1
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Porcel JM, Sancho-Marquina P, Monteagudo P, Bielsa S. Pleural effusion secondary to endometriosis: A systematic review. Am J Med Sci 2023; 366:296-304. [PMID: 37553023 DOI: 10.1016/j.amjms.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/05/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Endometriosis-associated pleural effusion is a rare occurrence with poorly defined clinical characteristics. METHODS A systematic review was performed to examine all articles on endometriosis-associated pleural effusion extracted from 4 databases (PubMed, Embase, Web of Science and Scopus) from inception until November 2022. RESULTS A total of 142 articles (isolated cases and small retrospective series) involving 176 patients (median age 33 years) with endometriosis-associated pleural effusion were included. The most frequent symptoms were dyspnea (67%), chest pain (55%) and abdominal pain (40%). Pleural effusion was predominantly unilateral (89%), right-sided (88.5%) and massive (56%). Ascites was evident in 42% of the cases. Pleural fluid had a bloody appearance in 99% of cases and always met the exudate criteria. Pleural fluid cytology identified only 9% of the patients, with pleural biopsy being the most common diagnostic procedure (74%). Most patients were treated with hormones (76%), thoracic surgery (60%) and abdominal surgery (27%). Effusion recurrence was observed in 26% of cases after a median follow-up of 1 year. CONCLUSIONS The presence of right-sided hemorrhagic pleural effusion in a young woman warrants an assessment for the possibility of endometriosis. Despite conventional treatment, effusion recurs in approximately a quarter of patients.
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Affiliation(s)
- José M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital Hospital, IRBLleida, Universitat de Lleida, Lleida, Spain.
| | - Paula Sancho-Marquina
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital Hospital, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Paula Monteagudo
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital Hospital, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Silvia Bielsa
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital Hospital, IRBLleida, Universitat de Lleida, Lleida, Spain
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2
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Quercia R, De Palma A, De Blasi F, Carleo G, De Iaco G, Panza T, Garofalo G, Simone V, Costantino M, Marulli G. Catamenial pneumothorax: Not only VATS diagnosis. Front Surg 2023; 10:1156465. [PMID: 37082366 PMCID: PMC10110870 DOI: 10.3389/fsurg.2023.1156465] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 04/22/2023] Open
Abstract
Background Catamenial pneumothorax (CP) is a rare type of spontaneous, recurring pneumothorax occurring in women, from the day before menstruation until 72 hours after its beginning. Conservative treatment is generally associated with recurrence of CP. Video-assisted thoracic surgery (VATS) approach allows not only to obtain diagnosis but also to guide definitive treatment of causing lesions, such as ectopic endometrial implants or diaphragmatic defects and fenestrations. We report our experience in VATS management of CP to focus on its role in CP. Materials and methods In this retrospective observational study, we collected data from women referred to our center for CP, from January 2019 to April 2022. All patients underwent VATS approach, with muscle-sparing thoracotomy when diaphragmatic fenestrations were detected, to perform selective diaphragmatic plication and/or partial diaphragmatic resection. Results were analyzed in terms of pneumothorax recurrence after surgical treatment. All patients were referred to gynecologists for medical therapy. Results Eight women (median age 36 years, range: 21-45), all with right side CP, were included; three already had pelvic endometriosis and two had already undergone lung apicectomy at other institutions. VATS allowed us to detect diaphragmatic fenestrations in seven patients (87.5%) and apical bullae in five (62.5%). Apicectomy was performed in five cases (62.5%), selective diaphragmatic plication in two (25%), and partial diaphragmatic resection in five (62.5%). Chemical pleurodesis with talc was performed in all to minimize the risk of recurrence. Pathological diagnosis of endometriosis on the resected diaphragm was achieved in five patients (62.5%). No recurrence occurred, except for one woman who stopped medical treatment for endometriosis. Conclusions In the management of patients with CP, VATS should be recommended not only to obtain an explorative diagnosis of ectopic endometrial implants or diaphragmatic fenestrations but also to allow the most appropriate surgical treatment and obtain pathological specimens for confirmation and definitive diagnosis of thoracic endometriosis. Medical therapy to achieve ovarian rest is mandatory in the postoperative period and should not be discontinued.
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3
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Kalbi DP, Al Sbihi AF, Manasrah N, Chaudhary AJ, Iqbal S. A Thoracic Endometriosis-Related Catamenial Hemopneumothorax in a Woman With Premature Ovarian Failure. Cureus 2021; 13:e17110. [PMID: 34532165 PMCID: PMC8436833 DOI: 10.7759/cureus.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. It is usually confined to the pelvis, particularly the ovaries, cul-de-sac, broad ligaments, and uterosacral ligaments, but it can also expand outside the pelvis. The thorax is among the common extrapelvic locations. Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functioning endometrial tissue in the pleura, lung parenchyma, and airways. This report presents a case of a young female patient with advanced endometriosis and premature ovarian failure who was admitted with dyspnea that turned to be due to a rare endometriosis-related complication.
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Affiliation(s)
- Deepak P Kalbi
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA.,Nuclear Medicine, Montefiore Medical Center, New York, USA
| | - Ali F Al Sbihi
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Ahmed J Chaudhary
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Sana Iqbal
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
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4
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Lin Z, Zhang Z, Wang Q, Li J, Peng W, Ge G. A systematic review and meta-analysis of video-assisted thoracoscopic surgery treating spontaneous pneumothorax. J Thorac Dis 2021; 13:3093-3104. [PMID: 34164200 PMCID: PMC8182496 DOI: 10.21037/jtd-21-652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background With the adoption of high-tech thoracoscopic surgical instruments, video-assisted thoracoscopic surgery (VATS) has gradually replaced traditional thoracotomy and is used in the clinical treatment of spontaneous pneumothorax. Methods The composite logic retrieval and Boolean logic retrieval methods were adopted for this meta-analysis. Databases such as PubMed, Medline, Cochrane Library, CNKI, Wanfang, VIP, and Google Scholar were searched using the combination of search terms “Video-assisted thoracoscopic surgery”, “spontaneous pneumothorax”, and “thoracotomy”. Literatures which used video-assisted thoracoscopic surgery for spontaneous pneumothorax as the experimental group were screened. The software RevMan 5.3 provided by the Cochrane system was employed for meta-analysis. Results A total of 12 studies were included. After the meta-analysis, heterogeneity testing of the operation time in 8 studies showed that Tau2 =29.99, Chi2 =16.99, degrees of freedom (df) =7, I2=59%>50%, and the operation time of participants in the experimental group was considerably inferior to that of control group. The mean difference (MD) was −31.02, 95% confidence interval (95% CI: −36.07 to −25.97), Z=12.03, P<0.0001. The heterogeneity test of the length of hospital stay in 9 studies showed that Tau2 =4.41, Chi2 =122.58, df =8, I2=59%>50%, P<0.01, and the length of hospital stay of participants in the experimental group was remarkably shorter than that of the control group. The MD was −7.29, 95% CI: (−8.76 to −5.82), Z=9.74, and P<0.01. The heterogeneity test of the bleeding volume in 6 studies showed that Tau2 =191.74, Chi2 =27.65, df =5, I2=82%>50%, P<0.01, and the bleeding volume of participants in the experimental group was remarkably lower in contrast to that of the control group. The MD was −65.48, 95% CI: (−77.84 to −53.13), Z=10.39, and P<0.01. The heterogeneity test of the chest tube removal time in 7 studies showed that Tau2 =0.29, Chi2 =28.27, df =6, I2=79%>50%, P<0.05, and the chest tube removal time of participants in the experimental group was substantially lower in contrast to that of the control group. The MD was −3.10, 95% CI: (−3.56 to −2.64), Z=13.30, P<0.01. Discussion This meta-analysis confirmed that VATS for spontaneous pneumothorax is better than other surgical methods.
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Affiliation(s)
- Zhenhai Lin
- Department of Cardiothoracic Surgery, Danzhou People's Hospital Affiliated to Hainan Medical College, Danzhou, China
| | - Zhidong Zhang
- Department of Cardiothoracic Surgery, Danzhou People's Hospital Affiliated to Hainan Medical College, Danzhou, China
| | - Qiugui Wang
- Respiratory Medicine, Department of Internal Medicine, Danzhou People's Hospital, Danzhou, China
| | - Junhua Li
- Department of Cardiothoracic Surgery, Danzhou People's Hospital Affiliated to Hainan Medical College, Danzhou, China
| | - Wen Peng
- Department of Cardiothoracic Surgery, Danzhou People's Hospital Affiliated to Hainan Medical College, Danzhou, China
| | - Guangquan Ge
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Hainan Medical College, Haikou, China
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5
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Wetzel A, Philip CA, Golfier F, Bonnot PE, Cotte E, Brichon PY, Darnis B, Chene G, Michy T, Hoffmann P, Tronc F, Dubernard G. Surgical management of diaphragmatic and thoracic endometriosis': A French multicentric descriptive study. J Gynecol Obstet Hum Reprod 2021; 50:102147. [PMID: 33862264 DOI: 10.1016/j.jogoh.2021.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Surgical management of Diaphragmatic and thoracic endometriosis (DTE) is still controversial, a thoracic or an abdominal approach can be proposed. METHODS We conducted a multicentric retrospective study in 8 thoracic, gynecology or digestive surgery units in 5 French university hospitals. The main objective was to review the current management of DTE. RESULTS 50 patients operated for DTE from 2010 to 2017 were included: 26 with a thoracic approach and 24 with an abdominal approach. Preoperative pelvic endometriosis (PE) concerned 25 patients. In 38 patients, DTE diagnosis was made on clinical symptoms (pneumothorax (n = 19), chronic or catamenial chest pain (n = 18) or hemopneumothorax (n = 1)). Median time from onset of symptoms to diagnosis was 47 months (0-212). PE surgery concurrently occurred in 22 patients. We report diaphragmatic nodules, pleuropulmonary nodules and diaphragmatic perforations in 42, 5 and 22 women respectively. Lesions were right-sided in 45 patients. Nodules were destructed in 12 cases and resected in 38 cases. When a diaphragmatic reconstruction was needed (n = 31), a simple suture was performed in 26 patients, while 5 patients needed a mesh repair. Pleural symphysis was performed for all patients who received a thoracic approach. DTE resection was considered complete in 46 patients. Three patients had severe 30-days complications of DTE surgery. Median follow-up was 20 months (range 1-69). Recurrence occurred in 10 patients. CONCLUSION The results emphasize the importance of systematically looking for chest pain in patients suffering from PE and underline the lack of a standardized procedure and treatment in DTE.
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Affiliation(s)
- Alexia Wetzel
- Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
| | - Charles-André Philip
- Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
| | - Francois Golfier
- Department of gynecology, Lyon-Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
| | - Pierre-Emmanuel Bonnot
- Department of digestive surgery, Lyon- Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
| | - Eddy Cotte
- Department of digestive surgery, Lyon- Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
| | - Pierre-Yves Brichon
- Department of thoracic surgery, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Benjamin Darnis
- Department of digestive surgery, Croix Rousse University Hospital, HCL, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
| | - Gautier Chene
- Department of gynecology, Hopital Femme Mère Enfant, HCL, 59 Boulevard Pinel, 69500 Bron, France.
| | - Thierry Michy
- Department of gynecology, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Pascale Hoffmann
- Department of gynecology, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Francois Tronc
- Department of thoracic surgery, Louis Pradel University Hospital HCL, 59 Boulevard Pinel, 69500 Bron, France.
| | - Gil Dubernard
- Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
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6
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Soares T, Oliveira MA, Panisset K, Habib N, Rahman S, Klebanoff JS, Moawad GN. Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment. Horm Mol Biol Clin Investig 2021; 43:137-143. [PMID: 34704688 DOI: 10.1515/hmbci-2020-0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
Endometriosis of the diaphragm has been gaining more attention in the practice of gynecologists and thoracic surgeons in recent years. Understanding related symptoms and developing imaging methods have improved their approach. A review of the literature was performed with the aim to report on incidence, diagnosis, treatment and prognosis of diaphragmatic endometriosis. We also cover the issue of the Thoracic Endometriosis Syndrome (TES). Complaints of cyclic chest pain in patients of childbearing age should have as differential diagnosis the presence of thoracic endometriosis. Catamenial pneumothorax is the main manifestation of diaphragmatic endometriosis and Thoracic Endometriosis Syndrome. Other possible manifestations are hemothorax, pulmonary nodules, and diaphragmatic hernia. Despite the possibility of drug treatment, many patients will be submitted to surgical treatment. The minimally invasive approach should be the one of choice. The robotic pathway allows for an easier approach due to its ability to articulate robotic arms, allowing the treatment of lesions in hard-to-reach locations, such as the posterior part of the diaphragm. Multidisciplinary treatment should be used in most cases, as only abdominal approach is not sufficient for the diagnosis and treatment of lesions in the thoracic cavity. The approach of endometriosis of the diaphragm and Thoracic Endometriosis Syndrome should be multidisciplinary, allowing the improvement of quality of life in most patients.
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Affiliation(s)
- Thiers Soares
- Department of Obstetrics and Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Cardoso Fontes Hospital, Gynecologic Section, Rio de Janeiro, Brazil.,Perinatal Hospital, Rio de Janeiro, Brazil.,Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Marco Aurelio Oliveira
- Department of Obstetrics and Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karen Panisset
- Perinatal Hospital, Rio de Janeiro, Brazil.,Maternal and Child Department, Fluminense Federal University, Niteroi, Brazil
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Beaujon Hospital-University of Paris, Clichy Cedex, France
| | - Sara Rahman
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Main Line Health, Wynnewood, PA, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
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7
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Guenther TM, Gustafson JD, Pribyl SM, Wozniak CJ. Recurrent Spontaneous Pneumothorax in a 47-Year-Old Woman. Mil Med 2020; 185:e1833-e1835. [PMID: 32687200 DOI: 10.1093/milmed/usz468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/15/2019] [Accepted: 12/13/2019] [Indexed: 11/12/2022] Open
Abstract
Pneumothorax is a condition where air exists in the chest cavity, outside the lung. The causes of pneumothorax are numerous and determining the etiology can aid in treatment and prevent recurrence. We describe a 47-year-old female patient with past medical history of endometriosis who presented to the emergency room with recurrent right sided pneumothorax, its onset correlating with onset of menses. She underwent video assisted thorascopic surgery for a suspected catamenial pneumothorax whereby nodular "chocolate" appearing areas were noted on the middle lobe and multiple similar appearing lesions and fenestrations were noted on the diaphragm. A biologic mesh was affixed to the diaphragm after which mechanical and chemical pleurodesis were performed. She tolerated the procedure well and has been symptom free since. Herein, we review the pathophysiology, diagnosis, and treatment strategies for catamenial pneumothorax in the hopes of increasing awareness and understanding of this rare cause of spontaneous pneumothorax.
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Affiliation(s)
- Timothy M Guenther
- Department of Surgery, University of California Davis, 2315 Stockton Blvd, Sacramento, CA 95817.,Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
| | - Joshua D Gustafson
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533.,Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Shea M Pribyl
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
| | - Curtis J Wozniak
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533.,Department of Cardiothoracic Surgery, University of California San Francisco, 500 Parnassus Ave #W420, San Francisco, CA 94143
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8
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Barzilai M, Roriz M, Guyard A, Debray MP, Pellenc Q, Papo T, Sacre K. [Haemothorax revealing thoracic endometriosis]. Rev Med Interne 2020; 41:780-783. [PMID: 32709436 DOI: 10.1016/j.revmed.2020.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/09/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis. CASE REPORT We report the case of a 36 year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed. CONCLUSION Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age.
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Affiliation(s)
- M Barzilai
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France
| | - M Roriz
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France
| | - A Guyard
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Pathologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - M-P Debray
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Radiologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Q Pellenc
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Chirurgie Vasculaire et Thoracique, Hôpital Bichat-Claude Bernard, Paris, France
| | - T Papo
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France
| | - K Sacre
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France.
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Kiss I, Pospisilova E, Kolostova K, Maly V, Stanek I, Lischke R, Schutzner J, Pawlak I, Bobek V. Circulating Endometrial Cells in Women With Spontaneous Pneumothorax. Chest 2019; 157:342-355. [PMID: 31542450 DOI: 10.1016/j.chest.2019.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/23/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The occurrence of catamenial pneumothorax (CP) is rare, and the awareness of this diagnosis among physicians is insufficient. CP is highly correlated with pelvic endometriosis and remains the most common form of thoracic endometriosis syndrome. Circulating endometrial cells (CECs) have been previously detected in patients with pelvic endometriosis. Could CECs bring new insights into pneumothorax management? METHODS This study aims to describe the occurrence and molecular characteristics of CECs in women with spontaneous pneumothorax (SP) (N = 20) with high suspicion of its catamenial character. CECs were enriched from peripheral blood by size-based separation (MetaCell). In addition to cytomorphology, gene expression profiling of captured cells was performed for 24 endometriosis-associated genes. RESULTS CECs were present in all 20 patients with SP. Enriched CECs exhibited four character features: epithelial, stem cell-like, stroma-like, and glandular. However, not all of them were present in every sampling. Gene expression profiling revealed two distinct phenotypes of CECs in SP and/or CP: one of them refers to the diaphragm openings syndrome and the other to endometrial tissue pleural implantations. Comparisons of the gene expression profiles of CECs in pneumothorax (CECs-SP group) with CECs in pelvic endometriosis (CECs-non-SP group) have revealed significantly higher expression of HER2 in the CECs-SP group compared with the CECs-non-SP group. CONCLUSIONS This proof-of-concept study demonstrates successful isolation and characterization of CECs in patients with SP. Identification of CECs in SP could alert endometriosis involvement and help early referral to gynecologic consultation for further examination and treatment.
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Affiliation(s)
- Imrich Kiss
- Department of Laboratory Genetics, Laboratory Diagnostics, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Gynecology, Military University Hospital and the 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eliska Pospisilova
- Department of Laboratory Genetics, Laboratory Diagnostics, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Katarina Kolostova
- Department of Laboratory Genetics, Laboratory Diagnostics, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic; Cellpeutics Sp.z o.o., Wroclaw, Poland
| | - Vilem Maly
- Department of Thoracic Surgery, Krajska zdravotni a.s. Hospital Usti nad Labem, Czech Republic
| | - Ivan Stanek
- Department of Thoracic Surgery, Krajska zdravotni a.s. Hospital Usti nad Labem, Czech Republic
| | - Robert Lischke
- 3rd Department of Surgery, University Hospital FN Motol and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Schutzner
- 3rd Department of Surgery, University Hospital FN Motol and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ireneusz Pawlak
- Department of Thoracic Surgery, Lower Silesian Oncology Centre, Wroclaw, Poland
| | - Vladimir Bobek
- Department of Laboratory Genetics, Laboratory Diagnostics, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic; Cellpeutics Sp.z o.o., Wroclaw, Poland; Department of Thoracic Surgery, Krajska zdravotni a.s. Hospital Usti nad Labem, Czech Republic; 3rd Department of Surgery, University Hospital FN Motol and 1st Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Histology and Embryology, Wroclaw Medical University, Wroclaw, Poland; Department of Thoracic Surgery, Lower Silesian Oncology Centre, Wroclaw, Poland.
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10
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Matak L, Bačić I, Mihanović J, Lisica-Šikić N, Dukić B, Petani B, Stanojević M. Recurrent pleural effusion and pain in the shoulder in women of reproductive age could have a gynecological cause: case series. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2019-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Endometriosis is a benign disorder defined as the presence of endometrial glands and stroma outside of the uterine cavity. It has been estimated that approximately 10% of the women of reproductive age and 30–50% of the women with infertility are affected.
Case presentation
We report two nulliparous patients with recurrent pleural effusion and pain in the right shoulder highly suspicious for thoracic endometriosis syndrome (TES).
Conclusion
The objective of this study was to present patients with unusual symptoms related to gynecological disease. The second aim was to show our single institution experience as a second level hospital in terms of treatment and diagnosis of TES and diaphragmatic endometriosis.
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Affiliation(s)
- Luka Matak
- Department of Gynecology and Obstetrics , General Hospital Zadar , Bože Peričića 5 , Zadar 23000 , Croatia , Croatia
| | - Ivan Bačić
- Department of Thoracic Surgery , General Hospital Zadar , Zadar , Croatia
| | - Jakov Mihanović
- Department of Abdominal Surgery , General Hospital Zadar , Zadar , Croatia
| | | | - Branko Dukić
- Department of Gynecology and Obstetrics , General Hospital Zadar , Bože Peričića 5 , Zadar 23000 , Croatia , Croatia
| | - Barbara Petani
- Department of Anesthesiology and Reanimation , General Hospital Zadar , Zadar , Croatia
| | - Milan Stanojević
- Department of Neonatology , Clinical Hospital Sveti Duh , Zagreb , Croatia
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11
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Fournel L, Bobbio A, Robin E, Canny-Hamelin E, Alifano M, Regnard JF. Clinical presentation and treatment of catameinal pneumothorax and endometriosis-related pneumothorax. Expert Rev Respir Med 2018; 12:1031-1036. [PMID: 30457394 DOI: 10.1080/17476348.2018.1551133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Catamenial pneumothorax (CP) is defined as a recurrent spontaneous pneumothorax occurring in females of reproductive age. In the 'perimenstrual period,' it is still considered relatively rare although accounting for 20-35% of spontaneous pneumothoraces occurring in premenopausal women. It is the most frequent manifestation of thoracic endometriosis, which can also cause pneumothorax during the intermenstrual period (TER non-CP). Areas covered: In this article, we review and comment the clinical presentation, etiopathogenesis, diagnostic criteria, and therapeutic management of CP and TER non-CP. We particularly emphasize on the surgical optimal treatment and associated multidisciplinary care and follow-up. Electronic databases, mostly PubMed, were used for searching terms including 'catamenial pneumothorax' and 'thoracic endometriosis.' Expert commentary: Clinical presentation and imaging of CP and TER non-CP are often unspecific except for possible visualization of endometriosis foci or diaphragmatic lesions at computed tomography-scan or magnetic resonance imaging. Thus, we recommend careful interrogatory and intraoperative inspection for appropriate diagnosis and treatment of pneumothorax in women. Despite better awareness of surgical teams, CP and TER-non CP are still associated with high rates of postoperative recurrence (around 30%). We strongly advocate for a multidisciplinary management including early surgical and chemical pleurodesis, resection of all visible endometriosis-related lesions, hormonal blockade, and prolonged follow-up.
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Affiliation(s)
- Ludovic Fournel
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Antonio Bobbio
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Edouard Robin
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Emelyne Canny-Hamelin
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Marco Alifano
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Jean-François Regnard
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
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12
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Porcel JM. Phenotyping primary spontaneous pneumothorax. Eur Respir J 2018; 52:52/3/1801455. [DOI: 10.1183/13993003.01455-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/05/2022]
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13
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Narula N, Ngu S, Avula A, Mansour W, Chalhoub M. Left-sided Catamenial Pneumothorax: A Rare Clinical Entity. Cureus 2018; 10:e2567. [PMID: 29974022 PMCID: PMC6029749 DOI: 10.7759/cureus.2567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Catamenial pneumothorax (CP) is an extremely rare pulmonary pathology seen in women of reproductive age, typically occurring within 72 hours from the onset of menstrual bleeding. Multiple theories have been proposed to explain the etiopathogenesis of CP; however, the exact underlying mechanism remains elusive. More than 90% of reported cases in the literature describe a right-sided presentation of pneumothorax. In this case report, we describe a rare left-sided presentation of CP and discuss the current literature on underlying etiopathogenesis, diagnostics, and available therapeutic modalities for managing this rare clinical entity.
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Affiliation(s)
- Naureen Narula
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Sam Ngu
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Akshay Avula
- Pulmonary and Critical Care Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Wissam Mansour
- Pulmonary and Critical Care Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Michel Chalhoub
- Pulmonary Medicine and Critical Care, Staten Island University Hospital, Northwell Health, Staten Island, USA
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