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The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the youth age and for its typical features can reduce the ability of the gynecologist. At the same time, missing a prompt diagnosis can delay the beginning of specific and punctual management of endometriosis, which could avoid a postponed diagnosis from 6 to 12 years, typical of adolescent girls complaining of dysmenorrhea. This article aimed to answer all the potential questions around the diagnosis and management of endometriosis in adolescents starting from a clinical case looking at the possible solution that is easily reproducible in the clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Extrapelvic endometriosis is an uncommon condition but can involve nearly every organ, resulting in a wide range of clinical manifestations. Herein, we describe the case of a 45-year-old woman not a candidate for hormonal therapy who had cyclic pain in the left thigh associated with progressive impairment of walking ability. Clinical, instrumental, and laboratory data supported the diagnosis of endometriosis involving the adductor muscles compartment associated with ovarian endometriomas. Laparoscopic bilateral salpingo-oophorectomy and local wide excision in collaboration with an experienced orthopedic oncologist were performed, and definitive histologic analysis confirmed the diagnosis of endometriosis. The patient was pain-free at 6-month follow-up and demonstrated substantial improvement in ambulation and quality of life. Large-muscle endometriosis is a rare entity that can compromise musculoskeletal integrity and decrease quality of life. In this case, surgical excision in collaboration with an orthopedic oncologist was the cornerstone of treatment. [Copyright &y& Elsevier]

Objective: To investigate the effect of levonorgestrel and mifepristone on the expression of endometrial receptivity markers in a three-dimensional endometrial construct. Design: In vitro study. Setting: University hospital and research laboratory. Patient(s): Twelve fertile donors. Intervention(s): Timed endometrial biopsy. Main Outcome Measure(s): Examine the effect of levonorgestrel along with another well-studied fertility-regulating drug, mifepristone, on the expression of endometrial receptivity factors in a three-dimensional stromal and epithelial cell coculture model by immunohistochemistry. Result(s): Both epithelial and stromal cells of in vitro endometrial construct showed the presence of estrogen receptor-α, estrogen receptor-β, progesterone receptors-(A+B), vascular endothelial growth factor, leukemia inhibitory factor, interleukin-1β, and cyclooxygenase-2, whereas the expression of progesterone receptor-B (AR), integrin αVβ3, and MUC1 were confined to epithelial cells. Mifepristone up-regulated expression of epithelial estrogen receptor-β and progesterone receptor-B and down-regulated stromal vascular endothelial growth factor and surface molecules MUC1 and integrin αVβ3 as observed in vivo. Levonorgestrel had no effect on the expression of endometrial receptivity markers studied. Conclusion(s): This in vitro model expresses progesterone-regulated endometrial receptivity factors seen in the physiologic condition. Treatment with levonorgestrel did not affect the expression of these endometrial receptivity markers in contrast to mifepristone. This in vitro model holds the potential to study endometrial receptivity, the embryo–endometrial interaction, and develop new agents for fertility control. [Copyright &y& Elsevier]