Irem Onur, MD

Dr. Onur is an associate professor of pathology with subspecialty certification in cytopathology in Turkey. She is deeply interested in medical writing and conveying the latest scientific information to medical professionals as well as the public.

Programmed-cell death pathway and immune dysfunction in endometriosis

Endometriosis is an estrogen-dependent, immune-associated disease. Women with endometriosis have different proportions of the activated forms of immunocompetent cells, such as T cells and macrophages compared to those from women without. Immune cell dysfunction in the uterine and abdominal cavity microenvironment enhances the ability of endometrial cells to adhere and invade. This leads to an increased proliferation and angiogenesis, as well as poor clearance of ectopic endometrium by immune cells. The molecule named “programmed-death-1 (PD-1)” is a negative regulator of…

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Preoperative Staging of Endometriosis: The Value of MRI After Dynamic Transvaginal Ultrasound

Since endometriosis is a chronic and progressive disease, early diagnosis and proper staging are important for the patient and for the clinician to discuss and plan the required surgical procedures for treatment. Common diagnostic tools for pre-operative staging of deep infiltrating endometriosis are the clinical history, physical examination, dynamic TVUS, and MRI. A team of researchers from Netherlands, Berger et al., evaluated the added value of each step (history, clinical examination, dynamic TVUS, and MRI) in the diagnostic pathway for…

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Any adjustable risk factor for Endometriosis?

Endometriosis is believed to be estrogen and progesterone-dependent. Lifestyle factors such as alcohol/caffeine intake, smoking, and physical activity influence estrogen levels in the body and, therefore, may impact the development of endometriosis. In the study of Hemmert et al. which has been published in Paediatric and Perinatal Epidemiology, the relationships between caffeine and alcohol intake, smoking, and physical activity levels reported prior to the diagnosis of endometriosis were evaluated. Four hundred and seventy-three women, ages 18-44 years, who underwent laparoscopy…

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A novel neurotransmitter, Ninj1, has been found to be expressed in endometriosis

Chronic inflammation is involved in the pathogenesis of endometriosis and adenomyosis, and inflammatory cytokines such as IL-1b are highly expressed in them. Inflammation and subsequent hyperinnervation are involved in the pathophysiology of pain generation. High levels of expression of various neurotransmitters are also present in these tissues. Nerve injury-induced protein 1 (Ninjurin, Ninj1), an adhesion molecule originally identified in dorsal root ganglion neurons and Schwann cells after nerve injury. It mediates hemophilic adhesion and promotes neurite outgrowth. The Ninj1 is…

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Anatomic distribution of endometriosis

In the study of Audebert et al. which has been published in the journal European Journal of Obstetrics and Gynecology, the anatomic distribution of endometriosis, the rate of deep infiltrating endometriosis during the various study periods, laterality of endometriosis, pelvic adhesions’ anatomic distribution and prevalence according to past history were analyzed. 1101 patients diagnosed with endometriosis through laparoscopy procedure were included in the study. The mean age of the 1101 patients was 33.06 years (range 15-63 years). Pain, infertility or…

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Quality of life for women with endometriosis

Endometriosis symptoms may cause difficulties in daily activities and social life, altering general health and personal relationships and severely decrease the quality of life. Yoldemir T. evaluates the factors affecting the quality of life in endometriosis patients and the management strategies in his recently published paper in the journal Climacteric. Since symptoms are linked to complex sensory and neural mechanisms related to the depth of endometriotic implants rather than the extent of disease, the stage of the disease and severity of symptoms…

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Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis

Abdominal wall endometriosis is a rare clinical entity frequently diagnosed with a significant delay and easily misinterpreted despite multimodality imaging. In the study of Jaramillo-Cardoso et al. which has recently been published in the journal Abdominal Radiology, the clinical, multimodality imaging, and pathologic characteristics of endometriosis in the abdominal wall were reviewed. Eighteen patients who had the prebiopsy or presurgical imaging studies and sufficient field of view to assess the AWE lesion were included in the study. Patients presented with…

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Fighting with endometriosis

Maduro M.R. reviewed three separate studies on potential new targets to successfully manage endometriosis in her recent paper titled “Novel Strategies to Fight Endometriosis” published in the journal Reproductive Sciences. In the autotransplantation rat model of Torres-Reveron et al., the rats were exposed to environmental enrichment (EE) (endo-EE, toys and nesting materials, 4 rats per cage, larger enclosed area) or no enrichment (endo-NE, 2 rats per cage) from postnatal day 21 and after 8 weeks performed sham surgery or induced…

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Endometrioma and endometriosis

Exacoustos C. et al. published an article titled “The isolated ovarian endometrioma: a history between myth and reality” in the Journal of Minimally Invasive Gynecology in 2018. They aimed to examine the association between ovarian endometriomas detectable at the transvaginal ultrasound and other specific extra-ovarian lesions including adhesions, deep infiltrating endometriosis, and adenomyosis. This is a retrospective study analyzing 255 women who had at least one ovarian endometrioma > 20 mm in diameter on ultrasound after presentation with pain or irregular…

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Endometriosis in adolescents

Dr. Mama S. T. from Cooper University Hospital, Camden, New Jersey, USA, recently has published his review on advances in the management of endometriosis in the adolescent in the journal “Current Opinion Obstetrics and Gynecology”. In adolescence, there is a significant delay in the diagnosis of endometriosis, often because physicians dismiss their symptoms. If the molecular mechanisms underlying progression of endometriosis are better understood, early diagnosis and use of maximum combined medical-surgical treatment can decrease the symptoms of the disease,…

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How are endometriosis patients managed clinically?

This review paper by Falcone and Flyckt, entitled “Clinical Management of Endometriosis” published in the journal Obstetrics & Gynecology aims to summarize the current strategies for treating endometriosis patients with pain, pelvic dysfunction, and subfertility related to their disease. There are many medical treatments to decrease endometriosis symptoms, to prevent recurrence and repeat surgery. Medical treatment is suppressive rather than curative, it does not increase fecundity and does not resolve endometriomas, nor deeply infiltrating disease. Despite their widespread use nonsteroidal anti-inflammatory drugs…

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Prior endometriosis surgery and the risk of pregnancy complications

Koninckx et al. discussed the association of pregnancy complications with endometriosis and endometriosis surgery in their recently published paper in the journal Fertility and Sterility. They especially mentioned about the retrospective study of Nirgianakis et al. published in the same issue which shows that laparoscopic excision of deep infiltrating endometriosis doesn’t affect the increased risk of placenta previa, gestational hypertension, and intrauterine growth retardation associated with endometriosis. They also suggested that previous deep endometriosis surgery doesn’t affect the probability of…

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Women recommended laparoscopy for chronic pelvic pain

Chronic pelvic pain is a diagnostic and therapeutic dilemma. It has many etiologies in many organ systems. Clinician and patient factors affect the management of chronic pelvic pain. Mirowska-Allen K.L. et al. have recently published an article titled, “The characteristics of women recommended a laparoscopy for chronic pelvic pain at a tertiary institution” in the journal Australian and New Zealand Journal of Obstetrics and Gynaecology. They aimed to understand the characteristics of women offered laparoscopic pelvic surgery for chronic pelvic pain. Their…

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The role of peritoneal washings in the diagnosis of endometriosis

Endometriosis is a common entity seen in the gynecologic tract and pelvic surfaces. It may be frequently asymptomatic and/or undiagnosed at the time of gynecologic surgery. Pathologists diagnose endometriosis based on the presence of at least two of the following elements: endometrial glands, endometrial stroma, and hemosiderin-laden macrophages. Cantley R.L. et al. from the University of Toledo Medical Center, Toledo, Ohio, USA published an article entitled “The role of peritoneal washings in the diagnosis of endometriosis” in Diagnostic Cytopathology. They aimed to examine the characteristics of…

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A clearer picture of "endometriosis after menopause"

Delfin Avendano Tan and Marie Josephine Guanlao Almeria are obstetrician-gynecologists from the Philippines. They recently published a review article titled "Postmenopausal endometriosis: drawing a clearer picture". In this paper, the authors discussed the pathogenesis, risk factors, and management of postmenopausal endometriosis. Women rarely have endometriosis after menopause (<3%). It is probably due to the persistence or recurrence of the premenopausal disease. New development or rising of endometriosis from a metaplastic transformation of peritoneal mesothelial cells into endometrial glandular cells are…

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