Abstract Endometriosis's pathophysiology remains incompletely understood, with evidence pointing towards a dysregulated immune response. Regulatory T (Treg) cells, pivotal in maintaining self-tolerance, may facilitate the survival of ectopic endometrial cells within the abdominal cavity, thereby contributing to endometriosis development. This study aimed to assess the prevalence of CD39+CD73+ suppressor Treg cell subsets in the peripheral blood of endometriosis patients. This research focuses on the pivotal role of regulatory T-cells (Tregs), which are essential for maintaining immune tolerance and preventing autoimmune diseases. A case-control study was conducted, including 32 women diagnosed with endometriosis and 22 control subjects. The frequency of peripheral blood CD39+CD73+ suppressor Treg cells was quantified using flow cytometry. No significant differences were observed in the frequency of CD3+CD4+CD25High cells (Median [M]: 10.1; Interquartile Range [IQR]: 6.32‒18.3 vs. M: 9.72; IQR: 6.22-19.8) or CD3+CD4+CD25HighCD39+Foxp3+ cells (M: 31.1; IQR: 19.7-44.0 vs. M: 30.55; IQR: 18.5-45.5) between controls and patients. However, a significantly lower frequency of CD3+CD4+CD25HighCD39+CD73+ cells was observed in the endometriosis group compared to controls (M: 1.98; IQR: 0.0377-3.17 vs. M: 2.25; IQR: 0.50-4.08; p = 0.0483), suggesting a reduction in systemic immune tolerance among these patients. This finding highlights the potential role of CD39 and CD73 expression on Treg cells as biomarkers for assessing disease severity and progression. Furthermore, elucidating the mechanisms driving these alterations may unveil new therapeutic strategies to restore immune equilibrium and mitigate endometriosis symptoms. Endometriosiss Endometriosis s understood response (Treg selftolerance, selftolerance self tolerance, self-tolerance cavity development CD39CD73 CDCD CD CD39+CD73 patients Tcells Tregs, Tregs , (Tregs) diseases casecontrol case conducted 3 2 subjects cytometry CD3CD4CD25High CDCDCDHigh CD3 CD4 CD25High High Median M [M] 10.1 101 10 1 IQR [IQR] 632183 6 18 6.32‒18. vs 9.72 972 9 72 6.2219.8 622198 6.22 19.8 19 8 6.22-19.8 CD3CD4CD25HighCD39Foxp3 CDCDCDHighCDFoxp CD25HighCD39 Foxp3 HighCD Foxp CD3+CD4+CD25HighCD39+Foxp3 (M 31.1 311 31 19.744.0 197440 19.7 44.0 7 44 0 19.7-44. 30.55 3055 30 55 18.545.5 185455 18.5 45.5 5 45 18.5-45.5 However CD3CD4CD25HighCD39CD73 CDCDCDHighCDCD CD3+CD4+CD25HighCD39+CD73 1.98 198 98 0.03773.17 00377317 0.0377 3.17 0377 17 0.0377-3.1 2.25 225 25 0.504.08 050408 0.50 4.08 50 4 08 0.50-4.08 0.0483, 00483 0.0483 0483 0.0483) CD7 progression Furthermore symptoms CD39CD7 CD39+CD7 (Tregs CDHigh [M 10. [IQR 63218 6.32‒18 9.7 97 2219 6.2219. 62219 622 6.2 19. 6.22-19. CD3CD4CD25HighCD39Foxp CDHighCD CD25HighCD3 CD3+CD4+CD25HighCD39+Foxp 31. 744 19.744. 19744 197 440 44. 19.7-44 30.5 305 545 18.545. 18545 185 18. 455 45. 18.5-45. CD3CD4CD25HighCD39CD7 CD3+CD4+CD25HighCD39+CD7 1.9 03773 0.03773.1 0037731 00377 0.037 317 3.1 037 0.0377-3. 2.2 504 0.504.0 05040 050 0.5 408 4.0 0.50-4.0 0048 0.048 048 CD39CD CD39+CD 6321 6.32‒1 9. 221 6.2219 6221 62 6. 6.22-19 CD25HighCD 74 19.744 1974 19.7-4 30. 54 18.545 1854 18.5-45 CD3CD4CD25HighCD39CD CD3+CD4+CD25HighCD39+CD 1. 0.03773. 003773 0037 0.03 3. 03 0.0377-3 2. 0.504. 0504 05 0. 40 4. 0.50-4. 004 0.04 04 632 6.32‒ 6.221 6.22-1 19.74 19.7- 18.54 18.5-4 0.03773 003 0.0 0.0377- 0.504 0.50-4 00 63 6.32 6.22- 18.5- 0.50- 6.3

Resumo Objetivos: descrever o perfil epidemiológico e clínico de mulheres com endometriose e determinar a associação com as características prognósticas da doença. Métodos: estudo descritivo retrospectivo envolvendo 237 mulheres atendidas em dois hospitais de referência em endometriose, no período entre 2011 e 2017. As associações entre os grupos foram estimadas utilizando modelos de regressão logística. Resultados: a maioria das mulheres (65,4%) estava em idade reprodutiva (29-39 anos), com índice de massa corporal entre 18,5-24,9 kg/m2 e alta prevalência (23-81%) dos sintomas clínicos da doença, sendo que 49,5% eram inférteis. O tempo médio de diagnóstico foi de 5 anos. O endometrioma ovariano e/ou endometriose profunda infiltrativa (EPI) foram os tipos mais frequentes de endometriose (87%), sendo que 59% das pacientes estavam no estágio III/IVda doença. Aproximadamente 87% das mulheres com diagnóstico cirúrgico apresentavam idade acima dos 30 anos, eram casadas (70%) e apresentavam menor paridade. A dispareunia foi associada negativamente à endometriose superficial. A infertilidade foi associada positivamente com a idade (30-39 anos) e com a EPI nas tubas uterinas; a dismenorreia com a EPI no ligamento uterosacral; as queixas intestinais cíclicas com a EPI no retosigmóide e intestino, e com a classificação EPI e estágio III/IV. Conclusões: conhecer o perfil epidemiológico e clínico das mulheres brasileiras com endometriose pode auxiliar no diagnóstico e no planejamento do tratamento.

Abstract Objectives: to describe the epidemiological and clinical profile of women with endometriosis and to determine the association with the prognostic characteristics of the disease. Methods: retrospective descriptive study involving 237 women attended at two referral hospitals for endometriosis, between 2011 and 2017. Associations between groups were estimated using logistic regression models. Results: most women (65.4%) were of reproductive age (29-39 years), with a body mass index in the range of 18.5-24.9 kg/m2 and a high prevalence (23-81%) of symptoms of the disease, with 49.5% being infertile. The average time of diagnosis was 5 years. Ovarian endometrioma and/or deep infiltrative endometriosis (DIE) were the most frequent type of endometriosis (87%), and 59% of patients were in the III/IV stage of the disease. Approximately 87% of women with surgical diagnosis were aged over 30, married (70%) and had lower parity. Dyspareunia was negatively associated with superficial endometriosis. Infertility was positively associated with age (30-39 years) and DIE in the uterine tubes; dysmenorrhea with DIE in the uterosacral ligament; cyclic intestinal complaints with DIE in the rectosigmoid and intestine, and with DIE classification and III/IVstage. Conclusions: knowing the epidemiological and clinical profile of Brazilian women with endometriosis can help in diagnosis and treatment planning.

RESUMO Introdução: a anovulação é uma das principais causas de infertilidade feminina, e a síndrome dos ovários policísticos (SOP) é a principal causa de anovulação. As mulheres com SOP, quando submetidas a indução medicamentosa da ovulação, costumam ter resposta satisfatória, recrutando folículos. No entanto, algumas podem não recrutar folículos ou, muitas vezes, têm uma produção excessiva deles, o que pode resultar em síndrome de hiperestímulo ovariano e/ou gravidez múltipla. O tratamento cirúrgico por laparoscopia comdrilling ovariano pode evitar ou reduzir a necessidade de indução da ovulação com medicamentos. Objetivos: identificar as indicações atuais do drilling ovariano laparoscópico e qual a melhor técnica operatória. Método: revisão da literatura médica, por meio de busca sistemática nas bases de dados MEDLINE, LILACS e Cochrane, utilizando as palavras-chave: laparoscopia, síndrome dos ovários micropolicísticos edrilling. Resultados: foram encontrados 105 artigos na literatura, sendo 27 de grande relevância descrevendo achados sobre o drilling ovariano. Conclusão: o drilling laparoscópico está indicado para pacientes com SOP com resistência ovulatória ao uso do citrato de clomifeno, índice de massa corpórea (IMC) inferior a 30 kg/m2 e hormônio luteinizante (LH) pré-cirúrgico superior 10 UI/L. A técnica operatória de preferência deve ser a realização de 5 a 10 perfurações na superfície de cada ovário bilateralmente por meio do uso de energia monopolar.

SUMMARY Introduction: anovulation is a major cause of female infertility, and polycystic ovary syndrome (PCOS) is the leading cause of anovulation. While undergoing drug-induced ovulation, women with PCOS usually have a satisfactory response recruiting follicles, but some are unable to recruit follicles or often produce an excessive number of follicles, which can result in ovarian hyper-stimulation syndrome and/or multiple pregnancy. Surgical laparoscopy with ovarian "drilling" may prevent or reduce the need for drug-induced ovulation. Objective: to identify the current indications of laparoscopic ovarian drilling and the best surgical technique. Method: a review of the medical literature based on systematic search in the Medline, Lilacs and Cochrane databases, using as keywords laparoscopy, polycystic ovary syndrome, and drilling. Results: we found 105 articles in the literature, 27 of these highly relevant, describing findings on ovarian drilling. Conclusion: laparoscopic drilling is indicated for patients with polycystic ovary syndrome with ovulatory resistance to the use of clomiphene citrate, body mass index less than 30 kg/m2 and preoperative luteinizing hormone above 10 IU/L. The preferred surgical technique should be the realization of 5 to 10 perforations on the surface of each ovary bilaterally using monopolar energy.

OBJETIVO: Avaliar as concentrações séricas de CA-125 e CD-23 solúvel e correlacioná-los com sintomas clínicos, localização e estádio da endometriose pélvica e classificação histológica da doença. MÉTODOS: Amostras de sangue foram coletadas de 44 mulheres com endometriose e 58 sem endometriose durante os primeiros três dias (1ª amostra) e durante o sétimo, o oitavo e o nono dia (2ª amostra) do ciclo menstrual. As dosagens de CA-125 e CD-23 solúvel foram realizadas por ELISA. O teste U de Mann-Whitney foi usado para idade, avaliação de dor (escala analógica visual) e para a concentração dos biomarcadores. RESULTADOS: Os níveis séricos de CA-125 foram mais altos nas pacientes com endometriose do que no grupo-controle quando avaliados em ambos os períodos do ciclo menstrual, assim como apresentaram-se elevados nessas mulheres quando referiam dor pélvica crônica, dispareunia de profundidade (coleta na 2ª amostra), dismenorreia (ambas as amostras) e dor ao evacuar durante o fluxomenstrual (coleta na 2ª amostra). A concentração de CA-125 foi mais alta no estádio avançado em ambas as amostras, assim como em mulheres com endometriomas ovarianos. Em relação ao CD-23 solúvel, nenhuma diferença estatisticamente significativa foi observada entre os grupos. CONCLUSÃO: As concentrações de CA-125 foram mais altas em pacientes com endometriose do que em pacientes sem a doença. Nenhuma diferença estatisticamente significativa foi observada para CD-23 solúvel entre os grupos.

OBJECTIVE: To evaluate serum concentrations of CA-125 and soluble CD-23 and to correlate them with clinical symptoms, localization and stage of pelvic endometriosis and histological classification of the disease. METHODS: Blood samples were collected from 44 women with endometriosis and 58 without endometriosis, during the first three days (1st sample) and during the 7th, 8th and 9th day (2nd sample) of the menstrual cycle. Measurements of CA-125 and soluble CD-23 were performed by ELISA. Mann-Whitney U test was used for age, pain evaluations (visual analog scale) and biomarkers concentrations. RESULTS: Serum levels of CA125 were higher in endometriosis patients when compared to the control group during both periods of the menstrual cycle evaluated in the study. This marker was also elevated in women with chronic pelvic pain, deep dyspareunia (2nd sample), dysmenorrhea (both samples) and painful defecation during the menstrual flow (2nd sample). CA-125 concentration was higher in advanced stages of the disease in both samples and also in women with ovarian endometrioma. Concerning CD-23, no statistically significant differences were observed between groups. CONCLUSION: The concentrations of CA-125 were higher in patients with endometriosis than in patients without the disease. No significantly differences were observed for soluble CD-23 levels between groups.

OBJETIVO: Examinar a relação entre aspectos clínicos e qualidade de vida em um grupo de pacientes com endometriose. MÉTODOS: Participaram desse estudo 130 mulheres atendidas durante o ano de 2008 em um centro multiprofissional de ginecologia especializado em endometriose. Este é um estudo de corte transversal realizado com uma amostra de conveniência. O diagnóstico de endometriose foi realizado por biopsia pós-laparoscopia, segundo os critérios da Sociedade Americana de Medicina Reprodutiva. Os dados clínicos e demográficos foram coletados a partir dos prontuários dos pacientes. A intensidade da dor foi avaliada com o uso de uma escala visual numérica (0-10) e os dados referentes à qualidade de vida foram coletados por meio do questionário SF-36. A análise dos dados consistiu de estatística descritiva e inferencial, teste de coeficiente de correlação de Spearman e o teste de Kruskal-Wallis para comparar escores entre grupos. RESULTADOS: As pacientes apresentaram idade entre 21 e 54 anos [<img src="/img/revistas/rbgo/v34n1/a03tx01.jpg" align="absmiddle" > ou = 34, desvio padrão (DP)=6,56], sendo que 87% tinham terceiro grau completo e 75% eram casadas. Dezessete por cento referiram casos de endometriose na família. O tempo médio de manifestação dos sintomas foi de 4,5 anos (DP=6,6), 63% das pacientes estavam no estágio 3 ou 4 de endometriose, 36% das pacientes sofriam de dismenorreia severa ou incapacitante e a intensidade média da dor, segundo escala visual numérica, foi de 5,6 (DP=3,5). Os resultados sugeriram que o estadiamento da doença não é determinante da intensidade da dor. Por um lado, o tempo de manifestação dos sintomas também não apresentou relação com a intensidade da dor e com os escores do SF-36. Por outro, a intensidade da dor apresentou associação com menores escores em algumas escalas do SF-36. CONCLUSÃO: As pacientes com endometriose apresentaram escores de qualidade de vida inferiores ao da população em geral e inferiores a algumas outras patologias.

PURPOSE: The present study examined the relationship between some clinical variables and quality of life in a group of patients with endometriosis. METHODS: A total of 130 women seen at a multidisciplinary center specializing in gynecology endometriosis in 2008 participated in the study. This was a cross-sectional study conducted with a convenience sample. The diagnosis of endometriosis was performed by biopsy according to the criteria of the American Society for Reproductive Medicine. The clinical and demographic data were collected from the patients' records. Pain intensity was assessed by a visual numerical scale (0-10), and data on the quality of life were collected using the SF-36. Data analysis consisted of descriptive and inferential statistical tests, Spearman correlation coefficient and Kruskal-Wallis test to compare scores between groups. Nonparametric tests were used for analysis because data were not normally distributed. RESULTS: The patients were 21 to 54 years of age [<img src="/img/revistas/rbgo/v34n1/a03tx01.jpg" align="absmiddle" > or = 34, standard diversion (SD)=6.56], 87% had a university degree, and 75% were married. Seventeen percent reported cases of endometriosis in the family. The average time of onset of symptoms was 4.5 years (SD=6.6), 63% of patients were in stage 3 or 4 of endometriosis 36% of patients had severe or disabling dysmenorrhea and the average intensity of pain according to a visual numerical scale was of 5.6 (SD=3.5). Results suggest that the staging of the disease did not determine the intensity of pain. The time of onset of symptoms also showed no relationship to pain intensity and SF-36 scores. On the other hand, the intensity of pain was associated with lower scores on some scales of the SF-36. CONCLUSION: Patients with endometriosis had lower scores of quality of life than the general population and lower than those of some other diseases.

A endometriose representa uma afecção ginecológica comum, atingindo de 5%-15% das mulheres no período reprodutivo e até 3%-5% na fase pós-menopausa. Essa doença é definida pelo implante de estroma e/ou epitélio glandular endometrial em localização extrauterina, podendo comprometer diversos locais. Humanos e animais são expostos diariamente a poluentes químicos que têm a capacidade de influenciar negativamente processos fisiológicos e, potencialmente, causar doenças, dentre elas a endometriose. Com esta revisão tivemos por objetivo relacionar a influência dos fatores ambientais e dietéticos na gênese da endometriose. O mecanismo pelo qual a dioxina e seus símiles (TCDD/PCBs) atuam na alteração da fisiologia endometrial permanence incerta e é especulativa devido à dificuldade em se avaliar a exposição na vida intraútero, infância e vida adulta e suas reais consequências, além das limitações de sua reprodução in vitro. Devemos entender melhor o mecanismo de ação desses poluentes amibentais não só na saúde reprodutiva, mas na saúde em geral do indivíduo, para se promover estratégias de prevenção que devem incluir não só a educação populacional, mas o estabelecimento de limites de exposição, técnicas menos poluentes e melhor aproveitamento dos nossos recursos naturais.

Endometriosis represents a common gynecological condition affecting 5%-15% of childbearing age women and up to 3% 5% of post-menopausal women. This disease is defined by the presence of stromal and/or endometrial glandular epithelium implants in extra-uterine locations possibly compromising several sites. Humans and animals are daily exposed to chemical pollutants that could adversely influence physiological processes and potentially cause diseases, including endometriosis. In this review, the authors aimed at settling the influence of environmental and dietary factors on endometriosis pathogenesis. The mechanism by which dioxin and its similes (TCDD/PCBs) act changing the endometrial physiology remains uncertain and is speculative due to the difficulty in assessing the exposure over intrauterine life, childhood and adulthood and its actual consequences, in addition to the limitations to its in vitro reproducibility. We need to better understand the mechanism of action of these environmental pollutants, not only on reproductive health, but also on overall health of individuals and so prevention strategies, including not only population education, but setting exposure limits, less polluting techniques and a better use of our natural resources, could be promoted.

OBJECTIVE: To evaluate vaginal cone therapy in two phases, passive and active, in women with stress urinary incontinence. METHODS: A prospective study was conducted at the Department of Obstetrics and Gynecology, São Paulo University, Brazil. Twenty-four women with a clinical and urodynamic diagnosis of stress urinary incontinence were treated with vaginal cones in a passive phase (without voluntary contractions of the pelvic floor) and an active phase (with voluntary contractions), each of which lasted three months. Clinical complaints, a functional evaluation of the pelvic floor, a pad test, and bladder neck mobility were analyzed before and after each phase. RESULTS: Twenty-one patients completed the treatment. The reduction in absolute risk with the pad test was 0.38 (p<0.034) at the end of the passive phase and 0.67 (p<0.0001) at the end of the active phase. The reduction in absolute risk with the pelvic floor evaluation was 0.62 (p<0.0001) at the end of the passive phase and 0.77 (p<0.0001) at the end of the active phase. The reduction in absolute risk of bladder neck mobility was 0.38 (p<0.0089) at the end of the passive phase and 0.52 (p<0.0005) at the end of the active phase. Complete reversal of symptomatology was observed in 12 (57.1%) patients, and satisfaction was expressed by 19 (90.4%). CONCLUSION: Using vaginal cones in the passive phase, as other researchers did, was effective. Inclusion of the active phase led to additional improvement in all of the study parameters evaluated in women with stress urinary incontinence. Randomized studies are needed, however, to confirm these results.

A cirurgia laparoscópica colorretal é considerada tecnicamente factível e segura, com resultados oncológicos comparáveis à cirurgia aberta. A cirurgia robótica é uma atraente modalidade de cirurgia minimamente invasiva, com algumas vantagens claras sobre a laparoscopia convencional. O objetivo deste trabalho é descrever a experiência pioneira da cirurgia colorretal robô-assistida no Brasil. A paciente de 35 anos operada com auxílio do sistema da Vinci® tinha endometriose profunda, com envolvimento do reto. É feita ampla revisão da literatura, discutindo não apenas a indicação e segurança da cirurgia robótica colorretal, mas também seus reais benefícios

Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci® surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery

OBJETIVO: Descrever aspectos clínicos e epidemiológicos das pacientes portadoras de endometriose pélvica operadas em nosso serviço. MÉTODOS: Estudo retrospectivo de 892 pacientes submetidas a videolaparoscopia com confirmação histológica do diagnóstico de endometriose. RESULTADOS: A média de idade foi de 33,2 ± 6,3 anos, sendo 78,7% brancas. Observamos 76,9% de mulheres com 2º ou 3º graus completos; 56,5% das pacientes eram nulíparas e 62,2% relataram dismenorreia como principal queixa. A dor pélvica crônica foi o sintoma mais prevalente, seguido pela dispareunia de profundidade, sendo referidos por 56,8% e 54,7% das pacientes, respectivamente. A infertilidade foi referida por 39,8% das 892 pacientes. CONCLUSÃO: A endometriose é uma doença geralmente diagnosticada na 4º década da vida das pacientes, as quais apresentam queixas clínicas relacionadas com frequência à dor pélvica e infertilidade, que devem sempre ser questionadas para orientar a hipótese diagnóstica.

OBJECTIVE: To describe clinical and epidemiological aspects of patients with pelvic endometriosis who were operated in our service. METHODS: A retrospective study was made of 892 patients submitted to laparoscopy with histological confirmation of diagnosis of endometriosis. RESULTS: The mean age was 33.2 ± 6.3 years and 78.7% were Caucasian. We found that 76.9% of women had higher education. 56.5% of patients were nulliparous and 62.2% reported dysmenorrhea as the main complaint. Chronic pelvic pain was the most prevalent symptom, followed by deep dyspareunia, mentioned by 56.8% and 54.7% of patients, respectively. Infertility was reported by 39.8% of the 892 patients. CONCLUSION: Endometriosis is a disease diagnosed in the 4th decade of life, of patients who have multiple complaints . They must always be questioned to properly orient diagnosis and monitor results of treatment.

OBJETIVO: Este estudo analisa a relação entre as características clínicas da endometriose e os padrões da resposta imune Th1/Th2. MÉTODOS: Estudo prospectivo realizado com 65 pacientes com endometriose (Grupo A) e 33 pacientes sem a doença (Grupo B). Foram realizadas avaliação no fluido peritoneal e sangue periférico de IL 2, 4 e 10, TNF-alfa e IFN-gama. A significância foi estabelecida em p < 0,05. RESULTADOS: TNF-alfa encontrava-se elevado em pacientes com endometriose que apresentavam dispareunia de profundidade comparado com controle (média 4,5 pg/ml e 2,3 pg/ml, p< 0,05). Dentre essas pacientes (n=32), 65,5% apresentavam endometriose profunda. Pacientes com endometriose e infertilidade apresentavam concentrações maiores de IL-2 no fluido peritoneal quando comparadas com controle (média 5,9 pg/ml e 0,2 pg/ml, p< 0,05), sendo que neste grupo, 63,5% (n=14) apresentavam endometriose profunda. Foi observada também maior concentração de IL-10 nas pacientes que apresentavam endometriose ovariana quando comparadas às sem esse tipo de endometriose, assim como quando comparadas às pacientes do grupo controle (média 50pg/ml, 18,7pg/ml e 25,7pg/ml, p<0,05). CONCLUSÃO: Estes resultados sugerem que quando dados clínicos específicos associam-se a uma produção elevada de certas citocinas, ocorre um padrão de resposta Th1 que pode estar associado à endometriose profunda.

OBJECTIVE: This study analyzed the relationship between clinical characteristics of endometriosis and Th1/Th2 immune response patterns. METHODS: A prospective study was performed with 65 patients with endometriosis (Group A) and 33 without the disease (Group B). Measurement of IL 2, 4 and 10, TNF-alpha and IFN-gamma was carried out in peripheral blood and peritoneal fluid. RESULTS: Serum TNF-alpha was higher in patients with endometriosis who had deep dyspareunia compared to controls (mean 4.5 pg/ml and 2.3 pg/ml, p<0.05). Among these patients (n=32), 65.5% had deep endometriosis. Patients with endometriosis and infertility had higher IL-2 concentrations in peritoneal fluid than controls (mean 5.9 pg/ml and 0.2 pg/ml, p<0.05). Among these patients (n=22), 63.5% (n=14) had deep endometriosis. A higher concentration of IL-10 was also observed in patients with ovarian endometriosis when compared to those without this type of disease, as well as when compared to control group patients (mean 50pg/ml, 18.7pg/ml and 25.7pg/ml, p<0.05). CONCLUSIONS: These results suggest that when specific clinical data are associated with a higher production of certain cytokines, there is a Th1 response pattern that may be related to deep infiltrating endometriosis.

A despeito do caráter benigno da endometriose, estima-se que 1% dos casos esteja relacionado com câncer, especialmente quando ambas as condições ocorrem nos ovários. Lesões extra-ovarianas encontradas no septo retovaginal, cólon, bexiga, vagina e peritônio da região pélvica também já foram associadas com neoplasias malignas. Várias características do tecido endometrial ectópico o aproximam do fenótipo neoplásico, e a própria endometriose possui comportamento tipicamente neoplásico com capacidade de invasão do estroma adjacente e associação com lesões à distância. Esta revisão atualiza conhecimentos diagnósticos, clínicos e terapêuticos dos implantes intestinais de tecido endometriótico, bem como sua relação com processos neoplásicos para melhor compreensão de seu caráter benigno ou de seu eventual potencial para malignidade.

Endometriosis is generally assumed to be a benign disease, but it is estimated that 1% of cases are associated with cancer, especially when both conditions are present in the ovary. Extra-ovarian lesions in the rectovaginal septum, colon, bladder, vagina and peritoneum were already associated with malign neoplasia. Several characteristics of endometrial tissue are very similar to the neoplasia phenotype. Endometriosis itself typically behaves as a neoplasia process, spreading over adjacent stroma and being associated with distant lesions. This is an update on the diagnostic, clinical, and therapeutic knowledge of, management of bowel implants of endometrial tissue, as well as the relation with neoplastic processes to better understand its benign nature or eventual potential for malignancy.

Neste estudo, quarenta pacientes selecionadas com endometriose pélvica e utilizando do método videolaparoscópico de corrida dos órgãos peritoneais na endometriose (COPE), puderam verificar se suas queixas encontram-se correlacionadas aos achados de lesões no trato gastrintestinal. O estudo avaliou 21 pacientes com e 19 pacientes sem sinais e sintomas gastrintestinais, visando estabelecer: associações e correlações entre os parâmetros clínicos que sinalizam a presença de focos endometrióticos e as localizações das lesões em cada segmento do trato gastrintestinal (TGI) e a correlação entre o estadiamento da endometriose (ASRM, 1996) e o comprometimento intestinal. A pesquisa atestou, de modo significativo, a correlação entre a presença dos sintomas gastrintestinais em conseqüência das lesões no trato gastrintestinal. Os sinais e sintomas gastrintestinais significativamente relacionados com a presença de endometriose ginecológica localizada no segmento retossigmóide e/ou íleo e com comprometimento do trato gastrintestinal foram: o puxo e o tenesmo cíclico, dor em cólica cíclica, obstipação cíclica, diarréia cíclica, dor acíclica, fezes afiladas e o sangramento intestinal cíclico. O estádio IV (ASRM) correlacionou-se com a presença de endometriose no trato gastrintestinal. O presente estudo demonstrou a correlação positiva dos sinais e sintomas gastrointestinais e ginecológicos e o estadiamento da doença ginecológica com o comprometimento gastrointestinal pela doença.

The peritoneal organs of 40 patients with pelvic endometriosis were scanned for endometriosis in this study by the videolaparoscopic method to verify the relation of their complaints with lesions found in the gastrointestinal tract. Twenty one of these patients who had gastrointestinal signs and symptoms and 19 who did not, were evaluated in order to establish associations and correlations between clinical parameters pointing to endometriotic lesions and sites of these lesions in each segment of the gastrointestinal tract as well as to correlate between the staging of the endometriosis and intestinal injury. Research significantly confirmed the correlation between gastrointestinal symptoms as a consequence of lesions in the gastrointestinal tract. Gastrointestinal signs and symptoms, significantly related with gynecological endometriosis in the rectum and sigmoid segment and/or ileum and with injury of the gastrointestinal tract, were cyclic tenesmus, cyclic colic pain, cyclic obstipation, cyclic diarrhea, acyclic pain, thin stools and cyclic intestinal bleeding. The ASRM l996 Stage IV correlated with the presence of endometriosis in the gastrointestinal tract. The study demonstrates the positive correlation of gastrointestinal and gynecological signs and symptoms and the staging of the gynecological disease with gastrointestinal injury from the disease.

OBJETIVO: avaliar o padrão de diferenciação histológica em lesões de peritônio superficial e lesões de endometriose pélvica profunda (EPP), localizadas em ligamentos úteros-sacros, intestino (reto e sigmóide) e septo retovaginal. MÉTODOS: estudo prospectivo não randomizado, que incluiu 139 pacientes. Foram obtidas 234 biópsias (179 com EPP - Grupo Profundas - e 55 com endometriose superficial - Grupo Superficiais). Das 179 lesões de EPP (Grupo Profundas), 15 foram obtidas do septo retovaginal, 72 de nódulos do reto e sigmóide e 92 de ligamentos útero-sacrais. As biópsias foram classificadas em glandulares bem diferenciadas, glandulares indiferenciadas, glandulares mistas e estromal, com base em uma classificação morfológica específica. RESULTADOS: no Grupo Profundas, 33,5% das biópsias apresentaram padrão glandular indiferenciado e 46,9%, padrão glandular misto. No Grupo Superficiais, houve predominância do padrão glandular diferenciado (41,8%). Comparando especificamente as diferentes localizações das biópsias de lesão de EPP (Grupo Profundas), notou-se que o padrão glandular misto foi predominante nos nódulos intestinais (61,1%). CONCLUSÕES: foi possível concluir que há predomínio de endometriose glandular bem diferenciada na endometriose superficial, predomínio da doença mista e indiferenciada na EPP e, especificamente estudando a endometriose de reto e sigmóide, houve predomínio da endometriose glandular mista.

PURPOSE: to evaluate the histological differentiation pattern in superficial peritoneum lesions and in deeply infiltrating endometriosis (DIE) in utero-sacral ligament, bowel (rectum and sigmoid colon) and rectovaginal septum. METHODS: this prospective non-randomized study included 139 patients. Of the total, 234 biopsies were obtained (179 with DIE - Deeply Group - and 55 superficial endometriosis - Superficial Group). From the 179 DIE lesions (Depply Group), 15 were obtained from rectovaginal septum, 72 from rectosigmoid nodules and 92 from utero-sacral ligament. Biopsies were classified in well-differentiated glandular pattern, undifferentiated glandular, mixed glandular differentiation and pure stromal disease, based on specific morphological classification. RESULTS: in the Depply Group (DIE), 33.5% of the biopsies showed undifferentiated glandular pattern and 46.9% mixed glandular pattern. In the Superficial Group, there was the predominance of the well-differentiated glandular pattern (41.8%). Comparing specifically the different localizations of the biopsies of DIE lesions (Deeply Group), a predominance of mixed pattern in bowel nodules (61.1%) was noted. CONCLUSIONS: it was possible to conclude that there is a predominance of well-differentiated glandular pattern in superficial endometriosis, a predominance of mixed undifferentiated in deeply pelvic endometriosis and, specifically studying endometriosis from the rectum and sigmoid colon, there was a predominance of the mixed pattern.