Endometriosis is a chronic, estrogen-dependent, inflammatory disease characterized by the growth of endometriotic tissue outside the uterus. Among the wide spectrum of clinical manifestations of endometriosis, chronic pelvic pain, dysmenorrhea, dyspareunia and subfertility are the main symptoms that significantly reduce the quality of life of affected women. Despite the fact that endometriosis is considered a benign disease, it shares some features typical of malignant tumors. One of them is abnormal morphology, which indicates atypia of the glandular epithelium without signs of hyperplasia, or it may be glandular hyperplasia, which may or may not be accompanied by cellular atypia. This situation is reflected in the term atypical endometriosis, the diagnosis of which is not easy. Cellular atypia of a severe degree can be of reactive origin, so the mutual differentiation of dysplastic and reactive changes in endometriotic tissue is limited and problematic. Our working group from the scientific center for the treatment of endometriosis at the Znojmo Hospital recently dealt with atypical endometriosis and pointed out the potential utility of immunohistochemistry in its diagnosing. Using a simple immunohistochemical panel with antibodies against estrogen receptors, progesterone receptors, and the tumor suppressor p53, we found significantly lower levels of hormone receptor expression and increased p53 expression in atypical endometriosis compared to normal (typical) endometriosis. Due to the low number of cases analyzed and the inconsistent results of studies dealing with hormone receptors (and other markers) in atypical endometriosis, the usefulness of the immunohistochemical panel described in our study must be verified on a larger number of cases. In routine histopathological practice, atypical endometriosis is not a well-known entity. However, it is important to become familiar with it because its presence is associated with a higher incidence of a certain group of tumors known as endometriosis-associated cancers, especially endometrioid carcinoma and clear cell carcinoma.

• Klíčová slova
• atypical endometriosis, endometriosis-associated ovarian cancer, hormone receptors, immunohistochemistry, p53,
• MeSH
• endometrióza * patologie   diagnóza   MeSH
• imunohistochemie MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Circulating endometrial cells (CECs) have emerged as a new biomarker of advanced disease in women with endometriosis. The identification of several subtypes of CECs (e.g., stem cell-like, epithelial, glandular, stromal) has opened the way for characterization of endometriosis-associated CECs. This study focused on the isolation and characterization of CECs and disseminated endometrial cells (DECs) in patients with spontaneous pneumothorax (SP). The primary objective was to differentiate between cancer and non-cancer cells in patients with no previous cancer diagnosis. The MetaCell® size-based separation protocol was used to enrich CECs/DECs. Evaluation of the captured cells by 3D microscopy was performed using a NANOLIVE™ microscope using a holographic approach. Based on gene expression analysis (GEA), we can conclude that mitochondria are much more active in primary tumors compared to endometriosis tissue (e.g. MT-ND1, MT-ATP6 genes). The culture of DECs is made of stromal, stem and immune cells. In vitro culture of DECs is characterized by an increase in the epithelial marker KRT18. Similarly, NFE2L2, a proerythroid factor, is also elevated. Further, a significant decrease in the amount of stem and immune cells was observed in the cell culture of DECs. The data presented here show how morphologically plastic the changes in the mitochondrial network can be and how cells can reflect them at the level of gene expression. The markers identified could help in the accompanying diagnostic process of the spontaneous pneumothorax in women of reproductive age.

• MeSH
• dospělí MeSH
• endometrióza * patologie   diagnóza   genetika   MeSH
• endometrium patologie   metabolismus   MeSH
• lidé MeSH
• mitochondrie * metabolismus   patologie   MeSH
• pneumotorax * patologie   diagnóza   MeSH
• stanovení celkové genové exprese metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Endometriosis is a common gynecological disease caused by the implantation of active endometrial cells outside the uterine cavity. In most cases, endometriosis occurs in the pelvic area, such as the ovary, Douglas' pouch, or uterine sacral ligament. Some rare cases of extrapelvic endometriosis can also occur in the perineum, urinary system, gastrointestinal tract, nervous system, chest, subcutaneous tissue, and skin. Endometriosis of the perineum is usually secondary to obstetric trauma, such as perineal laceration or episiotomy. To date, few cases of spontaneous perineal endometriosis have been reported. Herein, we report a rare case of spontaneous deep perineal endometriosis. Notably, the patient had typical symptoms of regular pain during menstruation with no history of delivery or perineal trauma. The patient recovered well after postoperative gonadotropin releasing hormone agonist injection.

• Klíčová slova
• Endometriosis, case report, perineum, primary,
• MeSH
• bolest MeSH
• endometrióza * diagnóza   MeSH
• epiziotomie MeSH
• lidé MeSH
• pánev MeSH
• perineum MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

Endometriosis is a chronic disease characterised by the presence of endometrial tissue outside the uterine cavity, affecting 5-15% of women, especially those of reproductive age. The disease may manifest itself as dysmenorrhoea, dyspareunia, sterility and chronic pelvic pain, among other symptoms. Although it is not malignant, it shares some characteristics with cancer and can lead to epithelial ovarian carcinoma. The risk of malignant transformation of endometriosis is estimated at 1% in premenopausal women and 1-2.5% in postmenopausal women. Our case report describes a 46-year-old female patient with long-standing abdominal pain and a history of surgically confirmed endometriosis. Imaging revealed a cystic mass in the left mesogastrium, which was subsequently surgically removed. Histological examination confirmed the presence of a low-grade endometrioid carcinoma arising from an extragenital endometriosis lesion. Following surgical treatment, the patient underwent adjuvant chemotherapy, after which she was in complete remission. The diagnosis of malignant transformation of endometriosis is complex, requiring a combination of thorough clinical examination, imaging, and histopathological verification. Therapy involves radical surgery and possibly adjuvant chemotherapy, similar to ovarian carcinomas. Despite advances in treatment and research, endometriosis remains a complex disease with unclear aetiology, heterogeneous clinical presentation, and risk of malignant transformation.

• Klíčová slova
• Endometriosis, diagnosis, endometriosis– malignant transformation, extragenital lesion, treatment, type 2 diabetes,
• MeSH
• endometrióza * patologie   komplikace   diagnóza   MeSH
• endometroidní karcinom * patologie   diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádorová transformace buněk * patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: The aim of this study is to evaluate serum copper (Cu) and zinc (Zn) levels in patients with epithelial ovarian cancer and endometrioma. MATERIALS AND METHODS: We included 21 epithelial ovarian cancer patients, 47 endometrioma patients, 31 healthy women of reproductive age, and 10 healthy women in menopause. Cu and Zn levels and Cu/Zn ratios were compared. RESULTS: In the endometrioma group, Cu levels (P = 0.04) and Cu/Zn ratio (P < 0.01) were higher, while Zn levels (P < 0.01) were lower compared to the control group. The threshold value of 1.15 with 62% sensitivity and 61% specificity was calculated for the Cu/Zn ratio using the ROC curve (AUC = 0.688; P = 0.005). In the ovarian cancer group, Cu levels (P ≤ 0.01) and Cu/Zn ratio (P = 0.02) were higher, whereas Zn levels (P ≤ 0.02) were lower compared to the control group. The Cu/Zn ratio threshold value of 1.37 was calculated with 76% sensitivity and 90% specificity (AUC = 0.829; P = 0.004). The Zn level was lower (P = 0.02), and the Cu/Zn ratio was higher (P = 0.01) in the ovarian cancer group compared to the endometrioma group. CONCLUSION: The threshold value of the Cu/Zn ratio for ovarian cancer could be determined with a specificity of 90%, whereas the sensitivity and specificity of the Cu/Zn ratio for endometrioma were low.

• Klíčová slova
• copper, Zinc, copper zinc ratio, endometrioma, ovarian cancer,
• MeSH
• dítě MeSH
• endometrióza * diagnóza   MeSH
• epiteliální ovariální karcinom MeSH
• lidé MeSH
• měď MeSH
• nádory vaječníků * diagnóza   MeSH
• zinek MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• měď MeSH
• zinek MeSH

OBJECTIVE: We present two case reports of asymptomatic ureteral endometriosis leading to hydronephrosis. We demonstrate the significance of routine ultrasound scanning of the upper urinary tract in patients with dia gnosed deep infiltrating endometriosis. CASE REPORTS: The first case report describes a symptomatic patient after a surgery for deep endometriosis. After the surgery, she was completely without symptoms, but during regular check-ups she developed progressive hydronephrosis on the right side and it did not respond to conservative treatment. Surgery deliberation of the ureter was indicated. The second case report describes a patient with already developed severe hydronephrosis on the left side. The functional kidney examination proved complete renal loss of the left kidney. Because of recurrent pyelonephritis in the nonfunctional kidney, nephrectomy was indicated. CONCLUSION: Ureteral endometriosis presents a rare, but insidious form of endometriosis, which is very often asymptomatic and diagnosed at a later stage. It can cause a complete silent loss of renal function. Routine ultrasound scanning examination of the upper urinary tract in all patients with diagnosed endometriosis could prevent this severe complication.

• Klíčová slova
• hydronephrosis, routine US scanning, ureteral endometriosis,
• MeSH
• endometrióza * diagnóza   diagnostické zobrazování   MeSH
• hydronefróza * diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• nemoci močovodu * diagnóza   diagnostické zobrazování   MeSH
• ultrasonografie MeSH
• ureter * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Endometriosis is a complex and chronic estrogen-dependent disease, affecting a significant proportion of women of reproductive age. Despite the long interest and extensive research, the pathogenesis of the disease is still debated. Although available non-invasive diagnostic methods have adequate accuracy, an invasive approach by laparoscopy is often necessary to obtain histological confirmation. In this scenario, the search for an accurate, reliable, cost-effective, clinically applicable non-invasive biomarker plays a crucial role in a potentially early diagnosis and, in this way, shape the future management of the disease. Considering these elements, the current review aims to summarize the most significant and novel results about biomarkers for the diagnosis and follow-up of women affected by endometriosis.

• Klíčová slova
• Biomarker, CA-125, Endometriosis, Human epididymis protein 4, Immunology, MicroRNA, Stem cells,
• MeSH
• biologické markery MeSH
• endometrióza * diagnóza   patologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• biologické markery MeSH

OBJECTIVES: The primary aim was to investigate the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the mapping of deep pelvic endometriosis (DE) in a diseased population. The secondary aim was to offer first insights into the clinical applicability of the new International Deep Endometriosis Analysis group (IDEA) consensus for sonographic evaluation, which was also adapted for MRI and surgical reporting in this study. METHODS: The study was a prospective observational cohort study. In this study, consecutive women planned for surgical treatment for DE underwent preoperative mapping of pelvic disease using TVS and MRI (index tests). The results were compared against the intraoperative findings with histopathological confirmation (reference standard). In case of disagreement between intraoperative and pathology findings, the latter was prioritised. Index tests and surgical findings were reported using a standardised protocol based on the IDEA consensus. RESULTS: The study ran from 07/2016 to 02/2018. One-hundred and eleven women were approached, but 60 declined participation. Out of the 51 initially recruited women, two were excluded due to the missing reference standard. Both methods (TVS and MRI) had the same sensitivity and specificity in the detection of DE in the upper rectum (UpR) and rectosigmoid (RS) (UpR TVS and MRI sensitivity and specificity 100%; RS TVS and MRI sensitivity 94%; TVS and MRI specificity 84%). In the assessment of DE in the bladder (Bl), uterosacral ligaments (USL), vagina (V), rectovaginal septum (RVS), and overall pelvis (P), TVS had marginally higher specificity but lower sensitivity than MRI (Bl TVS sensitivity 89%, specificity 100%, MRI sensitivity 100%, specificity 95%; USL TVS sensitivity 74%, specificity 67%, MRI sensitivity 94%, specificity 60%; V TVS sensitivity 55%, specificity 100%, MRI sensitivity 73%, specificity 95%; RVS TVS sensitivity 67%, specificity 100%, MRI sensitivity 83%, specificity 93%; P TVS sensitivity 78%, specificity 97%, MRI sensitivity 91%, specificity 91%). No significant differences in diagnostic accuracy between TVS and MRI were observed except USL assessment (p=0.04) where MRI was significantly better and pouch of Douglas obliteration (p=0.04) where MRI was significantly better and pouch of Douglas obliteration (κ) = 0.727 [p=0.04) where MRI was significantly better and pouch of Douglas obliteration (κ) = 0.727 [p=0.04) where MRI was significantly better and pouch of Douglas obliteration (p=0.04) where MRI was significantly better and pouch of Douglas obliteration (. CONCLUSION: We found that both imaging techniques had overall good agreement with the reference standard in the detection of deep pelvic endometriosis. This is the first study to date involving the IDEA consensus for ultrasound, its modified version for MRI, and intraoperative reporting of deep pelvic endometriosis in clinical practice.

• MeSH
• dospělí MeSH
• endometrióza diagnóza   patologie   MeSH
• konsensus MeSH
• lidé MeSH
• ligamenta patologie   MeSH
• magnetická rezonanční tomografie MeSH
• močový měchýř patologie   MeSH
• pánev patologie   MeSH
• prospektivní studie MeSH
• rektum patologie   MeSH
• senzitivita a specificita MeSH
• ultrasonografie metody   MeSH
• uterus patologie   MeSH
• vagina patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Cíl studie: Shrnutí současných poznatků a trendů v oblasti diagnostiky endometriózy. Typ studie: Literární přehled. Název a sídlo pracoviště: Centrum pro komplexní léčbu endometriózy a Onkogynekologické centrum, Gynekologicko-porodnická klinika, 1. lékařská fakulta, Univerzita Karlova a Všeobecná fakultní nemocnice Praha; Department of Gynaecology and Obstetrics, Burton Hospitals NHS, UK. Metodika: Systematický přehledový článek. Výsledky: Diagnóza endometriózy v primární péči je stanovena na podkladě anamnézy, fyzikálního vyšetření a základního ultrazvukového vyšetření, které zobrazí přítomnost endometroidních cyst, adenomyózy a nepřímé známky srůstů. Použití krevních či močových biomarkerů se nedoporučuje. Pacientky s podezřením na přítomnost endometriózy by měly být odeslány do specializovaného centra léčby endometriózy, kde jsou k dispozici zkušení sonografisté anebo radiologové v rámci expertního ultrazvuku anebo magnetické rezonance a specializovaný chirurgický tým. Vysoká diagnostická přesnost obou zobrazovacích metod nepodporuje rutinní využití laparoskopie v diagnostice endometriózy, může však být zvažována k vyloučení povrchové anebo extrapelvické endometriózy u symptomatických pacientek s negativním nálezem při zobrazovacích metodách. Závěr: Během základního ultrazvukového vyšetření by ošetřující gynekolog měl být schopen zobrazit přítomnost endometroidních cyst, adenomyózy a nepřímé známky adhezí a na základě ultrazvukového nálezu anebo typických symptomů odeslat pacientku do centra pro léčbu endometriózy. Expertní ultrazvukové vyšetření pánevní endometriózy je obvykle dostupné ve specia-lizovaných centrech léčby endometriózy. Vzhledem k vysoké diagnostické přesnosti ultrazvuku, jeho běžné dostupnosti v gynekologii, nižší ceně a absenci kontraindikací ve srovnání s magnetickou rezonancí je ultrazvuk metodou volby v zobrazení rozsáhlé pánevní endometriózy, zatímco magnetická rezonance je využívána jako metoda druhé volby v obtížných případech.

• Klíčová slova
• adenomyóza, endometrióza, endometroidní cysta, hluboká endometrióza, magnetická rezonance, ultrazvuk,
• MeSH
• endometrióza * diagnóza   MeSH
• lidé MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To present case report of patient with repeted endoscopic resections of deep infiltrating endometriosis (DIE) to demonstrate its possible risks for subsequent delivery. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Central Moravian Hospital Trust, Member of Agel holding, Prostějov, Czech Republic; Department of Obstetrics and Gynecology, Vyškov Hospital, Czech Republic; Department of Pathology, Vyškov Hospital, Czech Republic; Department of Pathology, University Hospital Brno, Medical faculty, Masaryk University Brno, Czech Republic; Department of Obstetrics and Gynecology, Palacky University, Faculty of Medicine and Dentistry, Olomouc, Czech Republic. METHODS AND RESULTS: We are presenting a case of 29 years old patient with multiple laparoscopic surgery for deep infiltrating endometriosis (DIE). At the same time, new risks are posed to the delivery process like a severe injuries of the uterine attachment aparate, vagina, parametria with the risk of developing life threatening bleeding. These case we presented here demonstrates the emergence of new risks and complications for another pregnancy with such women. CONCLUSION: Our case report demonstrates new possible obstetric risk factors as consequence of increasing radicality in surgical treatment of DIE.

• Klíčová slova
• DIE, deep infiltrating endometriosis, intrapartal uterine rupture, laparoscopy, life-threatening peripartal bleeding, life-threatening peripartal bleeding laparoscopy.,
• MeSH
• dospělí MeSH
• endometrióza diagnóza   chirurgie   MeSH
• komplikace těhotenství etiologie   MeSH
• laparoskopie škodlivé účinky   metody   MeSH
• lidé MeSH
• močový měchýř patofyziologie   MeSH
• ruptura dělohy etiologie   MeSH
• těhotenství MeSH
• vagina patofyziologie   MeSH
• výsledek těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Česká republika MeSH