Short-term effects of dienogest on ovarian endometriomas

Histopathologic evaluation of ovarian endometriotic cysts treated with progestin therapy

Key Points

Highlights:

• Progestin therapy using Dienogest histopathologically increase decidualization of endometriotic lesions.
• No other significant difference occurs regarding inflammation and histology between endometriomas treated with or without progestin therapy.

 Importance:

• Understanding how progestins affect ovarian endometriotic cysts may lead to further knowledge of possible cellular and molecular targets that could be developed to treat endometriosis or to reduce endometriosis-associated symptoms.

 Key Points:

• Histopathological analysis revealed that presence of diffuse and focal necrosis was about the same between the two study groups with no significant difference.
• Decidualization was more frequent in specimens obtained from women given progestin medication than those who did not take medication.
• No differences between groups were detected regarding the other histopathological aspects examined such as necrosis, glandular atrophy, and angiogenesis.
• Although no significant decrease in inflammation was seen in endometriosis samples taken after six months of progestin therapy, authors suggest that long-term administration might be needed to observe histopathologic differences.

 Limitations:

• Lack of randomization of histopathologic examination by the pathologist and the small sample size of the study group.

Lay Summary

First-line treatment of symptomatic, uncomplicated ovarian endometriosis is the use of progestins with or without estrogens such as Dienogest (DNG). These drugs are used to inhibit ovulation and thus reduce the estrogenic environment in which endometriosis relies upon for survival. Therefore, progestin therapy has been observed to minimize the growth of endometriotic lesions and decrease the symptoms. This study aimed to understand the histopathological effects of DNG on endometriotic cysts of women with ovarian endometriomas.

63 women between the ages of 20-45 with ultrasonographic diagnosis of a single ovarian endometrioma without any further infiltrating disease were ultimately included in the study’s analysis. Researchers made sure that these women were not on hormonal treatment for the past six months as these would also alter the histopathology of the lesions. 33 women decided to receive progestin therapy while 30 women received no hormone medication for six months before laparoscopic excision of their disease. Both groups after receiving either progestin or no progestin were taken for surgery after the six-month period.

Specimens that were obtained from ovarian cyst samples after laparoscopic surgery were sectioned, prepared, and stained for histopathologic evaluation by an experienced pathologist. The pathologist noted findings of inflammation, decidualization, atrophy, and angiogenesis if present in the specimen. Histopathological analysis revealed that presence of diffuse and focal necrosis was about the same between the two study groups with no significant difference. Additionally, no significant difference was seen in acute or chronic inflammation of specimens collected from both study cohorts. As expected, decidualization was more frequent in samples obtained from women given progestin medication than those who did not take medication (66.7% versus 23.3%, p=.001). No significant difference was seen in glandular atrophy or focal angiogenesis in specimens collected from both patient groups.

According to this study’s authors, endometriotic cyst walls obtained from women treated with DNG for six months were seen to have a slightly, nonsignificant lower inflammation rate than controls. Moreover, a significantly higher decidualization rate was observed in the study patients compared to controls. No differences between groups were detected regarding the other histopathological aspects examined such as necrosis, glandular atrophy, and angiogenesis.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29160135