Dynamics of thoracic endometriosis in the pleural cavity

Takahiro Ochi, Masatoshi Kurihara, Kenji Tsuboshima, Yuto Nonaka, Toshio Kumasaka
PloS one · 2022 · vol. 17(5) , pp. e0268299 · doi:10.1371/journal.pone.0268299 · PMID:35544515 · W4280561837
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study characterized thoracic endometriosis in 160 patients, finding visceral and parietal pleural lesions in a majority, with specific locations associated with recurrence after surgery.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This retrospective single-institution study analyzed 160 non-menopausal female patients with histopathologically confirmed thoracic endometriosis who underwent thoracoscopic surgery for pneumothorax (2015–2019), focusing on the clinicopathological distribution and histopathologic “dynamics” of pleural lesions. Visceral pleural endometriosis was present in 79 patients and parietal pleural endometriosis in 71, with endometriotic tissues identified in all lesions and stromal invasion localized or extending deeply from the outer external elastic layer; the paper reports the largest visceral pleural lesion burden in the S4 region and a concentration of parietal lesions in the dorsal 6th intercostal space. Postoperative recurrence was assessed by Kaplan-Meier analysis, yielding 1- and 2-year recurrence rates of 13.8% and 19.3%, respectively. The authors’ main limitation is that recurrence and outcomes were evaluated retrospectively and using pneumothorax collapse reappearance (rather than including postoperative pain or reoperation-based detection). This paper is centrally about endometriosis — specifically thoracic endometriosis-related pleural cavity lesions and recurrence dynamics in patients with pneumothorax, which is a manifestation linked to endometriosis rather than adenomyosis.

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Abstract

BACKGROUND: Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis. METHODS: In total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively. RESULTS: The cohort median age was 41 (range 22-53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6-1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively. CONCLUSIONS: Visceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence.

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Condition tags

mesh:D004715endometriosisthoracic_endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Pneumothorax Pneumothorax Pneumothorax Pneumothorax Adult Adult Chest Pain Chest Pain Chest Pain Female Female Humans Humans Middle Aged Middle Aged

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