- Jose Joseph, MD
Jose Joseph, MD
- Professor of Medicine
- UCSF, Fresno
Endometriosis is defined as the presence of endometrial glands in stroma outside the confines of the uterine cavity and musculature. Growth and maintenance of endometriotic implants is dependent upon the presence of ovarian steroids, and therefore endometriosis occurs almost exclusively among women of reproductive age or among those on estrogen replacement therapy . However, endometriosis has also been described in men receiving estrogen .
Endometriosis most commonly involves structures within the pelvis, particularly the ovaries, cul-de-sac, broad ligaments, and uterosacral ligaments. However, endometrial tissue can be found outside of the pelvis in the abdomen, thorax, brain, and skin .
The thoracic endometriosis syndrome (TES) will be reviewed here. Issues related to the general clinical features and treatment of endometriosis are discussed separately. (See "Pathogenesis, clinical features, and diagnosis of endometriosis" and "Overview of the treatment of endometriosis".)
Several hypotheses have been proposed to explain the pathogenesis of pelvic and thoracic endometriosis. The Sampson’s theory of retrograde menstruation through fallopian tube leading to auto-transplantation of endometrial tissue into the peritoneal cavity has been proposed as one mechanism . However, a meta-analysis suggested that endometrial tissue differed significantly from eutopic endometrium in clonality, enzymatic activity, protein expression, and histologic properties . Decreased apoptosis causing failure of the normal mechanisms that clear ectopic endometrial cells has also been suggested as a potential mechanism . Altered immune responses leading to the failure to clear peritoneal endometrial tissue, has been reported . Finally, development of ectopic endometrial tissue from a group of multipotential cells residing within the endometrial basal cell layer capable of transformation into endometrial cells has been proposed as mechanism [8,9].
The potential mechanism for migration of endometrial tissue from the pelvis to the thoracic cavity also remains uncertain. Possible routes include microembolization through the pelvic veins [1,10,11], and trans-diaphragmatic movement through diaphragmatic defects [12-14]. The hypothesis that microembolization might be a pathogenic mechanism has been questioned, as micro-embolization would be expected to affect both hemithoraces approximately equally, but TES has an overwhelming occurrence in the right hemithorax . In addition, the relatively high prevalence of pelvic endometriosis in women of reproductive age suggests that a comparably high number of TES cases would occur, if micro-embolization were the mechanism . Instead, the relatively low prevalence of TES makes micro-embolization a less likely explanation.
- Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 1996; 100:164.
- Schrodt GR, Alcorn MO, Ibanez J. Endometriosis of the male urinary system: a case report. J Urol 1980; 124:722.
- Jubanyik KJ, Comite F. Extrapelvic endometriosis. Obstet Gynecol Clin North Am 1997; 24:411.
- Vinatier D, Orazi G, Cosson M, Dufour P. Theories of endometriosis. Eur J Obstet Gynecol Reprod Biol 2001; 96:21.
- Redwine DB. Was Sampson wrong? Fertil Steril 2002; 78:686.
- Szymanowski K. Apoptosis pattern in human endometrium in women with pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol 2007; 132:107.
- Hever A, Roth RB, Hevezi P, et al. Human endometriosis is associated with plasma cells and overexpression of B lymphocyte stimulator. Proc Natl Acad Sci U S A 2007; 104:12451.
- O'Connell JT, Mutter GL, Cviko A, et al. Identification of a basal/reserve cell immunophenotype in benign and neoplastic endometrium: a study with the p53 homologue p63. Gynecol Oncol 2001; 80:30.
- Mok-Lin EY, Wolfberg A, Hollinquist H, Laufer MR. Endometriosis in a patient with Mayer-Rokitansky-Küster-Hauser syndrome and complete uterine agenesis: evidence to support the theory of coelomic metaplasia. J Pediatr Adolesc Gynecol 2010; 23:e35.
- PARK WW. The occurrence of decidual tissue within the lung; report of a case. J Pathol Bacteriol 1954; 67:563.
- Duke R, Fawcett P, Booth J. Recurrent subarachnoid hemorrhage due to endometriosis. Neurology 1995; 45:1000.
- Leong AC, Coonar AS, Lang-Lazdunski L. Catamenial pneumothorax: surgical repair of the diaphragm and hormone treatment. Ann R Coll Surg Engl 2006; 88:547.
- Redwine DB. Diaphragmatic endometriosis: diagnosis, surgical management, and long-term results of treatment. Fertil Steril 2002; 77:288.
- Funatsu K. Catamenial pneumothorax: an example of porous diaphragm syndromes? Chest 2002; 122:1865; author reply 1865.
- Channabasavaiah AD, Joseph JV. Thoracic endometriosis: revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine (Baltimore) 2010; 89:183.
- Guo SW, Wang Y. The prevalence of endometriosis in women with chronic pelvic pain. Gynecol Obstet Invest 2006; 62:121.
- Cooper MJ, Russell P, Gallagher PJ. Diaphragmatic endometriosis. Med J Aust 1999; 171:142.
- Cowl CT, Dunn WF, Deschamps C. Visualization of diaphragmatic fenestration associated with catamenial pneumothorax. Ann Thorac Surg 1999; 68:1413.
- Korom S, Canyurt H, Missbach A, et al. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg 2004; 128:502.
- Yamashita J, Iwasaki A, Kawahara K, Shirakusa T. Thoracoscopic approach to the diagnosis and treatment of diaphragmatic disorders. Surg Laparosc Endosc 1996; 6:485.
- Soderberg CH, Dahlquist EH. Catamenial pneumothorax. Surgery 1976; 79:236.
- Joseph J, Reed CE, Sahn SA. Thoracic endometriosis. Recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis. Chest 1994; 106:1894.
- Alifano M, Jablonski C, Kadiri H, et al. Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery. Am J Respir Crit Care Med 2007; 176:1048.
- Legras A, Mansuet-Lupo A, Rousset-Jablonski C, et al. Pneumothorax in women of child-bearing age: an update classification based on clinical and pathologic findings. Chest 2014; 145:354.
- Kim CJ, Nam HS, Lee CY, et al. Catamenial hemoptysis: a nationwide analysis in Korea. Respiration 2010; 79:296.
- Elliot DL, Barker AF, Dixon LM. Catamenial hemoptysis. New methods of diagnosis and therapy. Chest 1985; 87:687.
- Kalapura T, Okadigwe C, Fuchs Y, et al. Spiral computerized tomography and video thoracoscopy in catamenial pneumothorax. Am J Med Sci 2000; 319:186.
- Hope-Gill B, Prathibha BV. Catamenial haemoptysis and clomiphene citrate therapy. Thorax 2003; 58:89.
- Zaatari GS, Gupta PK, Bhagavan BS, Jarboe BR. Cytopathology of pleural endometriosis. Acta Cytol 1982; 26:227.
- Granberg I, Willems JS. Endometriosis of lung and pleura diagnosed by aspiration biopsy. Acta Cytol 1977; 21:295.
- Wang HC, Kuo PH, Kuo SH, Luh KT. Catamenial hemoptysis from tracheobronchial endometriosis: reappraisal of diagnostic value of bronchoscopy and bronchial brush cytology. Chest 2000; 118:1205.
- Kirschner PA. Catamenial pneumothorax: an example of porous diaphragm syndromes. Chest 2000; 118:1519.
- Peikert T, Gillespie DJ, Cassivi SD. Catamenial pneumothorax. Mayo Clin Proc 2005; 80:677.
- Bagan P, Le Pimpec Barthes F, Assouad J, et al. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg 2003; 75:378.
- Tsunezuka Y, Sato H, Kodama T, et al. Expression of CA125 in thoracic endometriosis in a patient with catamenial pneumothorax. Respiration 1999; 66:470.
- Marshall MB, Ahmed Z, Kucharczuk JC, et al. Catamenial pneumothorax: optimal hormonal and surgical management. Eur J Cardiothorac Surg 2005; 27:662.
- Koizumi T, Inagaki H, Takabayashi Y, Kubo K. Successful use of gonadotropin-releasing hormone agonist in a patient with pulmonary endometriosis. Respiration 1999; 66:544.
- Slabbynck H, Laureys M, Impens N, et al. Recurring catamenial pneumothorax treated with a Gn-RH analogue. Chest 1991; 100:851.
- Uemura T, Matsuyama A, Minaguchi H, Ikeda H. Danazol (an antigonadotropin) in the treatment of catamenial pneumothorax. Asia Oceania J Obstet Gynaecol 1985; 11:81.
- Akal M, Kara M. Nonsurgical treatment of a catamenial pneumothorax with a Gn-RH analogue. Respiration 2002; 69:275.
- Attaran S, Bille A, Karenovics W, Lang-Lazdunski L. Videothoracoscopic repair of diaphragm and pleurectomy/abrasion in patients with catamenial pneumothorax: a 9-year experience. Chest 2013; 143:1066.
- Oger P, Alifano M, Regnard JF, Gompel A. Difficult management of recurrent catamenial pneumothorax. Gynecol Endocrinol 2006; 22:713.
- Choong CK, Smith MD, Haydock DA. Recurrent spontaneous pneumothorax associated with menstrual cycle: Report of three cases of catamenial pneumothorax. ANZ J Surg 2002; 72:678.
- Sakamoto K, Ohmori T, Takei H. Catamenial pneumothorax caused by endometriosis in the visceral pleura. Ann Thorac Surg 2003; 76:290.
- Terada Y, Chen F, Shoji T, et al. A case of endobronchial endometriosis treated by subsegmentectomy. Chest 1999; 115:1475.
- Puma F, Carloni A, Casucci G, et al. Successful endoscopic Nd-YAG laser treatment of endobronchial endometriosis. Chest 2003; 124:1168.
- Lee CY, Di Loreto PC, Beaudoin J. Catamenial pneumothorax. Obstet Gynecol 1974; 44:407.