RELATIONSHIPS BETWEEN CLINICAL MANIFESTATIONS AND HISTOPATHOLOGICAL FEATURES IN ENDOMETRIOSIS: IMPLICATIONS FOR PRECISION DIAGNOSIS AND TREATMENT
Abstract
Endometriosis is a chronic inflammatory disease affecting reproductive-age women, often associated with pain and infertility. Aim: This study aims seeks to investigate the relationships between clinical and paraclinical presentations, and histopathological features in endometriosis, with the objective of improving diagnostic accuracy and guiding personalized treatment strategies. Materials and methods: A prospective study was carried out involving 40 patients evaluated at “Cuza-Vodă” and “Elena-Doamna” Obstetrics and Gynecology Clinical Hospitals, Iasi, between September 2019 to August 2024, of whom 40 met the inclusion criteria. Key clinical data and biomarker levels, including CA-125, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratios (PLR) and systemic immune inflammation index (SII) were analyzed for correlations with histopathological findings, as well as with rASRM staging and the EFI index. Results: Compared to the control group, the association of elevated CA-125 levels with systemic inflammatory markers (NLR, PLR, SII) highlights the chronic inflammatory process characteristic of this pathology. In terms of systemic inflammatory markers, the rASRM classification identifies lower values in stage IV compared to stage III, while the EFI classification does not reveal any significant changes. Conclusions: The study highlights the importance of correlating clinical and histopathological data in endometriosis for a more nuanced staging and personalized treatment approach. The association of CA-125, systemic inflammatory markers, and rASRM staging may provide the foundation for the identification of novel non-invasive biomarkers, as well as potential prognostic factors for endometriosis.
References
1. Zondervan KT, Becker CM, Missmer SA, Endometriosis. N Engl J Med 2020; 382: 1244-1256.
2. Marchetti M, Noventa M, Panizzolo E, et al. An ultrasound-based preoperative evaluation of the endometriosis fertility index, J Clin Med 2024; 13: 1488.
3. Păvăleanu I, Balan RA, Grigoraş A, et al. Correlations between the lymphoid infiltrate and the steroid hormone receptors in endometriosis, Med Surg J - Rev Med Chir Soc Med Nat 2023; 127(3): 415-424.
4. Ilea C, Lupaşcu I, Socolov D, Cărăuleanu A. Pelvic endometriosis and uretero-hydro-nephrosis, Med Surg J - Rev Med Chir Soc Med Nat Iasi 2015; 119(1): 170-174.
5. Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 2010; 94(5): 1609-1615.
6. Horne AW, Saunders PTK. Inflammation and endometriosis: are there a causal link? Reproduction 2022; 164(2).
7. American Society for Reproductive Medicine, Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997; 67(5): 817-821.
8. Liu Y, Metzger D, Charles MA. A prospective study on serum biomarkers in endometriosis diagnosis, Obstet Gynecol 2021; 137(3): 407-417.
9. Fest J, Ruiter R, Ikram MA, Voortman T, van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Sci Rep 201; 8(1):10566.
10. Giudice LC. Clinical Practice, Endometriosis. N Engl J Med 2010; 362: 2389-2398.
11. Wilson JD, Bumpus FM. Gynecological endocrinology: endometriosis and infertility. J Clin Invest 2021; 136(3): 292-303.
12. Macer ML, Taylor HS. Pathogenesis of endometriosis: biology, genetics, and immunology. Am J Reprod Immunol 2020; 83.
13. Zondervan KT, Becker CM. Endometriosis: emerging biomarkers. Lancet 2023; 412: 132-145.
14. Watson M, Proctor M. The Role of Hormonal Receptors in Endometriosis Staging. J Obstet Gynaecol Res, 2021;47: 1417-1423.
15. Noventa M, Marci R. Re-evaluation of ASRM staging in endometriosis. Eur J Obstet Gynecol Reprod Biol 2022; 274: 8-14.
16. Hwang JH, Yoo HJ. Inflammation and immune response in endometriosis, Am J Obstet Gynecol, 2020;223(2): 223-232.
17. Timofte D, et al. The relevance of oxidative stress status in type 2 diabetes and the chronic consumption of alcohol. Romanian Biotechnological Letters 2016; 21(1): 11247.
18. Dumbrava DP, Radu CC, Iov T, et al. An Unusual Case of Accidental Carbon Monoxide and Ethanol Intoxication in Two Commorientes Deaths. Rev Chim 2018; 69(7): 1889-1891.
19. Grigore M, Popovici RM, Gafitanu D, Himiniuc L, Murarasu M, Micu R. Logistic models and artificial intelligence in the sonographic assessment of adnexal masses - a systematic review of the literature. Med Ultrason 2020; 22(4): 469-475.
20. Luţuc MH, Nemescu D, Onofriescu A, Târnovanu M, Moscalu M, Onofriescu M, Pregnancy and recurrence rates in infertile patients operated for ovarian endometriosis. Med Surg J - Rev Med Chir Soc Med Nat Iasi 2015; 119(1): 127-134.

Additional Files
Published
Issue
Section
License
Copyright (c) 2024 The Medical-Surgical Journal

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form