[This corrects the article DOI: 10.3389/fgwh.2025.1701704.].

Background Uterine leiomyomata (or fibroids) are common benign tumors of the uterus. Fibroids are classified into subtypes by location: submucosal, intramural, subserosal. Although the symptomology and comorbidities associated with fibroids have been extensively assessed, there is less knowledge regarding factors associated with fibroid subtypes. We tested the associations between fibroid subtypes and a broad range of clinical diagnoses to characterize their shared and unique comorbidity profiles. Methods Using billing codes and clinical note text from the Vanderbilt University Medical Center's electronic health record (EHR) system, we identified individuals with three common fibroid subtypes (cases/controls): submucosal (2,445/28,746), intramural (4,877/20,315), subserosal (3,472/24,447). Using multivariate logistic regression, we performed a phenome-wide association study (PheWAS) for each subtype with over 1,800 constructed clinical diagnoses (phecodes) as predictors. Results We identified 149 significant phecode associations with submucosal fibroids, 218 with intramural fibroids, and 178 with subserosal fibroids. The most significant submucosal fibroid associations were "disorders of menstruation" (odds ratio [OR][95% Confidence Interval] = 5.35[4.79-5.97]) and "iron deficiency anemia secondary to blood loss (chronic)" (OR = 5.20[4.53-5.97]). The most significant association with intramural fibroids was also "disorders of menstruation" (OR = 4.68[4.31-5.08]). The most significant association in the subserosal analysis was with "other benign neoplasm of connective and other soft tissue" (OR = 5.35[4.74-6.04]). We performed sensitivity analyses to narrow down subtype-specific associations. From these, only submucosal fibroids had multiple anemia-, irregular menstruation-, and dysmenorrhea-related phecodes remain significant, and only submucosal and intramural fibroids remained significantly associated with infertility. Conclusions We identified multiple factors that were more strongly or uniquely associated with having a specific fibroid subtype. We demonstrated a greater severity of fibroid symptoms in individuals with a subtype-level fibroid diagnosis.

Background/Objectives: The diagnosis of endometriosis (EM) remains challenging due to the lack of a perfect diagnostic standard and the poor concordance between clinical symptoms and lesion severity. Although laparoscopy is widely used in clinical practice, it is invasive and associated with a non-negligible false-negative rate, while serum CA125 has limited diagnostic accuracy. In our previous studies, circulating endometrial cells (CECs) were identified in the peripheral blood of patients with EM, suggesting their potential as a non-invasive biomarker. Building on this finding, the present study aimed to systematically evaluate the clinical value of CECs in the diagnosis and stratified diagnosis of EM in the absence of a perfect diagnostic reference standard. Methods: Female patients treated at the Department of Obstetrics and Gynecology, Peking University People's Hospital, between June 2022 and June 2024 were enrolled. Participants were clinically classified according to laparoscopic evaluation into an EM group and a non-EM group. However, laparoscopy was not treated as a definitive diagnostic gold standard in the statistical analysis. Instead, given the absence of a perfect reference standard, nonparametric latent class analysis was applied to jointly estimate disease status and the diagnostic performance of CECs, CA125, and laparoscopy. Patients with EM were further stratified according to dysmenorrhea severity (mild, moderate, and severe), lesion activity status (active or dormant), and menstrual cycle phase. Peripheral blood samples were collected from all participants, and CECs were detected using subtraction enrichment combined with immunofluorescence and fluorescence in situ hybridization (SE-iFISH). Serum CA125 levels were measured concurrently. Results: A total of 302 participants were included. The primary analysis focused on 133 surgically confirmed EM patients and 146 non-EM controls. After adjustment for an imperfect diagnostic reference standard, CECs demonstrated superior diagnostic performance compared with serum CA125 in the overall cohort, with higher sensitivity (0.58 vs. 0.37) and specificity (0.81 vs. 0.75). Under laparoscopic assessment in patients with severe dysmenorrhea (VAS ≥ 7), where the sensitivity and specificity were 0.759 and 1.00, respectively, CECs demonstrated superior diagnostic performance compared with serum CA125, with higher sensitivity (0.694 vs. 0.355) and specificity (0.946 vs. 0.429). Similarly, in patients with active EM, where laparoscopy showed a sensitivity of 0.79 and a specificity of 1.00, CECs again demonstrated superior diagnostic performance compared with CA125 (sensitivity 0.73 vs. 0.35; specificity 0.96 vs. 0.31), showing high concordance with laparoscopic diagnosis. When stratified by menstrual cycle phase, CECs maintained superior diagnostic performance over CA125 during both the proliferative and menstrual phases, with higher sensitivity (0.84 vs. 0.44) and specificity (0.83 vs. 0.65). Conclusions: Circulating endometrial cells (CECs) demonstrate high diagnostic accuracy for EM, significantly outperforming serum CA125, and show high concordance with laparoscopic diagnosis across clinically relevant stratified conditions in the absence of a perfect diagnostic gold standard.

Endometriosis and endometrial cancer are distinct gynecological conditions that share overlapping biological mechanisms with implications for clinical management. Endometriosis is a chronic, benign disorder characterized by the ectopic implantation of functional tissue lining the uterus, primarily affecting women of reproductive age. It commonly causes chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. The disease is marked by persistent inflammation, hormonal dysregulation, and alterations in cellular signaling, which mirror some neoplastic processes despite lacking malignant potential. Endometrial cancer is a malignant tumor of the uterine lining, most frequently diagnosed in postmenopausal women. Its incidence is rising due to aging, obesity, and prolonged estrogen exposure. Epidemiological studies suggest a modest increase in endometrial cancer risk among women with endometriosis. However, detection bias and metabolic confounders may influence this association. Both conditions share estrogen dependence, chronic inflammatory microenvironments, and dysregulated pathways such as PI3K/AKT/mTOR. Somatic mutations in genes, including PTEN and ARID1A, further underline molecular intersections. Clinical management is tailored to disease type and severity. Endometriosis therapy emphasizes stepwise hormonal treatment, multidisciplinary pain management, and surgery when indicated. Endometrial cancer management relies on staging, with particular emphasis on molecular classification and histopathology to guide surgery, radiotherapy, chemotherapy, hormone therapy, and immunotherapy in advanced cases. Emerging noninvasive biomarkers and precision medicine strategies may enhance diagnosis, monitoring, and targeted treatment in both conditions. Understanding their shared and divergent mechanisms aids risk stratification, individualized therapy, and improved quality of life. Further prospective studies are needed to optimize patient-specific management and translate mechanistic insights into clinical practice.

Endometriosis is a chronic gynecological disorder that affects approximately 10% of women of reproductive age. In adolescents, it frequently remains underdiagnosed due to the heterogeneity of its clinical presentation. Pelvic pain and dysmenorrhea are often interpreted as physiological symptoms associated with the menstrual cycle, which contributes to delayd diagnosis and postpones timely intervention. Current management strategies primarily include nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal therapies, with the dual objective of relieving pain and, in the case of endometriosis, limiting disease progression. Ultrasound and magnetic resonance imaging (MRI) are valuable tools for diagnostic assessment. Laparoscopy may be sometimes required in cases where medical treatment proves ineffective. In adolescents, as in adults, a multidisciplinary approach is strongly recommended. Recent advances have focused on the identification of specific biomarkers and the development of non-invasive diagnostic methods, with the aim of improving early detection and enhancing patients' quality of life. This literature review provides an overview of current diagnostic and therapeutic strategies for endometriosis in adolescents, while exploring innovat.

An 18-year-old patient with an intact hymen presented with severe, cyclical dysmenorrhea, representing a common diagnostic challenge. Initial evaluation at an outside institution, including transabdominal ultrasound (TAUS) and magnetic resonance imaging (MRI), yielded an inaccurate initial radiological report, creating a diagnostic impasse. As transvaginal ultrasound (TVUS) is not feasible in this patient group, point-of-care transrectal ultrasound (TRUS) was performed, leveraging its superior near-field resolution, providing the definitive diagnosis of a non-communicating rudimentary uterine horn. The diagnosis established by TRUS was corroborated by intraoperative findings at laparoscopy. Surgical resection of the rudimentary horn resulted in complete and sustained symptom resolution, validating the clinical decision to pursue further investigation. This case, involving a routine application of a well-established technique, illustrates the diagnostic gap created by conflicting international guidance. This disconnect between recommendations and necessary clinical practice is particularly challenging in low-resource settings where advanced imaging is inaccessible. To address this uncertainty, we propose a pragmatic diagnostic algorithm positioning TRUS as a second-line, problem-solving modality. The pathway applies when initial non-invasive evaluation with TAUS and transperineal ultrasound (TPUS) is inconclusive due to limited fundal visualization. This highlights a key paradox: while guidance frameworks champion patient-centered principles, their rigid interpretation can create practical barriers in outlier cases. TRUS is then offered as a potential diagnostic step for consenting older adolescents when access to expert-interpreted MRI is either delayed or unavailable. This framework provides a clear pathway for formal studies to generate the evidence currently lacking in this specific population.

Primary dysmenorrhea is a prevalent health issue that has a negative impact on women's well-being. This study sought to explore the potential connection between dietary indices including dietary acid load (DAL), empirical dietary inflammatory index (eDII), and Literature-Based Adherence to Mediterranean diet Score (MEDI-LITE) with primary dysmenorrhea. A total of 105 university students including 57 with and 48 without primary dysmenorrhea participated in this cross-sectional study. Dietary data were collected using a 117-time Food Frequency Questionnaire (FFQ), and the dietary indices were calculated using developed formulas. Using pre-designed questionnaires, the Visual Analog Scale (VAS) and the Verbal Multidimensional Scoring System (VMS) were computed and used to determine the severity of dysmenorrhea pain and side effects. Dietary indices and primary dysmenorrhea relationship assessed by regression analysis adjusted for potential confounders. In the adjusted linear regression models, none of the dietary indices, including eDII, MEDI-LITE, and DAL, showed a statistically significant association with VAS scores. Similarly, the odds of primary dysmenorrhea across tertiles of these dietary indices did not differ significantly. No significant associations were observed between any of the dietary indices and the severity or complications of dysmenorrhea. The result of ROC analysis showed that the mentioned dietary indices were not significant predictors of dysmenorrhea status. The findings of our study showed no significant association between DAL, eDII, and MEDI-LITE and primary dysmenorrhea. Further, well-designed prospective studies are required to confirm these findings, with particular attention to the timing and pattern of dysmenorrhea symptoms.