Correlation between Anatomopathological Aspects and Pelvic Pain in Women with Deep Infiltrating Endometriosis

Abstract

Objective To correlate the morphological aspects with pelvic pain in women with deep infiltrating endometriosis.

Methods A retrospective study with 67 women with deep endometriosis who underwent surgical treatment in a tertiary hospital from 2007 to 2017. The following variables were considered: age, parity, body mass index, site of involvement, hormonal treatment before surgery, pelvic pain, and morphometric analysis. The histological slides of the surgical specimens were revised and, using the ImageJ software for morphometric study, the percentages of stromal/glandular tissues were calculated in the histological sections.

Results The mean age of the women was 38.9 ± 6.5 years. The mean pain score was 8.8 ± 1.9 and the mean time of symptomatology was 4.7 ± 3.5 years, with 87% of the patients undergoing hormone treatment prior to surgery. The average expression of CD10, CK7, and S100 markers was 19.5 ± 11.8%, 9.4 ± 5.9%, and 7.9 ± 5.8% respectively. It was found that the greater the expression of CD10, the greater the level of pain (p = 0.02). No correlation was observed between the expression of CD10, CK7, and S100 markers and age and duration of symptoms.

Conclusion Women with deep infiltrating endometriosis have a positive association between the level of pain and the fibrosis component in the endometrial tissue's histological composition.

Resumo

Objetivo Correlacionar os aspectos morfológicos com a dor pélvica em mulheres com endometriose profunda.

Métodos Estudo retrospectivo com 67 mulheres com endometriose profunda submetidas a tratamento cirúrgico em hospital terciário de 2007 a 2017. As seguintes variáveis foram consideradas: idade, paridade, índice de massa corporal, local do acometimento, tratamento hormonal antes da cirurgia, dor pélvica e análise morfométrica. As lâminas histológicas das peças cirúrgicas foram revisadas e, por meio do software ImageJ para estudo morfométrico, foram calculadas as porcentagens de tecidos estromais/glandulares nos cortes histológicos.

Resultados A média etária das mulheres foi de 38,9 ± 6,5 anos. O escore de dor médio foi de 8,8 ± 1,9 e o tempo médio de sintomatologia foi de 4,7 ± 3,5 anos, sendo que 87% das pacientes realizavam tratamento hormonal antes da cirurgia. A expressão média dos marcadores CD10, CK7 e S100 foi de 19,5 ± 11,8%, 9,4 ± 5,9% e 7,9 ± 5,8%, respectivamente. Verificou-se que quanto maior a expressão de CD10, maior o nível de dor (p = 0,02). Não foi observada correlação entre a expressão dos marcadores CD10, CK7 e S100 com a idade e duração dos sintomas.

Conclusão Mulheres com endometriose profunda apresentam associação positiva entre o nível de dor e o componente de fibrose na composição histológica do tecido endometrial.

Keywords

Deep infiltrating endometriosis - Histology - Pain

Palavras-chave

Endometriose profunda - Histologia - Dor

Contributions

All the authors participated actively in the study, as follows: DA Yela conceptualized and designed the study, she also wrote and reviewed the manuscript. She was also involved in the interpretation of results. MSS Silva conceptualized and designed the study and helped in the acquisition of data, interpretation of results, and writing the manuscript. L Eloy was responsible for the anatomopathological analyzes. CL Benetti-Pinto reviewed the manuscript.

Publikationsverlauf

Eingereicht: 24. April 2023

Angenommen: 16. Juni 2023

Artikel online veröffentlicht:
23. Dezember 2023

• References

• 1 Vigano P, Candiani M, Monno A, Giacomini E, Vercellini P, Somigliana E. Time to redefine endometriosis including its pro-fibrotic nature. Hum Reprod 2018; 33 (03) 347-352
• 2 Viganò P, Parazzini F, Somigliana E, Vercellini P. Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 2004; 18 (02) 177-200
• 3 Bulun SE. Endometriosis. N Engl J Med 2009; 360 (03) 268-279
• 4 Tosti C, Pinzauti S, Santulli P, Chapron C, Petraglia F. Pathogenetic Mechanisms of Deep Infiltrating Endometriosis. Reprod Sci 2015; 22 (09) 1053-1059
• 5 Mathieu d'Argent E, Cohen J, Chauffour C. et al. [Deeply infiltrating endometriosis and infertility: CNGOF-HAS Endometriosis Guidelines]. Gynécol Obstét Fertil Sénol 2018; 46 (03) 357-367
• 6 Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Primers 2018; 4 (01) 9
• 7 Schliep KC, Mumford SL, Peterson CM. et al. Pain typology and incident endometriosis. Hum Reprod 2015; 30 (10) 2427-2438
• 8 Kho RM, Andres MP, Borrelli GM, Neto JS, Zanluchi A, Abrão MS. Surgical treatment of different types of endometriosis: Comparison of major society guidelines and preferred clinical algorithms. Best Pract Res Clin Obstet Gynaecol 2018; 51: 102-110
• 9 Scholl B, Bersinger NA, Kuhn A, Mueller MD. Correlation between symptoms of pain and peritoneal fluid inflammatory cytokine concentrations in endometriosis. Gynecol Endocrinol 2009; 25 (11) 701-706
• 10 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9 (07) 671-675
• 11 Abrão MS, Neme RM, Carvalho FM, Aldrighi JM, Pinotti JA. Histological classification of endometriosis as a predictor of response to treatment. Int J Gynaecol Obstet 2003; 82 (01) 31-40
• 12 Kamergorodsky G, Ribeiro PA, Galvão MA. et al. Histologic classification of specimens from women affected by superficial endometriosis, deeply infiltrating endometriosis, and ovarian endometriomas. Fertil Steril 2009; 92 (06) 2074-2077
• 13 Porto BT, Ribeiro HS, Galvão MA, Sekula VG, Aldrigui JM, Ribeiro PA. [Histological classification and quality of life in women with endometriosis]. Rev Bras Ginecol Obstet 2015; 37 (02) 87-93
• 14 Andres MP, Borrelli GM, Abrão MS. Endometriosis classification according to pain symptoms: can the ASRM classification be improved?. Best Pract Res Clin Obstet Gynaecol 2018; 51: 111-118
• 15 Somigliana E, Vigano P, Benaglia L, Busnelli A, Vercellini P, Fedele L. Adhesion prevention in endometriosis: a neglected critical challenge. J Minim Invasive Gynecol 2012; 19 (04) 415-421
• 16 Augoulea A, Alexandrou A, Creatsa M, Vrachnis N, Lambrinoudaki I. Pathogenesis of endometriosis: the role of genetics, inflammation and oxidative stress. Arch Gynecol Obstet 2012; 286 (01) 99-103
• 17 Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci 2020; 14: 590823
• 18 Viganò P, Ottolina J, Bartiromo L. et al. Cellular Components Contributing to Fibrosis in Endometriosis: A Literature Review. J Minim Invasive Gynecol 2020; 27 (02) 287-295
• 19 Howard FM. An evidence-based medicine approach to the treatment of endometriosis-associated chronic pelvic pain: placebo-controlled studies. J Am Assoc Gynecol Laparosc 2000; 7 (04) 477-488
• 20 Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update 2009; 15 (04) 441-461