Different HLA-DR expression in endometriotic and adenomyotic lesions: correlation with transvaginal ultrasonography findings

Efficacy of Hormonal Therapies for Decreasing Uterine Volume in Patients with Adenomyosis

Study objective:

The aim of this study is to evaluate the efficacy of hormonal therapies for inhibiting an increase in uterine volume in patients with adenomyosis.

Design:

This was retrospective cohort study.

Setting:

This study was conducted at Nippon Medical School Musashikosugi Hospital.

Patients:

A total of 28 women diagnosed with adenomyosis using magnetic resonance imaging.

Methods:

After providing informed consent, patients were treated with gonadotropin-releasing hormone agonist (GnRHa group), a low-dose estrogen and progestin combination (LEP group), or dienogest (DNG group) for ≥16 weeks. Uterine volume was assessed using the formula for an ovoid; uterine volumes before and after 16 weeks of treatment were compared. A <5% increase in uterine volume at 16 weeks was considered to reflect inhibition of uterine volume increase and efficacy of the medication. We compared the efficacy rate among the groups.

Results:

In the GnRHa group, a significant reduction in uterine volume was noted, from 307.4 ± 230.1 to 177.9 ± 142.1 cm³ (P < 0.001). In the LEP and the DNG groups, there was no significant change (LEP: 226.7 ± 116.6 cm³ pre-treatment and 230.5 ± 128.6 cm³ post-treatment, P = 0.85; DNG: 232.6 ± 117.8 cm³ pre-treatment and 262.1 ± 136.8 cm³ post-treatment, P = 0.37). The number of responders (efficacy rate) in the GnRHa group, LEP group, and DNG group was 25/26 (96.2%), 7/15 (46.7%), and 6/11 (54.5%), respectively. The efficacy rate of GnRHa therapy was significantly higher than that of LEP or DNG therapy (P < 0.001 and P = 0.005, respectively).

Conclusion:

We conclude that the efficacy of GnRHa in reducing uterine volume should be considered when prescribing hormone therapy for adenomyosis.

The Effects of Dienogest on Macrophage and Natural Killer Cells in Adenomyosis: A Randomized Controlled Study

Background

Progestin has been used for symptomatic treatment of adenomyosis, although its effect on the immune system has not been studied. The aim of this study was to investigate the changes of macrophage and natural killer (NK) cell infiltration in tissues obtained from women with adenomyosis who did or did not receive oral progestin dienogest.

Materials and Methods

In this randomized controlled clinical trial study, 24 patients with adenomyosis who re- quired hysterectomy were enrolled. Twelve patients received dienogest 28-35 days before surgery, and the other 12 patients were not treated with any hormones. The endometrial and myometrial tissue samples were immediately collected after hysterectomy, and immunohistochemistry for a macrophage marker (CD68) and a NK cells marker (CD57) was performed.

Results

The number of CD57 cells was significantly increased in endometrial glands of the treated group compared to the untreated group (P=0.005) but not in stroma in the endometrium of the treated patients (P=0.416). The differ- ence in the number of CD68 cells was not statistically significant between treated and untreated groups in the endo- metrial glands (P=0.055) or stromal tissues (P=0.506).

Conclusion

Administration of oral progestin dienogest to patients with adenomyosis increased the number of uterine infiltrating NK cells in glandular structure of eutopic endometrium. The differential effects of progestin on NK cells depended on the site of immune cell infiltration. The effects of oral progestin on uterine NK cells in adenomyosis have the potentials to be beneficial to pregnancies occurring following discontinuation of treatment in terms of embryo im- plantation and fetal protection (Registration number: TCTR20150921001).

The Familial Risk of Endometriosis among the Female Relatives of Patients with Endometriosis in Greece

Introduction

Endometriosis is a gynecologic disease affecting up to 10% of the women and a major cause of pain and infertility. It is a complex genetic disease with an overall heritability estimated at around 4%. We aimed to study the familial risk of endometriosis among the female relatives of patients with endometriosis. Furthermore, we compared the demographic variable characteristics of patients with and without family history of endometriosis.

Methods

We evaluated the medical reports of 400 women with endometriosis and 400 without, all of whom underwent consultation for infertility or pelvic pain and had surgery between 2002 and 2016. This retrospective study was conducted in the Obstetrics and Gynecology Department of Venizeleio General Hospital of Heraklion, Crete. Data were collected from patients' charts and analyzed by statistical methods including x2 and Mann-Whitney U test.

Results

The overall risk of first-degree relatives of endometriosis was 10.2% versus only 0.7% of controls p<0.001. Among 25 pairs of sisters we found one or more sisters with endometriosis. Additionally, we reported a family with six members with endometriosis within three generations. In women with positive family history of endometriosis we observed earlier menarche and more severe stage of endometriosis. Moreover, we did not notice any difference in the demographic characteristics between the endometriosis and the control group patients; similar clinical data was observed in both groups.

Conclusions

These data support the view that genetic factors play a role in the development of this condition.