'Invisible' microscopic endometriosis: a review

Bowel Invisible Microscopic Endometriosis: Leave It Alone

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

Dissecting and temporarily resuspending the adherent ovary

Redwine DB, 2006 · Fertility and sterility

Complications of laparoscopic surgery: How to avoid them and how to repair them

Shirk GJ et al., 2006 · Journal of minimally invasive gynecology

Variations in tubal configuration in endometriosis?

Redwine DB, 2006 · Fertility and sterility

Occult microscopic endometriosis: undetectable by laparoscopy in normal peritoneum

Khan KN et al., 2014 · Human Reproduction

Is there any occurrence of hidden (occult) endometriotic lesions in normal peritoneum of women with and without visible endometriosis? We detected a slightly higher occurrence of occult microscopic endometriosis (OME) in normal peritoneum of women with visible endometriosis than in control women. Based on a small number of cases, the concept of invisible microscopic endometriosis in visually normal peritoneum has been reported for more than a decade but there is controversy regarding their tissue activity and clinical significance. STUDY DESIGN, SIZE, This case-controlled research study was conducted with prospectively collected normal peritoneal samples from 151 women with and 62 women without visible endometriosis. PARTICIPANTS/MATERIALS, SETTING, Normal peritoneal biopsy specimens from different pelvic sites of were collected during laparoscopy. A histological search of all peritoneal biopsy specimens for the detection of invisible endometriosis was done by immunoreaction to Ber-EP4 (epithelial cell marker), CD10 (stromal cell marker) and Calretinin (mesothelial cell marker). Tissue expression of estrogen/progesterone receptors (ER/PR) and cell proliferation marker, Ki-67, was performed by immunohistochemistry to identify tissue activity. MAIN Three different patterns of OME were detected based on (I) the presence of typical gland/stroma, (II) reactive hyperplastic change of endometrioid epithelial cells with surrounding stroma and (III) single-layered epithelium-lined cystic lesions with surrounding stroma. A higher tendency toward the occurrence of OME was found in women with visible endometriosis (15.2%, 23/151) compared with control women (6.4%, 4/62) (P = 0.06, χ(2) test). The epithelial cells and/or stromal cells of OME lesions were immunoreactive to Ber-EP4 and CD10 but not reactive to Calretinin. ER and PR expression was observed in all patterns of OME lesions. Ki-67 index was significantly higher in pattern I/II OME lesions than in pattern III OME lesions (P< 0.05 for each). LIMITATIONS, Bias in the incidence rate of OME lesions in this study cannot be ignored, because we could not analyze biopsy specimens from the Pouch of Douglas of women with revised classification of the American Society of Reproductive Medicine Stage III-IV endometriosis due to the presence of adhesions in the pelvis. We re-confirmed a decade long old concept of invisible (occult) endometriosis in visually normal peritoneum of women with visible endometriosis. The existence of a variable amount of tissue activity in these occult lesions may contribute to the recurrence/occurrence of endometriosis or persistence/recurrence of pain manifestation in women even after successful ablation or excision of visible lesions by laparoscopy. STUDY FUNDING/COMPETING INTEREST(S): This work was supported in part by Grants-in-aid for Scientific Research from the Japan Society for the Promotion of Science. There is no conflict of interest related to this study. Not applicable.

Peritoneal blood painting: an aid in the diagnosis of endometriosis

Redwine DB, 1989 · American journal of obstetrics and gynecology

Visual identification of endometriosis is important, identification of very subtle manifestations of disease has recently received increased attention. Colorless and other subtle manifestations of peritoneal disease can be seen more easily by painting the peritoneal surface with bloody peritoneal fluid.

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

Redwine DB, 1990 · Progress in clinical and biological research

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.