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Chen-Yost HI, Huang T, O'Brien K, Weir W, Reddy RM, Lieberman R, Pang J. Endometriosis first presenting in pleural fluid cytology. Diagn Cytopathol 2024; 52:E95-E99. [PMID: 38291867 DOI: 10.1002/dc.25278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
Most patients with thoracic endometriosis present with catamenial pneumothorax, a rare condition in which recurrent episodes occur within 72 h before or after the start of menstruation. We report a case of thoracic endometriosis presenting with recurrent bloody pleural effusions without pneumothorax diagnosed on pleural fluid cytology. We describe the cytomorphology and immunoprofile of thoracic endometriosis and discuss the differential diagnoses, including neoplastic processes. We also highlight the importance of communication with clinicians for timeliness of diagnosis and treatment, especially when thoracic endometriosis is not suspected.
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Affiliation(s)
| | - Tao Huang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kathleen O'Brien
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William Weir
- Section of Thoracic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Richard Lieberman
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Judy Pang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
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2
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Hirono T, Feng Y, Wang W, Yu H. Spontaneous recurrent menstrual pneumothorax: a case report. Ann Med Surg (Lond) 2024; 86:1096-1100. [PMID: 38333324 PMCID: PMC10849425 DOI: 10.1097/ms9.0000000000001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/27/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Endometriosis is most commonly found in the pelvic area, ~12% of people have it in other areas or organs, which is known as extrapelvic endometriosis. Thoracic endometriosis, which is also classified as extrapelvic endometriosis, manifests with four distinct forms: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, or lung nodules. Catamenial pneumothorax is the most common clinical symptom of these; however, it is frequently neglected by clinicians and goes undiagnosed and untreated. As a result, it is critical to raise awareness of this medical condition among clinicians. Case presentation The authors present a case report of a 34-year-old woman of reproductive age who had recurrent episodes of spontaneous pneumothorax during menstruation and underwent treatment with thoracoscopic surgery as well as gynaecological hormonal drugs including oral progesterone and dienogest throughout this time. Based on her symptoms, a catamenial pneumothorax caused by thoracic endometriosis was suspected. Clinical discussion The clinical symptoms, pathogenesis, diagnosis, and treatment of Catamenial Pneumothorax are analyzed. Furthermore, the usage of gynaecological hormone medications in this condition has been discussed. The mechanisms of oral contraceptives and progestin-based medications are evaluated by comparing the patient's treatment process, highlighting their pros and cons. Conclusions Thoracoscopic surgery combined with postoperative gynaecological hormonal medications may be the most effective treatment for this issue. Several gynaecological hormonal medicines are available, each of which has its own set of pros and cons, and must be thoroughly evaluated as well as correctly tailored to the patient's specific circumstances to have a positive therapeutic outcome.
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Affiliation(s)
| | - Ye Feng
- The University of Warwick, Coventry, UK
| | - Wenhui Wang
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing, China
| | - Huan Yu
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing, China
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3
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Ganesan PR, Kang D, Khan Z, Milteer HB. Diaphragmatic Endometriosis Presenting as Recurrent Catamenial Pneumothorax: A Case Report. Cureus 2023; 15:e45179. [PMID: 37842494 PMCID: PMC10575751 DOI: 10.7759/cureus.45179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Catamenial pneumothorax is one of the most common extra-pelvic presentations of endometriosis, with the gastrointestinal tract being the most common location. Catamenial pneumothorax is defined as spontaneous recurrent pneumothorax occurring in women of reproductive age in a temporal relationship with menses. Symptoms include dyspnea, sharp chest pain, and hypoxemia. A much rarer presentation is the involvement of endometriosis with the diaphragm. In this case, we present a 31-year-old female who presented with signs of pneumothorax. She has had multiple episodes leading to suspicion of catamenial pneumothorax. However, it wasn't until her surgery that the extent of diaphragmatic involvement, characterized by numerous holes secondary to endometriosis, was discovered. She was surgically treated, which led to a drastic improvement in symptoms and a reduction in subsequent episodes. We hope that this case can add to the current limited literature on diaphragmatic endometriosis cases. Since this patient presented with mainly catamenial pneumothorax symptoms, we urge clinicians to still consider diaphragmatic involvement as a primary cause in patients with recurrent episodes of pneumothorax.
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Affiliation(s)
- Pallavi R Ganesan
- Medical School, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Dayeon Kang
- Medical School, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Zoya Khan
- Medical School, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Hugh B Milteer
- Internal Medicine, Mobile Infirmary Medical Center, Mobile, USA
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4
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Rometti M, Patti L. Catamenial Pneumothorax in a Patient with Endometriosis: A Case Report. Cureus 2023; 15:e42193. [PMID: 37602109 PMCID: PMC10439767 DOI: 10.7759/cureus.42193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Pelvic pain is a common presentation to the emergency department (ED). For female patients, endometriosis can be difficult to diagnose and can have life-threatening complications if missed. In this case report, we present a case of a patient initially presenting to the ED with a few days of crampy lower abdominal pain. After initial imaging, she was found to have a large pelvic hematoma with concern for active extravasation and a large hemothorax. After further evaluation, she was suspected of having endometriosis leading to thoracic endometriosis and a catamenial pneumothorax. Although endometriosis is not typically an emergent diagnosis, the complications of significant endometrial tissue spread can cause life-threatening impacts. Clinicians should consider complications of endometriosis in females of menstruating age.
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Affiliation(s)
- Mary Rometti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Laryssa Patti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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5
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Solanki KK, Shook M, Yorke J, Vanlandingham A. A Rare Case of Catamenial Pneumothorax and a Review of the Current Literature. Cureus 2023; 15:e42006. [PMID: 37593305 PMCID: PMC10427888 DOI: 10.7759/cureus.42006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
A 34-year-old female smoker, with a history of pelvic endometriosis, presented with initial symptoms of shortness of breath and a choking sensation. She was found to have a right pneumothorax on chest x-ray. Over the next eight months, she ultimately underwent three tube thoracostomies, two video-assisted thoracoscopic surgeries (VATS), wedge resection, and repeated pleurodesis due to pneumothorax recurrence. She was seen multiple times post-surgically with the focus of treatment being smoking cessation rather than contraceptive therapy, despite an early follow-up visit noting that the initial symptoms coincided with her menstruation. The purpose of this article is to bring attention to this rarely diagnosed condition. With added awareness and understanding of the underlying causes and available treatments, medical providers could likely spare many women from similar experiences and dramatically improve the quality of their lives.
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Affiliation(s)
- Krupa K Solanki
- Pulmonology and Critical Care, East Tennessee State University - Quillen College of Medicine, Johnson, USA
| | - Micah Shook
- Internal Medicine, Norton Community Hospital, Norton, USA
| | - Jojo Yorke
- Pulmonology and Critical Care, East Tennessee State University - Quillen College of Medicine, Johnson, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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Svidinskaya EA, Lysenko AV, Brykin GV. [Mystery of endometriosis - catamenial pneumothorax]. Khirurgiia (Mosk) 2022:110-116. [PMID: 35477211 DOI: 10.17116/hirurgia2022041110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review is devoted to clinical picture, main theories of pathogenesis, traditional and innovative methods of diagnosis and surgical treatment of catamenial pneumothorax. Currently, clinicians prefer magnetic resonance imaging and thoracoscopy for diagnosis of this disease. Various researchers are actively searching for laboratory diagnostic methods that can confirm endometrioid nature of pneumothorax. Treatment and prevention of catamenial pneumothorax are a controversial issue depending both clinical picture and preferences of the attending physician. Currently, the majority of authors believe that hormonal therapy combined with diaphragm resection ensures optimal anti-relapse effect in patients with thoracic endometriosis.
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Affiliation(s)
- E A Svidinskaya
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Lysenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G V Brykin
- Sechenov First Moscow State Medical University, Moscow, Russia
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8
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Mittal A, Jomaa D, Hassan Z, Hines J, Thavarajah K. Catamenial Pneumothorax in the Setting of a Recent Stroke. Cureus 2022; 14:e23860. [PMID: 35530874 PMCID: PMC9072272 DOI: 10.7759/cureus.23860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Catamenial pneumothorax is a unique condition associated with thoracic endometriosis. It often presents in females of reproductive age as a recurrent pneumothorax aligned with the menstrual cycle. We present a case of a young female diagnosed with catamenial pneumothorax within one year of experiencing a stroke. The clinical presentation related to the stroke allowed for a unique diagnostic process and management considerations. The patient was successfully treated with progesterone-based contraception in the setting of an estrogen contraindication.
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Affiliation(s)
- Aayush Mittal
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Diana Jomaa
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Zakaa Hassan
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Jennifer Hines
- Pulmonary and Critical Care Medicine, Legacy Medical Group, Portland, USA
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9
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Toffolo Pasquini M, Auvieux R, Tchercansky A, Buero A, Chimondeguy D, Mendez J. [Catamenial pneumothorax]. Medicina (B Aires) 2022; 82:147-150. [PMID: 35037874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. Imaging studies can help with the diagnosis, although the gold standard is video-assisted thoracoscopic surgery (VATS). Surgical treatment in combination with at least 6 months of hormonal medical treatment has been shown to improve the prognosis and reduce the recurrence of this entity. We present the case of a 40-year-old patient with a history of pelvic endometriosis and multiple episodes of pneumothorax, who consulted at our institution for a new episode of spontaneous pneumothorax. A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.
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Affiliation(s)
| | - Rodolfo Auvieux
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Ariel Tchercansky
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | | | - Julián Mendez
- Servicio de Anatomía Patológica, Hospital Británico de Buenos Aires, Argentina
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10
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Mulette P, Jacquet A, Durlach A, Papathanassiou D, Lalire P, Graesslin O, Delepine G, Dury S, Dormoy V, Perotin JM, Lebargy F, Deslée G, Launois C. Pulmonary cavitations with increased 18F-FDG uptake revealing a thoracic endometriosis: A case report. Medicine (Baltimore) 2021; 100:e27550. [PMID: 34678890 PMCID: PMC8542117 DOI: 10.1097/md.0000000000027550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Thoracic endometriosis is a rare disorder that can involve airways, pleura and lung parenchyma. It is the most frequent form of extra-abdominopelvic endometriosis. Multiple lung cavitations are a rare feature of thoracic endometriosis. PATIENT CONCERNS A 46-year-old woman was referred to our hospital after incidental finding of multiple pulmonary cavitations with surrounding areas of ground glass opacity on a thoraco-abdominal computed tomography-scan performed for abdominal pain. Retrospectively, the patient also reported mild hemoptysis occurring 4 months ago. DIAGNOSES Positron emission tomography-computed tomography scan revealed moderate and homogeneous [18F] fluoro-2-deoxy-D-glucose (18F-FDG) uptake in pulmonary cavitations (maximum standardized uptake value 5.7). The diagnosis of thoracic endometriosis was confirmed by histological examination of surgical resection of a left lower lobe cavitation. INTERVENTIONS AND OUTCOME Gonadotropin-releasing hormone analogues associated with add-back therapy was started. Four months after initiating pharmacological treatment, the chest computed tomography-scan showed a dramatic decrease in lung cavitations size. LESSONS Thoracic endometriosis is a rare disorder requiring a multidisciplinary management including gynaecologist, pulmonologist, radiologist, nuclear physician, pathologist and thoracic surgeon for early diagnosis and treatment. Our case report highlights that an increased 18F-FDG uptake can be found in thoracic endometriosis syndrome presenting as multiple lung cavitations.
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Affiliation(s)
- Pauline Mulette
- Department of Respiratory Diseases, Reims University Hospital, France
| | - Amaury Jacquet
- Department of Pathology, Reims University Hospital, France
| | - Anne Durlach
- Department of Pathology, Reims University Hospital, France
- Pulmonary Pathologies and Cellular Plasticity, Inserm UMR-S 1250, Reims, France
| | - Dimitri Papathanassiou
- Department of Nuclear Medicine, Jean Godinot Institute, Reims, France
- Laboratory of Biophysics, Research Unit of Medicine, University of Reims Champagne-Ardenne, Reims, France
- Science and Information Technology Research Center (CReSTIC) EA 3804, University of Reims Champagne-Ardenne, Reims, France
| | - Paul Lalire
- Department of Nuclear Medicine, Jean Godinot Institute, Reims, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynecology, Reims University Hospital, France
| | - Gonzague Delepine
- Department of Cardiothoracic Surgery, Reims University Hospital, France
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, France
| | - Valérian Dormoy
- Pulmonary Pathologies and Cellular Plasticity, Inserm UMR-S 1250, Reims, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital, France
- Pulmonary Pathologies and Cellular Plasticity, Inserm UMR-S 1250, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Reims University Hospital, France
- Pulmonary Pathologies and Cellular Plasticity, Inserm UMR-S 1250, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, France
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Singh M, Singh RB, Singh AB, Carballo AL, Jain A. Thoracic Endometriosis: Still a Diagnostic Dilemma. Cureus 2021; 13:e15610. [PMID: 34131552 PMCID: PMC8196491 DOI: 10.7759/cureus.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 11/15/2022] Open
Abstract
We report a case of thoracic endometriosis syndrome (TES) presenting with a five-week history of progressive shortness of breath, cough, and wheezing. Investigations revealed a large, right-sided pleural effusion that was bloody on aspiration. A diagnosis of TES was one of the diagnoses entertained and eventually confirmed on finding evidence of pelvic endometriosis on laparotomy. The management of TES should include hormonal therapy, surgical management, or a combination of both.
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Affiliation(s)
- Madhu Singh
- Obstetrics and Gynecology, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
| | - Rahul B Singh
- Accident and Emergency, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
| | - Abhishek B Singh
- Obstetrics and Gynecology, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
| | - Aziel L Carballo
- Internal Medicine, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
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12
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Bozkanat KM, West NE, Ladores S, Montemayor K, Tupayachi Ortiz MG, Christianson M, Jain R. Catamenial haemoptysis in females with cystic fibrosis: a case series with review of management strategies. Respirol Case Rep 2021; 9:e00755. [PMID: 33976884 PMCID: PMC8103099 DOI: 10.1002/rcr2.755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2023] Open
Abstract
Catamenial haemoptysis, the expectoration of blood during menses, has not been extensively reported in the cystic fibrosis (CF) literature. We describe four cases (age range: 25-34 years) of catamenial haemoptysis across four CF centres in the United States. These cases may represent thoracic endometriosis versus hormonal fluctuations in airway inflammation or infection resulting in bronchial artery bleeding. We identify common and nuanced management strategies including use of pro-coagulants, hormone contraceptives, anti-inflammatories, bronchial artery embolization, and use of the newer cystic fibrosis transmembrane conductance regulator (CFTR) modulators.
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Affiliation(s)
- Kubra M. Bozkanat
- Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Natalie E. West
- Department of Internal MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Sigrid Ladores
- School of NursingUniversity of Alabama at BirminghamBirminghamALUSA
| | | | | | - Mindy Christianson
- Department of Obstetrics and Gynecology, Internal MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Raksha Jain
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
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13
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Dai Y, Li MH, Liu YJ, Liu B, Wu YS, Lang JH, Zhang ZY, Leng JH. Thoracic endometriosis presented as catamental hemoptysis: a case series of a rare disease. Curr Med Res Opin 2021; 37:685-691. [PMID: 33538197 DOI: 10.1080/03007995.2021.1885363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Thoracic endometriosis syndrome (TES) is a rare disease in which a functioning endometrial tissue is observed in the pleura, lung, parenchyma, airways, and/or diaphragm. The optimal management of this disease remains a matter of debate. We aimed to report TES cases and their effective hormonal treatment and management. METHODS In this retrospective study, women presented as catamenial hemoptysis (CH) diagnosed with thoracic endometriosis were included. The main outcome of measure was cessation or recurrence of the clinical manifestations of thoracic endometriosis. RESULTS The mean onset age of the 14 patients was 30.21 ± 5.40 years. CH was characteristic symptom of these patients. All patients underwent chest computed tomography (CT) scan during menstruation and 2 or 3 weeks after menstruation, which showed the obvious shrinking or disappearance of the lesions. All of the patients were given Gonadotropin releasing hormone agonists (GnRHa) for 3 to 6 months, eleven of them were administered with combined oral contraceptives (COC) cyclically after GnRHa. The median follow-up duration was 24 months. Hemoptysis recurrence was observed in one patient. CONCLUSIONS CH is a rare clinical entity of thoracic endometriosis, the change of CT images during and after menstruation or the response to GnRHa were helpful for accurate diagnosis. Hormonal treatment with GnRHa followed by COCs cyclically could be employed for efficient management of thoracic endometriosis.
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Affiliation(s)
- Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Meng-Hui Li
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated to Capital University of Medical Science, Beijing, China
| | - Yong-Jian Liu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Bing Liu
- Peking Union Medical College Hospital, Beijing, China
| | - Yu-Shi Wu
- Peking Union Medical College Hospital, Beijing, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Zhen-Yu Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated to Capital University of Medical Science, Beijing, China
| | - Jin-Hua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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14
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Mecha E, Makunja R, Maoga JB, Mwaura AN, Riaz MA, Omwandho COA, Meinhold-Heerlein I, Konrad L. The Importance of Stromal Endometriosis in Thoracic Endometriosis. Cells 2021; 10:180. [PMID: 33477657 PMCID: PMC7831500 DOI: 10.3390/cells10010180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Thoracic endometriosis (TE) is a rare type of endometriosis, where endometrial tissue is found in or around the lungs and is frequent among extra-pelvic endometriosis patients. Catamenial pneumothorax (CP) is the most common form of TE and is characterized by recurrent lung collapses around menstruation. In addition to histology, immunohistochemical evaluation of endometrial implants is used more frequently. In this review, we compared immunohistochemical (CPE) with histological (CPH) characterizations of TE/CP and reevaluated arguments in favor of the implantation theory of Sampson. A summary since the first immunohistochemical description in 1998 until 2019 is provided. The emphasis was on classification of endometrial implants into glands, stroma, and both together. The most remarkable finding is the very high percentage of stromal endometriosis of 52.7% (CPE) compared to 10.2% (CPH). Chest pain, dyspnea, right-sided preference, and diaphragmatic endometrial implants showed the highest percentages in both groups. No significant association was found between the recurrence rate and the various appearances of endometriosis. Sometimes in CPE (6.8%) and CPH (30.6%) no endometrial implants were identified underlining the importance of sensitive detection of endometriosis during and after surgery. We suggest that immunohistochemical evaluation should become mandatory and will improve diagnosis and classification of the disease.
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Affiliation(s)
- Ezekiel Mecha
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
| | - Roselydiah Makunja
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
| | - Jane B. Maoga
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Agnes N. Mwaura
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Muhammad A. Riaz
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Charles O. A. Omwandho
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
- Deputy Vice Chancellor, Kirinyaga University, Kerugoya 10300, Kenya
| | - Ivo Meinhold-Heerlein
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Lutz Konrad
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
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Hirsch M, Berg L, Gamaleldin I, Vyas S, Vashisht A. The management of women with thoracic endometriosis: a national survey of British gynaecological endoscopists. Facts Views Vis Obgyn 2021; 12:291-298. [PMID: 33575678 PMCID: PMC7863691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES This study evaluates current national opinions on screening, diagnosis, and management of thoracic endometriosis. BACKGROUND Thoracic endometriosis is a rare but serious condition with four main clinical presentations: pneumothorax, haemoptysis, haemothorax, and pulmonary nodules. There are no specialist centres in the United Kingdom despite growing patient desire for recognition, investigation, and treatment. METHODS We distributed a multiple-choice email survey to senior members of the British Society for Gynaecological Endoscopy. Descriptive statistics were used to present the results. Results: We received 67 responses from experienced clinicians having provided over 800 combined years of endometriosis patient care. The majority of respondents managed over 100 endometriosis patients annually, for more than five years. Over one third had never managed a patient with symptomatic thoracic endometriosis; just 9% had managed more than 30 cases over the course of their career. Screening varied by modality with only 4% of clinicians always taking a history of respiratory symptoms while 69% would always screen for diaphragmatic endometriosis during laparoscopy. The management of symptomatic thoracic endometriosis varied widely with the commonest treatment being surgery followed by hormonal therapies. Regarding management, 71% of respondents felt the team should comprise of four or more different specialists, and 56% believed care should be centralised either regionally or nationally. CONCLUSIONS Thoracic endometriosis is poorly screened for amongst clinicians with varied management lacking a common diagnostic or therapeutic pathway in the United Kingdom. Specialists expressed a preference for women to be managed in a large multidisciplinary team setting at a regional or national level.
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Affiliation(s)
- M Hirsch
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, United Kingdom
| | - L Berg
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, United Kingdom
| | - I Gamaleldin
- Women's Health, Southmead Hospital, Bristol, United Kingdom
| | - S Vyas
- Women's Health, Southmead Hospital, Bristol, United Kingdom
| | - A Vashisht
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, United Kingdom
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Hirata T, Koga K, Kai K, Katabuchi H, Kitade M, Kitawaki J, Kurihara M, Takazawa N, Tanaka T, Taniguchi F, Nakajima J, Narahara H, Harada T, Horie S, Honda R, Murono K, Yoshimura K, Osuga Y. Clinical practice guidelines for the treatment of extragenital endometriosis in Japan, 2018. J Obstet Gynaecol Res 2020; 46:2474-2487. [PMID: 33078482 PMCID: PMC7756675 DOI: 10.1111/jog.14522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/28/2020] [Indexed: 01/31/2023]
Abstract
The aim of this publication is to disseminate the clinical practice guidelines for the treatment of intestinal, bladder/ureteral, thoracic and umbilical endometriosis, already published in Japanese, to non-Japanese speakers. For developing the original Japanese guidelines, the clinical practice guideline committee was formed by the research team for extragenital endometriosis, which is part of the research program of intractable disease of the Japanese Ministry of Health, Labor and Welfare. The clinical practice guideline committee formulated eight clinical questions for the treatment of extragenital endometriosis, which were intestinal, bladder/ureteral, thoracic and umbilical endometriosis. The committee performed a systematic review of the literature to provide responses to clinical questions and developed clinical guidelines for extragenital endometriosis, according to the process proposed by the Medical Information Network Distribution Service. The recommendation level was determined using modified Delphi methods. The clinical practice guidelines were officially approved by the Japan Society of Obstetrics and Gynecology and the Japan Society of Endometriosis. This English version was translated from the Japanese version.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and GynecologyDoai Kinen HospitalTokyoJapan
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Kaori Koga
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Kentaro Kai
- Department of Obstetrics and GynecologyOita UniversityOitaJapan
| | | | - Mari Kitade
- Department of Obstetrics and GynecologyJuntendo UniversityTokyoJapan
| | - Jo Kitawaki
- Department of Obstetrics and GynecologyKyoto Prefectural UniversityKyotoJapan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic SurgeryNissan Tamagawa HospitalTokyoJapan
| | | | - Toshiaki Tanaka
- Department of Surgical OncologyUniversity of TokyoTokyoJapan
- Department of SurgeryInternational Catholic HospitalTokyoJapan
| | | | - Jun Nakajima
- Department of Thoracic SurgeryUniversity of TokyoTokyoJapan
| | | | - Tasuku Harada
- Department of Obstetrics and GynecologyTottori UniversityTottoriJapan
| | - Shigeo Horie
- Department of UrologyJuntendo UniversityTokyoJapan
| | - Ritsuo Honda
- Department of Obstetrics and GynecologyKumamoto UniversityKumamotoJapan
| | - Koji Murono
- Department of Surgical OncologyUniversity of TokyoTokyoJapan
| | - Kotaro Yoshimura
- Department of Plastic SurgeryJichi Medical UniversityShimotsukeJapan
| | - Yutaka Osuga
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
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17
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Vigueras Smith A, Cabrera R, Kondo W, Ferreira H. Diaphragmatic endometriosis minimally invasive treatment: a feasible and effective approach. J OBSTET GYNAECOL 2020; 41:176-186. [PMID: 32053018 DOI: 10.1080/01443615.2019.1702934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present review aims to analyse the current data available on the feasibility, safety and effectiveness of the minimally invasive surgical (MIS) treatment of diaphragmatic endometriosis (DE). Through the use of PubMed and Google Scholar database, we conducted a literature review of all available research related to diagnosis and treatment of DE, focussed on the minimally invasive techniques. The studies were selected independently by two authors according to the aim of this review. DE is an under-diagnosed disease affecting between 0.1% and 1.5% of fertile women. It is predominantly multiple, asymptomatic and highly associated with pelvic disease in about 50-90%. MIS techniques seems to be safe, effective and feasible in tertiary advanced endometriosis centre, offering definitive advantages in terms of hospital stay, post-operative pain and return to normal activity by using several surgical techniques as hydro-dissection plus resection, laser CO2 vaporisation, electrical fulguration, Sugarbaker peritonectomy, partial (shaving) and full-thickness diaphragmatic resection. Symptoms control range from 85% to 100%, with less than 3% of conversion, peri-operative complications and recurrence rate. All cases must be performed by multidisciplinary teams including at least a gynaecologist, thoracic surgeon and anaesthetist. The lack of prospective evaluation of DE interferes with the understanding about the natural history of disease and treatment results. Therefore, the development of adequate evidence-based recommendations about diagnosis, management and follow-up is difficult at this moment.
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Affiliation(s)
- Andres Vigueras Smith
- Department of Minimally Invasive Surgery Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ramiro Cabrera
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital, Curitiba, Brazil
| | - William Kondo
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital, Curitiba, Brazil
| | - Helder Ferreira
- Department of Minimally Invasive Surgery Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
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18
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Dogra N, Luthra A, Chauhan R, Bajaj R, Gourav KP. Recurrent unilateral hemorrhagic pleural effusion: A rare manifestation of thoracic endometriosis syndrome. Ann Card Anaesth 2020; 23:521-523. [PMID: 33109818 PMCID: PMC7879902 DOI: 10.4103/aca.aca_17_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Unilateral recurrent pleural effusions are commonly encountered in critical care practice. Relevant clinical history, physical examination, radiology, and diagnostic thoracentesis usually identify the cause of pleural effusion in most cases. Thoracoscopy or video-assisted thoracic surgery may be required in selective cases. We report a case of 32-year-old female with recurrent unilateral hemorrhagic pleural effusion that was the presenting feature of thoracic endometriosis syndrome.
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Affiliation(s)
- Neeti Dogra
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ankur Luthra
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Rajiv Chauhan
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ritika Bajaj
- Department of Obstetrics and Gynaecology, Jindal IVF and Sant Memorial Nursing Home, Chandigarh, India
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19
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Furuta C, Yano M, Numanami H, Yamaji M, Taguchi R, Haniuda M. Nine cases of catamenial pneumothorax: a report of a single-center experience. J Thorac Dis 2018; 10:4801-4805. [PMID: 30233852 DOI: 10.21037/jtd.2018.07.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Catamenial pneumothorax (CP) is defined as repeated pneumothorax related to menses and thoracic endometriosis. We performed a retrospective analysis of nine patients with CP to determine the clinical features as well as the effects of treatment and recurrence rates. Methods A retrospective review was conducted of the clinical and pathologic data in all CP patients undergoing treatment at our institution. Nine patients underwent treatment for CP. Of these, six underwent surgical treatment 8 times. Results The median age was 36 years. Six patients had experienced delivery. The laterality of the pneumothorax was right in all patients. Pelvic endometriosis was diagnosed in five patients. Six patients underwent surgical treatment. Partial resection of the lung was performed in four patients and partial resection of the diaphragm in five. Of these, both resections were performed in four patients. A pathological diagnosis of endometriosis was achieved in only three patients. The observation period was 16.7 months. In the six patients with surgical resection, five experienced recurrence at various intervals. Onset of pneumothorax occurred pre- or menstrual period in most cases. Conclusions The diagnosis and treatment of CP is not easy. A multidisciplinary approach and skillful management are required. Recurrence of CP is common following a temporary cure of pneumothorax by surgical treatment.
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Affiliation(s)
- Chihiro Furuta
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Motoki Yano
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Hiroki Numanami
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Masayuki Yamaji
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Rumiko Taguchi
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Masayuki Haniuda
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
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Adeoye PO, Adeniran AS, Adesina KT, Ige OA, Akanbi OR, Imhoagene A, Ibrahim OOK, Ezeoke GG. Thoracic endometriosis syndrome at University of Ilorin Teaching Hospital. Afr J Thorac Crit Care Med 2018; 24. [PMID: 34541502 DOI: 10.7196/SARJ.2018.v24i2.201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background
Endometriosis is defined as the presence of endometrial tissue (stroma and functional glands) outside the uterine cavity in
women of reproductive age. Ectopic sites are frequently located in the pelvis; extrapelvic sites have been reported in the gastrointestinal tract
and thoracic cavity. Thoracic manifestation of endometriosis constitutes thoracic endometriosis syndrome (TES).
Objectives
To examine the presentation pattern and outcome of in the management of TES.
Methods
This study is a retrospective review of medical records of patients diagnosed with endometriosis at the University of Ilorin
Teaching Hospital over a 3.5-year period from January 2014 to June 2017.
Results
A total of 21 patients presented with endometriosis, of whom 8 (38.1%) presented with TES. The most common variety of TES was
catamenial pleural effusion (CPE) accounting for 75%, followed by catamenial chest pain (37.5%). Two patients (25%) each presented with
catamenial pneumothorax and catamenial haemoptysis, while 1 (12.5%) had catamenial surgical emphysema. Closed thoracostomy tube
drainage plus chemical pleurodesis was the most frequent intervention technique, accounting for 62.5%.
Conclusion
TES remains an uncommon entity, despite being the most common extrapelvic manifestation of endometriosis. CPE appeared
to be the most common variant of TES in our environment. Currently available treatment options need to be improved, and more use made
of video-assisted thoracoscopic surgery.
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21
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Larraín D, Suárez F, Braun H, Chapochnick J, Diaz L, Rojas I. Thoracic and diaphragmatic endometriosis: Single-institution experience using novel, broadened diagnostic criteria. J Turk Ger Gynecol Assoc 2018; 19:116-121. [PMID: 29865779 PMCID: PMC6085532 DOI: 10.4274/jtgga.2018.0035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To describe our experience with the multidisciplinary management of both thoracic/diaphragmatic endometriosis (TED), applying a broadened definition of the “Thoracic endometriosis syndrome (TES)” to define cases. Material and Methods: We present a retrospective series of consecutive patients affected by pathology-proven TED, treated at our institution, during a period of 7 years. Results: Five women were included. Two patients were referred due to catamenial chest/shoulder pain, one due to recurrent catamenial pneumothorax, and one due to new-onset diaphragmatic hernia. One patient had no thoracic symptoms, but diaphragmatic endometriosis was found during gynecologic laparoscopy for pelvic endometriosis. Endometriosis was histologically confirmed in all cases. After follow-up, all patients remain asymptomatic. Conclusion: Broadened TES criteria could increase the incidence of TED and determine better knowledge of this condition. Multidisciplinary, minimally invasive surgery is effective and safe, but should be reserved for tertiary referral centers.
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Affiliation(s)
- Demetrio Larraín
- Department of Obstetrics and Gynecology, Endometriosis Unit, Clínica Santa María, Santiago, Chile,Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Francisco Suárez
- Department of Thoracic Surgery, Clínica Santa María, Santiago, Chile
| | - Hernán Braun
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Javier Chapochnick
- Department of Hepatobiliary Surgery, Clínica Santa María, Santiago, Chile
| | - Lidia Diaz
- Department of Pathology, Clínica Santa María, Santiago, Chile
| | - Iván Rojas
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
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22
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Kawaguchi Y, Hanaoka J, Ohshio Y, Igarashi T, Okamoto K, Kaku R, Hayashi K, Ishida M. Diagnosis of thoracic endometriosis with immunohistochemistry. J Thorac Dis 2018; 10:3468-3472. [PMID: 30069342 DOI: 10.21037/jtd.2018.05.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pathological and immunohistochemical features of thoracic endometriosis are not well understood. In the present study, we retrospectively analyzed the clinical and pathological diagnostic characteristics of 55 female pneumothorax cases. Methods This study was a retrospective observation of 55 women aged from 8 to 62 years old who underwent surgery for pneumothorax from November 2001 through January 2018. Immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR), and CD10 was performed for all cases. As controls, we analyzed resected specimens of spontaneous pneumothorax in men who received surgery. Results Of 55 cases, endometrial stroma and glands by Hematoxylin-Eosin (HE) stain was found in only one case. Thirty-seven cases (67.3%) were ER- and PR-positive in stromal bland spindle cells of the lung. The remaining 18 cases (32.7%) were ER-, PR-, and CD10-negative. The ER- and PR-positive specimens could be further classified according to 2 staining patterns: 'scattered pattern' and 'aggregated pattern'. Thirty-three cases (60.0%) were scattered and four cases (7.3%) were aggregated pattern. Only the aggregated pattern specimens exhibited positive staining for CD10. As the scattered pattern was also found in men, we only diagnosed the aggregated pattern cases as endometriosis. Conclusions A diagnosis of thoracic endometriosis is simple when both endometrial stroma and gland are present. In cases of endometriosis with stroma only, a further classification of "aggregated pattern", in which immunohistochemistry is ER-, PR- and CD10-positive might be necessary for diagnosis.
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Affiliation(s)
- Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.,Division of General Thoracic Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoyuki Igarashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Ryosuke Kaku
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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Suwatanapongched T, Boonsarngsuk V, Amornputtisathaporn N, Leelachaikul P. Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment. Singapore Med J 2016; 56:e120-3. [PMID: 26243981 DOI: 10.11622/smedj.2015115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Thoracic endometriosis (TE) is an uncommon disorder affecting women of childbearing age. We herein report clinical and thin-section computed tomography (CT) findings of two cases, in which one woman presented with catamenial haemoptysis (CH) alone and another woman presented with bilateral catamenial pneumothoraces (CP) coinciding with CH, a rare manifestation of TE. The dynamic changes demonstrated on thin-section chest CT performed during and after menses led to accurate localisation and presumptive diagnosis of TE in both patients. Following danazol treatment, the patient with CH alone had a complete cure, while the patient with CP and CH had an incomplete cure and required long-term danazol treatment. We discuss the role of imaging studies in TE, with an emphasis on the appropriate timing and scanning technique of chest CT in women presenting with CH, potential mechanisms, treatment and patient outcomes.
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Affiliation(s)
- Thitiporn Suwatanapongched
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Naparat Amornputtisathaporn
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisan Leelachaikul
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Pneumothorax associated with thoracic endometriosis (TE) generally occurs in women around 30 years old and it usually affects the right pleural cavity. We herein report two cases of TE associated with left-sided pneumothorax in young women. The prevalence of TE in younger patients may be underestimated if these cases are treated as spontaneous pneumothorax. Pneumothorax occurring in younger patients has not been reported to show laterality. TE-related or catamenial pneumothorax in young women must therefore represent a different clinical entity from the condition seen in older patients.
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Affiliation(s)
- Shungo Yukumi
- Department of Surgery, National Hospital Organization Ehime Medical Center, Japan
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Haga T, Kumasaka T, Kurihara M, Kataoka H, Miura M. Immunohistochemical analysis of thoracic endometriosis. Pathol Int 2013; 63:429-34. [PMID: 24200154 DOI: 10.1111/pin.12089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/17/2013] [Indexed: 11/28/2022]
Abstract
Thoracic endometriosis is a rare disease responsible for catamenial pneumothorax. The immunohistochemical features of thoracic endometriosis are not well understood. An immunohistochemical examination of 84 diaphragmatic specimens of catamenial pneumothorax using antibodies against estrogen receptor (ER), progesterone receptor (PgR), CD10 and smooth muscle actin (SMA) was conducted. The endometrial tissue was small, and focally located around the chasm of the tendon on the side of the thoracic cavity. Endometrial stroma were detected in 84/84 (100%) of the specimens, endometrial glands were detected in 21/84 (25%) and smooth muscle was detected in 1/84 (1.2%). The endometrial stroma exhibited positive staining for ER in 74/84 (88.1%) of the specimens, PgR in 84/84 (100%), CD10 in 74/84 (88.1%) and SMA in 46/84 (54.8%). Because thoracic endometriosis is small in size, and only 25% of the resected tissue specimens were accompanied with the endometrial gland, an immunohistochemical analysis can be useful for their detection. The fact that over half of the thoracic endometrial stroma showed positive staining for SMA, and the existence of thoracic endometriosis accompanied by smooth muscle, indicated that some part of the thoracic endometriosis may have the ability to differentiate into smooth muscle, although further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Takahiro Haga
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan
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Visouli AN, Darwiche K, Mpakas A, Zarogoulidis P, Papagiannis A, Tsakiridis K, Machairiotis N, Stylianaki A, Katsikogiannis N, Courcoutsakis N, Zarogoulidis K. Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. J Thorac Dis 2013; 4 Suppl 1:17-31. [PMID: 23304438 DOI: 10.3978/j.issn.2072-1439.2012.s006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/23/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Spontaneous recurrent pneumothorax during menstruation is reported as catamenial pneumothorax. It is encountered in 3-6% of spontaneous pneumothorax cases among menstruating women. The percentage among women referred for surgery is significantly higher (25-30%). Although it usually involves the right-side (85-95%) it can be left-sided or bilateral. It is associated with diaphragmatic perforations and/or thoracic endometriosis. There is pelvic endometriosis in up to 30-51% of cases. The lesions that are not always found may present as small or larger holes at the central tendon of the diaphragm, as red, blueberry, brown spots or larger nodules at the diaphragm, the visceral or parietal pleura. Lesion histology may reveal endometriosis. We present 5 cases of catamenial pneumothorax treated surgically during the last 6 years. PATIENTS AND METHODS Five women, with a mean age of 34+/-9.9 years (median 38, range, 19-45 years) presented with right-sided recurrent catamenial pneumothorax. In 3 patients diaphragmatic perforation(s) were found; perforation suturing (n=1), and diaphragmatic plication reinforced with bovine pericardial patch (n=1) were performed. All patients underwent atypical resection of upper and/or middle lobe segments of lung parenchyma that appeared abnormal (haemorrhagic/emphysematous or blebs). Four patients underwent pleurodesis and 1 patient underwent pleurectomy. Four interventions were performed through video assisted thoracoscopic surgery, while diaphragmatic plication was performed through a video assisted mini-thoracotomy. Histology did not reveal endometriosis tissue. RESULTS The postoperative course was uneventful. The patients were extubated in theatre and were discharged home at a mean of 7+/-4 days (median 6 days, range, 4-14 days). Two of them received hormonal therapy [Gonadotropin Releasing Hormone (GnRH) analogue] postoperatively. At a follow-up of 14.16 patient-years (mean 2.83+/-1.08 years, range, 1.33-3.83 years) there was recurrence, 6.5 months postoperatively, in one patient that had not undergone closure of a tiny diaphragmatic hole and had not received hormonal treatment postoperatively. She was treated medically (amenorrhea for 6 months with GnRH analogue) and had no further recurrences (in 3.3 years). CONCLUSIONS Surgery is the treatment of choice of catamenial pneumothorax. It should aim to complete management of all lesions. The most common complication is recurrence. Early diagnosis and multidisciplinary treatment including hormonal therapy may be beneficial in high risk patients.
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