Medicine, Section of Radiology, University of Bari Medical School, Bari, Italy
aff004; Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara, S. Anna University Hospital, Cona, Ferrara, Italy
aff005
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0226264
Souhrn
Aim
Women with adenomyosis are at higher risk of endometriosis recurrence after surgery. This study was to assess if the lymphatic vessel network drained from the uterus to near organs where endometriosis foci lied.
Methods
A prospective, observational study, Canadian Task Force Classification II-2, was conducted at Sacro Cuore Don Calabria Hospital, Negrar, Italy. 104 white women aged 18–43 years were enrolled consecutively for this study. All patients underwent laparoscopy for endometriosis and a tubal dye test was carried out.
Results
Evidence of dye dissemination through the uterine wall and outside the uterus was noted in 27 patients (26%) with adenomyosis as it permeated the uterine wall and a clear passage of the dye was shown in the pelvic lymphatic vessels regardless whether the tubes were unobstructed. Histological assessment of the uterine biopsies confirmed adenomyosis.
Conclusion
Adenomyosis is characterized by ectatic lymphatics that allow the drainage of intrauterine fluids (the dye and, perhaps, menstrual blood) at minimal intrauterine pressure from the uterine cavity though the lymphatic network to extrauterine organs. Certainly, this may not be the only explanation for endometriosis dissemination but the correlation between the routes of the dye drainage and location of endometriosis foci is highly suggestive.
Klíčová slova:
Biopsy – Histology – Laparoscopy – Ligaments – Surgical and invasive medical procedures – Uterus – Myometrium – Gynecologic surgery
Zdroje
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