Deep ovarian endometriosis: controversial and unresolved issues

A.I. Davydov, Вiталiй Пашков, A.I. Ishchenko, K.R. Bakhtiyarov, V.А. Lebedev, R. Chilova, Yu.A. Vorotnikova, M Ivantsova
In: Voprosy ginekologii, akušerstva i perinatologii · 2024 · vol. 23(2) , pp. 5–14 · doi:10.20953/1726-1678-2024-2-5-14 · W4406871893
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This review addresses unresolved issues in ovarian endometriosis classification and discusses surgical management, noting that histo-structural features guide the choice between ablative techniques and cystectomy.

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This review examines the controversial classification and terminology of ovarian endometriosis following recent World Health Organization updates, highlighting unresolved issues in both clinical and pathological definitions. The authors analyze the toxicity associated with the condition and evaluate the impact of surgical interventions, specifically comparing cystectomy against ablative techniques based on histo-structural features to preserve fertility. Additionally, the paper addresses hormonal treatment challenges by presenting data on progesterone resistance in endometrioid tissue and proposing ethinylestradiol as a means to enhance progestogen efficacy and promote apoptosis. This paper is centrally about endometriosis — specifically deep ovarian endometriosis, covering its classification, surgical management, and hormonal therapy resistance.

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Abstract

Endometriosis is one of the most controversial diseases in contemporary medicine. This especially concerns ovarian endometriosis. With the introduction of new World Health Organization (WHO) classifications, both clinical (ICD-11) and pathological, adopted in 2020, the classification and terminology of ovarian endometriosis have not been clarified, and many questions have arisen due to fundamental contradictions within one classification and when assessing their compliance. This article discusses aspects of the toxicity of ovarian endometriosis and the impact of cystectomy on the fertility of patients with this pathology. Together, molecular and morphogenetic features allow to substantiate the indications for surgical treatment of ovarian endometriosis, and histo-structural features enable to make the choice in favor of ablative techniques rather than cystectomy. In the conclusion of the article, the problem of choosing hormone therapy is considered. In this regard, data on the resistance of endometrioid tissue to progesterone are presented. Ethinylestradiol can not only neutralize this resistance, but also enhance the anti-proliferative effect of progestogen, as well as accelerate the processes of apoptosis of endometrioid cells.
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Deep ovarian endometriosis: controversial and unresolved issues Aleksandr I. Davydov / Vladimir M. Pashkov / Anatoliy I. Ishchenko / Kamil R. Bakhtiyarov / Vladimir A. Lebedev / Raisa A. Chilova / Yuliana A. Vorotnikova / Margarita V. Ivantsova / Endometriosis is one of the most controversial diseases in contemporary medicine. This especially concerns ovarian endometriosis. With the introduction of new World Health Organization (WHO) classifications, both clinical (ICD-11) and pathological, adopted in 2020, the classification and terminology of ovarian endometriosis have not been clarified, and many questions have arisen due to fundamental contradictions within one classification and when assessing their compliance. This article discusses aspects of the toxicity of ovarian endometriosis and the impact of cystectomy on the fertility of patients with this pathology. Together, molecular and morphogenetic features allow to substantiate the indications for surgical treatment of ovarian endometriosis, and histo-structural features enable to make the choice in favor of ablative techniques rather than cystectomy. In the conclusion of the article, the problem of choosing hormone therapy is considered. In this regard, data on the resistance of endometrioid tissue to progesterone are presented. Ethinylestradiol can not only neutralize this resistance, but also enhance the anti-proliferative effect of progestogen, as well as accelerate the processes of apoptosis of endometrioid cells. Key words: deep ovarian endometriosis, ovarian endometrioma, classification, terminology, toxicity, ablation, progesterone resistance For citation: Davydov A.I., Pashkov V.M., Ishchenko A.I., Bakhtiyarov K.R., Lebedev V.A., Chilova R.A., Vorotnikova Yu.A., Ivantsova M.V. Deep ovarian endometriosis: controversial and unresolved issues. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2024; 23(2): 5–14. (In Russian). DOI: 10.20953/ 1726-1678-2024-2-5-14 Open access

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