From their website:

The OESA meets approximately once a month in a women only setting to offer support in a peer environment. We do not offer medical advice or act as a referral service for treatment. Our members meet to share their struggles and triumphs with a disease that often causes social isolation.

The members of the OESA acknowledge that our friends and family are also greatly impacted by their loved one’s struggles with endometriosis so from time to time we do host open events in a social setting where friends and family can feel comfortable to mingle and get to know other people who have had endometriosis touch their lives.

The OESA’s members are diverse in cultural and socioeconomic backgrounds, we strive to maintain a positive environment for our members and encourage them to stay informed and to advocate for themselves and their health care.

Please visit their site at http://www.ottawaendosupport.org/

A month was spent trying to figure out where the hack was, talking to friends, and getting help from my web provider. They ran some kind of script to clean all my files at the code level, which worked for roughly 24 hours before the hack reasserted itself, and then the web provider threw up its hands and gave me a manual on how to unhack my site myself…at the code level.

Despite the hack, I was still able to post new blog entries during the month of March, but it was a pain in the butt having to work around the hack and redirecting urls. I’m so glad that mess is cleaned up, and I hope visitors to my site were not affected by the hack. It seems to have been a back-end-only event, thankfully.

My friend Ray helped me out further by forwarding me a user discussion on the hack, since it appears to have hit globally at the end of February.

Well, I must have followed the instructions correctly, because the sites look clean, so we’re back in business.

Endometriosis of the lung
A case report and brief review of the literature
Tatiana Jelihovsky and A.F. Grant
From the Departmenit of Pathology and the Page Chest Pavilion, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
Published in the journal Thorax (1968), 23, 434.

A case is described of endometriosis of the lung in a symptomless 54-year-old woman. This and the 11 previously recorded cases of histologically examined pulmonary endometriosis have been divided into two groups. Six of these women had died during pregnancy or shortly after delivery,and their lungs contained deposits of decidua but no endometrial glands; the remaining six patients, at least five of whom had had previous pregnancies, had surgically resected lung specimens showing larger single lesions with endometrial glands. The possible relationship between these two groups is discussed.

Endometriosis of the lung is rare. Although the condition has been diagnosed clinically in patients with a history of recurrent catamenial haemo-ptyses, a search of the literature revealed only 11 cases in which endometrial tissue was found on histological examination of the lungs. These fell into two distinct groups. In the first, small islands of decidua were found at necropsy in the lungs of six subjects who had died either during pregnancy or shortly after delivery (Table I). In the second, larger single lesions with endometrial glands were found in surgically resected specimens (Table II). One of these was from a post-menopausal woman (Sturzenegger, 1960), and it is the purpose of this paper to present a second such case.

CASE HISTORY

A 54-year-old woman, born in Hungary but living in Australia during the past eight years, was found on mass miniature radiography to have a shadow in the right lung and was referred for further investigation. She gave a history of exertional dyspnoea for the past few years, during which she had gained weight. At the time of examination her weight was 200 lb. (90 7 kg.).

There was no history of cough, haemoptysis, or chest pain. She had had two uncomplicated pregnancies, 35 and 14 years previously, and her menopause had occurred in 1964 with no subsequent bleeding. She gave no history of any operation or serious illness.

INVESTIGATION

A radiograph of the chest (Fig. I) showed a thin-walled cystic lesion in the right mid-zone with a little irregularity of the lower wall of the cyst. A tomogram showed the lesion to extend from the 8 cm. to the 11 cm. cut and to have the appear-ance of a multilocular cyst. The Mantoux test was negative at 1/1,000 O.T. Lung function studies were within normal limits. The vital capacity was 2-55 1., F.E.V.1 2-25 1., F.E.V.1/V.C. 88%, and the indirect M.B.C. 83 I./min. The haemoglobin was 13-7 g./100ml. and white cell count 6,400/c.mm. (neutrophils 71%, lymphocytes 28%, monocytes 1%). The erythro-cyte sedimentation rate was 21 mm./hour (Westergren). No carcinoma cells or acid-fast bacilli were found in the sputum.

On 30 August 1965 a right thoracotomy was performed and a cystic lesion was removed from the posterior region of the upper lobe.
On 12 October 1965 she was referred to a gynaecologist, who found a fibroid tumour of the uterus.
On 3 August 1966 the chest radiograph was normal.

PATHOLOGY

Gross The specimen was a wedge of lung with pleura on one surface. It measured 2-5 x 2-3 cm. andcontained a collapsed cyst 2 cm. in diameter. The wall of the cyst was thin, but on the side nearest thepleura a polypoid nodule projected into the lumen.

Microscopic (Figs 2 and 3) The lesion was welldemarcated but not encapsulated. It lay immediately under the pleura, which was slightly thickened byfibrosis. In the polypoid portion of the lesion there were glandular spaces which varied from small tubules to large dilated cysts and were lined by dark-staining, columnar epithelium with prominent elongated nuclei and occasional wider cells with pale-staining cytoplasm and round nuclei. The stroma was very cellular. It was more fibrous and contained larger blood vessels than does normal endometrial stroma.
This and the structure of the glands gave the lesion the appearance of an endometrial polyp. At the tip of the polypoid projection there was a small muscular artery with an internal and an external elastic lamina and a prominent intima. In its thinner portion the cyst wall was lined by a single layer of low columnar to flattened epithelial cells resting upon a loose connective tissue stroma. Unfortunately, the connexion with the bronchus was not demonstrated in the sections, although a large bronchiole was seen immediately outside the cyst wall.

DISCUSSION

This case resembles that described by Sturzenegger (1960) in that the patient was post-menopausal and gave no history of haemoptysis. The absence of haemoptysis in our patient is surprising in view of the large number of vessels and the prominent artery lying immediately under the surface of the polypoid projection.

The theories of pathogenesis have been covered in several previous papers (Hartz, 1956; Lattes, Shepard, Tovell, and Wylie, 1956; Mobbs and Pfanner, 1963; Park, 1954). Although pleural endometriosis can be explained by coelomic metaplasia or spread through pleuroperitoneal sinuses, a similar explanation for endometriosis within the lung is more difficult to accept, especially in the presence of a circulation which is known to transport other fragmentary material such as trophoblast. The possibility of vascular spread has been shown experimentally in rabbits by Hobbs and Bortnick (1940) but is more difficult to prove in the human. At least two of the cases listed in Table I (Dr. Godman’s case reported by Lattes et al. (1956) and Cameron and Park’s first case (1965)) showed decidual tissue in blood vessels, and in none of these was the decidual tissue in contact with the pleura. It is likely that the lesions were embolic in origin. In the second group, on the other hand, most of the lesions were directly beneath the pleura. The only exception is the case described by Lattes et al. (1956) in which the proximity of the lesion to the pleura was not mentioned, although the illustration of the gross specimen suggests that it may have been. The proximity of the lesions to the pleura makes it difficult to exclude a pleural origin with subsequent growth into the lung substance. If both groups of lesions are embolic in origin, why are there glands in all the larger and probably older lesions (Table II) but not in the small, apparently recent deposits of decidua (Table I)? In at least three of the cases in the first group (Park, 1954; Cameron and Park, 1965), the decidual cells appear to have been growing in the lung parenchyma. Whether they would have persisted after the pregnancy is not known. Neither is it known whether the glands seen in the second group had been transported as glands or whether they appeared later by metaplasia and if so from which cells. Most of the patients in the second group had had previous pregnancies (no history is given in Sturzenegger’s case (1960)). If their lung lesions had resulted from metastases during those pregnancies, it would be interesting to know whether cells other than differentiated decidual cells were present in the emboli.

We are very grateful to Dr. V. J. McGovern, Director of Fairfax Institute of Pathology, Royal Prince Alfred Hospital, for his help in the preparation of this paper.

REFERENCES

Cameron, H. M., and Park, W. W. (1965). Decidual tissue within the lung. J. Obstet. Gynaec. Brit. Cwlth, 72, 748.

Hartz, P. H. (1956). Occurrence of decidua-like tissue in the lung. Report ofa case. Amer. J. clin. Path., 26, 48.

Hobbs, J.E.,and Bortnick, A.R.(1940). Endometriosis of the lung; an experimental and clinical study. Amer. J. Obstet. Gynec., 40, 832.

Kovarik, J. L., and Toll, G. D. (1966). Thoracic endometriosis with recurrent spontaneous pneumothorax. J. Amer. med. Ass.. 196,595.

Lattes, R., Shepard, F., Tovell, H., and Wylie, R. (1956). A clinical and pathologic study ofendometriosis ofthe lung. Surg. Gynec.Obstet., 103, 552.

Mobbs,G.A.,and Pfanner,D.W. (1963). Endometriosis ofthe lung. Lancet, 1, 472.

Park, W. W. (1954). The occurrence of decidual tissue within the lung: reportofa case. J.Path. Bact., 67, 563.

Rodman, M. H., and Jones, C. W. (1962). Catamenial hemoptysis due to bronchial endometriosis. New Engl. J. Med., 266, 805.

Sturzenegger, H. (1960). Lung enendometriose unter dem Bild des Rundschattens. Schweiz. Z. Tuberk., 17, 259.

“As women we believe that pain is a natural part of life, so we try and cope on our own, and we suffer in silence,” said Lotus-FM radio personality Pauline Sangham (42) who lived with severe pain for years before she was diagnosed and treated for endometriosis-a condition whereby lesions on the ovaries and other pelvic organs cause extreme pain during a women’s menstrual cycle.

Endometriosis is a debilitating condition that affects as many as one in 10 women, more than double the amount of women affected by breast cancer. But despite its severity and high prevalence there is an average delay in diagnosis of eight- to 10-years. The reason for the late diagnosis and its accompanying suffering is ignorance among many women about what is normal menstrual pain, and what is excessive.

“Pain and discomfort during the first day or two [of a woman's menstrual cycle] is normal, but severe pain throughout and afterwards is not,” said Allan Alperstein associate professor at the obstetrics and gynaecology department at the University of Cape Town.

“Endometriosis is a horrible disease that affects these women’s lives on all levels,” said Alperstein. The pain experienced by some women is so severe that they are literally incapacitated for a week every month. On a professional level, this leads to poor work performance, high absenteeism and could seriously hamper a women’s career progress, or in the case of a girl, her academic performance at school.

The effects on a woman’s personal life are even harsher. “I was a monster mom and a monster wife,” said Sangham. She admitted to having bad moods during severe bouts of pain. She also shied away from sex as the endometrial lesions in her pelvis made intercourse painful.

Pauline believes these factors placed a lot of strain on her marriage, and when she eventually had a hysterectomy after years of suffering, her husband finally left her saying that she couldn’t give him the child he always wanted.

What makes Pauline’s story even more tragic is that if diagnosed early and treated correctly, her endometriosis might have been managed well enough with medication and surgery that would have minimised her pain, and prevented her from having had a hysterectomy.

Pauline blames her ignorance of the disease as well as inappropriate treatment for her suffering and misfortune. She urges other women who think that they might have endometriosis to arm themselves with knowledge on how to manage this condition so that it doesn’t take over their lives.

Here is more information on endometriosis:

What exactly is endometriosis?

Endometriosis is a chronic disease where tissue that resembles the lining of the womb (uterus) is found elsewhere in the body. This tissue forms endometrial lesions which are most often found on the ovaries and other organs in a woman’s pelvis. In very rare cases they can be found in the lungs and even the brain.
Once implanted outside the womb, the endometrial tissue reacts to changing levels of hormones in a woman’s body during the course of her menstrual cycle, causing it to grow. This can cause inflammation and the formation of scar tissue, leading to pain.

Endometrial lesions can also lead to adhesions, which are ‘sticky’ areas of endometrial tissue that can fuse organs together. In addition, endometriosis can cause ovarian cysts (fluid-filled masses in the ovaries) which can become large and painful.

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are chronic pelvic pain, period pain and pain during or after intercourse. Other symptoms can include fatigue, painful bowel movements during periods and lower back pain.

Between 30% and 50% of women with endometriosis experience some degree of infertility. Not all women with endometriosis have symptoms and some women are only diagnosed with the disease when they seek help for problems with infertility.

Different women experience different degrees of pain and the amount of pain experienced is not always related to the size or number of endometrial lesions. While some women experience pain only at specific times during the menstrual cycle, one in four women with endometriosis suffer pain at all times during the cycle.

Who gets endometriosis?
It is estimated that endometriosis affects one in 10 women during their reproductive years, and is equally common among all ethnicities.

Risk factors for developing endometriosis include: endometriosis in the family, early onset of the menstrual period and heavy menstrual flow. Women who use oral contraceptive pills and women with low body weight (low body mass index) may be less likely to develop endometriosis.

How is endometriosis diagnosed?
The symptoms of endometriosis can be difficult to recognise and even women experiencing pain from endometriosis may not realise that they have the disease. The symptoms often overlap with those of other conditions such as irritable bowel syndrome and pelvic inflammatory disease, making diagnosis very challenging.

Furthermore, there is a lack of awareness about endometriosis amongst the general public and, as there is no simple test that can be used to determine whether a woman has endometriosis, it can take several years for the condition to be diagnosed.

Physical examinations, scans (ultrasound and MRI) and other tests are used in diagnosing endometriosis, but in order to make a reliable diagnosis, it is necessary to carry out a surgical procedure called a laparoscopy. During a laparoscopy, a thin tube containing a camera is passed into the abdomen (usually through the belly button). This allows the surgeon to inspect the organs in the pelvis and to take a small sample of tissue for analysis.

How is endometriosis treated?

There is no permanent cure for endometriosis. The aims of endometriosis treatment are to relieve pain, to slow the growth of endometriosis, to improve fertility (where a woman wishes to have children) and/or to prevent the disease from coming back after successful treatment. Options for treatment include pain killers, such as non-steroidal anti-inflammatory drugs (NSAIDs), and hormonal therapies such as the oral contraceptive pill, progestins and gonadotropin-releasing hormone analogues. Laparoscopic surgery can be carried out to remove the endometrial lesions, but lesions may return after surgery. Nutritional therapy and complementary therapies are also used by some women.

These treatments often do not meet the needs of all women living with endometriosis and may only be safe and/or effective for a limited period of time. GnRH-analogue treatments, for example, are effective but can only be used for a limited period of time due to concerns about side effects, including bone thinning.

There is a real need for a specific, effective treatment with a side effect profile which makes it suitable for long term use by endometriosis patients.

Pudendal neuralgia may represent a promising, although complex, avenue for understanding and treating certain forms of chronic pelvic pain.

In a presentation at the annual meeting of the International Anesthesia Research Society in March, John S. McDonald, MD, chair of the Department of Anesthesiology at Harbor-UCLA Medical Center, Torrance, Calif., offered insights into the treatment of chronic pelvic pain (CPP) generally and urged physicians to be alert for pudendal neuralgia, an etiology that may be overlooked in evaluating patients presenting with this kind of pain.

CPP may signal a variety of conditions. Some are well known, such as endometriosis and interstitial cystitis. But pudendal neuralgia, which may involve damage to or compression of the pudendal nerve, can also cause CPP and is less well understood, Dr. McDonald told Pain Medicine News.

Differentiating pudendal neuralgia from other conditions can be challenging. When patients present with symptoms of CPP, many physicians use magnetic resonance imaging to identify causes such as endometriosis or ovarian cysts, and if present, to recommend surgery or other treatment, according to Dr. McDonald. Pudendal neuralgia, however, may coexist with these or other conditions, leaving persistent pain even after surgery.

Common symptoms suggesting pudendal neuralgia include pain when sitting and pelvic floor dysfunction, pain during and after sexual activity and bowel movements, and pain originating in the inferior hypogastric plexus together with frequent need to urinate, Dr. McDonald noted. In conducting a differential diagnosis, physicians must carry out a pelvic exam and often perform diagnostic pudendal nerve blocks, challenging procedures that may require consultation with a gynecologist. For this reason, Dr. McDonald suggests referring patients reporting CPP to a specialist in pelvic pain.

Several treatments for pudendal neuralgia exist. Anticonvulsants or antidepressants may be effective for this as for other neuropathies, and Dr. McDonald’s research indicates that local anesthetic nerve blocks represent another option. A 2000 study by Dr. McDonald of 26 women showed that repeated local anesthetic block of the pudendal nerve may relieve pain if appropriately placed (Obstet Gynecol 2000;95:306-309). Other physicians have explored surgical options, which aim to decompress the pudendal nerve.

Although the etiology of pudendal neuralgia is not entirely clear, research points to demographic risks and potential contributing factors. While prevalence in the general population is unclear, it is far more common among women than men, possibly because labor and endometriosis may damage the pudendal nerve. Among men, bicycle riders seem to be at particular risk, Dr. McDonald said, perhaps owing to poorly designed bicycle seats.

Animal studies indicate more detailed pathophysiology, although results require confirmation and further explanation. Reduced oxygen flow to the pudendal nerve may cause trauma associated with pudendal neuralgia, according to some research. A study in rats co-authored by Dr. McDonald and presented at the Western Anesthesia Residents Conference in 2007 indicates that pudendal neuralgia may lead to referred pain, which conceivably complicates the diagnosis in humans. In this study, innervation of the pudendal nerve seems to cause innervation that presents as bladder pain. “Symptoms like these may be labeled as interstitial cystitis” and be misdiagnosed, Dr. McDonald told Pain Medicine News.

Fred Howard, MD, associate chair of the Department of Obstetrics and Gynecology at the University of Rochester Medical Center, in New York, noted that pudendal neuralgia is “not terrifically well known” among physicians. It is, he agreed with Dr. McDonald, “a real challenge to diagnose.” Conversely, he cautioned that increased attention to its existence and characteristics may lead to overdiagnosis.

Dr. Howard stated that unilateral pain, especially when sitting, combined with hyperalgesia and allodynia, may be tip-offs to pudendal neuralgia. Interstitial cystitis presents with very similar symptoms, however, and he suggested that pelvic exams require a specialist’s expertise.