Ultrastructural Investigation of Pelvic Peritoneum in Patients With Chronic Pelvic Pain and Subtle Endometriosis in Association With Chromoendoscopy

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• 作者：Abolfazl Mehdizadehkashi ; MD^a ; Kobra Tahermanesh ; MD^b ; ^{tahermanesh.k@iums.ac.ir} ; Abbas Fazel Anvari-Yazdi ; PhD^c ; Shahla Chaichian ; MD^d ; Negar Azarpira ; MD^e ; Maliheh Nobakht ; PhD^f ; Seyedeh Mehr Abed ; MD^g ; Neda Hashemi ; MD^b
• 关键词：Chronic pelvic pain ; Minimal endometriosis ; Peritoneum ; Scanning electron microscopy
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2017
• 出版时间：1 January 2017
• 年：2017
• 卷：24
• 期：1
• 页码：114-123
• 全文大小：2569 K
• 卷排序：24

文摘

To evaluate the pelvic peritoneum under chromoendoscopy by scanning electron microscopy (SEM) as well as light microscopy with hematoxylin and eosin staining and immunohistochemistry (IHC) assays in patients with chronic pelvic pain (CPP) associated with subtle endometriosis.DesignCase series study (Canadian Task Force classification II).SettingA referral academic community tertiary medical center.PatientsThree women aged 29 to 37 years were referred to the obstetrics and gynecology clinic of the tertiary university hospital with CPP. They were suspicious for endometriosis, were not responding to medical treatments, and had undergone previous pelvic laparoscopy to determine the stage of endometriosis and preparation of peritoneal samples under the guidance of staining with methylene blue in 0.25% dilution.InterventionsComparison of stained and unstained pelvic peritoneal samples after the instillation of 0.25% methylene blue into the pelvic cavity.Measurements and Main ResultsIn 3 patients, laparoscopic examination showed minimal endometriosis. A total of 18 samples (9 stained and 9 unstained) from the 3 patients were prepared for SEM. Ten of the samples (55.6%) showed microstructural peritoneal destruction (7 of 9 stained [77.7%] and 3 of 9 [33.4%] unstained). Eighteen samples (9 stained and 9 unstained) from the 3 patients were also prepared for IHC. Six of these samples (33.3%) were S-100–positive, including 4 of 9 (44.4%) stained samples and 2 of 9 (22.2%) unstained samples.ConclusionsIn general, in the context of CPP and endometriosis, there is no established relationship between the severity of pain and stage of endometriosis. In the pathophysiology of CPP associated with endometriosis, ultrastructural changes can play a significant role. Under methylene blue staining, some destroyed areas were detected, but the stained areas do not necessarily correlate with increased microstructural peritoneal destruction.