Ultrastructural Investigation of Pelvic Peritoneum in Patients With Chronic Pelvic Pain and Subtle Endometriosis in Association With Chromoendoscopy.
To evaluate the pelvic peritoneum under chromoendoscopy by scanning electron microscopy (SEM) as well as light microscopy with hematoxylin and eosin staining and immunohistochemistry (IHC) assays in patients with chronic pelvic pain (CPP) associated with subtle endometriosis.



Case series study (Canadian Task Force classification II).



A referral academic community tertiary medical center.



Three women aged 29 to 37 years were referred to the obstetrics and gynecology clinic of the tertiary university hospital with CPP. They were suspicious for endometriosis, were not responding to medical treatments, and had undergone previous pelvic laparoscopy to determine the stage of endometriosis and preparation of peritoneal samples under the guidance of staining with methylene blue in 0.25% dilution.



Comparison of stained and unstained pelvic peritoneal samples after the instillation of 0.25% methylene blue into the pelvic cavity.



In 3 patients, laparoscopic examination showed minimal endometriosis. A total of 18 samples (9 stained and 9 unstained) from the 3 patients were prepared for SEM. Ten of the samples (55.6%) showed microstructural peritoneal destruction (7 of 9 stained [77.7%] and 3 of 9 [33.4%] unstained). Eighteen samples (9 stained and 9 unstained) from the 3 patients were also prepared for IHC. Six of these samples (33.3%) were S-100-positive, including 4 of 9 (44.4%) stained samples and 2 of 9 (22.2%) unstained samples.



In general, in the context of CPP and endometriosis, there is no established relationship between the severity of pain and stage of endometriosis. In the pathophysiology of CPP associated with endometriosis, ultrastructural changes can play a significant role. Under methylene blue staining, some destroyed areas were detected, but the stained areas do not necessarily correlate with increased microstructural peritoneal destruction.
Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
Abolfazl
A
Mehdizadehkashi
Endometriosis and Gynecologic Disorders Research Center, Department of Obstetrics and Gynecology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Electronic address: tahermanesh.k@iums.ac.ir.
Kobra
K
Tahermanesh
Department of Biomedical Engineering, Materials and Biomaterials Research Center, Tehran, Iran.
Abbas
A
Fazel Anvari-Yazdi
Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
Shahla
S
Chaichian
Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Negar
N
Azarpira
Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Maliheh
M
Nobakht
School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
Seyedeh Mehr
SM
Abed
Endometriosis and Gynecologic Disorders Research Center, Department of Obstetrics and Gynecology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Neda
N
Hashemi
D000291:Adnexal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D002908:Chronic Disease; D059350:Chronic Pain / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004801:Eosine Yellowish-(YS) / Q000494:pharmacology; D005260:Female; D006416:Hematoxylin / Q000494:pharmacology; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008751:Methylene Blue / Q000494:pharmacology; D008855:Microscopy, Electron, Scanning; D008859:Microscopy, Polarization; D017699:Pelvic Pain / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010537:Peritoneum / Q000000981:diagnostic imaging* / Q000601:surgery / Q000648:ultrastructure; D013194:Staining and Labeling / Q000379:methods*
D008751:Methylene Blue; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin
Chronic pelvic pain; Minimal endometriosis; Peritoneum; Scanning electron microscopy