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Su J, She L, Fan Y, Wang H, Zhang Q, Zhang J, Ma H. Model Predicting the Risk of Endometrial Hyperplasia Developing into Endometrial Cancer. J Inflamm Res 2024; 17:6159-6171. [PMID: 39262650 PMCID: PMC11389718 DOI: 10.2147/jir.s471620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/19/2024] [Indexed: 09/13/2024] Open
Abstract
Background This study retrospectively analyzed the medical records of 200 patients with endometrial hyperplasia to predict the risk of concurrent endometrial cancer. Methods Patients were categorized into either the endometrial cancer group or the endometrial hyperplasia group based on post-hysterectomy pathology. The investigation compared general information, tumor indices, fertility history, preoperative endometrial sampling methods, comorbidities, and clinical symptoms between the groups to identify risk factors for endometrial hyperplasia complicating endometrial cancer. Results (1) Of the 200 patients, 68 (34.0%) were diagnosed with concurrent endometrial cancer post-hysterectomy. Among these, 60 (88.24%) had endometrioid adenocarcinoma, while 8 (11.76%) had other types. Stage I was identified in 58 patients (85.29%) and Stage II in 10 patients (14.71%). High differentiation was observed in 57 cases (83.82%), moderate differentiation in 7 cases (10.29%), and poor differentiation in 4 cases (5.89%), indicating that most endometrial cancers complicated by hyperplasia were early-stage, well-differentiated endometrioid carcinomas; (2) Univariate analysis revealed statistically significant differences in age, menopausal status, length of menopause, and preoperative endometrial pathology of severe atypical hyperplasia between the groups; (3) Multivariate analysis indicated significant differences for age ≥ 53.5 years (OR: 4.307, 95% CI: 2.018-9.192, p < 0.05), menopausal status (OR: 5.250, 95% CI: 2.449-11.252, p < 0.05), and severe atypical endometrial hyperplasia (OR: 4.817, 95% CI: 1.260-18.419, p < 0.05); (4) Significant differences were observed among patients with endometrial hyperplasia when stratified by the presence of zero, one, two, or three high-risk factors. Conclusion In conclusion, patients aged ≥ 53.5 years, those who are menopausal, and those with severe atypical endometrial hyperplasia preoperatively are at higher risk for endometrial cancer. The risk increases with the number of high-risk factors present in patients with atypical endometrial hyperplasia.
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Affiliation(s)
- Jing Su
- Department of Obstetrics and Gynecology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Lina She
- Department of Obstetrics and Gynecology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Yang Fan
- Department of Obstetrics and Gynecology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Honghong Wang
- Department of Pathology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Qiaorui Zhang
- Department of Obstetrics and Gynecology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Jiao Zhang
- Department of Obstetrics and Gynecology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Hongyun Ma
- Department of Obstetrics and Gynecology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, People's Republic of China
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Balulescu L, Nistor S, Lungeanu D, Brasoveanu S, Pirtea M, Secosan C, Grigoras D, Caprariu R, Pasquini A, Pirtea L. Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery. Front Med (Lausanne) 2023; 10:1216455. [PMID: 37675138 PMCID: PMC10477596 DOI: 10.3389/fmed.2023.1216455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Uterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss. Materials and methods This single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: "LM + TOHA" group (29 patients), and "LM" group (31 patients). The study's main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb). Results Delta Hb was statistically lower in the "LM + TOHA" group compared to "LM" group, with mean ± standard (min-max): 1.68 ± 0.67 (0.39-3.99) vs. 2.63 ± 1.06 (0.83-4.92) g/dL, respectively (p < 0.001). There was a statistically significant higher need for postoperative iron perfusion in the "LM" group, specifically 0 vs. 12 patients (p < 0.001), and lower postoperative anemia in "LM + TOHA" group (p < 0.001). Necessary artery clipping time was 10.62 ± 2.47 (7-15) minutes, with no significant impact on overall operative time: 110.2 ± 13.65 vs. 106.3 ± 16.48 (p = 0.21). There was no difference in the length of hospitalization or 12-month post-intervention fertility. Discussion Performing bilateral TOHA prior to laparoscopic myomectomy has proven to be a valuable technique in reducing surgery-associated blood loss, while minimizing complications during surgery, with no significant increase in the overall operative time. Clinical trial registration ISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343.
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Affiliation(s)
- Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Samuel Nistor
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Dorin Grigoras
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Radu Caprariu
- Department of Radiology and Medical Imaging, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Pasquini
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- “Pius Brinzeu” County Clinical Emergency Hospital, Timisoara, Romania
| | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
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Matsuura Y, Nishida H, Kosaka T, Shigekawa K, Takasaki K, Ichinose T, Hirano M, Hiraike H, Nagasaka K. Case report: Posterior reversible encephalopathy syndrome, an adverse effect of lenvatinib and pembrolizumab combination therapy, in a patient with advanced endometrial cancer. Front Oncol 2023; 12:1079716. [PMID: 36741713 PMCID: PMC9895820 DOI: 10.3389/fonc.2022.1079716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
Background Lenvatinib-pembrolizumab combination (LEAP) is an approved therapy in Japan for advanced endometrial cancer, based on the data from the KEYNOTE-775 clinical trial. We report a case of posterior reversible encephalopathy syndrome (PRES) in a patient who received LEAP therapy for advanced endometrial cancer. Case presentation A 53-year-old patient with stage IVB endometrial cancer having rectal metastases, after four cycles of paclitaxel-carboplatin therapy, was found to have increased rectal invasion, peritoneal dissemination, and multiple paraaortic lymph node metastases. She was treated with LEAP therapy and discharged on day 12 without adverse events, except for mild anemia on day 11 of treatment. She was carefully managed in the outpatient department, but on day 18, she was admitted to the emergency department with severely impaired consciousness and generalized seizures. Computed tomography of the head and lumbar tap showed no abnormal findings, and the seizures resolved with anticonvulsant medication alone. Based on a thorough physical examination and findings on magnetic resonance imaging (MRI), which showed high signal intensity in the left occipital lobe, encephalopathy, rather than encephalitis, was the likely diagnosis. Symptomatic improvement was observed, and pembrolizumab monotherapy was resumed. Conclusions If consciousness is impaired during LEAP treatment, it is necessary to differentiate between immunogenic encephalitis caused by pembrolizumab or encephalopathy caused by lenvatinib. MRI and lumbar tap can help in distinguishing between the two and diagnosing the responsible drug.
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Pituitary suppression with GnRH agonists before ART may be insufficient to treat women with severe adenomyosis. Reprod Biomed Online 2023; 46:150-155. [PMID: 36402667 DOI: 10.1016/j.rbmo.2022.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTION Does aromatase inhibitor improve IVF outcomes by reducing local oestrogen production in patients with adenomyosis undergoing long-term gonadotrophin-releasing hormone agonist (GnRHa) treatment? DESIGN Four patients with severe adenomyosis who failed to improve after long-term treatment (≥3 months) with depot GnRHa received treatment with an aromatase inhibitor for 21 days. Blood oestradiol concentrations were monitored after GnRHa treatment both before and after treatment with an aromatase inhibitor. Women received a transfer of IVF autologous or donor oocytes. Pregnancy and ongoing pregnancy rates were the primary outcomes. Blood oestradiol concentration after treatment with an aromatase inhibitor was a secondary outcome. RESULTS Patients with severe adenomyosis presented with hyperestrogenism due to local production from the lesions even after long-term treatment with GnRHa. Treatment with an aromatase inhibitor reduced hyperestrogenism and improved clinical outcomes in adenomyosis patients who have experienced previous embryo transfer failures. CONCLUSION Women with severe adenomyosis would benefit from letrozole or a combination of GnRHa plus letrozole before receipt of treatment with assisted reproductive technology. For women with severe adenomyosis, GnRHa treatment alone may be insufficient to suppress oestrogen production by adenomyotic lesions. Thus, it should be mandatory to test for oestradiol concentrations in patients with severe adenomyosis who have received long-term GnRHa treatment. Also, GnRHa may not always be the sole strategy for medical management of adenomyotic lesions. Letrozole is safe and can improve IVF outcomes for patients with adenomyosis.
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Zhang H, Cao B, Tong J, Guo J, Zheng J, Zhu L, Niu Z, Chen L. An innovative surgical approach: suture fixation of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis. BMC Womens Health 2022; 22:451. [DOI: 10.1186/s12905-022-01932-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Placement of a levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment for adenomyosis, especially for patients who have severe dysmenorrhea symptoms but a strong desire to preserve fertility. Nonetheless, for patients with adenomyosis accompanied by an enlarged uterus, expulsion of the ring is a troublesome problem. In this study, we sewed and fixed the LNG-IUS in the uterus, which provides a good solution to this problem.
Methods
In this prospective case series approved by the Ethics Committee of Hangzhou Women’s Hospital, 12 patients with adenomyosis were successfully enrolled after providing informed consent, and all patients underwent long-term postoperative follow-up.
Results
Twelve patients with adenomyosis underwent suture fixation with an LNG-IUS, and during the long-term postoperative follow-up, every patient experienced complete remission of their symptoms: a significant decrease in menstrual flow, relief of dysmenorrhea, and improvement in quality of life. Only one person reported expulsion a year later.
Conclusion
In patients with adenomyosis suffering from dysmenorrhea or excessive menstrual blood loss, suture fixation of an LNG-IUS using the hysteroscopic cold knife surgery system is a minimally invasive and effective alternative treatment for adenomyosis and decreases the risk of LNG-IUS expulsion.
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Successful laparoscopic management of acute abdominal pain due to spontaneous rupture of subserosal vessels overlying a uterine fibroid: a case report and surgical video. BMC Womens Health 2022; 22:388. [PMID: 36138425 PMCID: PMC9502635 DOI: 10.1186/s12905-022-01970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background Acute abdomen comprises several emergencies. Hemoperitoneum associated with uterine fibroids, which can present as acute abdominal pain, is rare and difficult to diagnose. Especially, spontaneous hemorrhage from the rupture of the superficial vessels overlying a uterine fibroid is extremely rare, and its diagnosis and management have not been established. Case presentation We report a case of a 55-year-old woman who presented at our hospital with acute abdomen. After performing a computed tomography scan, we conducted a laparoscopic examination and diagnosed hemoperitoneum of ambiguous origin. We treated the patient surgically, performing a laparoscopic myomectomy to remove the origin of the hemorrhage. The patient recovered well. Conclusions We report a case of hemoperitoneum of ambiguous origin that was diagnosed laparoscopically and treated by laparoscopic myomectomy to remove the origin of the hemorrhage. Surgeons should rapidly diagnose and manage acute abdominal pain in women with a history of uterine fibroids to prevent severe morbidity or even mortality. Therefore, laparoscopic surgery is recommended in patients with stable hemodynamics. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01970-0.
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Wu S, Liu J, Jiang L, Yang L, Han Y. Spontaneous rupture of the uterus in the third trimester after high-intensity ultrasound ablation in adenomyosis: A case report. Front Med (Lausanne) 2022; 9:966620. [PMID: 36186811 PMCID: PMC9519988 DOI: 10.3389/fmed.2022.966620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Adenomyosis is a benign uterine disease. Due to the higher incidence of adenomyosis and patients' demands for fertility, high-intensity ultrasound ablation has been widely used in gynecological patients with uterine fibroids and adenomyosis. Ultrasound ablation of lesions can help alleviate symptoms in patients without increasing the incidence of obstetric complications in subsequent pregnancies. High-intensity ultrasound ablation is not considered a risk factor for uterine rupture. However, we describe a case of adenomyosis treated with high-intensity ultrasound ablation presenting with uterine rupture in the third trimester. The patient underwent an emergency cesarean section to deliver the baby successfully and underwent uterine repair surgery. When treating patients with adenomyosis, care should be taken to protect the myometrium, endometrium, and serous layer to reduce the risk of uterine rupture.
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Affiliation(s)
- Siyun Wu
- Department of Obstetrics and Gynecology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Jun Liu
- Department of Obstetrics and Gynecology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Libin Jiang
- Department of Obstetrics and Gynecology, Zhongshan Torch Development Zone Hospital, Zhongshan, Guangdong, China
| | - Lijun Yang
- Department of Obstetrics and Gynecology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Yanhua Han
- Department of Obstetrics and Gynecology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
- *Correspondence: Yanhua Han
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Li B, Wang Y, Wang Y, Li S, Liu K. Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall With Lynch Syndrome: A Rare Case Report and Review of Literature. Front Oncol 2022; 12:832228. [PMID: 35402227 PMCID: PMC8983876 DOI: 10.3389/fonc.2022.832228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMalignant transformation of deep infiltrating endometriosis (DIE) invading the cervix and rectum is quite rare, especially in patients combined with Lynch syndrome (LS). We report a rare case of a 49-year-old perimenopausal woman with endometrioid carcinoma arising from the pouch of Douglas, invading the cervix and rectum 1 year after a unilateral salpingo-oophorectomy treatment for ovarian endometriosis. The genetic testing of the patient showed germline mutations in MSH2, which combined with the special family history of colorectal cancer of the patient, was also thought to be associated with LS. We have analyzed the reported cases of DIE malignant transformation over the last 10 years, and reviewed the relevant literature, in order to strengthen the clinical management of patients with endometriosis, particularly patients with DIE, and reveal a possible correlation between malignant transformation of endometriosis and LS.Case PresentationA 49-year-old perimenopausal woman presented with hypogastralgia, diarrhea, and intermittent fever for more than 1 month. A Transvaginal ultrasound (TVS) showed a cervix isthmus mass, and a magnetic resonance imaging (MRI) showed a mass in pouch of Douglas with high suspicion of malignancy, possibly invading the anterior wall of the rectum. Prior to surgery, the patient performed the ultrasound guided pelvic mass biopsy through the vagina, and the pathology of the mass showed endometrioid carcinoma. The patient received a gynecological–surgical laparotomy and enterostomy, and a histopathology revealed endometrioid carcinoma infiltrating the cervical wall and rectal wall. In the family genetic history of the patient, her mother and two sisters suffered from colorectal cancer, so lesion tissue and blood were taken for genetic testing, which showed a germline mutation in MSH2, with LS being considered. After the surgical treatment, the patient received six courses of paclitaxel–carboplatin chemotherapy. During the course of treatment, bone marrow suppression occurred, but was healed after symptomatic treatment. To date, the patient is generally in good health, and imaging examination showed no evidence of recurrence.ConclusionThe risk of malignant transformation of endometriosis is increased in perimenopause and postmenopause, as DIE is a rare malignant transformation of endometriosis. DIE can invade other adjacent organs and cause poor prognosis, thus, comprehensive gynecological–surgical treatment should be necessary. In addition, if histopathology showed endometrioid carcinoma, the possibility of LS should be considered, and if necessary, immunohistochemical staining and gene detection should be improved to provide follow-up targeted therapy and immunotherapy.
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Wang X, Guo Y. Clinical analysis of 44 cases of atypical polypoid adenomyoma of the uterus. BMC Womens Health 2022; 22:60. [PMID: 35246106 PMCID: PMC8895791 DOI: 10.1186/s12905-022-01643-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical polypoid adenomyoma (APA) is a rare intrauterine polypoid lesion that occurs predominantly in premenopausal women. Although APA was previously considered a benign lesion and treated conservatively, an increasing number of cases show that APA has a high rate of recurrence or residual disease and that it precedes the development of carcinoma. The clinical management of APA remains to be established. The aim of this study was to analyse the clinicopathological features of APA and discuss its diagnosis and prognosis. METHODS Forty-four patients with APA were admitted to Beijing Obstetrics and Gynecology Hospital from 2005 to 2019, and their clinical and histopathologic features were evaluated. B-ultrasound was performed, and all the patients (n = 44) underwent hysteroscopy. Endometrium excision was performed by means of the four-step diagnosis and treatment method. Hysteroscopic transcervical resection (TCR) was performed in 5 patients with APA-H and 11 with APA-L. Except for one patient who underwent transcervical endometrial resection, all the patients underwent hysterectomy and salpingectomy or salpingo-oophorectomy. Data from a median follow-up of 42 months (ranging from 3 to 174 months) were available for these patients. RESULTS Pathological diagnosis were made according to the degree of abnormality of the APA surface glands, resulting in APA-L in 36 patients and APA-H in 8 patients. Among these patients, 28 (25 APA-L and 3 APA-H) were treated conservatively. The effect of the four-step diagnosis and treatment method as an APA therapy was excellent. During the follow-up, no evidence of recurrence was found. CONCLUSIONS For patients with intracavitary lesions > 1 cm, the hysteroscopic four-step diagnosis and treatment method and pathological diagnosis are the basis of clinical treatment. More than 30% of APA surface glands have complex structures characterized by branching and budding or other high-risk factors, such as endometrial hyperplasia, which are indications for hysterectomy. For patients who desire to become pregnant or to preserve the uterus, hysteroscopy with complete excision of the lesions should be the preferred treatment method. The patients should be treated and followed up closely with regular hysteroscopy and endometrial biopsy.
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Affiliation(s)
- Xin Wang
- Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, 17 Qihelou Street, Dongcheng District, 100006, Beijing, China
| | - Yinshu Guo
- Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, 17 Qihelou Street, Dongcheng District, 100006, Beijing, China.
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Prašnikar E, Kunej T, Gorenjak M, Potočnik U, Kovačič B, Knez J. Transcriptomics of receptive endometrium in women with sonographic features of adenomyosis. Reprod Biol Endocrinol 2022; 20:2. [PMID: 34980152 PMCID: PMC8722101 DOI: 10.1186/s12958-021-00871-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Women with uterine adenomyosis seeking assisted reproduction have been associated with compromised endometrial receptivity to embryo implantation. To understand the mechanisms involved in this process, we aimed to compare endometrial transcriptome profiles during the window of implantation (WOI) between women with and without adenomyosis. METHODS We obtained endometrial biopsies LH-timed to the WOI from women with sonographic features of adenomyosis (n=10) and controls (n=10). Isolated RNA samples were subjected to RNA sequencing (RNA-seq) by the Illumina NovaSeq 6000 platform and endometrial receptivity classification with a molecular tool for menstrual cycle phase dating (beREADY®, CCHT). The program language R and Bioconductor packages were applied to analyse RNA-seq data in the setting of the result of accurate endometrial dating. To suggest robust candidate pathways, the identified differentially expressed genes (DEGs) associated with the adenomyosis group in the receptive phase were further integrated with 151, 173 and 42 extracted genes from published studies that were related to endometrial receptivity in healthy uterus, endometriosis and adenomyosis, respectively. Enrichment analyses were performed using Cytoscape ClueGO and CluePedia apps. RESULTS Out of 20 endometrial samples, 2 were dated to the early receptive phase, 13 to the receptive phase and 5 to the late receptive phase. Comparison of the transcriptomics data from all 20 samples provided 909 DEGs (p<0.05; nonsignificant after adjusted p value) in the adenomyosis group but only 4 enriched pathways (Bonferroni p value < 0.05). The analysis of 13 samples only dated to the receptive phase provided suggestive 382 DEGs (p<0.05; nonsignificant after adjusted p value) in the adenomyosis group, leading to 33 enriched pathways (Bonferroni p value < 0.05). These included pathways were already associated with endometrial biology, such as "Expression of interferon (IFN)-induced genes" and "Response to IFN-alpha". Data integration revealed pathways indicating a unique effect of adenomyosis on endometrial molecular organization (e.g., "Expression of IFN-induced genes") and its interference with endometrial receptivity establishment (e.g., "Extracellular matrix organization" and "Tumour necrosis factor production"). CONCLUSIONS Accurate endometrial dating and RNA-seq analysis resulted in the identification of altered response to IFN signalling as the most promising candidate of impaired uterine receptivity in adenomyosis.
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Affiliation(s)
- Erika Prašnikar
- Department of Reproductive Medicine and Gynaecological Endocrinology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Tanja Kunej
- Department of Animal Science, Biotechnical Faculty, University of Ljubljana, 1230 Domžale, Slovenia
| | - Mario Gorenjak
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Uroš Potočnik
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
- Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, 2000 Maribor, Slovenia
| | - Borut Kovačič
- Department of Reproductive Medicine and Gynaecological Endocrinology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Jure Knez
- Department of Gynaecology, University Medical Centre Maribor, 2000 Maribor, Slovenia
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Gulino FA, Dilisi V, Capriglione S, Cannone F, Catania F, Martire FG, Tuscano A, Gulisano M, D’Urso V, Di Stefano A, Cimino MC, Filippini M, Latella S, Sammarini M, Musmeci G, Palumbo MA. Anti-Mullerian Hormone (AMH) and adenomyosis: Mini-review of literature of the last 5 years. Front Endocrinol (Lausanne) 2022; 13:1014519. [PMID: 36120472 PMCID: PMC9471373 DOI: 10.3389/fendo.2022.1014519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Adenomyosis is a form of endometriosis characterized by the presence of endometrial tissue in the myometrium. The correlation between anti-Mullerian hormone (AMH) expression and adenomyosis is unclear. Few studies investigated this possible correlation with promising results. The aim of this mini-review is to illustrate the potential prognostic and therapeutic role of AMH in adenomyosis. MATERIALS AND METHODS A study protocol was completed conforming to the Preferred Reporting Items for Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. We performed an electronic databases search from each database's inception from August 2017 to August 2022 for full-text articles and published abstracts. For database searches, the following main keywords were the following text words: "adenomyosis" or "uterine endometriosis" [Mesh] AND "AMH" or "anti-mullerian hormone". RESULTS From the literature search, 8 abstracts of studies were retrieved and independently screened for inclusion by three authors. It was found that the most common therapeutic strategies (such as adenomyomectomy and high-intensity focused ultrasound (HIFU) do not alter AMH levels. Moreover, a higher expression of the AMH receptor II was observed in adenomyotic tissue, hence a possible therapeutic use of AMH was hypothesized. CONCLUSION The available evidence shows an unclear relationship between adenomyosis and AMH. Probably, women with adenomyosis have lower levels of AMH and the surgical treatment (adenomyomectomy, HIFU) does not alter this characteristic, therefore in all of them, ovarian function is not influenced.
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Affiliation(s)
- Ferdinando Antonio Gulino
- Department of Obstetrics and Gynecology, Azienda di Rilievo Nazionale e Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy
- *Correspondence: Ferdinando Antonio Gulino,
| | - Valentina Dilisi
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Ospedale “Santa Maria Alla Gruccia”, Montevarchi, Italy
| | - Francesco Cannone
- Department of Obstetrics and Gynecology, Azienda di Rilievo Nazionale e Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy
| | - Francesco Catania
- Department of Obstetrics and Gynecology, Ospedale “Santa Maria Alla Gruccia”, Montevarchi, Italy
| | | | - Attilio Tuscano
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Marianna Gulisano
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Valentina D’Urso
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Alessandra Di Stefano
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Monia Caterina Cimino
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Maurizio Filippini
- Department of Obstetrics and Gynaecology, Ospedale di Stato, Cailungo, San Marino
| | - Silvia Latella
- Department of Obstetrics and Gynaecology, Ospedale di Stato, Cailungo, San Marino
| | - Margaret Sammarini
- Department of Obstetrics and Gynaecology, Ospedale di Stato, Cailungo, San Marino
| | - Giulia Musmeci
- Department of Hospital Pharmacy, San’Elia Hospital, Caltanissetta, Italy
| | - Marco Antonio Palumbo
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
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12
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Aimagambetova G, Terzic S, Laganà AS, Bapayeva G, la Fleur P, Terzic M. Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients. J Clin Med 2021; 11:196. [PMID: 35011935 PMCID: PMC8746136 DOI: 10.3390/jcm11010196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 12/15/2022] Open
Abstract
Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups' stratification along with specific biomarkers' identification will ensure low recurrence and decrease mortality rates in young women with EC.
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Affiliation(s)
- Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (S.T.); (P.l.F.); (M.T.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
| | - Gauri Bapayeva
- National Research Center of Mother and Child Health, Clinical Academic Department of Women’s Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
| | - Philip la Fleur
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (S.T.); (P.l.F.); (M.T.)
| | - Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (S.T.); (P.l.F.); (M.T.)
- National Research Center of Mother and Child Health, Clinical Academic Department of Women’s Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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13
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Terzic M, Aimagambetova G, Bapayeva G, Ukybassova T, Kenbayeva K, Kaiyrlykyzy A, Ibrayimov B, Lyasova A, Terzic S, Alkatout I, Gitas G, Hortu İ, Garzon S, Laganà AS. Pipelle endometrial sampling success rates in Kazakhstani settings: results from a prospective cohort analysis. J OBSTET GYNAECOL 2021; 42:1255-1260. [PMID: 34592892 DOI: 10.1080/01443615.2021.1953452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the feasibility of Pipelle endometrial sampling and to explore factors influencing Pipelle success rate in the clinical settings of Kazakhstan. This prospective analysis included 87 patients who had undergone Pipelle biopsy due to medical indications for endometrial sampling. We analysed physician and patient-related factors potentially influencing the success rate of this method. Pipelle endometrial biopsy overall success rate was 82.76%. The indications for the procedure and patients' age were key factors influencing Pipelle sampling success (p < .001). The success rate was the highest in the group with abnormal uterine bleeding as a biopsy indication in the reproductive age group (93.19%; p < .001).Pipelle biopsy was found to be an acceptable option for endometrial sampling in our clinical setting; at the same time, physicians should consider the potential influencing factors on its success rate like indications for the procedure, BMI and patients' age as well as their menopausal status. In order to provide precise future directions, there is a need to study a larger number of patients.IMPACT STATEMENTWhat is already known on this subject? Compared to dilation and curettage sampling conducted in the operation room, Pipelle endometrial sampling is relatively inexpensive, associated with less morbidity, safe, accurate, and can be performed in an office setting.What do the results of this study add? This is the first prospective data analysis about Pipelle endometrial sampling in Kazakhstani population.What are the implications of these findings for clinical practice and/or further research? Enabling the timely diagnosis of current endometrial pathology, Pipelle endometrial sampling approach may have an important impact on healthcare safety and efficiency, and improve overall treatment outcomes and the quality of life of Kazakhstani population if used consistently.
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Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan.,Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Kamila Kenbayeva
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Aiym Kaiyrlykyzy
- National Laboratory of Astana, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Bakytkali Ibrayimov
- Department of Pathological Anatomy, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Alla Lyasova
- Pathology Bureau of Nur-Sultan City Administration, Nur-Sultan, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - İsmet Hortu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ege University, İzmir, Turkey.,Department of Stem Cell, Institute of Health Sciences, Ege University, İzmir, Turkey
| | - Simone Garzon
- lDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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14
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Terzic M, Aimagambetova G, Kunz J, Bapayeva G, Aitbayeva B, Terzic S, Laganà AS. Molecular Basis of Endometriosis and Endometrial Cancer: Current Knowledge and Future Perspectives. Int J Mol Sci 2021; 22:9274. [PMID: 34502183 PMCID: PMC8431548 DOI: 10.3390/ijms22179274] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
The human endometrium is a unique tissue undergoing important changes through the menstrual cycle. Under the exposure of different risk factors in a woman's lifetime, normal endometrial tissue can give rise to multiple pathologic conditions, including endometriosis and endometrial cancer. Etiology and pathophysiologic changes behind such conditions remain largely unclear. This review summarizes the current knowledge of the pathophysiology of endometriosis and its potential role in the development of endometrial cancer from a molecular perspective. A better understanding of the molecular basis of endometriosis and its role in the development of endometrial pathology will improve the approach to clinical management.
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Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan 010000, Kazakhstan or (M.T.); (S.T.)
- National Research Center for Maternal and Child Health, Clinical Academic Department of Women’s Health, University Medical Center, Turan Avenue 32, Nur-Sultan 010000, Kazakhstan; (G.B.); (B.A.)
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan 010000, Kazakhstan;
| | - Jeannette Kunz
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan 010000, Kazakhstan;
| | - Gauri Bapayeva
- National Research Center for Maternal and Child Health, Clinical Academic Department of Women’s Health, University Medical Center, Turan Avenue 32, Nur-Sultan 010000, Kazakhstan; (G.B.); (B.A.)
| | - Botagoz Aitbayeva
- National Research Center for Maternal and Child Health, Clinical Academic Department of Women’s Health, University Medical Center, Turan Avenue 32, Nur-Sultan 010000, Kazakhstan; (G.B.); (B.A.)
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan 010000, Kazakhstan or (M.T.); (S.T.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
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15
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Qin X, Sun W, Wang C, Li M, Zhao X, Li C, Zhang H. Mifepristone inhibited the expression of B7-H2, B7-H3, B7-H4 and PD-L2 in adenomyosis. Reprod Biol Endocrinol 2021; 19:114. [PMID: 34289871 PMCID: PMC8293536 DOI: 10.1186/s12958-021-00800-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The immune mechanism was shown to be involved in the development of adenomyosis. The aim of the current study was to evaluate the expression of the immune checkpoints B7-H2, B7-H3, B7-H4 and PD-L2 in adenomyosis and to explore the effect of mifepristone on the expression of these immune checkpoints. METHODS The expression of B7-H2, B7-H3, B7-H4 and PD-L2 in normal endometria and adenomyosis patient samples treated with or without mifepristone was determined by immunohistochemistry analysis. RESULTS In adenomyosis patient samples, the expression of B7-H2, B7-H3 and B7-H4 was increased in the eutopic and ectopic endometria compared with normal endometria, both in the proliferative and secretory phases. Moreover, the expression of B7-H2 and B7-H3 was higher in adenomyotic lesions than in the corresponding eutopic endometria, both in the proliferative and secretory phases. The expression of PD-L2 was higher in adenomyotic lesions than in normal endometria in both the proliferative and secretory phases. In the secretory phase but not the proliferative phase, the expression of B7-H4 and PD-L2 in adenomyotic lesions was significantly higher than that in the corresponding eutopic endometria. In normal endometria and eutopic endometria, the expression of B7-H4 was elevated in the proliferative phase compared with that in the secretory phase, while in the ectopic endometria, B7-H4 expression was decreased in the proliferative phase compared with the secretory phase. In addition, the expression of B7-H2, B7-H3, B7-H4 and PD-L2 was significantly decreased in adenomyosis tissues after treatment with mifepristone. CONCLUSIONS The expression of the immune checkpoint proteins B7-H2, B7-H3, B7-H4 and PD-L2 is upregulated in adenomyosis tissues and is downregulated with mifepristone treatment. The data suggest that B7 immunomodulatory molecules are involved in the pathophysiology of adenomyosis.
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Affiliation(s)
- Xiaoyan Qin
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Wenjing Sun
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Chong Wang
- Department of Surgery, Shandong Rongjun General Hospital, Jinan, Shandong, 250013, People's Republic of China
| | - Mingjiang Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Xingbo Zhao
- Department of Obstetrics and Gynaecology, Shandong University, Jinan, Shandong, 250000, People's Republic of China
| | - Changzhong Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Hui Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China.
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Prediction of Myometrial Invasion in Stage I Endometrial Cancer by MRI: The Influence of Surgical Diagnostic Procedure. Cancers (Basel) 2021; 13:cancers13133275. [PMID: 34208926 PMCID: PMC8268377 DOI: 10.3390/cancers13133275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Fertility sparing treatment can be considered for young women with clinical stage 1A endometrial cancer (EC) without myometrial invasion (MI). Surgical diagnostic procedures (SDP) were needed to make diagnosis of EC, but different extents of SDP including diagnostic hysteroscopic biopsy (DHB, group 1), operative hysteroscopic partial resection (OHPR, group 2), operative hysteroscopic complete resection (OHCR, group 3), and cervical dilatation and fractional curettage (D&C, group 4) may affect the accuracy of MI assessment by magnetic resonance imaging (MRI) after SDP. Here, we retrospectively review those initially diagnosed with stage 1A EC and compare MI status on MRI reports and final histopathology of hysterectomy. We found that the MRI accuracy of MI was better in patients with EC diagnosed with D&C. Three diagnostic procedures using hysteroscopy might interfere with the diagnostic power of MI on MRI. Thus, D&C for diagnosis of EC and further hysteroscopic complete resection with hormone as a fertility sparing treatment for those confirmed as stage 1A without MI from MRI may be a choice in the future. Abstract Young women with endometrial cancer (EC) can choose fertility-sparing treatment for stage 1A disease without myometrial invasion (MI). The surgical diagnostic procedure (SDP) may affect the accuracy of magnetic resonance imaging (MRI) to assess MI. Here, we evaluated different SDP and compared the MI on MRI results with further pathologic results after hysterectomy. We retrospectively collected data on 263 patients with clinical stage IA EC diagnosed between January 2013 and December 2015. Patients were classified into four groups based on SDP, including diagnostic hysteroscopic biopsy (DHB, group 1), operative hysteroscopic partial resection (OHPR, group 2), operative hysteroscopic complete resection (OHCR, group 3), and cervical dilatation and fractional curettage (D&C, group 4). The sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value of MRI to assess MI were 73.1%, 46.7%, 63.9%, 71.8%, and 48.3%, respectively. Three hysteroscopic procedures (groups 1 to 3) had a trend with a higher odds ratio of discrepancy between MRI and histopathology (p = 0.068), especially in group 2 (odds ratio 2.268, p = 0.032). Here, we found MRI accuracy of MI was better in patients with EC diagnosed with D&C. Three diagnostic procedures using hysteroscopy might interfere with the diagnostic power of MI on MRI.
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17
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Du YY, Yan XJ, Guo YJ, Wang J, Wen XD, Wang N, Yang Y. Transvaginal Real-Time Shear Wave Elastography in the Diagnosis of Endometrial Lesions. Int J Gen Med 2021; 14:2849-2856. [PMID: 34211293 PMCID: PMC8242144 DOI: 10.2147/ijgm.s312292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 01/15/2023] Open
Abstract
Background To explore the value of transvaginal real-time shear wave elastography (SWE) in the diagnosis of endometrial lesions. Methods A total of 140 female patients with endometrial lesions, confirmed by pathological results, were divided into three groups: 45 cases of endometrial polyps, 29 cases of endometrial hyperplasia and 66 cases of endometrial cancer. A total of 100 cases of normal endometrium were used as the control group, including 52 cases in the proliferative stage and 48 cases in the secretory stage. Transvaginal real-time shear wave elastography was performed in all four groups. Results Emean, Emax and Esd were expressed as the average standard deviation. Among the control group, the results were 26.24±9.74, 38.09±9.18, and 4.25±2.73 kPa, respectively, in the proliferative endometrium cases and 12.51±7.46, 27.22±11.32, 4.40±2.52 kPa, respectively, in the secretory endometrium cases. Among the experimental group, the result was 15.68±8.18, 27.28±10.28 and 3.62±1.81 kPa respectively in the endometrial polyps cases; 21.20 ± 12.57, 36.32 ± 15.04, and 5.09 ±3.93 kPa in the endometrial hyperplasia cases; 49.36±25.51, 86.66±42.27 and 14.86±10.63 kPa in the endometrial cancer cases. The difference was statistically significant (P <0.05). When the truncation values of Emean, Emax and Esd were 28.50, 52.45 and 9.05 kPa, respectively, to distinguish between normal endometrium and endometrial cancer, Emax has the highest diagnostic value. Conclusion Real-time SWE technology might be used as an auxiliary method in the diagnosis and differential diagnosis of endometrial cancer. More quantitative indicators are conducive to diagnosis.
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Affiliation(s)
- Yuan-Yuan Du
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xiao-Jing Yan
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yan-Jing Guo
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jing Wang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xiao-Duo Wen
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Nan Wang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yi Yang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
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18
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Huang JH, Duan H, Wang S, Wang YY, Lv CX. Upregulated microRNA let-7a accelerates apoptosis and inhibits proliferation in uterine junctional zone smooth muscle cells in adenomyosis under conditions of a normal activated hippo-YAP1 axis. Reprod Biol Endocrinol 2021; 19:81. [PMID: 34082774 PMCID: PMC8173847 DOI: 10.1186/s12958-021-00753-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/27/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Let-7a is a small non-coding RNA that has been found to take part in cell proliferation and apoptosis. The hippo-YAP1 axis, known as a tumour suppressor pathway, also plays an important role in cell proliferation and apoptosis. YAP1, TAZ, and phospho-YAP1 play key roles in actions of the hippo-YAP1 axis. Adenomyosis (ADS) is a proliferative disease leading to a large uterus in patients with prolonged illness. Abnormal proliferation of smooth muscle cells (SMCs) in the uterine endometrial-myometrial junctional zone (JZ) is an important reason for developing ADS. This study aimed to explore the expression levels of let-7a and components of the hippo-YAP1 axis in SMCs in the uterine endometrial-myometrial JZ in ADS and to explore the roles of let-7a and the hippo-YAP1 axis of JZ SMC proliferation and apoptosis in ADS. METHODS We collected JZ tissues for the primary culture of SMCs from 25 women diagnosed with ADS and 27 women without ADS. We used quantitative real-time polymerase chain reaction and western blotting to measure the mRNA and protein expression levels of let-7a, YAP1, TAZ, and phospho-YAP1 in ADS JZ SMCs. A CCK-8 assay and flow cytometry analysis of apoptosis were utilized to test the proliferation and apoptosis of JZ SMCs. The let-7a overexpression lentiviral vector GV280 was used to increase the expression level of let-7a. We added verteporfin to block the phosphorylation of components of the hippo-YAP1 axis. RESULTS We found that the let-7a level was decreased, while the YAP1 and TAZ levels were increased in ADS JZ SMCs. Upregulated let-7a affected the expression levels of components of the hippo-YAP1 axis, accelerated apoptosis, and inhibited proliferation in JZ SMCs. Furthermore, accumulated YAP1 led to increasing proliferation of JZ SMCs after verteporfin treatment to block the phosphorylation of components of the hippo-YAP1 axis. If components of the hippo-YAP1 axis were unphosphorylated, upregulated let-7a could not inhibit the proliferation of ADS JZ SMCs. Upregulated let-7a could not activate the hippo-YAP1 axis in verteporfin treatment. CONCLUSIONS Our findings suggest that the let-7a and hippo-YAP1 axis may act as important regulators of JZ SMCs proliferation, and upregulated let-7a may be an effective method to treat ADS.
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Affiliation(s)
- Jun-Hua Huang
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qi Helou Road, Dong Cheng, Beijing, 100006, P.R. China
| | - Hua Duan
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qi Helou Road, Dong Cheng, Beijing, 100006, P.R. China.
| | - Sha Wang
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qi Helou Road, Dong Cheng, Beijing, 100006, P.R. China
| | - Yi-Yi Wang
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qi Helou Road, Dong Cheng, Beijing, 100006, P.R. China
| | - Cheng-Xiao Lv
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qi Helou Road, Dong Cheng, Beijing, 100006, P.R. China
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Loverro G, Damiani GR, Malvasi A, Loverro M, Schonauer LM, Muzzupapa G, Dinaro E. Myomectomy during pregnancy: an obstetric overview and two case-series. Minerva Obstet Gynecol 2021; 73:646-653. [PMID: 33988017 DOI: 10.23736/s2724-606x.21.04676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Uterine fibroids (UFs) are the most common benign disease affecting female reproductive system, occur in 20-40 % of women, and in 10 % of pregnancies. The aim of the investigation was to summarize evidences about the management and treatment of UFs and related complications in pregnancy. MATERIALS AND METHODS A literature review was performed using scientific databases, including all case report and case series, using a combination of key words relating to the problem exposed. Data about gestational age at diagnosis, maximum fibroids diameter, type of surgery and gestational age at surgery, delivery and perinatal outcome were collected. Two clinical cases were also included. RESULTS Sixty-six articles were selected and 199 patients were included. In 76 % of patients the gestational age at myomectomy was lower than 20 weeks, in 85 % laparotomic surgery was chosen, in 41 % of cases the maximum fibroid diameter was between 7-20 cm, in 41 % of pregnancies the route of delivery was cesarean section. The eight percent of cases was complicated by miscarriage or fetal demise or neonatal death. CONCLUSIONS Myomectomy is a feasible procedure in those pregnancies complicated by symptomatic fibroids, though surgery in pregnancy is associated with an increased risk of obstetric complications.
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Affiliation(s)
- Giuseppe Loverro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Gianluca R Damiani
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, Bari, Italy -
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Matteo Loverro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Luca M Schonauer
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Giuseppe Muzzupapa
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Edoardo Dinaro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
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20
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First-stage clear-cell endometrial carcinoma with paraaortic lymph node recurrence: a case report. MENOPAUSE REVIEW 2021; 20:57-60. [PMID: 33935622 PMCID: PMC8077803 DOI: 10.5114/pm.2021.105273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/19/2020] [Indexed: 11/17/2022]
Abstract
Introduction Endometrial cancer (EC) is the sixth most common malignancy in women worldwide; in developed countries this oncological entity climbs to fourth place. In 2012 worldwide 319 600 new cases were registered and about 1/3 of those were diagnosed in Europe, i.e. more than 100 000 cases. Statistics in Bulgaria show an increase in the incidence; the National Cancer Registry reported an incidence rate of 8.6% for 2013, with 1293 new cases; about 300 women die because of this diagnosis every year. Clear-cell endometrial carcinoma (EC) is relatively rare, in 1-6% of cases, with significantly shorter survival rates even for early stages (I and II), compared to the other histological subtypes. Case report A 62-year-old patient was subjected to surgery for clear-cell endometrial carcinoma, stage pT1N0M0, FIGO stage IA. Despite radical surgical treatment as per Bulgarian oncological standards - total hysterectomy with bilateral adnexectomy and pelvic lymph node dissection with postoperative radiotherapy - there was a recurrence in a the paraaortic lymph node 15 months later. A second surgical intervention with radical resection of the parailiac metastatic lymph nodes on the left was done with subsequent pseudo-adjuvant platinum-based chemotherapy, and no further relapse has occurred 36 months later. Conclusions Clear-cell EC is an aggressive disease with worse prognosis than the endometroid subtype. Therefore, comprehensive surgery and surgical staging should be performed, including pelvic and paraaortic lymph node dissection, regardless of stage.
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Stachowicz N, Smoleń A, Ciebiera M, Łoziński T, Poziemski P, Borowski D, Czekierdowski A. Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems. Diagnostics (Basel) 2021; 11:diagnostics11030442. [PMID: 33806571 PMCID: PMC8001089 DOI: 10.3390/diagnostics11030442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. AIM The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. MATERIAL AND METHODS It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. RESULTS The median age was 60.3 years (range ± 10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71-0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65-0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70-0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73-0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. CONCLUSIONS New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.
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Affiliation(s)
- Norbert Stachowicz
- Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-080 Lublin, Poland;
- Correspondence:
| | - Agata Smoleń
- Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-080 Lublin, Poland;
| | - Michał Ciebiera
- Center of Postgraduate Medical Education, Second Department of Obstetrics and Gynecology, 01-809 Warsaw, Poland;
| | - Tomasz Łoziński
- Department of Obstetrics and Gynaecology, Pro-Familia Hospital, 35-001 Rzeszów, Poland;
| | - Paweł Poziemski
- Department of Obstetrics and Gynecology, Mińsk Mazowiecki County Hospital, 05-300 Mińsk Mazowiecki, Poland;
| | - Dariusz Borowski
- Clinic of Fetal-Maternal Medicine, Gynecology and Neonatology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, 85-067 Bydgoszcz, Poland;
| | - Artur Czekierdowski
- Department of Gynecological Oncology and Gynecology, Medical University of Lublin, 20-081 Lublin, Poland;
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Preoperative MRI and LDH in women undergoing intra-abdominal surgery for fibroids: Effect on surgical route. PLoS One 2021; 16:e0246807. [PMID: 33561167 PMCID: PMC7872248 DOI: 10.1371/journal.pone.0246807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Our institution implemented a preoperative protocol to identify high-risk cases for which power morcellation should be avoided. MATERIAL AND METHODS In this retrospective cohort study, an institutional protocol requiring preoperative Magnetic Resonance Imaging with diffusion-weighted imaging and serum Lactate Dehydrogenase levels was implemented. Chart review was performed including all women who underwent intra-abdominal surgery for symptomatic fibroids from 4/23/2013 to 4/23/2015. RESULTS A total of 1,085 women were included, 479 before and 606 after implementation of the Magnetic Resonance Imaging / Lactate Dehydrogenase protocol. The pre-protocol group had more post-menopausal women (4% vs. 2%, p = 0.022) and women using tamoxifen (2% vs. 0%, p = 0.022) than those in the post-protocol group, but baseline patient characteristics were otherwise similar between groups. Incidence of malignant pathological diagnoses did not change significantly over the time period in relation to protocol implementation. The rate of open surgery for both hysterectomy and myomectomy remained the same in the year preceding and the year following initiation of the protocol (open hysterectomy rate was 19% vs. 16% in pre- and post-protocol groups, respectively, P = 0.463, and open myomectomy rate was 10% vs. 9% rates in pre- and post-protocol groups, respectively, P = 0.776). There was a significant decrease in the use of power morcellation (66% in pre- and 50% in post-protocol cohorts, p<0.001) and an increased use of containment bags (1% in pre- and 19% in post-protocol cohort). When analyzing the subset of women who had abnormal Magnetic Resonance Imaging / and Lactate Dehydrogenase results, abnormal Magnetic Resonance Imaging results alone resulted in higher rates of open approach (65% for abnormal vs. 35% for normal). Similarly, a combination of abnormal Magnetic Resonance Imaging and Lactate Dehydrogenase tests resulted in higher rates of open approach (70% for abnormal and 17% for normal). Abnormal Lactate Dehydrogenase results alone did not influence route. CONCLUSIONS Rates of MIS procedures were decreased for women with abnormal preoperative Magnetic Resonance Imaging results. False positive results appear to be one of the main drivers for the use of an open surgical route.
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Tu J, Yang H, Chen Y, Chen Y, Chen H, Li Z, Li L, Zhang Y, Chen X, Yu Z. Current and Future Roles of Circular RNAs in Normal and Pathological Endometrium. Front Endocrinol (Lausanne) 2021; 12:668073. [PMID: 34122342 PMCID: PMC8187767 DOI: 10.3389/fendo.2021.668073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/11/2021] [Indexed: 01/20/2023] Open
Abstract
The uterine endometrium, which lines the mammalian uterus, is essential for embryo implantation. This lining undergoes significant changes during sexual and menstrual cycles. The endometrium is also associated with hormone-related diseases such as endometriosis and endometrial cancer. Circular RNAs (circRNAs) play a role in various biological processes. Recent studies have determined that circRNAs function in both normal and pathological endometrial environments. Here, we review high-throughput studies pertaining to circRNAs as well as individual circRNAs active in the endometrium, in order to explore the myriad functions of circRNAs in the endometrium and mechanisms underlying these functions, from panoramic and individual perspectives. Owing to their abundant expression, stability, and small size, circRNAs have displayed potential usefulness as diagnostic markers and treatment targets for endometrial-related diseases. Therefore, the specific role of circRNAs in the endometrium warrants systematic investigation in the future.
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Affiliation(s)
- Jiajie Tu
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-Inflammatory and Immune Medicine, Institute of Clinical Pharmacology, Anhui Medical University, Hefei, China
- *Correspondence: Jiajie Tu, ; Zhiying Yu,
| | - Huan Yang
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yu Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yu Chen
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - He Chen
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Zhe Li
- The First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Lei Li
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yuanyuan Zhang
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xiaochun Chen
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Zhiying Yu
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Jiajie Tu, ; Zhiying Yu,
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Laganà AS. Management of endometrial cancer: current insights and future directions. Transl Cancer Res 2020; 9:7685-7687. [PMID: 35117370 PMCID: PMC8798098 DOI: 10.21037/tcr-2020-ec-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.
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Scioscia M, Virgilio BA, Laganà AS, Bernardini T, Fattizzi N, Neri M, Guerriero S. Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge. Diagnostics (Basel) 2020; 10:E848. [PMID: 33092074 PMCID: PMC7589178 DOI: 10.3390/diagnostics10100848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 12/22/2022] Open
Abstract
Ultrasound is an effective tool to detect and characterize endometriosis lesions. Variances in endometriosis lesions' appearance and distorted anatomy secondary to adhesions and fibrosis present as major difficulties during the complete sonographic evaluation of pelvic endometriosis. Currently, differential diagnosis of endometriosis to distinguish it from other diseases represents the hardest challenge and affects subsequent treatment. Several gynecological and non-gynecological conditions can mimic deep-infiltrating endometriosis. For example, abdominopelvic endometriosis may present as atypical lesions by ultrasound. Here, we present an overview of benign and malignant diseases that may resemble endometriosis of the internal genitalia, bowels, bladder, ureter, peritoneum, retroperitoneum, as well as less common locations. An accurate diagnosis of endometriosis has significant clinical impact and is important for appropriate treatment.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Bruna A. Virgilio
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, VA, Italy
| | - Tommaso Bernardini
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Nicola Fattizzi
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Manuela Neri
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (M.N.); (S.G.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Stefano Guerriero
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (M.N.); (S.G.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
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Clarke MA, Long BJ, Wentzensen N. Toward a risk-based approach to evaluate and manage abnormal uterine bleeding. Am J Obstet Gynecol 2020; 223:607. [PMID: 32497608 DOI: 10.1016/j.ajog.2020.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Megan A Clarke
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Rockville, MD
| | - Beverly J Long
- Department of Obstetrics and Gynecology, George Washington School of Medicine, Washington, DC
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Rockville, MD
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