Hormone-resistant endometriosis following total abdominal hysterectomy and bilateral salpingo-oophorectomy: correlation with histology and steroid receptor content.
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This case report describes aggressive, hormone-resistant endometriosis developing years after hysterectomy and oophorectomy, demonstrating elevated progesterone receptors despite hormone therapy.
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Abstract
Endometriosis is rare after hysterectomy and oophorectomy for conditions unrelated to endometriosis. We present a case of delayed development of aggressive, hormone-resistant endometriosis temporally remote from hysterectomy and oophorectomy performed for chronic pelvic inflammatory disease. Treatment with depo-medroxyprogesterone acetate resulted in continued growth of the retroperitoneal endometrioma and necessitated posterior exenteration because of the endometrioma's location. Estrogen and progesterone receptor levels were measured to clarify why this woman's endometriosis was resistant to hormone therapy. Despite administration of large amounts of depo-medroxyprogesterone acetate, the progesterone receptor content was elevated while the estrogen receptor content was undetectable. Why this patient developed this particular type of aggressive endometriosis is unclear, but the lack of down-regulation of progesterone receptors in response to high-dose progestin therapy may indicate an alteration in basic regulatory and cellular processes within the endometriotic implant.
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Cited by (27)
- Surgical challenges in the treatment of perimenopausal and postmenopausal endometriosis 2018
- Postmenopausal Invasive Endometriosis Requiring Supralevator Pelvic Exenteration 2015
- Recurrence of endometriosis after hysterectomy. 2014
- Chronic Abdominal Pain of Gynecologic Causes: Diagnosis and Treatment 2014
- Resolving endometriosis-induced pain utilizing a low-glycemic diet 2008
- Two Cases of Extrapelvic endometriosis following Laparoscopy-assisted vaginal hysterectomy and Cesarean section 2007
- Aggressive endometriosis with focal change suggesting early neoplastic transformation 2007
- Endometriosis presenting like a psoas abscess 2007
- Hysterectomy for treatment of pain associated with endometriosis 2006
- Reduced progesterone action during endometrial maturation: A potential risk factor for the development of endometriosis 2005
- Irradiation ovarienne pour endométriose réfractaire inopérable 2005
- Low-Grade Endometrial Stromal Sarcoma Arising From Sciatic Nerve Endometriosis 2004
- Treatment with Aromatase Inhibitors 2003
- Diagnosis and treatment of endometriosis 2003
- The Role of Laparoscopy in the Chronic Pelvic Pain Patient 2003
- Expression and Mitogenic Effect of Fibroblast Growth Factor-9 in Human Endometriotic Implant Is Regulated by Aberrant Production of Estrogen 2003
- Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who received hormone replacement therapy 2002
- Estrogen Production and Metabolism in Endometriosis 2002
- Mechanisms of excessive estrogen formation in endometriosis 2002
- A case of persistent endometriosis after total hysterectomy with both salpingo-oophorectomy managed by radiation therapy 2001
- Aromatase as a Therapeutic Target in Endometriosis 2000
- Estrogen biosynthesis in endometriosis: molecular basis and clinical relevance 2000
- Aromatase: a key molecule in the pathophysiology of endometriosis and a therapeutic target 1999
- Molecular Action of GnRH Analogues on Ectopic Endometrial Cells 1998
- Endometrioma of the vagina in menopause 1996
- Management of Recurrent Endometriosis After Hysterectomy and Bilateral Salpingo-Oophorectomy 1995
- Diseases of the Peritoneum 1994
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