What's new in endo & adenomyosis research

Women who live with endometriosis frequently experience restrictions to abilities due to the symptoms and pain associated with this chronic condition. Recreational activities are the activities participated in for enjoyment and leisure which have been demonstrated to possess beneficial outcomes for individuals' health and wellbeing. Literature examining restrictions within abilities when living with endometriosis predominantly focuses upon functional activities required within daily life and physical activities, with little acknowledgement of the activities which individuals choose to participate in during their free-time for enjoyment. Through an exploratory lens, this thesis examines experiences of participating in recreational activities when living with endometriosis in Aotearoa New Zealand and the perceived benefits to wellbeing as shaped by participation. With this research being underpinned by phenomenology, twenty semi-structured interviews of individuals with clinically suspected or confirmed endometriosis took place. Through reflexive thematic analysis, eight themes were developed. In relation to experiences of participating in recreational activities, the themes included barriers to participation, difficulties within participating, enablers to encourage participation, adaptions enacted to enable participation, outcomes associated with participation, and finally the emotional experiences in relation to experiences, disruptions and inabilities. When considering the positive outcomes as a result of participating in recreation, this was based on the themes of benefits associated with recreation participation and recreation as a means of coping. This research suggests despite the significant restrictions endometriosis may cause for individuals there may be a space for recreational activities to improve health and wellbeing when adapted towards personal manifestations of endometriosis.

A endometriose é uma patologia ginecológica crônica, inflamatória e estrogênio-dependente, que afeta aproximadamente 10% das mulheres em idade reprodutiva. Caracterizada pela presença de tecido endometrial fora da cavidade uterina, a doença provoca sintomas debilitantes como dor pélvica crônica, dismenorreia grave e infertilidade, impactando severamente a qualidade de vida física, emocional e social das pacientes. O presente artigo de revisão objetiva analisar a importância das intervenções no estilo de vida — especificamente alimentação, atividade física e terapias complementares — como estratégias para a melhoria do bem-estar global. Através da análise de 18 artigos científicos, observou-se que a reeducação alimentar, focada em nutrientes anti-inflamatórios e antioxidantes; a prática regular de exercícios físicos e a utilização de terapias, como acupuntura e meditação, são fundamentais para a modulação da dor e redução do estresse oxidativo. Os resultados indicam que uma abordagem multidisciplinar e holística permite que a mulher compreenda melhor sua condição e adote hábitos que mitigam a progressão da doença e promovem o empoderamento pessoal diante do quadro clínico.

(No abstract on file for this paper.)

Background. Endometriosis is a chronic estrogen-dependent inflammatory disease with a multifactorial pathogenesis. Increasing evidence suggests that the gut microbiome contributes to disease development through interactions involving immune regulation, intestinal barrier integrity, microbial metabolites, and estrogen metabolism, while endometriosis may also alter microbial composition. Aim. To summarize current evidence on the relationship between the gut microbiome and endometriosis, focusing on pathogenic mechanisms, microbial alterations, diagnostic potential, and microbiome-directed therapies. Material and methods. A narrative literature review with a structured search strategy was conducted using PubMed, Embase, the Cochrane Library, and Google Scholar. Search terms included endometriosis, gut microbiome, dysbiosis, estrobolome, intestinal permeability, inflammation, oxidative stress, probiotics, and fecal microbiota transplantation. Results. Current evidence supports a bidirectional relationship between gut dysbiosis and endometriosis. Microbial alterations may promote immune dysregulation, increased intestinal permeability, oxidative stress, lipopolysaccharide-mediated inflammation, and enhanced estrogen recirculation via the estrobolome, facilitating lesion establishment and persistence. Conversely, chronic inflammation, hormonal treatment, surgery, and bowel involvement may further modify the gut microbiome. Although no consistent microbial signature has been identified, several taxa and functional pathways have been associated with disease phenotype and severity. Conclusions. The gut microbiome is an important modifier of endometriosis rather than a single causative factor. Microbiome-derived biomarkers and targeted therapies show promise but require validation in prospective studies before routine clinical use.

Endometriosis involving the urinary tract is uncommon, with the urinary bladder being the most frequently affected site.Its nonspecific urinary manifestations may result in delayed diagnosis.Congenital Müllerian anomalies, particularly a unicornuate uterus with a noncommunicating functional rudimentary horn, may be associated with hematometra and endometriosis secondary to obstructed menstrual outflow and retrograde menstruation.We report an unusual coexistence of bladder endometriosis, a right unicornuate uterus with a noncommunicating left rudimentary cavity, and hematometra in a 22-year-old nulliparous woman who presented with a one-year history of cyclical dysuria, hematuria, and dyspareunia.She had regular menstrual cycles associated with dysmenorrhea and had attempted conception without success.Pelvic magnetic resonance imaging demonstrated a right hemi-uterus measuring approximately 7 × 3 × 2.5 cm and a separate left-sided endometrial cavity measuring 4.1 × 3.5 × 4.2 cm, which did not communicate with the uterus and was distended with hematometra.An ill-defined T2 hypointense lesion measuring 3.4 × 2.3 × 3 cm with T1 hyperintense foci was centered in the vesicouterine pouch, extending posteriorly into the lower uterine segment and cervix and anteriorly into the bladder wall with intraluminal extension.Thickening of the proximal bilateral round ligaments was also noted, with the overall appearance suggestive of deep pelvic endometriosis.Cystoscopy showed multiple reddish-brown cystic lesions involving the lateral and posterior walls of the urinary bladder.Near-complete transurethral resection of the bladder lesions was performed, along with laparoscopic drainage and partial excision of the rudimentary horn.Histopathological examination of the resected bladder lesions confirmed bladder endometriosis.Postoperatively, the patient was started on leuprolide acetate and remained symptom-free at six-month follow-up.This case highlights the importance of considering bladder endometriosis in young women presenting with cyclical urinary symptoms and demonstrates the value of magnetic resonance imaging in delineating Müllerian anomalies, hematometra, and the extent of deep pelvic endometriosis.The coexistence of extensive bladder endometriosis with a unicornuate uterus and hematometra underscores the importance of coordinated urological and gynecological management.

(No abstract on file for this paper.)

Systematic review of human neuroimaging and electrophysiological studies in endometriosis, with appraisal of menstrual cycle phase and hormonal status reporting and of pain-phenotype stratification. This registration documents the protocol and methods of the review as conducted; searches (PubMed, Web of Science, CNKI; 28 September 2026), screening, data extraction and first-pass risk-of-bias assessment were completed before registration, and this timing is reported openly.

Introduction Endometriosis is characterized by the presence of functionally active endometrial tissue outside the uterine cavity, primarily within the peritoneal cavity. Its etiology and pathogenesis remain incompletely understood; however, endometriosis is considered a chronic inflammatory disease associated with immune system dysfunction. Galectins and other mediators of immune and inflammatory responses may play an important role in the pathogenesis of the disease. This study aimed to investigate the potential involvement of selected immune and inflammatory mediators in endometriosis by assessing the concentrations of galectin-1 (Gal-1), galectin-3 (Gal-3), galectin-8 (Gal-8), galectin-9 (Gal-9), asprosin, FSTL1, meteorin, neuregulin-4, isthmin 1, SFRP2, and TNF-α in the serum and peritoneal fluid of women with deep infiltrating endometriosis, deep infiltrating endometriosis coexisting with adenomyosis, and adenomyosis. Methods The study included 33 women in whom endometriosis was diagnosed during laparoscopy and subsequently confirmed by histopathological examination. The reference group consisted of 14 women without endometriosis. Blood serum and peritoneal fluid samples were collected, and the concentrations of the investigated parameters were determined using enzyme-linked immunosorbent assays (ELISAs). Results In patients with deep infiltrating endometriosis coexisting with adenomyosis, alterations in the detectability of Gal-1, Gal-3, and Gal-9 were observed, suggesting a potential involvement of these galectins in the regulation of immune and inflammatory responses. Differences in the concentrations of asprosin, FSTL1, and TNF-α were also observed in this group, suggesting a possible association of these parameters with the inflammatory environment accompanying the disease. Conclusions The observed alterations in Gal-1, Gal-3, and Gal-9 levels in patients with deep infiltrating endometriosis coexisting with adenomyosis may indicate their involvement in the regulation of immune and inflammatory responses. Differences in the concentrations of asprosin, FSTL1, and TNF-α suggest their potential association with the inflammatory environment of the disease. Further studies in larger cohorts are needed to determine the biological and clinical significance of these parameters and their potential interactions.

Abstract Background The levonorgestrel-releasing intrauterine system (LNG-IUS) is effective for adenomyosis, yet expulsion frequently limits its clinical application. This study aimed to compare clinical outcomes of three hysteroscopic LNG-IUS placement techniques for adenomyosis. Methods This retrospective cohort recruited 131 adenomyosis patients (non-suture fixation n = 32, suture fixation n = 23, conventional placement n = 76) at Fujian Maternity and Child Health Hospital from October 2024 to October 2025. The primary outcome was LNG-IUS expulsion or displacement. Follow-up assessments were performed at baseline, 1 month and 6 months after placement for uterine volume, endometrial thickness, hemoglobin, carbohydrate antigen 125, dysmenorrhea and menstrual blood loss. Intraoperative parameters and postoperative adverse events were recorded. Between-group comparisons used ANOVA or Kruskal-Wallis tests; within-group changes used repeated-measures ANOVA or the Friedman test, with Bonferroni correction for multiple comparisons. Subgroup analysis was stratified by uterine cavity depth (cut-off 9.0 cm). Propensity-score matching (1:1:1), generalized estimating equations (GEE) and Cox regression were applied for data analyses. Results Expulsion or displacement rates at 1 and 6 months were 0% in both fixation groups versus 19.74% and 27.63% in the conventional group ( P < 0.01). All groups achieved significant improvements in clinical parameters ( P 9.0 cm, fixation techniques yielded lower expulsion or displacement rates and superior 6-month clinical improvements versus conventional placement; comparable efficacy was observed among all groups for depth ≤ 9.0 cm. Operation time was shorter for non-suture fixation and conventional placement than suture fixation ( P 0.05). In the PSM-matched cohort ( n = 23 per group), expulsion-displacement remained 0% in fixation groups vs. 69.56% conventional. GEE analysis in the matched cohort further revealed significant group × time interactions across the longitudinal clinical outcomes ( P 150 cm³ as the only independent risk factor (HR = 8.822, 95% CI 3. 172–24. 530, P 9.0 cm, hysteroscopic fixation methods were associated with significantly lower observed expulsion rates compared with conventional placement. Non-suture fixation has practical merits of shorter operative time and lower technical requirements. Further prospective studies are required for external validation.

Endometrial decidualization is a hormonally programmed differentiation and tissue-remodeling process that prepares the endometrium for embryo implantation and supports early pregnancy. It involves coordinated changes in endometrial stromal cells, the extracellular matrix, vascular function, metabolism, and local immune composition. Hypoxia-inducible factor-1α (HIF-1α) is an oxygen-sensitive transcription factor that responds to changes in tissue oxygenation and metabolic state. Evidence from endometrial stromal-cell models and reproductive tissues suggests that HIF-1α may participate in decidual cell differentiation, metabolic adaptation, angiogenic signaling, and immune regulation. However, the strength of evidence differs substantially among these processes, and findings from trophoblasts, placenta, immune cells, or non-reproductive tissues cannot automatically be interpreted as direct evidence for decidual stromal-cell mechanisms. This review summarizes current evidence for HIF-1α in endometrial decidualization, distinguishes direct endometrial findings from mechanistic extrapolation, and considers the interaction of HIF-1α with metabolic, vascular, immune, and epigenetic pathways. Overall, HIF-1α is best considered a context-dependent component of the decidualization network rather than an independent master regulator. Defining its cell-specific and temporal functions, including its relationship with HIF-2α, will be important for determining whether HIF-directed interventions can be developed without disrupting physiological reproductive adaptation.

Relação entre a dor associada à endometriose e o sofrimento psicológico em mulheres com endometriose: uma scoping review Mariana Filipa Monteiro Soares Escola Superior de Saúde Fernando Pessoa Porto, 2026 Item Detalhes Tipo de revisão Scoping review — protocolo metodológico, sem apresentação de resultados Orientação metodológica Joanna Briggs Institute (JBI); PRISMA-ScR para apresentação da revisão concluída Fase de desenvolvimento A pesquisa preliminar da literatura foi realizada em abril de 2026 nas fontes identificadas na secção 7 e na tabela da secção 8. Parte do processo de revisão teve início antes do registo no OSF; os procedimentos para a sua conclusão encontram-se descritos neste protocolo. Equipa de revisão Mariana Filipa Monteiro Soares — Escola Superior de Saúde Fernando Pessoa; Professora Doutora Maria Teresa Moreira — orientadora; Professora Doutora Andreia Lima — terceira revisora. A seleção dos estudos será efetuada por duas revisoras independentes e eventuais divergências não resolvidas por consenso serão apreciadas pela terceira revisora. Autora correspondente Mariana Filipa Monteiro Soares — [email protected] 1. Introdução A endometriose é uma doença crónica caracterizada pela presença de tecido semelhante ao endométrio fora do útero e encontra-se associada a manifestações clínicas como dismenorreia, dor pélvica crónica, dispareunia e sintomas intestinais ou urinários. Para além das manifestações físicas, a doença pode interferir na qualidade de vida e no bem-estar psicológico das mulheres (World Health Organization, 2025; Becker et al., 2022). A relação entre endometriose e saúde mental tem sido abordada em revisões sistemáticas e meta-análises, nas quais a ansiedade e a depressão surgem entre os desfechos psicológicos mais frequentemente estudados. A literatura de síntese sugere ainda que a dor, em particular a dor pélvica, constitui um elemento relevante na relação entre endometriose e sintomas psicológicos, embora os resultados variem entre estudos e dependam das populações, instrumentos e definições utilizadas (Gambadauro et al., 2019; Delanerolle et al., 2021; van Barneveld et al., 2022). A presente scoping review tem como finalidade mapear a evidência científica sobre a relação entre a dor associada à endometriose e o sofrimento psicológico, incluindo sintomas de ansiedade, depressão e sofrimento psicológico ou emocional. Este protocolo descreve a investigação realizada até ao momento e os procedimentos previstos para a sua conclusão, sem antecipar os resultados da revisão. 2. Fundamentação e lacuna da revisão As revisões já publicadas abordaram dimensões relevantes deste problema, mas com âmbitos distintos. Gambadauro et al. (2019) avaliaram a associação entre endometriose e sintomas depressivos, incluindo a possível influência da dor pélvica. Delanerolle et al. (2021) sintetizaram manifestações e comorbilidades de saúde mental em mulheres com endometriose. van Barneveld et al. (2022) examinaram depressão, ansiedade e fatores correlacionados, entre os quais a dor. Estes trabalhos demonstram que a ligação entre dor e saúde mental não constitui uma questão inédita e devem ser considerados na fundamentação de qualquer revisão subsequente. A pertinência da presente scoping review reside na diferença de finalidade e de unidade de análise: em vez de estimar primordialmente prevalências ou efeitos combinados, pretende-se descrever de que modo os diferentes tipos de estudos investigam ou sintetizam a relação entre manifestações dolorosas específicas e ansiedade, depressão ou sofrimento psicológico/emocional, que instrumentos e definições aplicam, que populações e contextos abrangem e que aspetos permanecem insuficientemente estudados. Esta abordagem poderá integrar evidência de estudos primários e de revisões de literatura, com diferentes métodos e descrever a heterogeneidade metodológica, sem pressupor que a relação seja causal nem que não existam sínteses anteriores sobre o tema. Como complemento à análise das revisões já publicadas, será verificada a existência de revisões e protocolos diretamente equivalentes, com registo das fontes e das datas de consulta. A justificação científica assenta no objetivo de mapear sistematicamente as características dos estudos e das sínteses científicas sobre a relação dor–sofrimento psicológico e de identificar, a partir da evidência recolhida, os aspetos menos estudados. 3. Objetivo da revisão Mapear a evidência científica sobre a relação entre a dor associada à endometriose e a ansiedade, a depressão ou o sofrimento psicológico/emocional em mulheres adultas com endometriose. 4. Questões da revisão 1. Que evidências científicas existem sobre a relação entre a dor associada à endometriose e o sofrimento psicológico em mulheres com endometriose? 2. Que características da dor associada à endometriose são avaliadas nos estudos incluídos? 3. Que desfechos psicológicos e instrumentos de avaliação são utilizados? 4. Que tipos de estudos, populações e contextos compõem a evidência disponível? 5. Que lacunas permanecem na evidência sobre essa relação? 5. Estrutura PCC Elemento PCC Definição operacional P — População Mulheres adultas (idade ≥18 anos) com diagnóstico de endometriose, segundo a definição utilizada no estudo. Em amostras mistas, serão considerados apenas dados relativos às participantes elegíveis que possam ser identificados separadamente. C — Conceito Relação diretamente analisada ou descrita entre dor atribuída à endometriose (p. ex., dor pélvica, dor pélvica crónica, dismenorreia, dispareunia, disquesia ou outra manifestação dolorosa) e pelo menos um desfecho de ansiedade, depressão ou sofrimento psicológico/emocional. Serão elegíveis resultados quantitativos ou descrições qualitativas interpretáveis, independentemente de a relação constituir objetivo principal, análise secundária ou hipótese central. A mera medição concomitante de dor e sintomas psicológicos, sem análise ou descrição explícita da sua relação, não será suficiente. C — Contexto Sem restrições de localização geográfica, contexto clínico, assistencial ou comunitário. 6. Critérios de elegibilidade 6.1. Critérios de inclusão • Serão incluídos estudos com mulheres adultas (≥18 anos) com diagnóstico de endometriose, incluindo amostras mistas apenas quando os dados da população elegível sejam extraíveis separadamente. • Serão incluídos estudos que avaliem dor atribuída à endometriose, como dor pélvica, dor pélvica crónica, dismenorreia, dispareunia, disquesia ou outras manifestações dolorosas descritas pelos autores. • Serão incluídos estudos que relatem uma análise, comparação, associação estatística ou descrição qualitativa explícita entre a dor associada à endometriose e ansiedade, depressão ou sofrimento psicológico/emocional, desde que essa informação seja extraível e interpretável. • Serão incluídos estudos de qualquer tipo ou desenho metodológico, incluindo estudos primários e revisões de literatura, desde que cumpram os restantes critérios de elegibilidade, independentemente do contexto de realização. • Não será aplicada restrição por ano de publicação, para evitar a exclusão prévia de evidência pertinente para o mapeamento da literatura. • Serão considerados estudos publicados em português ou inglês. Esta limitação, motivada pelos recursos linguísticos disponíveis para análise integral, será reconhecida como possível fonte de viés de seleção. • Serão avaliados para elegibilidade os estudos cujo texto integral seja recuperável; será documentada separadamente a impossibilidade de recuperação após tentativas de acesso. Fundamentação dos critérios de elegibilidade: a finalidade de uma scoping review consiste em mapear a extensão, a natureza e as características da evidência disponível (Peters et al., 2020, 2022). Assim, serão consideradas análises principais ou secundárias que descrevam explicitamente a relação entre a dor e os desfechos psicológicos definidos e que disponibilizem informação passível de extração. A simples avaliação de dor e de sintomas psicológicos no mesmo estudo, sem análise ou descrição da sua relação, não será suficiente. Estes critérios permitirão identificar evidência diretamente pertinente para a questão de investigação e serão aplicados de forma uniforme na avaliação da elegibilidade. 6.2. Critérios de exclusão • Serão excluídos estudos realizados exclusivamente em participantes menores de 18 anos ou sem diagnóstico de endometriose. • Serão excluídos estudos com populações mistas quando os dados das mulheres adultas com endometriose não possam ser identificados separadamente. • Serão excluídos estudos que não apresentem dados sobre dor atribuída à endometriose. • Serão excluídos estudos sem ansiedade, depressão ou sofrimento psicológico/emocional avaliados ou relatados, ou que não estabeleçam relação analisável entre estes desfechos e a dor. • Estudos sobre catastrofização, coping, resiliência, autoeficácia, imagem corporal, qualidade de vida, função sexual, sono e outras dimensões serão excluídos apenas quando não disponibilizem igualmente uma relação extraível entre dor e os desfechos psicológicos definidos. • Estudos de intervenções ou tratamentos serão excluídos apenas quando não apresentem resultados primários ou secundários que permitam extrair a relação dor–sofrimento psicológico definida no conceito da revisão. • Serão excluídas publicações que não constituam estudos e que não disponibilizem informação científica extraível sobre a relação em análise, como editoriais, comentários, cartas e correções. As revisões de literatura não serão excluídas por constituírem estudos secundários. • Não serão aplicadas exclusões exclusivamente com base no ano de publicação. • Serão excluídos textos integrais publicados apenas em idiomas diferentes do português e do inglês, documentando-se essa limitação. • Relatórios não recuperados em texto integral após tentativas documentadas serão registados como não recuperados e não como exclusões após apreciação da elegibi

KAT6B/A::KANSL1 fusion-positive uterine mesenchymal neoplasms are rare and may show overlapping endometrial stromal and smooth muscle features. We report a 47-year-old woman with regular menses, no dysmenorrhea, and a 7-year history of a presumed uterine fibroid. She underwent laparoscopic myomectomy at an outside hospital in November 2024. The fragmented specimen was interpreted as an endometrial stromal tumor with smooth muscle differentiation, but the tumor–myometrium interface could not be assessed, and an endometrial stromal nodule could not be distinguished from low-grade endometrial stromal sarcoma. Subsequent pelvic magnetic resonance imaging showed postoperative changes, possible residual leiomyomas, and heterogeneous enhancement at the uterine fundus. Pelvic computed tomography showed heterogeneous uterine enhancement without definite extrauterine disease. Because the original specimen was fragmented and a potentially malignant uterine mesenchymal neoplasm could not be excluded, completion hysterectomy with bilateral salpingo-oophorectomy was performed. The hysterectomy specimen contained multiple residual intramyometrial nodules with marked regional heterogeneity. One component showed fascicular smooth muscle morphology and diffuse desmin and h-caldesmon expression, whereas other nodules showed tongue-like myometrial infiltration, focal intravascular growth, spiral arteriole-like vessels, and diffuse ER, PR, CD10, and SMA expression. Whole-transcriptome sequencing identified an in-frame KAT6B::KANSL1 fusion involving KAT6B exon 3 and KANSL1 exon 11. Because the tumor expressed ER and PR, postoperative letrozole was administered for 30 days, after which surveillance was selected following review of the final pathologic and molecular findings. At 8 months after completion surgery, no clinical or radiologic recurrence was detected; this limited follow-up does not permit conclusions regarding long-term biological behavior or endocrine treatment benefit.

Background Umbilical endometriosis is an uncommon form of extrapelvic endometriosis and may be misdiagnosed as other umbilical or urachal disorders. Cyclic umbilical bleeding or discharge is an important clinical clue, but the diagnosis is often confirmed only after surgical excision and histopathological examination. Case presentation A 31-year-old woman presented to the hospital with a history of umbilical discharge for more than one year. The symptom occurred predominantly during menstruation and was characterized by recurrent umbilical discharge with occasional bloody secretion. Physical examination revealed mild erythema and swelling of the umbilicus, without active discharge at the time of examination. Preoperative computed tomography of the lower abdomen and pelvis showed no obvious abnormality. The initial clinical diagnosis was urachal fistula with possible umbilical infection. The patient underwent surgical excision of the umbilical lesion under general anesthesia. Intraoperatively, purulent discharge was observed at the umbilicus, and complete excision of the umbilical lesion was performed. Histopathological examination revealed endometrial glands and stroma beneath the squamous epithelium with hemosiderin deposition, while immunohistochemistry showed CD10, CK7, and PR positivity with negative/weak ER expression, supporting the diagnosis of umbilical endometriosis. Conclusion This case emphasizes the diagnostic challenge of primary umbilical endometriosis presenting with chronic umbilical discharge. Careful assessment of menstrual history, imaging findings, and pathological examination is essential for accurate diagnosis.

(No abstract on file for this paper.)

Наружный генитальный эндометриоз остается одним из наиболее значимых заболеваний и встречается, по современным эпидемиологическим оценкам, у 6-10% женщин репродуктивного возраста. Тяжелые формы заболевания с поражением ретроцервикальной зоны и кишечника представляют наибольшую сложность для диагностики и хирургического лечения, требуют мультидисциплинарного подхода и тщательного баланса между радикальностью вмешательства и сохранением репродуктивной функции. В представленном клиническом случае было выполнено органосохраняющее лапароскопическое вмешательство в объеме иссечения очагов эндометриоза, билатеральной цистэктомии с энуклеацией капсул эндометриом и адгезиолизиса у пациентки 43 лет с тяжелым наружным генитальным эндометриозом: двусторонними эндометриомами яичников диаметром до 9 см, ретроцервикальным эндометриозом и вовлечением ректосигмоидного отдела толстой кишки.

The involvement of microbiota in the pathogenesis of endometriosis has been increasingly suggested; however, existing evidence remains inconsistent, largely owing to the challenges of analyzing extremely low-biomass samples. To clarify whether distinct microbial signatures exist among the non-endometriosis endometrium (nEM), eutopic endometrium with endometriosis (eEM), and endometrioma, we performed a comparative microbiome analysis using 16 S ribosomal RNA (rRNA) gene sequencing of the V4–V5 region on an Illumina NextSeq 1000 platform. Of 48 samples collected, 37 (10 nEM, 18 eEM, and 9 endometrioma) yielded data suitable for analysis. No significant differences were observed in alpha or beta diversity. Lactobacillus was the predominant genus in both nEM and eEM, although no genus differed significantly between groups after correction for multiple comparisons. Sequence-level examination of all 146 amplicon sequence variants (ASVs) showed that background-associated sequences accounted for 41% of the dataset. Because no extraction blank was processed, contamination among the remaining sequences could not be excluded. Inter-individual variation exceeded any difference between groups, and no disease-specific microbial signature was identified. These findings indicate that 16S rRNA gene sequencing of low-biomass endometrial tissue is unlikely to yield a usable biomarker for endometriosis on its own.

A endometriose está associada à infertilidade e pode influenciar os resultados da reprodução assistida por diferentes mecanismos anatômicos, inflamatórios e hormonais. Esta revisão integrativa teve como objetivo analisar as evidências sobre a transferência de embriões congelados (FET) em mulheres com endometriose e/ou adenomiose, com enfoque nas estratégias de preparo endometrial, nas concentrações séricas de progesterona e nos desfechos reprodutivos e obstétricos. Foi realizada busca na base PubMed, em setembro de 2026, utilizando os descritores “Frozen Embryos” e “Endometriosis”, combinados pelo operador AND, considerando estudos publicados entre 2021 e 2026. Dos 41 estudos identificados, quatro estudos observacionais retrospectivos atenderam aos critérios de inclusão. Os resultados demonstraram que a endometriose não esteve associada de forma consistente a menores concentrações séricas de progesterona. Entretanto, níveis de progesterona avaliados em momentos específicos do ciclo apresentaram associação com maiores taxas de gravidez clínica e nascimento vivo, especialmente em determinados subgrupos. Além disso, o tipo de preparo endometrial esteve relacionado a alguns desfechos obstétricos em mulheres com endometriose, embora não tenha sido demonstrada superioridade universal de ciclos naturais ou artificiais. Entre pacientes com adenomiose submetidas a ciclos hormonais, concentrações mais elevadas de progesterona estiveram associadas ao nascimento vivo. Conclui-se que a escolha do preparo endometrial em mulheres com endometriose deve ser individualizada, considerando a presença de adenomiose, o protocolo utilizado e o momento da avaliação da progesterona. São necessários estudos prospectivos e ensaios clínicos para estabelecer parâmetros hormonais e estratégias de preparo mais precisos para essa população.

Endometriosis is a chronic, estrogen-dependent inflammatory disease and a major contributor to female infertility. Endometriosis-associated infertility arises from interacting anatomical and biological mechanisms, including pelvic adhesions and tubal dysfunction, reduced ovarian reserve, altered follicular and oocyte competence, oxidative stress, immune dysregulation, and impaired endometrial function. This narrative review integrates current concepts of disease pathogenesis with evidence-based fertility management. It first examines the molecular, cellular, and immune processes that support ectopic lesion establishment and may impair reproduction. It then discusses diagnostic phenotyping, infertility evaluation, prognostic tools, medical suppression, fertility-preserving surgery, intrauterine insemination, and in vitro fertilization. Particular attention is given to the strength and clinical relevance of current evidence, including surgery for ovarian endometrioma before assisted reproduction, prolonged gonadotropin-releasing hormone agonist pretreatment, fresh versus frozen embryo transfer, and the use of intracytoplasmic sperm injection without male-factor infertility. Emerging anti-angiogenic, immunomodulatory, antioxidant, stem-cell, and gene- or epigenetic-based interventions remain investigational. Because neither a single treatment nor a single assisted-reproduction protocol is optimal for all patients, management should integrate age, ovarian reserve, symptom burden, disease phenotype, prior surgery, coexisting infertility factors, and reproductive priorities. Mechanistically informed clinical trials using live birth and patient-centered outcomes are needed to advance precision fertility care.

Background Adenomyosis (AM) is characterized by ectopic endometrial invasion and myometrial fibrosis, yet the molecular links between local metabolic remodeling, lysine crotonylation (Kcr), and epithelial dysfunction remain poorly understood. We investigated the metabolic and crotonylation-related landscape of AM and sought to identify epithelial molecular features associated with these alterations. Methods Clinical metabolic profiles, public and newly generated tissue metabolomic data, crotonyl-CoA measurements, and tissue crotonylation assays were integrated with single-cell and bulk transcriptomic analyses. Kcr-related transcriptional patterns were characterized using multiple gene-set scoring approaches and co-expression analysis, followed by multi-algorithm feature prioritization. SDC4-associated epithelial states were further examined using trajectory inference, cell-cell communication analysis, transcription-factor prediction, and in silico perturbation. Results Adjusted clinical analyses showed no robust differences in circulating lipid profiles, whereas tissue-level metabolomic analyses revealed alterations in lipid- and lysine-related metabolites in AM. Crotonyl-CoA estimates were higher in AM tissue, accompanied by increased H3K18cr. A higher p65-associated Kcr signal was also observed in a single IP comparison; given that only one IP measurement was available per group, this finding should be considered a preliminary descriptive observation. Single-cell analyses identified prominent Kcr-related transcriptional patterns in epithelial cells and linked this state to adhesion, junctional organization, and epithelial remodeling. SDC4 was consistently prioritized across five machine-learning procedures and was predominantly expressed in epithelial populations. SDC4-positive epithelial cells exhibited distinct inferred differentiation states and intercellular communication patterns, while computational perturbation further implicated SDC4-associated networks in epithelial adhesion, cytoskeletal organization, and junctional regulation. Conclusion These findings connect local metabolic remodeling and crotonylation-related alterations with a distinct epithelial transcriptional state in AM and identify SDC4 as a consistently prioritized candidate associated with epithelial remodeling. The preliminary p65-associated Kcr observation provides additional context for investigating potential associations among Kcr, p65, and SDC4-related epithelial programs.

This document presents Version 1 (2026) of the ISON Neuropelveological Guidelines for Pelvic Nerve-Sparing Surgery in Gynecology, developed under the auspices of the International Society of Neuropelveology (ISON). The guidelines propose a neurofunctional framework for preserving pelvic neurological function during gynecologic surgery, with particular emphasis on radical hysterectomy for cervical cancer and surgery for deep endometriosis. They integrate the historical development of nerve-sparing surgery, pelvic neurofunctional anatomy, mechanisms of surgical nerve injury, intraoperative electrical stimulation and functional mapping, and postoperative assessment of urinary, colorectal, and sexual function. The central principle is that nerve-sparing surgery should be defined by preservation of neurological function rather than by the extent of anatomical nerve exposure. Neural identification and dissection should be tailored to disease distribution and surgical necessity, while uninvolved neural pathways should remain undisturbed whenever possible. In oncological surgery, nerve preservation must not compromise oncological radicality. Practical recommendations address surgical planning, targeted neural identification, unilateral and bilateral preservation, postoperative functional surveillance, and reporting standards. Particular attention is given to bladder emptying, bladder filling sensation, and the prevention of secondary damage associated with unrecognized postoperative dysfunction. Intended for gynecologic surgeons, gynecologic oncologists, endometriosis specialists, neuropelveologists, and clinicians involved in pelvic functional care, this document provides a framework for surgical practice, training, and future research into the preservation and restoration of pelvic neurological function.

Low-grade chronic inflammation plays an important role in the pathogenesis of many gynecological diseases, including polycystic ovary syndrome (PCOS), uterine fibroids, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) and endometriosis. The aim of this paper was to present the assumptions of the anti-inflammatory diet and review the current state of knowledge about its potential importance in these diseases. An anti-inflammatory diet based on increased intake of omega-3 fatty acids, fiber and polyphenols, while reducing the intake of pro-inflammatory foods, has the potential to reduce pro-inflammatory cytokine levels and alleviate clinical symptoms. The Mediterranean diet has the best documented dietary model with anti-inflammatory effects. Available scientific data indicate the beneficial effect of dietary interventions on the hormonal and metabolic profile of PCOS, pain severity in uterine fibroids and endometriosis and the exacerbation of somatic and affective discomfort in PMS/PMDD. However, the quality of scientific evidence remains variable, and an anti-inflammatory diet should be considered an adjunct to standard treatment, rather than an alternative to it. Further randomized clinical trials are required to conclusively define the role of individual components of the anti-inflammatory diet in this disease group.

This systematic review aims to investigate the association between endometriosis and the development of inflammatory and autoimmune dermatological diseases. The main objective is to determine whether women diagnosed with endometriosis have a higher risk of developing these skin conditions compared with women without endometriosis. The research will analyze observational studies published from 2016 onward, focusing on diseases such as psoriasis, hidradenitis suppurativa, atopic dermatitis, alopecia areata, vitiligo, chronic urticaria, cutaneous lupus erythematosus and acne vulgaris. Additionally, the review will explore potential shared inflammatory and immunological mechanisms that may explain these associations. The expected outcomes are to identify which dermatological diseases show the strongest associations with endometriosis, evaluate the consistency of the available evidence and contribute to a better understanding of their potential relationship.

Folder sobre a conscientização da endometriose, abordando conceito, prevalência, sintomas frequentes, diagnóstico e formas de tratamento. Destaca sinais como dor pélvica crônica, dor durante a relação sexual, alterações menstruais, dificuldade para engravidar e alterações intestinais e urinárias, além de apresentar informações sobre diagnóstico clínico e por exames de imagem e opções terapêuticas.

Endometriosis is a chronic, estrogen-dependent inflammatory disorder affecting approximately ten percent of reproductive-age women worldwide. Despite its high prevalence and profound impact on quality of life, the biological mechanisms that sustain and amplify the disease remain incompletely understood. This critical narrative review synthesises peer-reviewed evidence published predominantly between 2013 and 2026 to examine how estrogen signalling, immune cell dysfunction, and peritoneal inflammation form a self-amplifying pathological circuit in endometriosis. Ovarian and locally synthesised estrogen acts through genomic receptors, particularly estrogen receptor beta (ERbeta), to confer apoptosis resistance upon ectopic stromal cells and to drive macrophage recruitment via the NF-kappaB/CCL2 axis. Phenotypically altered peritoneal macrophages, expanded regulatory T cells, functionally impaired natural killer cells, and activated mast cells collectively sustain an immune-tolerant microenvironment in which ectopic lesions survive and proliferate. The resulting inflammatory milieu, characterised by elevated interleukin-6, interleukin-8, tumour necrosis factor-alpha, and prostaglandin E2, feeds back to stimulate aromatase (CYP19A1) expression in ectopic tissue, thereby completing a self-reinforcing loop. Epigenetic silencing of ERalpha and progesterone receptor genes prevents effective progesterone-mediated immune regulation and further entrenches the disease. Current hormonal treatments interrupt individual nodes of this circuit but rarely achieve durable remission. Emerging evidence supports multi-target approaches incorporating Janus kinase inhibitors, natural compounds, and immunomodulatory strategies. This review offers a unified mechanistic framework to guide future research into biomarker discovery and therapeutics for endometriosis.

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This article analyzes the clinical course of infertility in women of reproductive age, major risk factors, modern diagnostic approaches, and treatment outcomes. The relationship between infertility and ovulatory disorders, menstrual cycle abnormalities, tubal pathology, polycystic ovary syndrome, pelvic inflammatory diseases, reduced ovarian reserve, and endometriosis was evaluated. The importance of comprehensive diagnostic assessment and individualized treatment in improving reproductive function was assessed. The findings emphasize the importance of early reproductive health assessment, timely identification of infertility causes, and selection of individualized treatment strategies.

Диеногест широко применяется для консервативного лечения аденомиоза, однако часть пациенток не получает достаточного облегчения боли или прекращает приём из-за маточных кровотечений. Цель обзора — обобщить опубликованные в 2021–2026 гг. данные о клинических, эхографических и эластографических показателях, которые позволяют выделить таких пациенток до начала лечения. Поиск выполнен в базах PubMed и Europe PMC, в обзор включено 19 публикаций. По данным метаанализов, диеногест снижает дисменорею в среднем на 5,86 см по визуальной аналоговой шкале, но результаты исследований очень неоднородны. С худшим результатом связаны старший возраст, высокий уровень CA-125, объём матки более 352,7 см³, диффузная форма аденомиоза, сопутствующая миома и кровотечения на фоне терапии; размеры матки лучше всего предсказывают кровотечения. Ультразвуковые признаки MUSA связаны с тяжестью симптомов, но как предикторы ответа на диеногест не изучались. Жёсткость очага по данным эластографии отражает выраженность фиброза, коррелирует с тяжестью дисменореи и ассоциирована с рецидивом после отмены препарата. Прогностическая модель, объединяющая три группы показателей, пока не создана и требует проспективной проверки.

Background: Endometriosis causes pelvic pain and fatigue, impairing physical fitness and sports participation. While physical activity helps manage symptoms, precise exercise programming guidance remains limited. Aim: This narrative review evaluates sports science and clinical evidence relevant to individualized exercise programming for women with endometriosis. Material and methods: PubMed was the principal database, supplemented by Google Scholar and Scopus. The search covered publications from 2016–2026, including systematic reviews, meta-analyses, interventional studies, and guidelines. Evidence was classified as direct, component (multimodal), or extrapolated. Results: A favourable signal arises from progressive multimodal physical activity programmes, though evidence certainty is low and active components cannot be isolated. Yoga and assessment-guided pelvic floor training have direct, population-specific support. No validated endometriosis-specific FITT (Frequency, Intensity, Time, Type) training protocol is established. Modality selection should reflect dominant symptoms, pelvic floor findings, and responses to physical loading. Conclusions: Targeted physical activity is a valuable management component, but a universal training prescription is currently unjustified. A symptom-responsive framework is offered to guide exercise professionals; comparative dose-finding sports science trials are required before firm recommendations can be made.

Background: Abnormal uterine bleeding (AUB) is a frequent gynecological disorder affecting women of reproductive age and beyond. It presents as irregular, heavy, or prolonged bleeding, negatively impacting the quality of life for a significant proportion of women globally. The FIGO PALM-COEIN classification facilitates the distinction between structural and non-structural etiologies of AUB, supporting evidence-based management strategies. Objective: To analyze the pharmacological treatments, causative factors, risk profile, and management approaches for AUB in women attending the Obstetrics and Gynecology Department at MIMS Tertiary Care Hospital, Mandya. Methodology: This prospective crosssectional observational study enrolled 172 women aged 18—50 years who presented with AUB. Patient demographic information, menstrual history, comorbidities, structural findings (via USG and PALM-COEIN classification), diagnostic modalities, and treatment regimens were systematically recorded and analyzed utilizing descriptive statistics and a structured patient profile format. Results: Women aged 39—50 years comprised the majority of cases (51%), with irregular heavy bleeding being reported by 76.2%, frequently accompanied by pelvic pain and dysmenorrhea (55.2%). Thyroid disorders were the predominant comorbidity (87%), followed by PCOS (7%) and diabetes (3%). Structural etiologies determined using PALM-COEIN classification revealed leiomyoma as the leading cause (54.7%), with polyp (19.8%), adenomyosis (15.1%), and endometriosis (10.5%) also commonly seen. Most cases (64%) were managed surgically, while 36% received medical treatment. Meprate (48.4%) and Regesterone (33.9%) were the preferred oral hormonal agents, both representing progestin therapy. Paracetamol was the most commonly prescribed analgesic (51.9%), and Tranexamic acid (53%) was slightly favored over Mefenamic acid (47%) for antifibrinolytic intervention. Postoperative support centered on iron and vitamin supplementation, with Metronidazole and Ceftriaxone as the primary antibiotic regimen. Conclusion: AUB most often affects middleaged women, manifesting with irregular heavy bleeding and thyroid gland dysfunction as the most frequent comorbidity. Leiomyoma remains the principal structural cause. Surgical management predominates, while rational, individualized medical therapy supports comprehensive, patient-centered care. Early diagnosis and tailored treatment improve outcomes in AUB

La endometriosis es una enfermedad inflamatoria crónica, estrógeno-dependiente y heterogénea, asociada con dolor pélvico, infertilidad y deterioro significativo de la calidad de vida. Durante los últimos años, su abordaje ha experimentado una transformación sustancial, particularmente por el abandono progresivo de la laparoscopia como requisito universal para establecer el diagnóstico, el mayor protagonismo de la evaluación clínica y de las técnicas de imagen especializadas, y la incorporación de nuevas alternativas farmacológicas. El objetivo de esta revisión fue analizar críticamente la evidencia contemporánea sobre el diagnóstico y tratamiento de la endometriosis, integrando estrategias farmacológicas, quirúrgicas y reproductivas, así como los avances dirigidos hacia una atención individualizada. Se realizó una revisión narrativa estructurada de literatura científica y guías clínicas, priorizando publicaciones entre 2020 y 2026. El manejo actual debe orientarse por los síntomas, fenotipo y localización de la enfermedad, edad, deseo reproductivo, reserva ovárica, tratamientos previos y preferencias de la paciente. Las terapias hormonales continúan siendo fundamentales para el control del dolor, mientras que los antagonistas de la hormona liberadora de gonadotropinas amplían las opciones en casos refractarios. La cirugía mantiene indicaciones específicas y requiere una valoración individualizada, especialmente ante endometriomas, endometriosis profunda e infertilidad. La evidencia actual favorece un modelo longitudinal, multidisciplinario y centrado en la paciente.

Some women with adenomyosis respond poorly to progestins, and conventional grey-scale ultrasound cannot reliably identify them before treatment. This thesis reviews studies published in 2022–2025 on ultrasound elastography of adenomyotic lesions. Lesion stiffness is higher than that of normal myometrium, is accompanied by higher expression of fibrosis markers and correlates with the severity of dysmenorrhoea. In women treated with dienogest for six months, higher lesion stiffness was associated with symptom relapse after treatment was stopped. No study has yet reported a stiffness threshold that predicts insufficient response during treatment. Elastography therefore deserves evaluation as a component of prognostic models of response to progestin therapy.

Polypoid endometriosis (PEM) is a rare form of endometriosis characterized by polyp-like lesions and atypical clinical and imaging features. Although PEM is generally benign, extensive abdominopelvic involvement and unusual manifestations may create substantial diagnostic challenges. Massive hemorrhagic ascites is exceptionally uncommon in PEM, and its clinical characteristics and management remain poorly described. A 41-year-old woman presented with progressive postmenstrual abdominal distension for four months, with marked worsening during the last week. She had a history of adenomyosis and surgically confirmed ovarian endometriosis. Imaging demonstrated mixed adnexal masses, massive ascites, and omental thickening, while serum CA125 and CA19-9 levels were elevated. Approximately 4000 mL of hemorrhagic ascites was drained by ultrasound-guided paracentesis, and cytologic examination showed no malignant cells. Laparoscopic exploration revealed extensive dense adhesions and multiple friable polyp-like lesions diffusely involving the abdominopelvic cavity, omentum, and mesentery. Intraoperative frozen-section examination revealed benign findings, and final histopathological examination confirmed PEM. Whole-exome sequencing identified a BMP4 p.H251Y missense variant. Postoperatively, the patient received 6 courses of GnRHa therapy followed by Dienogest, with no evidence of recurrence during 9 months of follow-up. This case highlights an exceptionally rare presentation of PEM characterized with massive hemorrhagic ascites and extensive abdominopelvic lesions, closely mimicking advanced gynecologic malignancy. Increased awareness of this unusual presentation, together with appropriate clinical assessment, may facilitate accurate diagnosis and help avoid unnecessarily radical surgery. Given the limited number of reported PEM cases, further studies are needed to clarify the pathogenesis and optimal postoperative management of this rare disease.

В тезисе рассмотрены исследования 2021–2025 гг. о клинических и ультразвуковых признаках, позволяющих до начала лечения заподозрить недостаточный эффект диеногеста у пациенток с аденомиозом. Худший долгосрочный результат связан со старшим возрастом и высоким уровнем CA-125, а объём матки более 352,7 см³ указывает на повышенный риск неудачи терапии. Диффузная форма аденомиоза и сопутствующая миома ассоциированы с более слабым ответом. Длинник матки и толщина миометрия по данным трансвагинального исследования предсказывают кровотечения, из-за которых препарат чаще всего отменяют. Признаки MUSA связаны с тяжестью симптомов, но как предикторы ответа на диеногест не изучались. Предложен минимальный набор показателей для оценки перед назначением препарата.

Corrected R1 release accompanying the revised manuscript submitted to the International Journal of Women's Health (manuscript 643362). This archive contains analysis code, cached inputs, derived result tables, reproducibility instructions and file checksums. The revision corrects variant-identity matching and duplicate handling, recalculates multiple-testing and power analyses, updates complete-window colocalization, and reanalyzes GSE7305 using paired samples. The corrected screen includes 9,157 unique gene–cell-type tests and prioritizes 10 genes across 28 MR/colocalization pairs. These findings support exploratory genetic prioritization and do not establish therapeutic efficacy. The README documents the reproducible analyses, archived ancillary results and remaining limitations.This record provides the corrected R1 analysis code and derived results for manuscript 643362. It supersedes the analysis files in the earlier deposit (https://doi.org/10.5281/zenodo.21234009) for the revised manuscript.

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Ovarian fibromas are uncommon benign sex cord-stromal tumors that frequently present as unilateral solid masses and may mimic ovarian malignancy, particularly in postmenopausal women.Preoperative diagnosis remains challenging because imaging findings and tumor markers often overlap with those of other adnexal lesions.We present the case of an ovarian fibroma initially misdiagnosed as an endometrioma, illustrating the limitations of preoperative assessment.We report the case of a 60-year-old postmenopausal woman with an incidentally detected right adnexal mass initially interpreted as an endometrioma on transvaginal ultrasound and computed tomography (CT).The patient subsequently underwent laparoscopic resection, and histopathological examination confirmed the diagnosis of ovarian fibroma.Ovarian fibromas may mimic other adnexal masses, making preoperative diagnosis challenging.Imaging studies and serum tumor markers have limited specificity and may be insufficient to reliably distinguish these tumors from other ovarian lesions.In postmenopausal women, persistent solid adnexal masses generally warrant surgical exploration regardless of ancillary findings.Therefore, definitive diagnosis of ovarian fibroma relies on histopathological examination.Ovarian fibroma remains an important differential diagnosis of solid adnexal masses in postmenopausal women.The limitations of preoperative assessment reinforce the role of surgical excision, while histopathological examination remains the gold standard for definitive diagnosis.

Endometriosis and adenomyosis are characterized by the presence of endometrial-like tissue outside its normal anatomical location and are associated with pain, infertility, and other clinical manifestations. Although they share pathogenic features, including inflammation, hormonal responses, immune dysregulation, and fibrosis, their clinical and histopathological phenotypes are highly heterogeneous. This review integrates tissue mechanics and mechanobiology with inflammation, hormonal signaling, oxidative stress, angiogenesis, and neurogenesis to propose a microenvironment-dependent framework for understanding lesion formation, maintenance, and progression. Direct measurements of tissue stiffness, including elastography, have been reported, but standardized comparisons among lesion types remain limited. Existing evidence suggests that tissue stiffening may affect cellular proliferation, invasion, fibrosis, and tissue remodeling through mechanotransduction pathways such as integrin signaling. However, much of this evidence derives from in vitro studies, experimental models, or other fibrotic diseases, and direct causal relationships in human endometriosis and adenomyosis remain insufficiently established. Conversely, chronic inflammation, recurrent bleeding, and ECM accumulation may contribute to both tissue stiffening and fibrosis, indicating reciprocal interactions between mechanical and biological processes. Thus, lesion phenotypes may reflect interactions among lesion origin, cell-intrinsic properties, and the local microenvironment. Mechanobiology may complement established inflammatory, hormonal, immune, and fibrotic concepts and provide hypotheses for understanding lesion heterogeneity and progression. Longitudinal, lesion-level studies integrating mechanical and biological parameters are needed to test these hypotheses.

Ectopic adrenal cortical tissue (EACT) is an uncommon developmental heterotopia and is exceptionally rare in the ovary of adult women. A 52-year-old woman, 6 years after menopause, was evaluated for progressive enlargement of a uterine leiomyoma and postmenopausal spotting. Transvaginal ultrasonography and pelvic magnetic resonance imaging demonstrated multiple uterine leiomyomas but no adnexal mass or endometrioma. During total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, dense adhesions between the sigmoid colon and posterior cul-de-sac were unexpectedly encountered. Histopathologic examination of the adhesion-related tissue revealed neither endometriosis nor significant inflammatory change. Microscopic examination of the ovary identified a 1.9 mm, sharply circumscribed nodule composed of clear, vacuolated zona fasciculata-like cells and compact eosinophilic zona reticularis-like cells. The lesional cells showed diffuse Melan-A immunoreactivity and focal-to-patchy inhibin-α positivity, supporting adrenocortical differentiation. The findings established a diagnosis of ovarian EACT. This case emphasizes that microscopic ovarian adrenal rests may be radiologically occult and should be distinguished from ovarian steroidogenic neoplasms by integrating clinical, morphologic, and immunohistochemical findings.

Pelvic pain may persist despite guideline-concordant endometriosis care. Evidence for primary motor cortex repetitive transcranial magnetic stimulation (M1-rTMS) in this population is limited. We assessed daily pain and activity interference, treatment delivery and safety after clinically indicated M1-rTMS. A prospective, single-centre observational cohort enrolled women with confirmed endometriosis and chronic pelvic pain. Ten left M1-rTMS sessions were scheduled over two weeks (10 Hz, 80% resting motor threshold, 1500 pulses/session). Daily diaries recorded pelvic pain and activity interference during pre-treatment, treatment, and post-treatment days 1–28 and week 8. Changes were estimated using linear mixed-effects models. Forty-two participants were enrolled and 40 initiated treatment; analyses included 37 for pain and 35 for interference. Model-based marginal mean pain decreased from 5.69 to 4.69 (change, −1.00; 95% CI, −1.46 to −0.55; p < 0.001), and interference from 6.03 to 4.63 (change, −1.39; 95% CI, −1.84 to −0.95; p < 0.001). Both remained below pre-treatment at week 8. Ten of 34 evaluable participants achieved ≥30% pain reduction and three achieved ≥50%. Of the 400 planned sessions, 386 were delivered; a total of 33/40 participants attended all ten and 38/40 at least eight. Twenty-eight participants reported 47 treatment-emergent adverse events; one was severe, none was serious, and all were resolved. M1-rTMS was feasible to deliver with high protocol fidelity and acceptable tolerability. Modest reductions in pain and activity interference were observed, although clinically important pain relief occurred in a minority; without a sham, usual-care, or untreated comparator, these changes cannot be attributed causally to rTMS. Controlled trials are required to determine efficacy and optimal dosing.

We report a case of a 55-year-old female who presented to the emergency department with symptoms of appendicitis.Imaging demonstrated appendiceal mucocele and possible early appendicitis.She underwent a laparoscopic appendectomy and subsequent histopathology demonstrated irregular fibrosis of the appendiceal wall as a result of endosalpingiosis with secondary mucocele formation.In this report, we present an exceedingly rare case of endosalpingiosis causing an appendicitis mimic.Although endosalpingiosis is typically considered a benign incidental finding, appendiceal involvement can mimic acute appendicitis, as in this case, and may be associated with an increased risk of gynecologic malignancy.The patient was followed up with the gynecological team due to this malignancy risk and is planned for laparoscopic oophorectomy, with the final histopathology diagnosis being appendiceal endosalpingiosis with secondary mucocele.

Endosalpingiosis (ES) is a benign, nonneoplastic condition of the Müllerian system characterized by the ectopic implantation of fallopian tube-like ciliated columnar epithelium. Unlike endometriosis, ES lacks endometrial stroma and therefore does not produce the characteristic hemorrhagic episodes or extensive inflammatory responses associated with endometriosis. Although ES is primarily identified in the visceral pelvic peritoneum, extrapelvic manifestations are exceedingly rare, with pulmonary and pleural localization, accounting for ∼0.1% of reports. This report describes the clinical presentation of thoracic ES in a 40-year-old woman who presented with catamenial spontaneous primary pneumothorax. Despite a remote surgical history for ovarian endometriosis 10 years earlier, the patient had a prolonged period of clinical latency and no evidence of current pelvic recurrence. Videothoracoscopic surgery revealed a 5-mm apical pulmonary nodule and diffusely calcified pleural plaques. Histopathology and immunohistochemistry are remain gold-standard diagnostic methods for differentiating ES from thoracic endometriosis syndrome or malignancy. The diagnosis was confirmed by epithelial immunoreactivity for Müllerian transcription factors (PAX8 and WT1), keratin 7, and estrogen/progesterone receptors, together with the absence of cluster of differentiation 10 expression, which argued against endometrial stroma, and calretinin negativity, which argued against mesothelial origin. The pathophysiology of thoracic ES may resemble that of pulmonary endometriosis, involving transdiaphragmatic or vascular migration of Müllerian cells. For symptomatic presentations, surgical excision combined with long-term suppressive hormonal therapy is recommended to reduce epithelial proliferation. Given that the emerging literature suggests a possible link between ES and gynecological malignancies, rigorous long-term postoperative surveillance remains essential.

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