**14. Acknowledgment**

This chapter has been financed by the funds of the "Asociación Jornadas Quirúrgicas de Antequera" (Málaga). Spain.

#### **15. References**

80 Endometriosis - Basic Concepts and Current Research Trends

is associated with decreased development of clear cell cancers only (Nagle *et al.*, 2008). The decreased risk of clear cell ovarian cancer amongst users of combined oestrogen and progestin hormone replacement therapy is interesting given the role of progestin as a potential chemopreventive agent in ovarian cancer (Nagle *et al.*, 2008). 86% of the patients with an extraovarian cancer had undergone a prior hysterectomy and bilateral salpingo-

Pelvic pain or pelvic mass in a postmenopausal woman with a previous history of endometriosis should raise suspicions of reactivation or malignant transformation of endometriosis. Vaginal bleeding may signify the presence of a vaginal or rectovaginal septum lesion. Malignant transformation of colorrectal endometriosis may produce gastrointestinal dysfunction and/or bleeding. Urinary symptoms may herald urinary tract

The differential histological diagnosis of endometrioid and colonic adenocarcinoma is difficult because colonic adenocarcinoma has a significant mucosal component, while endometrioid adenocarcinoma usually involves the outer layers of the colon (30% are intramural) and endoscopic biopsies usually yield insufficient tissue for a definitive pathologic diagnosis (Slavin *et al.*, 2000; Yantiss *et al.*, 2001). Immunohistochemical staining seems to be useful in differentiating colonic endometrioid adenocarcinoma. The endometrioid tumor expresses cytokeratin 7 and CA-125, whereas cytokeratin 20 and

Primary surgical treatment with complete resection of pelvic tumors should be performed when feasible. Appropriate staging biopsies of lymph nodes and tissues in the upper abdomen should be performed when macroscopic disease is confined to pelvis. After surgical resection, is recommended the progestin therapy. Although postoperative treatment has not been clearly defined, 70% of these patients have been reported to receive

Malignant transformation within endometriomas or within extragonadal endometriosis confined to the genital tract carries a much better prognosis, with a 67% 5-year survival for those with disease confined to the ovary and 100% 5-year survival for those with extragonadal disease confined to the site of the origin. Disseminated intraperitoneal disease

The specialist approach to deep endometriosis has now evolved into a collaborative one, much like the multidisciplinary management of colorectal cancer. Preoperative assessment involves radiologist, gynaecologist, colorectal surgeon and in cases where bladder or ureteric involvement are suspected, a urologist. This approach results in the ability to

This chapter has been financed by the funds of the "Asociación Jornadas Quirúrgicas de

involvement with this disease (Slavin *et al.*, 2000; Van Gorp *et al.*, 2004).

carcinoembryonic antigen decorate colonic adenocarcinoma (Slavin *et al.*, 2000).

had a poor prognosis, with a 12% 5-year survival (Van Gorp *et al.*, 2004).

achieve complete excision of all the endometriosis at the one operation.

chemotherapy or radiotherapy (Modesitt *et al.*, 2002).

**13. Conclusion** 

**14. Acknowledgment** 

Antequera" (Málaga). Spain.

oophorectomy (Modessit *et al.*, 2002).


Abdominopelvic Complications of Endometriosis 83

Nagle CM, Olsen CM, Webb PM, Jordan SJ, Whiteman DC, Green AC. (2008). Endometrioid

Naraynsingh V, Raju GC, Ratan P, Wong J. (1985). Massive ascites due to omental

Nezhat C, Kazerooni T, Berker B, Lashay N, Fernandez S, Marziali M. (2005). Laparoscopic

Pang ST, Chao A, Wang CJ, Lin G, Lee CL. (2008) Transurethral partial cystectomy and

Pritts EA, Taylon RN. (2003). An evidence-based evaluation of endometriosis-associated

Sait KH. (2008). Massive ascites as a presentation in a young woman with endometriosis: a

Schuld J, Justinger C, Wagner M, Bohle RM, Kollmar O, Schilling MK, Richter S. (2011).

Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. (2008). Surgical treatment of

Slavin RE, Krum R, Van Dinh T. (2000). Endometriosis-associated intestinal tumours: A

Taylor RN, Yu J, Torres PB, Schickedanz AC, Park JK, Mueller MD, Sidell N. (2009).

Tunuguntla A, Van Buren N, Mathews MR, Ehrenfried JA. Endometriosis of the pancreas presenting as a cystic pancreatic neoplasm with possible metastasis. Van Gorp T, Amant F, Neven P, Vergote I. (2004). Endometriosis and the development of

Veeraswamy A, Lewis M, Mphil AM, Kotikela S, Hajhosseini B, Nezhat C. (2010).

Vercellini P, Frontino G, De Giorgi O, Pietropaolo G, Pasin R, Crosignani PG. (2003).

Vercellini P, Barbara G, Abbiati A, Somigliana E, Viganò P, Fedele L. (2009). Repetitive

Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M. (2005). Surgical

Wills HJ, Reid GD, Cooper MJ, Tsaltas J, Morgan M. Woods RJ. (2009). Bowel resection for

Extragenital Endometriosis. *Clin Obstet Gynecol*; 53; 449-466.

44: 2477-2484.

*Steril*; 90: 2014.e1-e3.

804.e15-e18.

31: 456-463.

*Sci* ; 16: 140-146.

*Gynaecol*; 18: 349-371.

*Am*; 30: 163-180.

508-513.

49: 415-418.

*Reprod Biol*; 146: 15-21.

*Gynecol*; 1285-1292.

endometriosis. *Postgrad Med J*; 61: 539-540.

case report. *Fertil Steril*; 90: 2015.e17-e19

literature. *J Minim Invasive Gynecol*; 12: 196-200.

infertility. *Endocrinol Metab Clin North Am*; 32: 653-667.

and clear cell ovarian cancers – A comparative analysis of risk factors. *Eur J Cancer*;

management of hepatic endometriosis: report of two cases and review of the

laparoscopic reconstruction for the management of bladder endometriosis. *Fertil* 

Bronchobiliary fistula: a rare complication of hepatic endometriosis. *Fertil Steril*;

endometriosis: a 7-year follow-up on the requirement for further surgery. *Obstet* 

clinical an pathological study of 6 cases with a review of the literature. *Hum Pathol*;

Mechanistic and therapeutic implications of angiogenesis in endometriosis. *Reprod* 

malignant tumours of the pelvis. A review of literature. *Best Pract Res Clin Obstet* 

Endometriosis preoperative and postoperative medical treatment. *Obstet Gynecol N* 

surgery for recurrent symptomatic endometriosis: What to do? *Eur J Obstet Gynecol* 

treatment of deep endometriosis and risk of recurrence. *J Minim Invasive Ginecol*: 12:

severe endometriosis: An Australian series of 177 cases. *Aust N Z J Obstet Gynaecol*;


Dirim A, Celikkaya S, Aygun C, Caylak B. (2009). Renal endometriosis presenting with a

Dousset B, Leconte M, Borghese B, Millischer AE, Roseau G, Arkwright S, Chapron C.

Fauconnier A, Chapron C. (2005). Endometriosis and pelvis pain: epidemiological evidence of the relationship and implications. *Hum Reprod Update*; 11: 595-606. Fedele L, Bianchi S, Zanconato G, Berlanda N, Borrato F, Frontino G. (2005a). Tailoring

Fedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N, Carmignani L. (2005b). Long-

Fedele L, Bianchi S, Zanconato G, Berlanda N, Raffaelli R, Fontana N. (2006). Laparoscopic

Grunewald C, Jördens A. (2010). Intra-abdominal hemorrhage due to previously unknown

outcome: A case report. *Eur J Obstet Gynecol Reprod Biol*; 148: 204-205. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. (2008). Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. *Am J Surg*; 196: 207-212. Inoue T, Moriwaki T, Niki I. (1992). Endometriosis and spontaneous rupture of the uterine vessels in a pregnancy complicated by endometriosis. *Lancet*; 340: 240-241. Kataoka ML, Togashi K, Yamaoka T, Koyama T, Ueda H, Kobayashi H, Rahman M, Higuchi

(2010). Complete surgery for low rectal endometriosis. Long-term of a 100-case

radicality in demolitive surgery for deeply infiltrating endometriosis. *Am J Obstet* 

term follow-up after conservative surgery for bladder endometriosis. *Fertil Steril*;

excision of recurrent endometriomas: long-term outcome and comparison with

endometriosis in the third trimester of pregnancy with uneventful neonatal

T, Fujii S. (2005). Posterior cul-de-sac obliteration associated with endometriosis:

Prentice A, Saridogan E. (2005). ESHRE Special Interest Group for Endometriosis and Endometrioum Guideline Development Group. ESHRE guideline for the

pelvic nerve pathways in dysmenorrhoea: a systematic review of effectiveness. *Acta* 

Predictors of hysterectomy in women with common pelvic problems: a uterine

vésicale: diagnostic et traitment. À propos d'une série de 24 patientes. *Gynecol* 

management of ureteral endometriosis in case of moderate-severe

Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, Hummelshoj L,

Learman LA, Kuppermann M, Gates E, Gregorich SE, Lewis J, Washington AE. (2007).

Le Tohic A, Chis C, Yazbeck C, Koskas M, Madelenat P, Panel P. (2009). Endométriose

Li CY, Wang HQ, Liu HY, Lang JH. (2008). Management of ureteral endometriosis: a report

Mereu L, Gagliardi JL, Clarizia R, Mainardi P, Landi S, Minelli L. (2010). Laparoscopic

Modesitt SC, Tortolero-Luna G, Robinson JB, Gershenson DM, Wolf JK. (2002). Ovarian and extraovarian endometriosis-associated cancer. *Obstet Gynecol*; 100: 788-795.

diagnosis and treatment of endometriosis. *Hum Reprod*; 20: 2698-2704. Latthe PM, Proctor MI, Farquhar CM, Johnson N, Khan KS. (2007). Surgical interruption of

giant subcapsular hematoma: case report. *Fertil Steril*; 92: 391.e5-e7.

prospective study. *Ann Surg*; 251: 887-895.

primary surgery. *Fertil Steril*; 85: 694-699.

MR imaging evaluation. *Radiology*; 234: 815-823.

survival analysis. *J Am Coll Surg*; 204: 633-641.

of ten cases. *Chin Med Sci J*; 23: 218-223.

hydroureteronephrosis. *Fertil Steril*; 93: 46-51.

*Gynecol* ; 193: 114-117.

*Obstet Gynecol*; 86: 4-15.

*Obstet Fertil*; 37: 216-221.

83: 1729-1733.


**5** 

*Poland* 

**Endometrial Tumors in Postoperative Scars -** 

Endometriosis is defined as the presence of endometrial glands and stroma in another places of the female body than the uterine cavity. Despite of being a relatively common disease it still remains a diagnostic and therapeutic enigma, mainly thanks to its variable presentations. When endometriosis is localized intraperitoneally, the major problem in young women is involuntary sterility, whereas by extraperitoneal localization they suffer

In 1903 Robert Mayer was the first, who described the presence of endometriosis in the postoperative scar, as mentioned in Bytom study (43), and from this time the number of publications in this field is slowly rising, but still a lot of problems ought to be satisfactory elucidated. An investigation of this disease and making firm conclusions is not easy because of inconsistent and small series of patients, often casuistic (2, 5, 6, 8, 11, 12, 13, 16, 19, 22, 30, 36, 39, 42, 46, 48, 52). Up to now only one large systemic review (29) was published and two biggest single retrospective studies (57, 41) included 81 and 72 patients

The most widely accepted theory of arising of the endometriosis is an implantation of endometrial fragments brought by retrograde menstrual flow in a peritoneal surface (50).

Meyer**'**s theory explains the origin of endometriosis by celomic metaplasia mainly in the ovaries, peritoneum and urinary bladder due to their common development from the celomic epithelium. Mesenchymal cells with retained multi-potential under the properties circumstances undergo metaplasia into endometriotic cells. This theory may explain the incidence of endometriosis in women with uterine agenesis or in males treated by

**1. Introduction** 

appropriately.

estrogens (3).

**2. Pathogenesis** 

predominantly of bothersome pain.

Endometriosis is doubtless a multifactorial disease.

This should be typical for intraperitoneal lesions.

**Pathogenesis, Diagnostics and Treatment** 

Stanisław Horák and Anita Olejek *Chair and Clinical Department of Gynecology, Obstetrics and Gynecological Oncology,* 

*Silesian Medical University* 

