Clinico-pathological patterns of the thoracic endometriosis

One talks about thoracic endometriosis (TE) in cases where functioning endometrium grows in the respiratory ways, mediastinum, diaphragm, or the pulmonary parenchyma most often manifesting in the recurrent pneumothorax. Material and Methods: We have analyzed 42 cases of the TE. The patients age was 16-61 years, the average being 40.5±0.4 years. Pre-operational diagnoses were primary spontaneous pneumothorax, pulmonary tuberculosis, lung haemosiderosis, lung tumor. The surgery was performed in 37 patients. Results: HRCT detected some typical patterns. No changes were detected in 26 cases. The microscopic examination detected clusters of endometrial glands, cytogenic stroma with a fibroblastic transformation, hemosiderin deposits. The immuno-histochemical study revealed the Pr and Er receptors expression in the gland epithelium and cytogenic stroma cells, bcl-2 expression in the gland epithelium, and moderate proliferative activity (Ki-67) in the cytogenic stroma. Conclusion: Our data allow to determine following features of the TE: the predominantly right-side localization, the young age of the patients, the cyclic recurrence of the hemoptysis and pain in the chest, the recurrent right-side pneumothorax, the correlation of the onset and/or regression of the radiological symptoms with the beginning and/or end of the menstrual cycle, infertility, pelvic pain, algomenorrhea, and surgeries on the pelvic organs in the anamnesis. In most of our observations, the endometriosis affected the diaphragm and was accompanied by the pneumothorax. Thus, the clinical and morphological hypodiagnostics of the TE is conditioned by the lack of the complex analysis and correlation of the anamnestic, clinical, and histological data.