Murat Osman

Senior Research Columnist: Murat Osman is a MD candidate at The George Washington University School of Medicine and Health Sciences. His interest in research is primarily focused on Medical Oncology and Radiology. He is also focused on cultivating his passion for medical science and human health through scientific writing and advocacy.

Is there a definitive guideline for the surgical management of endometriosis?

Endometriosis is a chronic inflammatory disease that is defined by the presence of ectopic endometrial tissue outside of the uterus. Unfortunately, endometriosis continues to be a leading cause of chronic pelvic pain in women of reproductive age. This article titled, “Surgical treatment of different types of endometriosis…” by Kho et al. from the Women’s Health Institute in Cleveland clinic and institutions in Sao Paulo, Brazil aim to elucidate and compare the current treatment options and guidelines for patients with different…

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What is being done to help surgeons detect endometriosis during laparoscopy

The gold standard for the diagnosis of endometriosis is diagnostic laparoscopy and histologic confirmation. During laparoscopy, visualization of as many lesions as possible may hold better long-term clinical outcomes. Peritoneal endometriosis is difficult to diagnose intraoperatively due to the heterogeneity of the endometriotic lesions (lesions are currently grouped as either non-pigmented, red, white, or black based on gross findings). Thus, enhanced imaging techniques such as contrast agents may have the potential to aid surgeons in locating these lesions and providing…

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Contraceptives for the management of endometriosis pain

Endometriosis is a common gynecologic disease that affects many women of reproductive age and is associated with significant morbidity. One of the treatment options for women with endometriosis is the use of oral contraceptives (OCPs) for pain management. However, its effectiveness has not been clearly presented in randomized control studies.  This article titled, "Oral contraceptives for pain associated with endometriosis" by Brown et al. published in the "Cochrane Database of Systematic Reviews" aims to determine if there is any significant…

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Therapeutic strategies involving uterine stem cells in reproductive medicine

Stem cells are undifferentiated cells that often serve to regenerate tissue in states of injury or apoptosis. The endometrium has progenitor cells that replace tissue lost after each menstrual cycle. It has been postulated that excessive stem cell recruitment to the endometrium may contribute to the development of endometriosis. Thus, preventing stem-cell trafficking may lessen disease progression. Bone marrow-derived stem cells are mesenchymal stem cells that originate from the bone marrow. These cells not only produce immune cells, but also…

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Emerging medical treatments for endometriosis

Endometriosis is a disease whereby uterine tissue grows outside the walls of the uterus to the surfaces of other tissues in the body. It is a chronic disease and relies upon estrogen to grow and survive. Current medical therapies take advantage of this weakness by creating a hypoestrogenic environment either by blocking ovarian estrogen secretion (GnRH-agonist, GnRH-a) or by inhibiting estrogenic stimulation of the ectopic endometrium (progestins and androgenic progestins). Clemenza and authors at the University of Florence, Italy have…

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Thoracic Endometriosis Syndrome : A case report describing endometriosis involvement of the lung

Leonardo-Pinto and authors from the Universidade Estadual de Campinas, Brazil, have recently published a case report titled, "Hemoptysis and Endometriosis: An Unusual Association - Case Report and Review of the Literature" in the Journal, Revista Brasileira De Ginecologia E Obstetricia describing a rare clinical presentation of endometriosis. Thoracic endometriosis syndrome describes one of the extrapelvic manifestations of endometriosis. TES is characterized by catamenial (symptoms predominantly during menstrual periods) pneumothorax (air in the pleural space), hemothorax (blood in the pleural space), hemoptysis (coughing…

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Endometriosis surgery and preservation of fertility, what surgeons should know

Endometriosis can involve most of the pelvic organs including the uterus, ovaries and fallopian tubes and thus has the potential to cause infertility. This article titled, “Endometriosis surgery and preservation of fertility, what surgeons should know” written by H. Roman and published in the Journal of Visceral Surgery aims to discuss several surgical indications for surgery in women with endometriosis. An overarching consideration in the management of surgery is to weigh the potential benefits and complications between excising all endometriotic…

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The use of retinoic acid for the treatment of endometriosis

Endometriosis is one of the leading causes of chronic pelvic pain in women during their childbearing years. Several drugs have been researched to either reduce inflammation, decrease growth, or kill endometriotic cells. Retinoic acid (Vitamin A) is one such molecule that has been researched in the treatment of many conditions. Lu et al. from the Clinical Medical College of Dali University recently published a study titled, “Retinoic acid regulates endometriotic stromal cell growth through upregulation of Beclin 1". Lu et…

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Direct shedding of endometrioma contents visualized by ultrasonography

Endometriosis is one of the leading causes of chronic pelvic pain in women during their childbearing years. Researchers from Italy have recently published a case report in the European Journal of Obstetrics & Gynecology and Reproductive Biology observing the direct shedding of endometriotic cyst contents to a neighboring ovarian follicle.  Case reports detail the clinical management of a patient in order to highlight a certain clinical phenomenon or to raise questions for further study. A 39-year old gravida 0, para 0 (never pregnant)…

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Using the "Mushroom Cap" sign to describe endometriotic masses

Endometriosis is a disease whereby ectopic endometrial cells attach and grow outside of the uterus. A number of imaging techniques have been used to evaluate and assess endometriotic lesions. Magnetic resonance imaging (MRI) is a type of imaging modality used to assess tissues and can be used to evaluate and locate endometriotic lesions. Doctors Arevalo and Mendez at the University Hospital of San Carlos, Madrid, Spain recently published a paper in Abdominal Radiology describing and detailing what they see on MRI…

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Independent development of endometrial epithelium and stroma within the same endometriosis

Endometriosis is one of the leading causes of chronic pelvic pain in women during their childbearing years. A popular theory for the pathogenesis of endometriosis posits that circulating progenitor cells differentiate into the endometrial stroma and glandular tissue once they attach onto a surface outside the uterus. However, the understanding of the origin of the components that make up these lesions is still being elucidated. This article elucidates the evolution of endometriotic stroma and glandular tissue by tracking synonymous and…

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The use of histone deacetylase inhibitors for the treatment of endometriosis

Histone deacetylase inhibitors prevent the deacetylation of specific gene sequences thereby allowing the increased transcription of certain genes. Trichostatin A, a histone deacetylase inhibitor, has been seen to induce the expression of a pro-apoptotic gene called nonsteroidal anti-inflammatory drug-activated gene 1 (NAG-1). Increased expression of this gene has been observed to increase the apoptosis of endometriotic stromal cells in an investigation by Seo and colleagues. They concluded that epigenetic aberrations that decrease the expression of these pro-apoptotic genes could be…

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A review on the role of immune cells on the pathogenesis of endometriosis

Immune cells play a vital role in the homeostasis against infectious pathogens but also in the pathogenesis of endometriosis. Recent research has suggested that different immune cells have unique roles in this pathogenesis. Neutrophils, which are typically the primary acute response to infection, have been seen to be present in increased numbers in the peritoneal fluid of patients with endometriosis in part due to chemotactic factors such as IL-8. It has also been suggested that neutrophils aid in the initial…

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Collaboration Between the Surgical and Medical Experts of Endometriosis Needed

The authors of this perspective article aim to initiate a dialogue regarding the current evidence regarding the surgical and medical treatment of endometriosis. In their view, the quality of data regarding the outcomes of surgery for endometriosis is lacking and that more surgical randomized controlled trials are needed. When debating the role of medical and surgical treatment of endometriosis, care should be taken to use the consensus of a group of experts for consensus guidelines. This is compounded by the…

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Novel lipid biomarkers may make early detection of endometriosis possible

Currently, specific clinical diagnostic indicators for the early detection of endometriosis have not been found with enough specificity and sensitivity for widespread use. Novel diagnostic biomarkers are needed that are both effective and non-invasive to detect endometriosis as early as possible. In this paper, authors investigate alterations in the lipid profile of endometriotic lesions using ultra-high-performance liquid chromatography with electrospray ionization high-resolution mass spectrometry (UHPLC- ESI-HR-MS). 21 patients with laparoscopic and hysteroscopic diagnosed endometriosis were included in the study while…

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Which cell defines endometriosis?

A well-accepted theory regarding the pathogenesis of endometriosis hypothesizes that the origin of endometriosis is from peritoneal dissemination of endometrial cells and stroma during the neonatal period or menarche. Varying cellular components of endometriosis have been observed in the setting of different clinical conditions such as adolescent versus adult endometriosis. Additionally, the phenotype of endometriosis varies with its localization. For example, deep endometriosis tends to involve the pouch of Douglas (recto-uterine pouch) and uterosacral ligaments and occasionally contains a fibrotic-muscular…

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A new hypothesis for the origin of endometriosis-associated ovarian cancers

Endometriosis has been associated with an increased risk in the development of the clear cell, endometrioid, and low-grade serous tumors. Thus, progression to these forms of type I tumors is associated with endometriosis precursor lesions that are atypical. The transition of non-malignant to malignant endometriosis precursor lesions have been associated with PTEN and ARID1A mutations. However, this process is still being elucidated. Another possible factor for this progression is the role of reactive oxygen species (ROS) that form within the…

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Are there any risk factor associated with the progression of endometriosis to ovarian cancer?

Endometriosis is a disease whereby endometrial glands proliferate outside of the endometrial lining. Apart from causing significant morbidity, It has been found that endometriosis is associated with an increased risk of progression to endometroid and clear cell ovarian cancer. However, the exact mechanisms of this progression are still being studied. For clinicians, understanding the risk factors that are associated with this progression may identify individuals who are at higher risk and conduct appropriate screening measures. In this study, patient information…

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Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis.

Endometriosis may affect the pelvic reproductive system, but it can also be found in non-reproductive organs such as the gastrointestinal and urinary tract. The article outlined below discusses the diagnosis and management of genitourinary and gastrointestinal endometriosis. Gastrointestinal endometriosis: The spread of endometriosis to the gastrointestinal usually involves the rectosigmoid colon and should be considered if symptoms such as diarrhea, hematochezia, constipation, dyspareunia, and dyschezia are present. Management of this disease includes surgery for those who are symptomatic and refractory to…

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Estrogen receptor splice variants may be associated with endometriosis pathogenesis and clinical severity.

Endometriosis is defined as the presence of uterine stroma and glands outside of the uterine cavity and is one of the leading causes of chronic pelvic pain in women. Thus, understanding key genetic markers of this disease and evaluating those with the risk of progression is a key aim of current research. Estrogen receptors and their variants have been seen to be an important player in the pathogenesis of endometriosis. Briefly, there are two main forms of estrogen receptors. Estrogen…

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