В представленном материале описан клинический случай впервые выявленного эндометриоза у женщины, находящейся в постменопаузальном периоде. Распространенность данной патологии у лиц после наступления менопаузы составляет 2–5% с вероятностью малигнизации 0,9%. Однако, несмотря на невысокий риск злокачественности, согласно существующим рекомендациям необходимо проводить оперативное лечение. В представленном случае гистологическое исследование подтвердило наличие эндометриоидной ткани в макропрепарате. Ключевые слова: эндометриоз, постменопаузальный период.
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The presented material describes the clinical case of newly diagnosed endometriosis in a woman who is in the postmenopausal period. The prevalence of this pathology in individuals after the onset of menopause is 2–5% with a malignancy probability of 0.9%. However, in spite of the low risk of malignancy, according to existing recommendations it is necessary to conduct operative treatment. In the presented case, a histological study confirmed the presence of endometrioid tissue in the macro preparation. Key words: endometriosis, postmenopausal period.
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3. Dunselman GA, Vermeulen N, Becker C. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (3): 400–12.
4. Hudelist G, Fritzer N, Thomas A. Diagnostic delay for endometrisis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 27 (12): 3412–6.
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6. Inceboz U. Endometriosis after menopause. Womens Health (Lond) 2015; 11 (5): 711–5.
7. Streuli I, Gaitzsch H, Wenger JM, Petignat P. Endometriosis after menopause: physiopathology and management of an uncommon condition. Climacteric 2017; 20 (2): 138–43.
8. Matsushima T, Asakura H. Huge ovarian endometrioma that grew after menopause: Case report. J Obstet Gynaecol Res 2016; 42 (3): 350–2.
9. Bulun SE, Gurates B, Fang Z. Mechanisms of excessive estrogen formation in endometriosis. J Reprod Immunol 202; 55 (1–2): 21–33.
10. Hadfield RM, Manek S, Weeks DE et al. Linkage and association studies of the relationship between endometriosis and genes encoding the detoxification enzymes GSTM1, GSTT1 and CYP1A1. Mol Hum Reprod 2001; 7 (11): 1073–8.
11. Daly AK. Polymorphic Variants of Cytochrome P450: Relevance to Cancer and Other Diseases. Adv Pharmacol 2015; 74: 85–111.
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13. Klenov VE, Potretzke TA, Sehn JK, Thaker PH. Postmenopausal Invasive Endometriosis Requiring Supralevator Pelvic Exenteration. Obstet Gynecol 2015; 126 (6): 1215–8.
14. Morotti M, Remorgida V, Venturini PL, Ferrero S. Endometriosis in menopause: a single institution experience. Arch Gynecol Obstet 2012; 286 (6): 1571–5.
15. Choi SW, Lee HN, Kang SJ, Kim HO. A case of cutaneous endometriosis developed in postmenopausal woman receiving hormonal replacement. J Am Acad Dermatol 1999; 41 (2 Pt. 2): 327–9.
16. Deval B, Rafii A, Dachez Felce M et al. Sigmoid endometriosis in a postmenopausal woman. Am J Obstet Gynecol 2002; 187 (6): 1723–5.
17. Popoutchi P, dos Reis Lemos CR, Silva JC et al. Postmenopausal intestinal obstructive endometriosis: case report and review of the literature. Sao Paulo Med J 2008; 126 (3): 190–3.
18. Beuke M, Dahlem R, Fisch M. Distal stenosis of the ureter due to extrinsic endometriosis in a postmenopausal woman. Aktuelle Urol 2006; 37 (2): 143–4.
19. Pugliese JM, Peterson AC, Philbrick JHJr, Allen RCJr. Ureteral endometriosis in patients after total abdominal hysterectomy: presentation and diagnosis: a case series. Urology 2006; 67 (3): 622.
20. Goldsmith PJ, Ahmad N, Dasgupta D et al. Case hepatic endometriosis: a continuing diagnostic dilemma. HPB Surg 2009; 407206.
21. Эндометриоз: диагностика, лечение и реабилитация. Федеральные клинические рекомендации по ведению больных. М., 2013. / Endometrioz: diagnostika, lecheniye i reabilitatsiya. Federal'nyye klinicheskiye rekomendatsii po vedeniyu bol'nykh. M., 2013. [in Russian]
22. Gemmell LC, Webster KE, Kirtley S et al. The management of menopause in women with a history of endometriosis: a systematic review. Hum Reprod Update 2017; 11: 1–20.
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1. Adamyan L.V., Kulakov V.I., Andreyeva Ye.N. Endometriozy. Rukovodstvo dlya vrachey. M.: Meditsina, 2006. [in Russian]
2. Ginekologiya. Pod. red. V.Ye.Radzinskogo, A.M.Fuksa. M.: GEOTAR-Media, 2014. [in Russian]
3. Dunselman GA, Vermeulen N, Becker C. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (3): 400–12.
4. Hudelist G, Fritzer N, Thomas A. Diagnostic delay for endometrisis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 27 (12): 3412–6.
5. Lapina I.A., Dobrokhotova Yu.E., Gavrilov M.V. et al. Modern possibilities of ovarian endometrioid cyst treatment. Gynecology. 2017; 19 (1): 42–5. [in Russian]
6. Inceboz U. Endometriosis after menopause. Womens Health (Lond) 2015; 11 (5): 711–5.
7. Streuli I, Gaitzsch H, Wenger JM, Petignat P. Endometriosis after menopause: physiopathology and management of an uncommon condition. Climacteric 2017; 20 (2): 138–43.
8. Matsushima T, Asakura H. Huge ovarian endometrioma that grew after menopause: Case report. J Obstet Gynaecol Res 2016; 42 (3): 350–2.
9. Bulun SE, Gurates B, Fang Z. Mechanisms of excessive estrogen formation in endometriosis. J Reprod Immunol 202; 55 (1–2): 21–33.
10. Hadfield RM, Manek S, Weeks DE et al. Linkage and association studies of the relationship between endometriosis and genes encoding the detoxification enzymes GSTM1, GSTT1 and CYP1A1. Mol Hum Reprod 2001; 7 (11): 1073–8.
11. Daly AK. Polymorphic Variants of Cytochrome P450: Relevance to Cancer and Other Diseases. Adv Pharmacol 2015; 74: 85–111.
12. Cherniak Iu.I., Kolesnikov S.I., Cherniak E.V. Tsitokhrom R450: osnovnyye predstavleniya, metody issledovaniya, znacheniye dlya prakticheskoy meditsiny. Irkutsk, 2014. [in Russian]
13. Klenov VE, Potretzke TA, Sehn JK, Thaker PH. Postmenopausal Invasive Endometriosis Requiring Supralevator Pelvic Exenteration. Obstet Gynecol 2015; 126 (6): 1215–8.
14. Morotti M, Remorgida V, Venturini PL, Ferrero S. Endometriosis in menopause: a single institution experience. Arch Gynecol Obstet 2012; 286 (6): 1571–5.
15. Choi SW, Lee HN, Kang SJ, Kim HO. A case of cutaneous endometriosis developed in postmenopausal woman receiving hormonal replacement. J Am Acad Dermatol 1999; 41 (2 Pt. 2): 327–9.
16. Deval B, Rafii A, Dachez Felce M et al. Sigmoid endometriosis in a postmenopausal woman. Am J Obstet Gynecol 2002; 187 (6): 1723–5.
17. Popoutchi P, dos Reis Lemos CR, Silva JC et al. Postmenopausal intestinal obstructive endometriosis: case report and review of the literature. Sao Paulo Med J 2008; 126 (3): 190–3.
18. Beuke M, Dahlem R, Fisch M. Distal stenosis of the ureter due to extrinsic endometriosis in a postmenopausal woman. Aktuelle Urol 2006; 37 (2): 143–4.
19. Pugliese JM, Peterson AC, Philbrick JHJr, Allen RCJr. Ureteral endometriosis in patients after total abdominal hysterectomy: presentation and diagnosis: a case series. Urology 2006; 67 (3): 622.
20. Goldsmith PJ, Ahmad N, Dasgupta D et al. Case hepatic endometriosis: a continuing diagnostic dilemma. HPB Surg 2009; 407206.
21. Endometrioz: diagnostika, lecheniye i reabilitatsiya. Federal'nyye klinicheskiye rekomendatsii po vedeniyu bol'nykh. M., 2013. [in Russian]
22. Gemmell LC, Webster KE, Kirtley S et al. The management of menopause in women with a history of endometriosis: a systematic review. Hum Reprod Update 2017; 11: 1–20.
1. ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России. 650056, Россия, Кемерово, ул. Ворошилова, д. 22А;
2. ГАУЗ «Областная клиническая больница скорой медицинской помощи им. М.А.Подгорбунского». 650000, Россия, Кемерово, ул. Николая Островского, д. 22
*isza@mail.ru
1. Kemerovo State Medical University of the Ministry of Health of the Russian Federation. 650056, Russian Federation, Kemerovo, ul. Voroshilova, d. 22a;
2. M.A.Podgorbunsky Regional Clinical Hospital Ambulance. 650000, Russian Federation, Kemerovo, ul. Nikolaia Ostrovskogo, d. 22
*isza@mail.ru