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Background. Ovarian heterotopias are quite successfully diagnosed with ultrasound examinations. Considering the high risk of spread of the disease, as well as reproductive consequences (infertility, pelvic adhesive processes, chronic pelvic pain syndrome, dysmenorrhea), early differential diagnosis of endometrioid cysts and, accordingly, early initiation of treatment are of particular importance.Objective: to combine ultrasound criteria using 3D visualization and the content of biomarkers to verify stage 1–2 endometrioid ovarian cysts.Material and methods. In 59 infertile women with endometrioid ovarian cysts, in the dynamics of the menstrual cycle, ultrasound examinations were performed using Acuson S2000 (Siemens, Germany) and Voluson E8 (General Electric, USA) with the possibility of Doppler measurements and three-dimensional reconstruction of tissue images. Also, in laboratories “Invitro”, “Hemotest”, “Nauka” (Samara, Russia) the biomarkers were determined: interleukins IL-1β, IL-6, cancer antigen 125 (CA-125), human epididymis protein 4 (HE4) and the index by Risk of Ovarian Malignancy Algorithm (ROMA). The control group included 195 fertile women of reproductive age. In patients with endometrioid cysts, the diagnosis was subsequently confirmed morphologically.Results. Small unilateral and bilateral ovarian cysts corresponding to stage 1–2 endometriosis by revised American Fertility Society classification (rAFS) were clearly differentiated in 56 (94.9%) patients, in 3 (5.4%) of them the ultrasound result was questionable. In 48 (81.4%) women the lesion was unilateral and in 11 (18.6%) it was bilateral. The structure of cystic formations in all cases was hypoechoic, heterogeneous, in 36 (61.0%) cases it was finely cellular, without blood flow.Conclusion. Ovarian endometriomas in “gray scale” are round formations of reduced echogenicity and fine suspension, with an even, clear contour, not fused with the surrounding tissues, avascular, changing size depending on menstrual cycle phase. An ovarian mass may have a capsule with locus signals on Doppler. The sensitivity of ultrasound examination in “gray scale” in the presence of an endometrioid cyst is 94.6%.

Rationale: An important role of immunological factors in the endometriosis pathophysiology allows for their consideration as diagnostic and prognostic disease markers. A promising approach to the diagnosis of immunological abnormalities is based on the non-invasive cell diagnostic technology of quantitative phase imaging (QPI), with underlying principles of laser interferometry and holography.Aim: To assess the QPI potential to identify diagnostic criteria for cell immunity abnormalities in female patients with external endometriosis.Materials and methods: We performed a quantitative assessment of the cytotoxic potential of peripheral blood lymphocytes from 22 patients with endometrioid ovarian cysts (mean age, 27.1 ± 3.4 years), 20 patients with uterine leiomyoma (mean age, 29.3 ± 4.1 years) and 20 health non-pregnant women of child-bearing age (mean age, 28.7 ± 3.6 years). We used the non-invasive QPI technique with the module for phase interference microscopy of the Russian hardand software complex Bioni (Westtrade Ltd., Russia).Results: We studied phase interference pictures of native lymphocytes to identify morphological and densitometry characteristics for CD4+ и CD8+ cells. Two groups of cells were identified in the cytotoxic lymphocyte population, which differed in their values of the phase thickness (Hcyt) and the area of cytoplasm adjacent to the membrane and containing the perforin granules (Scyt). It was found, that in the healthy controls the proportion of perforin-positive cytotoxic CD8+ lymphocytes was 37.1 ± 5.15%, in the patients with endometriosis 29.8 ± 6.34%, and in those with uterine leiomyoma 42.6 ± 5.89%.Discussion: Assessment of the lymphocyte cytotoxic potential by quantitative determination of cells containing perforin granules may be an important diagnostic and prognostic criterion of the disease course.Conclusion: Studies of the intracellular structures of lymphocytes by non-invasive and non-reagent technology QPI allows not only for a detailed evaluation of pathophysiological mechanisms of immune competent cell transformation in the course of a pathological process, but also gives future directions for development of new approaches to functional assessment of the immune system based on the results obtained.

The article analyzes magnetic resonance images of the 117 patients with endometrioid ovarian cysts including 12 patients with ovarian cancer raised from endometrioid cysts. Such symptoms as vascularized solid component formation, cyst enlargement and T2-shading regression showed strong correlation with malignant transformation of endometrioid cyst. The solid component within the cyst needs to be differentiated between malignant tumor growth, decidualization and inflammatory tissue. Magnetic resonance imaging is a powerful non-invasive method of malignant transformation of the endometrioid ovarian cysts.

The article is focused on the problem of diagnosis and surgical treatment of infiltrative forms of endometriosis with lesions of both internal genitalia and urinary tract. A clinical observation of a young woman who underwent a robot-assisted operation on the internal genitals and organs of the urinary system is given. The article emphasizes the need for complete clinical examination in women with suspected endometriosis. The young age of patients, even the absence of bright clinic signs or absence of a long anamnesis of the disease should not exclude the possibility of severe case of endometriosis and the possibility of a combined lesions of pelvic organs. If infiltrative endometriosis is detected, the patients treatment should be carried out in a specialized hospital using modern surgical technologies.