Ovarian Endometriomas And Peritoneal Endometriosis – Different Clinical Implications Of The Disease

OVARIAN ENDOMETRIOMAS AND PERITONEAL ENDOMETRIOSIS – DIFFERENT CLINICAL IMPLICATIONS OF THE DISEASESimone Subtil, Inu00eas Ramalho, Sara Campos, Margarida Figueiredo-DiasGynecology Department, Coimbra University Hospital Center, Portugal. Faculty of Medicine, University of Coimbra, PortugalProblem statement: Isolated ovarian endometriomas and peritoneal endometriotic disease are believed to be different expressions of the same etiopathogenic entity. Nevertheless, clinical signs and symptoms, clinical and imagiologic diagnosis, and treatment options usually require individualization according to two main consequent disorders: pain severity and infertility. Determining clinical features of patients with both types of endometriosis can be useful in understanding different outcomes between ovarian endometriomas and peritoneal endometriosis.Methods: A cross-sectional study including 383 patients submitted to pelvic surgery and corresponding histologic diagnosis of endometriosis was performed at the Gynecology Department of Coimbra University Hospital Center in order to analyze and compare clinical parameters between two groups: patients with isolated ovarian endometriomas and patients with diffuse peritoneal endometriosis. Statistical analysis was performed using SPSS 20.0 (p<0.05).Results: The average age of diagnosis in both groups was 36,8±8,0 years and pain symptoms were common among all endometriosis patients as 64% referred dysmenorrhea, 56% chronic pelvic pain and 31% dyspareunia. Incidence of isolated ovarian endometriomas was 22% (78 patients) and remaining 78% (281 patients) presented peritoneal diffuse endometriosis with or without endometriomas. Clinical symptoms, specifically on what concerns associated pain complaints, were similar between both groups (p=n.s.). Incidence of infertility was significantly higher in peritoneal endometriosis group (p<0.001), unlike CA-125 serum values, which were significantly higher in isolated ovarian endometriomas group (p<0.01). There was no significant difference between both groups on what concerns age at diagnosis, body mass index, age at menarche, menstrual pattern (cycle length and duration of flow), obstetric or abdominal surgery personal background.Conclusion: Isolated ovarian endometriomas and peritoneal endometriosis were similarly associated to pain complaints, most importantly chronic pelvic pain and acute cyclic pain. Despite ovarian endometriomas label the disease to advanced stages, peritoneal endometriosis was related to more severe consequences, regarding infertility. Significant elevated CA-125 levels in isolated ovarian endometriomas compared to peritoneal endometriosis is an interesting observation regarding endometriotic and clear cell ovarian cancer carcinogenesis.