Endometriosis and Deep endometriosis - 16/01/2018 Dott Matteo Generali AUSL Modena Carpi U.O. Ostetricia e Ginecologia
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Endometriosis and Deep
endometriosis
16/01/2018
Dott Matteo Generali
AUSL Modena Carpi
U.O. Ostetricia e Ginecologia
Definizione L’endometriosi è una patologia ginecologica, benigna, cronica, ormonodipendente caratterizzata dalla presenza di tessuto endometriale componente stromale e ghiandolare, al di fuori della cavità uterina Von Rokitansky C. Ueber uterusdrusen-neubildung in uterus and ovarilsarcomen. Z Ges Aerzte Wein 1860; 37: 577–93 Sampson J. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. 1927;
Incidenza
Giudice LC, Endometriosis 2004
Localizzazioni pelviche ESHRE guideline for the diagnosis and treatment of endometriosis 2005
Sintomatologia
90%
60%
50%
45%
10% 20%
Chapron C Endometriosis and infertility: pathophysiology and management 2010
Time to diagnosis Hadfield R Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. 1996;
Etiopatogenesi ESHRE guideline for the diagnosis and treatment of endometriosis 2005
Le cellule endometriosiche
Migrano
Aderiscono
Invadono la matrice
extracellulare
Neovascolarizzano
Starzinsky.The putative role of cell adhesion molecules in endometriosis: can we learn from tumor metastasis?
1999;
3 forme di endometriosi
ovarica Peritoneale-aderenze Deep endometriosis
Lesione infiltrante il peritoneo o
retro peritoneale di almeno 5 mm;
4-37% donneCompartimenti pelvici Anteriore Centrale Posteriore Vescica ureteri Utero ed annessi Douglas Rettosigma
Compartimenti pelvici
Anteriore Centrale Posteriore
Vescica ureteri Utero ed annessi Retto
Centrale
Utero ed
annessiLa mia conoscenza della pelvi
Lezione di anatomia del dottor Tulp 1632 RembrandtLa mia conoscenza della patologia
Compartimento centrale
utero ed annessi
Descrivere dimensioni, morfologia, ecostruttura
Valutazione della mobilità e dei rapporti
anatomici con visceri adiacenti
Cercare la collaborazione della paziente
nell’evocare i sintomiUtero
Ovaio
Hard Marker endometrioma Typical ultrasound appearance of an ovarian endometrioma: a unilocular cyst with (less than 5 locules) ground glass echogenicity and little to moderate peripheral vascularisation. Note the normal ovarian tissue around the cyst.
Endometrioma atipico
Atypical ultrasound appearance of an ovarian endometrioma:
Unilocular cyst
Ground glass echogenicity,
Internal papillation
No vascularisation in the papillary projection.
This is not a true papillations but hyperechoic tissue consisting of
blood clots or fibrin lying adjacent to the cyst wall
Almost 50% of the endometriomas had other ultrasound characteristics than the
typical ‘unilocular cyst with ground glass echogenicity of the cyst fluid’.Guerriero S, Ajossa S, Mais V, et al. The diagnosis of endometriomas using colour Doppler energy imaging. Hum Reprod 1998;6:1691–5.
Endometriod borderline tumor Ultrasound characteristics of endometriomas differ in pre- and postmenopausal women. Masses in postmenopausal women, whose cystic contents have a ground glass appearance, have a high risk of malignancy. Endometriomas could serve as precursors of endometrioid borderline ovarian tumours. Endometrioid borderline ovarian tumours have the potential to progress to low-grade invasive carcinoma. Borderline tumours and carcinomas arising from endometrioid cysts show a vascularised solid component at ultrasound examination
Endometriosi e tube Endometriosis that affects the ovary and Fallopian tubes can create a tubo– ovarian complex, in which the ovaries and tubes are identified and recognised, but the ovaries cannot be separated by pushing the tube with the vaginal probe
Endometriosi e aderenze Ovarian endometriomas are frequently associated with other endometriotic lesions , such as adhesions and DIE, which are not easy to diagnose. Underestimation of extensive adhesions in women with endometriomas before surgery is one of the main reasons why surgery is often incomplete leading to repeat operations
Compartimento posteriore
D.I.E.Morphological features - Hypoechoic nodules - Irregular margins « indian hairdresser sign » - No vascularization or minal peripheral spots
Compartimento posteriore
Introduzione della sondaCompartimento posteriore
63%
interessamento
Specificita 97% Donne con POD intestinale
VPN 92.6% obliteration Vs
1.4% senza
obliterazioneLegamenti uterosacrali
Legamenti uterosacrali
Intestino
10-15cm
30 cmM Muscolare ipoecogeno (rivestito da linea
iperecogena che delinea la parte esterna
ed interna del muscolo) M
SM Strato sottomucoso iperecogeno SM
Mu
Mu Mucosa ipoecogenaSchematic and ultrasound image of a nodule of deep infiltrating endometriosis in the upper rectum (arrow). Nodules located above the level of a virtual line (red line) passing through the insertion of the uterosacral ligaments on the cervix are considered to be located in the upper rectum or recto-sigmoid junction.
Water-contrast in the rectum during transvaginal sonography is performed by injecting saline solution into the rectal lumen during transvaginal ultrasound examination. Note the presence of the deep infiltrating endometriosis nodule bulging into the bowel lumen. The lesion clearly reduces the rectal lumen. It infiltrates only the muscle layer of the bowel. The lesion is covered by the hyperechogenic submucosa and hypoechogenic mucosa.
Compartimento anteriore
E gli ureteri???
Vescica… ureteri…
…e Reni
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