The features of the course of retrocervical endometriosis

Alieva P.M., Dumanovskaya M.R., Solopova A.E., Smetnik A.A., Chuprynin V.D., Pavlovich S.V.

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Relevance: Retrocervical endometriosis is one of the severe forms of endometriosis due to the increased risk of involvement of the adjacent organs, namely the intestines. This phenotype of endometriosis as well as others has nonspecific symptoms, therefore, it is difficult to diagnose it with ultrasound examination of the pelvic organs, unlike endometrioid ovarian cysts. According to the Russian clinical guidelines, it is possible to use magnetic resonance imaging of the pelvic organs for a more detailed assessment of the affected sites if deep infiltrative endometriosis is suspected. Taking a patient’s medical history and making a physical examination should be complemented by radio diagnostic assessment performed by the experts in the field of pelvic organ studies; thus, it becomes possible to assess the degree of invasion and choose the right tactics for the management of patients.
Case report: The article presents a clinical observation of the progression of retrocervical endometriosis combined with endometrioid ovarian cysts. It was possible to manage the patient conservatively when she presented to the hospital due to a comprehensive diagnosis, the size of endometrioid cysts and the absence of involvement of adjacent organs. However, low compliance and the lack of timely treatment led to the progression of the disease and the need for surgery.
Conclusion: The various methods for diagnosing endometriosis aimed at timely detection of the disease can be improved in order to avoid the negative consequences of endometriosis and reduce the number of operations in a woman’s life.

Authors’ contributions: Alieva P.M., Dumanovskaya M.R., Solopova A.E. – collecting and processing material, writing the text; Smetnik A.A., Chuprynin V.D., Pavlovich S.V. – editing the text.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
Patient Consent for Publication: The patient provided an informed consent for the publication of her data and associated images.
For citation: Alieva P.M., Dumanovskaya M.R., Solopova A.E., Smetnik A.A., Chuprynin V.D., Pavlovich S.V. The features of the course of retrocervical endometriosis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (2): 157-164 (in Russian)
https://dx.doi.org/10.18565/aig.2023.222

Keywords

endometriosis
conservative therapy
nutrition
surgical treatment

References

  1. Zondervan K.T., Becker C.M., Koga K., Missmer S.A., Taylor R.N., Vigano P. Endometriosis. Nat. Rev. Dis. Primers. 2018; 4(1): 9. https://dx.doi.org/10.1038/s41572-018-0008-5.
  2. Адамян Л.В., Андреева Е.Н. Генитальный эндометриоз: этиопатогенез, клиника, диагностика, лечение. Методическое пособие для врачей. М.; 2001. [Adamyan L.V., Andreeva E.N. Genital endometriosis: etiopathogenesis, clinical picture, diagnosis, treatment. Methodological manual for doctors. Moscow; 2001 (in Russian)].
  3. Carsote M., Terzea D.C., Valea A., Gheorghisan-Galateanu A.A. Abdominal wall endometriosis (a narrative review). Int. J. Med. Sci. 2020; 17(4): 536-42. https://dx.doi.org/10.7150/ijms.38679.
  4. Baușic A., Coroleucă C., Coroleucă C., Comandașu D., Matasariu R., Manu A. et al. Transvaginal ultrasound vs. Magnetic Resonance Imaging (MRI) value in endometriosis diagnosis. Diagnostics (Basel). 2022; 12(7): 1767. https://dx.doi.org/10.3390/diagnostics12071767.
  5. Nisenblat V., Bossuyt P.M., Farquhar C., Johnson N., Hull M.L. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst. Rev. 2016; 2(2): CD009591. https://dx.doi.org/10.1002/ 14651858.CD009591.pub2.
  6. Kido A., Himoto Y., Moribata Y., Kurata Y., Nakamoto Y. MRI in the diagnosis of endometriosis and related diseases. Korean J. Radiol. 2022; 23(4): 426-45. https://dx.doi.org/10.3348/kjr.2021.0405.
  7. Koninckx P.R., Ussia A., Adamyan L., Wattiez A., Gomel V., Martin D.C. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil. Steril. 2019; 111(2): 327-40. https://dx.doi.org/10.1016/j.fertnstert.2018.10.013.
  8. Laganà A.S., Garzon S., Gotte M., Vigano P., Franchi M., Ghezzi F., Martin D.C. The pathogenesis of endometriosis: molecular and cell biology insights. Int. J. Mol. Sci. 2019; 20(22): 5615. https://dx.doi.org/10.3390/ijms20225615.
  9. Gordts S., Koninckx P., Brosens I. Pathogenesis of deep endometriosis. Fertil. Steril. 2017; 108(6): 872-885.e1. https://dx.doi.org/10.1016/j.fertnstert.2017.08.036.
  10. Yuan M., Li D. Zhang Z., Sun H., An M., Wang G. Endometriosis induces gut microbiota alterations in mice. Hum. Reprod. 2018; 33(4): 607-16. https://dx.doi.org/10.1093/humrep/dex372.
  11. Chadchan S.B., Popli P., Ambati C.R., Tycksen E., Han S.J., Bulun S.E. et al. Gut microbiota-derived short-chain fatty acids protect against the progression of endometriosis. Life Sci. Alliance. 2021; 4(12): e202101224. https://dx.doi.org/ 10.26508/lsa.202101224.
  12. Tota J.E., Chevarie-Davis M., Richardson L.A., Devries M., Franco E.L. Epidemiology and burden of HPV infection and related diseases: implications for prevention strategies. Prev. Med. 2011; 53 Suppl 1: S12-21. https://dx.doi.org/10.1016/j.ypmed.2011.08.017.
  13. Heidarpour M., Derakhshan M., Derakhshan-Horeh M., Kheirollahi M., Dashti S. Prevalence of high-risk human papillomavirus infection in women with ovarian endometriosis. J. Obstet. Gynaecol. Res. 2017; 43(1): 135-9. https://dx.doi.org/10.1111/jog.13188.
  14. Rocha R.M., Souza R.P., Gimenes F., Consolaro M.E.L. The high-risk human Papillomavirus continuum along the female reproductive tract and its relationship to infertility and endometriosis. Reprod. Biomed. Online. 2019; 38(6): 926-37. https://dx.doi.org/10.1016/j.rbmo.2018.11.032.
  15. Oppelt P., Renner S.P., Strick R., Valletta D., Mehlhorn G., Fasching P.A. et al. Correlation of high-risk human papilloma viruses but not of herpes viruses or Chlamydia trachomatis with endometriosis lesions. Fertil. Steril. 2010; 93(6): 1778-86. https://dx.doi.org/10.1016/j.fertnstert.2008.12.061.
  16. Chiaffarino F., Cipriani S., Ricci E., Mauri P.A., Esposito G., Barretta M. et al. Endometriosis and irritable bowel syndrome: a systematic review and meta-analysis. Arch. Gynecol. Obstet. 2021; 303(1): 17-25. https://dx.doi.org/10.1007/s00404-020-05797-8.
  17. Xie J., Kvaskoff M., Li Y., Zhang M., Qureshi A.A., Missmer S.A., Han J. Severe teenage acne and risk of endometriosis. Hum. Reprod. 2014; 29(11): 2592-9. https://dx.doi.org/10.1093/humrep/deu207.
  18. Zhang M., Qureshi A.A., Hunter D.J., Han J. A genome-wide association study of severe teenage acne in European Americans. Hum. Genet. 2014 ; 133(3): 259-64. https://dx.doi.org/10.1007/s00439-013-1374-4.
  19. Tsubura A., Uehara N., Kiyozuka Y., Shikata N. Dietary factors modifying breast cancer risk and relation to time of intake. J. Mammary Gland Biol. Neoplasia. 2005; 10(1): 87-100. https://dx.doi.org/10.1007/s10911-005-2543-4.
  20. Huang M., Liu J., Lin X., Goto A., Song Y., Tinker L.F. et al. Relationship between dietary carbohydrates intake and circulating sex hormone-binding globulin levels in postmenopausal women. J. Diabetes. 2018; 10(6): 467-77. https://dx.doi.org/10.1111/1753-0407.12550.
  21. Minihane A.M., Vinoy S., Russell W.R., Baka A., Roche H.M., Tuohy K.M. et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. Br. J. Nutr. 2015; 114(7): 999-1012. https://dx.doi.org/10.1017/S0007114515002093.
  22. Seki H., Sasaki T., Ueda T., Arita M. Resolvins as regulators of the immune system. Scientific World Journal. 2010; 10: 818-31. https://dx.doi.org/10.1100/tsw.2010.72.
  23. Marcinkowska A., Gornicka M. The role of dietary fats in the development and treatment of endometriosis. Life (Basel). 2023; 13(3): 654. https://dx.doi.org/10.3390/life13030654.
  24. Tomio K., Kawana K., Taguchi A., Isobe Y., Iwamoto R., Yamashita A. et al. Omega-3 polyunsaturated Fatty acids suppress the cystic lesion formation of peritoneal endometriosis in transgenic mouse models. PLoS One. 2013; 8(9):e73085. https://dx.doi.org/10.1371/journal.pone.0073085.
  25. Cromeens M.G., Carey E.T., Robinson W.R., Knafl K., Thoyre S. Timing, delays and pathways to diagnosis of endometriosis: a scoping review protocol. BMJ Open. 2021; 11(6): e049390. https://dx.doi.org/10.1136/bmjopen-2021-049390.
  26. Kim M.R., Chapron C., Romer T., Aguilar A., Chalermchockcharoenkit A., Chatterjee S. et al. Clinical diagnosis and early medical management for endometriosis: Consensus from Asian Expert Group. Healthcare (Basel). 2022; 10(12): 2515. https://dx.doi.org/10.3390/healthcare10122515.
  27. Туманова У.Н., Щеголев А.И., Павлович С.В., Серов В.Н. Факторы риска развития эндометриоза. Акушерство и гинекология. 2020; 2: 68-75. [Tumanova U.N., Shchegolev A.I., Pavlovich S.V., Serov V.N. Risk factors for endometriosis. Obstetrics and Gynecology. 2020; (2): 68-75 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.2.68-75.
  28. Vigano D., Zara F., Usai P. Irritable bowel syndrome and endometriosis: New insights for old diseases. Dig. Liver Dis. 2018; 50(3): 213-9. https://dx.doi.org/10.1016/j.dld.2017.12.017.
  29. Пронина В.А., Думановская М.Р., Чернуха Г.Е. Оптимизация принципов ранней диагностики эндометриоза на основе оценки коморбидности и клинической манифестации. Акушерство и гинекология. 2023; 4: 87-96. [Pronina V.A., Dumanovskaya M.R., Chernukha G.E. Principles of early diagnosis of endometriosis based on the assessment of comorbidity and clinical manifestations. Obstetrics and Gynecology. 2023; (4): 87-96 (in Russian)]. https://dx.doi.org/10.18565/aig.2023.9.
  30. Koninckx P.R., Ussia A., Tahlak M., Adamyan L., Wattiez A., Martin D.C., Gomel V. Infection as a potential cofactor in the genetic-epigenetic pathophysiology of endometriosis: a systematic review. Facts Views Vis. Obgyn. 2019; 11(3): 209-16.
  31. Campos G.B., Marques L.M., Rezende I.S., Barbosa M.S., Abrao M.S., Timenetsky J. Mycoplasma genitalium can modulate the local immune response in patients with endometriosis. Fertil. Steril. 2018; 109(3): 549-560.e4. https://dx.doi.org/10.1016/j.fertnstert.2017.11.009.
  32. Guo F., He Y., Fan Y., Du Z., Sun H., Feng Z. et al. G-CSF and IL-6 may be involved in formation of endometriosis lesions by increasing the expression of angiogenic factors in neutrophils. Mol. Hum. Reprod. 2021; 27(11): gaab064. https://dx.doi.org/10.1093/molehr/gaab064.
  33. Mier-Cabrera J., Aburto-Soto T., Burrola-Mendez S., Jimenez-Zamudio L., Tolentino M.C., Casanueva E., Hernandez-Guerrero C. Women with Endometriosis improved their peripheral antioxidant markers after the application of a high antioxidant diet. Reprod. Biol. Endocrinol. 2009; 7: 54. https://dx.doi.org/10.1186/1477-7827-7.
  34. Attaman J.A., Stanic A.K., Kim M., Lynch M.P., Rueda B.R., Styer A.K. The anti-inflammatory impact of omega-3 polyunsaturated Fatty acids during the establishment of endometriosis-like lesions. Am. J.  Reprod. Immunol. 2014; 72(4): 392-402. https://dx.doi.org/10.1111/aji.12276.
  35. Yalcın Bahat P., Ayhan I., Ureyen Ozdemir E., İnceboz U., Oral E. Dietary supplements for treatment of endometriosis: A review. Acta Biomed. 2022; 93(1): e2022159. https://dx.doi.org/10.23750/abm.v93i1.11237.
  36. Pereira F.E.X.G., Medeiros F.D.C., Rocha H.A.L., Silva K.S.D. Effects of omega-6/3 and omega-9/6 nutraceuticals on pain and fertility in peritoneal endometriosis in rats. Acta Cir. Bras. 2019; 34(4): e201900405. https://dx.doi.org/10.1590/s0102.
  37. Missmer S.A., Chavarro J.E., Malspeis S., Bertone-Johnson E.R., Hornstein M.D., Spiegelman D. et al. A prospective study of dietary fat consumption and endometriosis risk. Hum. Reprod. 2010; 25(6): 1528-35. https://dx.doi.org/10.1093/humrep/deq044.
  38. Barnard N.D., Holtz D.N., Schmidt N., Kolipaka S., Hata E., Sutton M. et al. Nutrition in the prevention and treatment of endometriosis: A review. Front. Nutr. 2023; 10: 1089891. https://dx.doi.org/10.3389/fnut.2023.1089891.
  39. Bazot M., Darai E. Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertil. Steril. 2017; 108(6): 886-894. https://dx.doi.org/10.1016/j.fertnstert.2017.10.026.
  40. Chapron C., Santulli P., de Ziegler D., Noel J.C., Anaf V., Streuli I. et al. Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum. Reprod. 2012; 27(3): 702-11. https://dx.doi.org/10.1093/humrep/der462.
  41. Kwok H., Jiang H., Li T., Yang H., Fei H., Cheng L. et al. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC Womens Health. 2020; 20(1): 111. https://dx.doi.org/10.1186/s12905-020-00974-y.
  42. Perello M., Martinez-Zamora M.A., Torres X., Munros J., Llecha S., De Lazzari E. et al. Markers of deep infiltrating endometriosis in patients with ovarian endometrioma: a predictive model. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 209: 55-60. https://dx.doi.org/10.1016/j.ejogrb.2015.11.024.

Received 18.09.2023

Accepted 22.01.2024

About the Authors

Patimat M. Alieva, obstetrician-gynecologist, postgraduate student at the Department of Gynecological Endocrinology, Academician V.I. Kulakov NMRC for OG&P,
Ministry of Health of Russia, 117997, Russia, Moscow, Academician Oparin str., 4, aalievapm@gmail.com
Madina R. Dumanovskaya, PhD, Researcher, Gynecological Endocrinology Department, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Oparina str., 4, m_dumanovskaya@oparina4.ru, https://orcid.org/0000-0001-7286-6047
Alina E. Solopova, Dr. Med. Sci., Associate Professor, Leading Researcher, Department of Radiology, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Academician Oparin str., 4, a_solopova@oparina4.ru, https://orcid.org/0000-0003-4768-115X
Antonina A. Smetnik, PhD, Head of the Department of Gynecological Endocrinology, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Academician Oparin str., 4, a_smetnik@oparina4.ru, https://orcid.org/0000-0002-0627-3902
Vladimir D. Chuprynin, PhD, Head of the Surgical Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Academician Oparin str., 4, +7(495)438-35-75, v_chuprynin@oparina4.ru
Stanislav V. Pavlovich, PhD, Academic Secretary, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Academician Oparin str., 4; Professor, Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First MSMU,
Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, s_pavlovich@oparina4.ru, https://orcid.org/0000-0002-1313-7079

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.