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the presence of endometrium elsewhere than in the lining of the uterus; causes premenstrual pain and dysmenorrhea (同)adenomyosis

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/03 07:01:47」(JST)

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An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst of ovary is a condition related to endometriosis.

Pathophysiology

Endoscopic image of a ruptured chocolate cyst in left ovary.

It is caused by endometriosis,^[1] and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries. As the blood builds up over months and years, it turns brown. When it ruptures, the material spills over into the pelvis and onto the surface of the uterus, bladder, bowel, and the corresponding spaces between.

Treatment

Treatment for endometriosis can be medical or surgical.

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used first in patients with pelvic pain, particularly if the diagnosis of endometriosis has not been definitively (excision and biopsy) established. The goal of directed medical treatment is to achieve an anovulatory state. Typically, this is achieved initially using hormonal contraception. This can also be accomplished with progestational agents (i.e., medroxyprogesterone acetate), danazol, gestrinone, or gonadotropin-releasing hormone agonists (GnRH), as well as other less well-known agents. These agents are generally used if oral contraceptives and NSAIDs are ineffective. GnRH can be combined with estrogen and progestogen (add-back therapy) without loss of efficacy but with fewer hypoestrogenic symptoms. These medications are often ineffective in treating endometriomas and any relief is short lived while taking the medications. Hormonal treatment has a large number of sometimes permanent side effects, such as hot flushes, loss of bone mass, deepening of voice, weight gain, and facial hair growth.

Surgery

Laparoscopic surgical approaches include excision of ovarian adhesions and of endometriomas. Endometriomas frequently require surgical removal and excision is considered to be far superior in terms of permanent removal of the disease and pain relief. Surgery can sometimes have the effect of improving fertility but can have the adverse effect of leading to increases in cycle day 2 or 3 FSH for many patients.^{[citation needed]} Laser surgery and cauterization are considered to be far less effective and only burn the top layer of endometrial tissue, allowing for the endometrioma and endometriosis to grow back quickly. Likewise, endometrioma drainage or sclerotherapy are somewhat controversial technique for removing endometriomas with varied degrees of success. Conservative surgery can be performed to preserve fertility in younger patients but as earlier stated can have the effect of raising FSH values and making the ovaries less productive, especially if functional ovarian tissue is removed in the surgical process.^{[citation needed]} Operative laparoscopic surgery can provide pain relief and improved fertility. Radical surgical options could include singular or bilateral oophorectomy. ^[2]^[3]

References

^ "Female Genital Pathology". Retrieved 2009-05-12.
^ "What You Need To Know About Ovarian Cysts, Common Types". HealthCentral.
^ Endometrioma/Endometriosis at eMedicine

UpToDate Contents

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1. 卵巣子宮内膜腫の診断およびマネージメント diagnosis and management of ovarian endometriomas
2. 子宮内膜症の病因、臨床的特徴、および診断 pathogenesis clinical features and diagnosis of endometriosis
3. 子宮内膜症の治療の概要 overview of the treatment of endometriosis
4. 子宮内膜症を有する女性における不妊症の病因および治療 pathogenesis and treatment of infertility in women with endometriosis
5. 付属器腫瘤のマネージメント management of an adnexal mass

English Journal

Endometriosis in adolescents.

Dowlut-McElroy T1, Strickland JL.
Current opinion in obstetrics & gynecology.Curr Opin Obstet Gynecol.2017 Oct;29(5):306-309. doi: 10.1097/GCO.0000000000000402.
PMID 28777193

Polychlorinated biphenyls and its potential role in endometriosis.

Yao M1, Hu T1, Wang Y1, Du Y1, Hu C1, Wu R2.
Environmental pollution (Barking, Essex : 1987).Environ Pollut.2017 Oct;229:837-845. doi: 10.1016/j.envpol.2017.06.088. Epub 2017 Jul 31.
PMID 28774553

Effect of alpha-lipoic acid on endometrial implants in an experimental rat model.

Pınar N1, Soylu Karapınar O2, Özcan O3, Özgür T4, Bayraktar S5.
Fundamental & clinical pharmacology.Fundam Clin Pharmacol.2017 Oct;31(5):506-512. doi: 10.1111/fcp.12293. Epub 2017 May 30.
PMID 28429826

Japanese Journal

子宮内膜症診断治療の最前線(教育講演,第63回日本産科婦人科学会・学術講演会)

北脇城
日本産科婦人科學會雜誌 63(12), 2111-2117, 2011-12-01
NAID 110008799030

Changes in serum anti-Müllerian hormone levels may predict damage to residual normal ovarian tissue after laparoscopic surgery for women with ovarian endometrioma.

Kitajima Michio,Khan Khaleque Newaz,Hiraki Koichi,Inoue Tsuneo,Fujishita Akira,Masuzaki Hideaki
Fertility and Sterility 95(8), 2589-2591, 2011-06-30
… Comparing to control benign cysts, we found a significant decline in serum anti-Müllerian hormone levels with consequent depletion of follicles in tissue specimens after surgery for women with ovarian endometrioma. …
NAID 120003307674

「卵巣子宮内膜症」

Endometriosis of ovary
	Transvaginal ultrasonography showing a 67 x 40 mm endometrioma as distinguished from other types of ovarian cysts by a somewhat grainy and not completely anechoic content.
Classification and external resources
Specialty	urology
ICD-10	N80.1
ICD-9-CM	617.1
	[edit on Wikidata]