Eyes wide shut: the illusory tale of 'occult' microscopic endometriosis

Bowel Invisible Microscopic Endometriosis: Leave It Alone

Redwine DB et al., 2018 · Journal of minimally invasive gynecology

Chapter 64: Visual Appearance of Endometriosis

Hilgers TW et al., 2004 · The Medical and Surgical Practice of NaProTECHNOLOGY

Endometriotic implants are catalogued across their full morphological spectrum—classic powder-burn lesions, red flame lesions, clear vesicles, white fibrotic plaques, and subtle vascular changes—with photographic documentation guiding surgical recognition. Familiarity with atypical implant appearances is essential because underrecognition of non-pigmented lesions leads to incomplete excision and persistent symptomatology.

Diaphragmatic endometriosis: diagnosis, surgical management, and long-term results of treatment

Redwine DB, 2002 · Fertil Steril

To describe symptoms, surgical diagnosis and treatment, and long-term outcome of patients with symptomatic diaphragmatic endometriosis. Observational follow-up study. American tertiary referral center for the surgical treatment of endometriosis. PATIENT(S): Eight patients with diaphragmatic endometriosis causing severe or disabling symptoms. INTERVENTION(S): Laparoscopic diagnosis of diaphragmatic endometriosis followed by upper abdominal laparotomy for full-thickness resection of the diaphragm. MAIN OUTCOME MEASURE(S): Reduction of several symptoms as measured on a 5-point ranked ordinal scale administered by a phone survey up to 7 years after surgery. RESULT(S): Laparoscopy from an umbilical port may identify small "sentinel lesions" of endometriosis on the anterior or mid diaphragm. Eight symptomatic patients all had significant invasive disease with dimensions up to 5 cm across of the posterior right diaphragm, which could not always be seen from the umbilical port site. All such lesions can be seen by a laparoscope placed beneath the right costal margin. Laparoscopic treatment of symptomatic disease is not rational given the posterior placement of the disease out of sight behind the liver and the full-thickness nature of the disease in all eight patients. Laparotomy with full thickness resection of the diaphragm resulted in complete eradication of symptoms in seven of eight patients, and good symptomatic reduction in one. CONCLUSION(S): Treatment of diaphragmatic endometriosis by laparotomy results in a high rate of symptom relief. Laparoscopic treatment of diaphragmatic endometriosis will result in a high rate of incomplete diagnosis and incomplete treatment with a high rate of continuing symptoms.

Was Sampson wrong?

Redwine DB, 2002 · Fertility and Sterility

'Invisible' microscopic endometriosis: a review

Redwine DB, 2003 · Gynecologic and obstetric investigation

Endometriosis can have very subtle visual appearances. All theories of origin imply some early and presumably tiny form of the disease which potentially cannot be detected by the unaided human eye. A review of the literature indicates that with increasing magnification at surgery, virtually all endometriosis can be visualized. Invisible microscopic endometriosis is an unproven entity which retards intellectual progress in the study of this disease.

A serial section study of visually normal pelvic peritoneum in patients with endometriosis

Redwine DB et al., 1990 · Fertility and sterility

Defined criteria were used to select small samples of visually normal study peritoneum for serial section light microscopy in 45 patients with biopsy-proven endometriosis and 10 patients without endometriosis. A glandular element compatible with possible endometriosis was found in only 1 patient. Visually normal peritoneum does not harbor a high prevalence of invisible microscopic endometriosis.

The visual appearance of endometriosis and its impact on our concepts of disease

Redwine DB, 1990 · Progress in clinical and biological research

Evaluation of the impact of intraobserver variability on endometrial dating and the diagnosis of luteal phase defects

Scott RT et al., 1993 · Fertil Steril

To determine the magnitude of intraobserver variation in dating endometrial biopsies and its impact on clinical management. Blinded histopathologic interpretation of endometrial biopsy specimens 1 year apart by five pathologists. Large military tertiary care center. Endometrial biopsy specimens from 51 patients undergoing evaluation for potential luteal phase defects. None. Calculation of the magnitude of the individual and overall intraobserver variation in endometrial dating for the five pathologists and estimation of its potential impact on clinical management. The intraobserver variation was 0.69 +/- 0.05 days (means +/- SE). There was no significant difference in the magnitude of the variation for 1-day or 2-day dating ranges. The theoretical probability of altering clinical management by having the same pathologist redate a given specimen ranged from 15% to 28%. Histologic dating of endometrial biopsies is subject to a small but highly clinically significant intraobserver variability that may have a major impact on clinical management.