⁉️⚠️Question for the ladies: If I told you that every month during your menstruation, you could experience coughing up blood, would you think I’m joking?
🤯✅Such a thing could indeed occur in the extremely rare case of thoracic endometriosis!!!
👩🫁Today’s healthcare espresso shot swims in waters quite unknown to an Internist and deals with a fairly common gynecological condition that is particularly rare in its nature!
🟦Vol 7: Endometriosis
👀🌏It is a chronic, benign condition in which cells from the inner lining of the uterus implant and multiply in other parts of the body.
1 in 10 women of reproductive age and up to 4 in 10 women with infertility will develop the disease, usually between 25 and 35 years old.
🔬🩻Endometriotic cells usually implant in areas of the reproductive system or around it, but they can also implant in more distant locations in the abdomen (e.g., intestines, urinary system) or even outside the abdomen (e.g., thoracic endometriosis).
🩹💉😞💲Pain and infertility are the main clinical manifestations of the disease, while in cases of rare localization, unusual symptoms may occur due to the normal function of endometriotic cells in abnormal locations (such as the striking case mentioned at the beginning). Endometriosis has been correlated with other diseases (e.g., malignancies and autoimmune disorders) and can significantly affect patients’ quality of life.
🧑⚕️💊Diagnosis relies on imaging tests and laparoscopy. Treatment is surgical in cases deemed necessary, while medical therapies mainly focus on managing the primary clinical manifestations mentioned above.
🤔What, however, attracted the interest of an Internist in this disease?
🧐Its nature: A benign condition where normal cells develop in a location other than expected. This is not commonly encountered. More importantly, how can such a thing occur (pathophysiology, as we call it in Medicine).
🔝🧠The pathophysiology of the disease has not been fully elucidated. Literally everything has been investigated and associated with the disease’s pathophysiology!
🥗🧘☕🍷🩸🧬🦠🌐In summary: Active transport from the uterus to other locations, remnants of primordial cells from embryonic development in unexpected sites, hormones and vitamins, genetic factors (mutations and variants), epigenetic mechanisms (gene expression), the Immune system and inflammatory mechanisms, microbiome (variations in the quality and quantity of the millions of microbes living normally within us), habits and lifestyle, environmental factors, cell and molecule function at the microscopic level.
🤩😎🧙And this is where the magic happens in Science. Through all this research, many promising tests and therapies have emerged that are expected to significantly improve overall endometriosis management in the coming years.
📖References
-Malvezzi H, Marengo EB, Podgaec S, Piccinato CA. Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology. J Transl Med. 2020 Aug 12;18(1):311. doi: 10.1186/s12967-020-02471-0. PMID: 32787880; PMCID: PMC7425005.
-Ochoa Bernal MA, Fazleabas AT. The Known, the Unknown and the Future of the Pathophysiology of Endometriosis. Int J Mol Sci. 2024 May 27;25(11):5815. doi: 10.3390/ijms25115815. PMID: 38892003; PMCID: PMC11172035.
-Swift B, Taneri B, Becker CM, Basarir H, Naci H, Missmer SA, Zondervan KT, Rahmioglu N. Prevalence, diagnostic delay and economic burden of endometriosis and its impact on quality of life: results from an Eastern Mediterranean population. Eur J Public Health. 2024 Apr 3;34(2):244-252. doi: 10.1093/eurpub/ckad216. PMID: 38070492; PMCID: PMC10990517.