Extragenital endometriosis: diagnostic difficulties, modern treatment policy

DOI

https://dx.doi.org/10.18565/aig.2022.8.154-162

Yarmolinskaya M.I., Rusina E.I., Semenova V.O., Beganova A.K.
1) D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, Saint Petersburg, Russia; 2) I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia

The incidence of extragenital endometriosis (EE) is 6–8% of all forms of endometriosis; however, there has been an increase in the prevalence of the disease in recent years. EE is characterized by the growth of tissue similar in morphological structure and function to the endometrium in the organs and tissues that are not related to the reproductive system. A wide range of non-specific clinical manifestations and the ensuing difficulties in diagnosing EE at various sites lead to its delayed diagnosis and to the absence of pathogenetically based therapy.
The authors reviewed literature on the diagnosis and treatment of EE and analyzed their own experience on this topic. They described clinical cases, by providing the features of female patients’ medical histories, diagnosis, surgical and medical treatments for endometriosis of the intestine, catamenial pneumothorax, urinary system, and umbilicus.
Conclusion: The diagnosis and treatment of extragenital forms of endometriosis requires an interdisciplinary approach, by attracting gynecologists, general and thoracic surgeons, urologists, and gastroenterologists, to decide on the personalized strategies for patient management and on the mandatory prescription of long-term pathogenetically based anti-relapse therapy.

extragenital endometriosis

catamenial pneumothorax

endometriosis of the gastrointestinal tract

urinary system

umbilicus

and nervous system

Full text (in Russian)

Министерство здравоохранения Российской Федерации.Эндометриоз. Клинические рекомендации. М.: Российское общество акушеров-гинекологов; 2020. [Endometriosis. Guideline. M.: Ministry of Health of Russian Federation. ROAG; 2020. (in Russian)]. Available at: https://yadi.sk/i/yYPwxWe4uTZcWg
Айламазян Э.К., Ярмолинская М.И., Молотков А.С., Цицкарава Д.З. Классификации эндометриоза. Журнал акушерства и женских болезней. 2017; 66(2): 77-92. [Aylamazyan E.K., Yarmolinskaya M.I., Molotkov A.S., Tsitskarava D.Z. Classifications of endometriosis. Zhurnal akusherstva i zhenskih boleznej/Journal of obstetrics and women's diseases. 2017;66(2):77-92. (in Russian)]. https://dx.doi.org/10.1016/10.17816/JOWD66277-92.
Hirata T., Koga K., Osuga Y. Extra-pelvic endometriosis: A review. Reprod. Med. Biol. 2020; 19(4): 323-33. https://dx.doi.org/10.1002/rmb2.12340.
ESHRE Endometriosis Guideline Development Group. Endometriosis. Guideline of European Society of Human Reproduction and Embryology. 2022. 192p. Available at: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline
Романов М.Д., Киреева Е.М. Легочный эндометриоз: лечебная тактика. Новости хирургии. 2018; 26(1): 103-8. [Romanov M.D., Kireeva E.M. Pulmonary Endometriosis: Treatment Tactics. Novosti Khirurgii/ Surgery News. 2018;26 (1): 103-108. (in Russian)]. https://dx.doi.org/10.18484/2305-0047.2018.1.103.
Перельман М.И., ред. Национальные клинические рекомендации по диагностике и лечению спонтанного пневмоторакса. М.: Российское общество хирургов, Ассоциация торакальных хирургов России; 2014. 60с. [Porkhanov V.A., Sigal E.I., Razumovsky A.Yu., Yablonsky P.K. et al. National clinical guidelines for the diagnosis and treatment of spontaneous pneumothorax. Russian Society of Surgeons. 2014:60.(in Russian)].
Soares T., Oliveira M.A., Panisset K., Habib N., Rahman S., Klebanoff J.S. et al. Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment. Horm. Mol. Biol. Clin. Investig. 2022; 43(2): 137-43. https://dx.doi.org/10.1515/hmbci-2020-0066.
Charatsi D., Koukoura O., Ntavela I.G., Chintziou F., Gkorila G., Tsagkoulis M. et al. Gastrointestinal and urinary tract endometriosis: A review on the commonest locations of extrapelvic endometriosis. Adv. Med. 2018; 2018: 3461209.https://dx.doi.org/10.1155/2018/3461209.
Tomassetti C., Johnson N., Petrozza J., Abrao M., Einarsson J., Horne A. et al. An international terminology for endometriosis. Hum. Reprod. Open. 2021; 2021(4): hoab029. https://dx.doi.org/10.1093/hropen/hoab029.
Milone M., Mollo A., Musella M., Maietta P., Sosa Fernandez L.M., Shatalova O. et al. Role of colonoscopy in the diagnostic work-up of bowel endometriosis. World J. Gastroenterol. 2015; 21(16): 4997-5001. https://dx.doi.org/10.3748/wjg.v21.i16.4997.
Hirata T., Koga K., Kai K., Katabuchi H., Kitade M., Kitawaki J. et al. Clinical practice guidelines for the treatment of extragenital endometriosis in Japan. J. Obstet. Gynaecol. Res. 2020; 46(12): 2474-87. https://dx.doi.org/10.1111/jog.14522.
Habib N., Centini G., Lazzeri L., Amoruso N., El Khoury L., Zupi E. et al. Bowel endometriosis: current perspectives on diagnosis and treatment. Int. J. Womens Health. 2020; 12: 35-47. https://dx.doi.org/10.2147/IJWH.S190326.
Vercellini P., Sergenti G., Buggio L., Frattaruolo M.P., Dridi D., Berlanda N. Advances in the medical management of bowel endometriosis. Best Pract. Res. Clin. Obstet. Gynaecol. 2021; 71: 78-99. https://dx.doi.org/10.1016/j.bpobgyn.2020.06.004.
Ferrero S., Stabilini C., Barra F., Clarizia R., Roviglione G., Ceccaroni M. Bowel resection for intestinal endometriosis. Best Pract. Res. Clin. Obstet. Gynaecol. 2021; 71: 114-28. https://dx.doi.org/10.1016/j.bpobgyn.2020.05.008.
Balla A., Quaresima S., Subiela J.D., Shalaby M., Petrella G., Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int. J. Colorectal Dis. 2018; 33(7): 835-47. https://dx.doi.org/10.1007/s00384-018-3082-y.
De Cicco C., Corona R., Schonman R., Mailova K., Ussia A., Koninckx P. Bowel resection for deep endometriosis: A systematic review. BJOG. 2011; 118(3):285-91. https://dx.doi.org/10.1111/j.1471-0528.2010.02744.x.
Hernandez Gutierrez A., Spagnolo E., Zapardiel I., Garcia-Abadillo Seivane R., Lopez Carrasco A., Salas Bolivar P. et al. Post-operative complications and recurrence rate after treatment of bowel endometriosis: Comparison of three techniques. Eur. J. Obstet. Gynecol. Reprod. Biol. X. 2019; 4: 100083.https://dx.doi.org/10.1016/j.eurox.2019.100083.
Попов А.А., Пучков К.В., Федоров А.А., Федотова И.С., Тюрина С.С. Хирургическое лечение больных с колоректальнымэндометриозом: анатомические особенности, показания, техника операций, осложнения. Российский вестник акушера-гинеколога. 2020; 20(2): 95-104. [Popov A.A., Puchkov K.V., Fedorov A.A., Fedotova I.S., Tiurina S.S. Surgical treatment of patients with colorectal endometriosis: anatomical features, indications, surgical technique, complications. Russian Bulletin of Obstetrician-Gynecologist. 2020; 20(2): 95-104. (in Russian)]. https://doi.org/10.17116/rosakush20202002195.
Bratu D., Chicea R., Ciprian T., Beli L., Dan S., Mihetiu A. et al. A rare case of ileus caused by ileum endometriosis. Int. J. Surg. Case Rep. 2016; 26: 24-6. https://dx.doi.org/10.1016/j.ijscr.2016.06.023.
Barbosa R.N., Andres M.P., Kho R.M., Abrão M.S. Ileum endometriosis: A cause of bowel obstruction. J. Minim. Invasive Gynecol. 2018; 25(5): 759-60.https://dx.doi.org/10.1016/j.jmig.2017.10.001.
Goai X.Y., Sellayah R., Naqash N. Intussusception of terminal ileum into cecum associated with endometriosis. ANZ J. Surg. 2020; 90(5): 932-3.https://dx.doi.org/10.1111/ans.15436.
Mabrouk M., Raimondo D., Mastronardi M., Raimondo I., Del Forno S., Arena A. et al. Endometriosis of the appendix: when to predict and how to manage-A multivariate analysis of 1935 endometriosis cases. J. Minim. Invasive Gynecol. 2020; 27(1): 100-6. https://dx.doi.org/10.1016/j.jmig.2019.02.015.
Sooklal S., Ahmad A. Endometriosis of the appendix. Clin. Gastroenterol. Hepatol. 2021;19(9): e89. https://dx.doi.org/10.1016/j.cgh.2019.04.07.
Wang D., Yang Q., Wang H., Liu C. Malignant transformation of hepatic endometriosis: a case report and literature review. BMC Womens Health. 2021; 21(1): 249. https://dx.doi.org/10.1186/s12905-021-01366-6.
Тарасенко С.В., Натальский А.А., Песков О.Д., Павлов А.В., Богомолов А.Ю., Авилушкина Е.О., Тараканов П.В. К вопросу об эндометриозе печени. Хирургия. Журнал им. Н.И. Пирогова. 2020; 11: 134-6. [Tarasenko S.V., Natalskiy A.A., Peskov O.D., Pavlov A.V.,Bogomolov A.Yu., Avilushkina E.O. et al. Surgical treatment of a patient with liver endometriosis. Khirurgiya. Zurnal im. N.I. Pirogova/Pirogov Russian Journal of Surgery. 2020;(11):134-6. (in Russian)]. https://dx.doi.org/10.17116/hirurgia2020111134.
Krzeczowski R.M., Jackson T.N., Kabbani W., Grossman Verner H.M., Sladek P. Splenic cysts and the case of mistaken identity. Cureus. 2022; 14(2): e22012. https://dx.doi.org/10.7759/cureus.22012.
Barbara G., Buggio L., Facchin F., Vercellini P. Medical treatment for endometriosis: tolerability, quality of life and adherence. Front. Glob. Womens Health. 2021; 27(2): 729601. https://dx.doi.org/10.3389/fgwh.2021.729601.
Ярмолинская М.И., ред. Медикаментозная терапия генитального эндометриоза: реалии и перспективы. Руководство для врачей. М.: ГЭОТАР-Медиа; 2021. 384с. https://dx.doi.org/10.33029/9704-6034-4-MET-20221-1-384. [Yarmolinskaya M.I., ed. Pharmacological treatment of endometriosis: realities and prospects: guide for doctors. M:GEOTAR-Media; 2021. 384 p. (in Russian)]. https://dx.doi.org/10.33029/9704-6034-4-MET-20221-1-384.
Ярмолинская М.И., Сейидова Ч.И., Пьянкова В.О. Современная тактика назначения медикаментозной терапии генитального эндометриоза. Акушерство и гинекология. 2021; 4: 55-62. [Yarmolinskaya M.I., Seyidova Ch.I., Pyankova V.O. Modern tactics in prescribing drug therapy for genital endometriosis. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 4: 55-62. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.4.55-62.
Gil Y., Tulandi T. Diagnosis and treatment of catamenial pneumothorax: A systematic review. J. Minim. Invasive Gynecol. 2020; 27(1): 48-53.https://dx.doi.org/10.1016/j.jmig.2019.08.005.
Heinemann K., Imthurn B., Marions L., Gerlinger C., Becker K., Moehner S. et al. Safety of dienogest and other hormonal treatments for endometriosis in real-world clinical practice (VIPOS): A Large Noninterventional Study. Adv. Ther. 2020; 37(5): 2528-37. https://dx.doi.org/10.1007/s12325-020-01331-z.
Zakhari A., Edwards D., Ryu M., Matelski J.J., Bougie O., Murji A. Dienogest and the risk of endometriosis recurrence following surgery: A systematic review and meta-analysis. J. Minim. Invasive Gynecol. 2020; 27(7): 1503-10.https://dx.doi.org/10.1016/j.jmig.2020.05.007.
Ярмолинская М.И., Флорова М.С. Возможности терапии диеногестом 2 мг у больных наружным генитальным эндометриозом. Проблемы репродукции. 2017; 23(1): 70-9. [Yarmolinskaya M.I., Florova M.S.The possibility of treatment with dienogest 2 mg in patients with genital endometriosis. Problemy reprodukcii/Russian Journal of Human Reproduction. 2017;23(1):70-9. (in Russian)]. https://dx.doi.org/10.17116/repro201723170-79.
Barra F., Scala C., Leone Roberti Maggiore U., Ferrero S. Long-term administration of dienogest for the treatment of pain and intestinal symptoms in patients with rectosigmoid endometriosis. J. Clin. Med. 2020; 9(1): 154.https://dx.doi.org/10.3390/jcm9010154.
Leonardi M., Espada M., Kho R.M., Magrina J.F., Millischer A.E., Savelli L. et al. Endometriosis and the urinary tract: from diagnosis to surgical treatment. Diagnostics (Basel). 2020; 10(10): 771. https://dx.doi.org/10.3390/diagnostics10100771.
Angioni S., Nappi L., Pontis A., Sedda F., Luisi S., Mais V. Dienogest. A possible conservative approach in bladder endometriosis. Results of a pilot study. Gynecol. Endocrinol. 2015; 31(5): 406-8.https://dx.doi.org/10.3109/09513590.2015.1006617.
Hirata T., Koga K., Taniguchi F., Takazawa N., Honda R., Tanaka T. et al. National survey of bladder endometriosis cases in Japan. J. Obstet. Gynaecol. Res. 2021; 47(4): 1451-61. https://dx.doi.org/10.1111/jog.14656.
Dridi D., Chiaffarino F., Parazzini F., Donati A., Buggio L., Brambilla M. et al. Umbilical endometriosis: A systematic literature review and pathogenic theory proposal. J. Clin. Med. 2022; 11(4): 995. https://dx.doi.org/10.3390/jcm11040995.
Hirata T., Koga K., Kitade M., Fukuda S., Neriishi K., Taniguchi F. et al. A national survey of umbilical endometriosis in Japan. J. Minim. Invasive Gynecol. 2020; 27(1): 80-7. https://dx.doi.org/10.1016/j.jmig.2019.02.021.
Тезиков Ю.В., Липатов И.С., Калинкина О.Б., Аравина О.Р., Бенян А.С., Медведчиков-Ардия М.А., Федорина Т.А., Юнусова Ю.Р. Катамениальный пневмоторакс как проявление легочных форм эндометриоза. Акушерство и гинекология. 2019; 6: 156-62. [Tezikov Y.V., Lipatov I.S., Kalinkina O.B., Aravina O.R., Benyan A.S., Medvedchikov-Ardia M.A. et al. Catamenial pneumatorax as manifestation of thoracic form of endometriosis. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2019; 6:156-62. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.6.156-162.
Воскресенский О.В., Смоляр А.Н., Дамиров М.М., Галанкина И.Е., Желев И.Г. Торакальный эндометриоз и катамениальный пневмоторакс. Хирургия. Журнал им. Н.И. Пирогова. 2014; 10: 4-9. [Voskresenskiĭ O.V., Smoliar A.N., Damirov M.M., Galankina I.E., Zhelev I.G. Thoracic endometriosis and catamenial pneumothorax. Khirurgiya. Zurnal im. N.I. Pirogova/Pirogov Russian Journal of Surgery. 2014;(10):4‑9. (in Russian)].
Siquara De Sousa A.C., Capek S., Amrami K.K., Spinner R.J. Neural involvement in endometriosis: Review of anatomic distribution and mechanisms. Clin. Anat. 2015; 28(8): 1029-38. https://dx.doi.org/10.1002/ca.22617.
Possover M. Laparoscopic morphological aspects and tentative explanation of the aetiopathogenesis of isolated endometriosis of the sciatic nerve: a review based on 267 patients. Facts Views Vis. Obgyn. 2021; 13(4): 369-75.https://dx.doi.org/10.52054/FVVO.13.4.047.
Thibodeau L.L., Prioleau G.R., Manuelidis E.E., Merino M.J., Heafner M.D. Cerebral endometriosis. Case report. J. Neurosurg. 1987; 66(4): 609-10.https://dx.doi.org/10.3171/jns.1987.66.4.0609.
Ichida M., Gomi A., Hiranouchi N., Fujimoto K., Suzuki K., Yoshida M. et al. A case of cerebral endometriosis causing catamenial epilepsy. Neurology. 1993; 43(12): 2708-9. https://dx.doi.org/10.1212/wnl.43.12.2708.
Meggyesy M., Friese M., Gottschalk J., Kehler U. Case report of cerebellar endometriosis. Neurol. Surg. A Cent. Eur. Neurosurg. 2020; 81(4): 372-6. https://dx.doi.org/10.1055/s-0040-1701622.
Vilos G.A., Hollett-Caines J., Abu-Rafea B., Ahmad R., Mazurek M.F. Resolution of catamenial epilepsy after goserelin therapy and oophorectomy: case report of presumed cerebral endometriosis. J. Minim. Invasive Gynecol. 2011; 18(1): 128-30. https://dx.doi.org/10.1016/j.jmig.2010.09.002.
Maniglio P., Ricciardi E., Meli F., Tomao F., Peiretti M., Caserta D. Complete remission of cerebral endometriosis with dienogest: A case report. Gynecol. Endocrinol. 2018; 34(10): 837-9. https://dx.doi.org/10.1080/09513590.2018.1463362.

Received 08.08.2022

Accepted 10.08.2022

Maria I. Yarmolinskaya, Professor of Russian Academy of Sciences, Dr. Med. Sci., Professor, Head of the Department of Gynecology and Endocrinology, Head of the Center “Diagnostics and treatment of endometriosis”, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology; Professor at the Department of Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, m.yarmolinskaya@gmail.com, https://orcid.org/0000-0002-6551-4147,
Mendeleevskaya liniya, 3, Saint Petersburg, 199034, Russian Federation.
Elena I. Rusina, Dr. Med. Sci., Leading Researcher at the Department of Gynecology and Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, pismo_rusina@mail.ru, https://orcid.org/0000-0002-8744-678X, Mendeleevskaya liniya, 3, Saint Petersburg, 199034, Russian Federation.
Valeriia O. Semenova, resident physician, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, pyankova.valeriia@rambler.ru
https://orcid.org/0000-0002-9101-1981, Mendeleevskaya liniya, 3, Saint Petersburg, 199034, Russian Federation.
Alexandra K. Beganova, Junior Researcher, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, alexandra.beganova@yandex.ru,
https://orcid.org/0000-0002-4705-7990, Mendeleevskaya liniya, 3, Saint Petersburg, 199034, Russian Federation.
Corresponding author: Valeriia O. Semenova, pyankova.valeriia@rambler.ru

Authors' contributions: Yarmolinskaya M.I. – the concept and design of the investigation; editing; Yarmolinskaya M.I., Rusina E.I., Semenova V.O., Beganova A.K. – material collection and processing; Yarmolinskaya M.I., Semenova V.O., Beganova A.K. – writing the text.
Conflicts of interest: The authors declare that there are no manifest and potential conflicts of interest related to the publication of this article.
Funding: The review has been prepared within research and development (R&D) No. 1021062812154-3-3.2.2 “Strategy for promoting the health of women with gynecological and endocrine diseases in different age periods: a pathogenetic rationale for drug rehabilitation and the development of new areas of organ-sparing surgical interventions”.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
For citation: Yarmolinskaya M.I., Rusina E.I., Semenova V.O., Beganova A.K.
Extragenital endometriosis: diagnostic difficulties, modern treatment policy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 8: 154-162 (in Russian)
http://dx.doi.org/10.18565/aig.2022.8.154-162

Extragenital endometriosis: diagnostic difficulties, modern treatment policy

Yarmolinskaya M.I., Rusina E.I., Semenova V.O., Beganova A.K.

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