Clinical pitfalls of pain recurrence in endometriosis arising in the posterior vaginal fornix.
Endometriotic nodules in the lower genital tract often cause dysmenorrhea and dyspareunia. We report here a case of posterior vaginal fornix endometriosis that was overlooked for several years. We performed a trans-vaginal resection after the associated pain was not relieved by repetitive gonadotropin-releasing hormone agonist (GnRHa) therapy or abdominal surgery. After the resection, the patient's symptoms disappeared. The patient subsequently conceived and proceeded to a full-term delivery. The pathological diagnosis was 'endometriosis of the vagina.' Immunohistochemical staining revealed that the progesterone receptor-positive cells outnumbered the estrogen receptor-positive cells. We emphasize that the existence of vaginal lesions should be considered in cases in which pain has not improved despite long-term GnRHa administration, or in cases involving dyspareunia. To provide appropriate treatment, attentive evaluation and careful examination of the disease are necessary for a patient with prolonged unsatisfactory progress.
Tachibana
Masahito
M
Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan. masahito@mail.tains.tohoku.ac.jp
Murakami
Takashi
T
Utsunomiya
Hiroki
H
Terada
Yukihiro
Y
Yaegashi
Nobuo
N
Okamura
Kunihiro
K
D000328:Adult; D003613:Danazol / Q000627:therapeutic use; D004412:Dysmenorrhea / Q000188:drug therapy / Q000209:etiology; D004414:Dyspareunia / Q000188:drug therapy / Q000209:etiology*; D004715:Endometriosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007150:Immunohistochemistry; D000267:Tissue Adhesions / Q000601:surgery; D017211:Treatment Failure; D014623:Vaginal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery
D004965:Estrogen Antagonists; D007987:Gonadotropin-Releasing Hormone; D003613:Danazol