Assessment of uterine circulation in ectopic pregnancy by transvaginal color Doppler

Diagnostic value of detection of serum β-HCG and CT-IgG combined with transvaginal ultrasonography in early tubal pregnancy

The diagnostic value of detection of serum β-human chorionic gonadotropin (β-HCG) and Chlamydia trachomatis immunoglobulin G (CT-IgG) combined with transvaginal ultrasonography in early tubal pregnancy was investigated. A total of 55 patients with early tubal pregnancy were selected as the tubal pregnancy group, while 55 subjects of normal intrauterine pregnancy were enrolled as the intrauterine pregnancy group. Transvaginal ultrasonography and quantitative detection of serum β-HCG and CT-IgG were performed for all patients, and the clinical examination results were analyzed and compared. The endometrial thickness and serum β-HCG level of patients with early tubal pregnancy were significantly lower than those of women with intrauterine pregnancy (6.7±1.5 vs. 11.6±1.2 mm; 776±109 vs. 5,598±187 U/l), and the differences were statistically significant (p<0.01); the serum CT-IgG antibody positive rate of patients in tubal pregnancy group (49.1%) was significantly higher than that in intrauterine pregnancy group (12.7%) (p<0.01); the serum CT-IgG antibody positive rates of patients with degree I, II and III of pelvic adhesion intubal pregnancy group were 28.6, 75.0 and 81.8%, respectively; the more severe the pelvic adhesion was, the higher the CT-IgG positive rate would be. The diagnostic coincidence rate of combined detection was significantly higher than that of single detection of serum β-HCG, progesterone and endometrial thickness. The detection of serum β-HCG and CT-IgG combined with transvaginal ultrasonography can diagnose the early tubal pregnancy soonest possible, and help choose the appropriate therapeutic methods depending on the situation to reduce the tubal damage of patients, so as to provide a reliable basis for the diagnosis, treatment and prognosis, and it has important clinical application value.

Enhanced beta-catenin expression and inflammation are associated with human ectopic tubal pregnancy

STUDY QUESTION

Is there a molecular link between Wnt signaling in fallopian tube inflammation and ectopic tubal implantation?

SUMMARY ANSWER

Enhanced beta-catenin expression, reduced E-cadherin expression and glycogen accumulation in the tubal epithelia and hyperplasia in tubal arteries were found in ectopic tubal pregnancy, consistent with the effects induced by Wnt signaling and inflammation.

WHAT IS KNOWN ALREADY

Chronic inflammation caused by infection can alter gene expression in the fallopian tube cells possibly leading to the development of ectopic pregnancy. Knockout mouse models have shown a relationship between Wnt/beta-catenin signaling and predisposition to tubal ectopic pregnancy.

STUDY DESIGN, SIZE, DURATION

Women with ectopic tubal pregnancy (n = 18) were included in the case group, while women with chronic salpingitis (n = 13) and non-pregnant women undergoing sterilization procedures or salpingectomy for benign uterine disease (n = 10) were set as the controls. This study was performed between January 2012 and November 2012.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The ampullary segments of fallopian tubes were collected from patients. Tissues of tubal pregnancy were separated into implantation sites and non-implantation sites. Beta-catenin and E-cadherin expression were determined using immunohistological and immunofluorescence staining. Glycogen production was measured with periodic acid Schiff by staining. The diameter and wall thickness of tubal arteries were evaluated by histological analysis method.

MAIN RESULTS AND THE ROLE OF CHANCE

Immunohistological staining revealed that beta-catenin protein expression was 100% positive in the ectopic pregnant and inflamed tubal tissues, and the staining intensity was significantly higher than in non-pregnant tubal tissues. In contrast, E-cadherin expression was reduced in ectopic pregnant fallopian tubes, possibly as a consequence of increased Wnt signaling. Moreover, glycogen accumulated in the tubal cells, and hyperplasia was observed in the tubal arteries with ectopic pregnancy, which is consistent with the effects induced by Wnt signaling and inflammation. All these changes could create the permissive environment that promotes embryos to ectopically implant into the fallopian tube.

LIMITATIONS, REASONS FOR CAUTION

This finding requires a further confirmation about what activates Wnt signaling in ectopic tubal pregnancies. Also, it is generally recognized that Chlamydia infection is associated with ectopic pregnancy, and disturbs tubal epithelia via the Wnt signaling. However, the infection type in the samples used was salpingitis.

WIDER IMPLICATIONS OF THE FINDINGS

A better understanding of the underlying mechanisms leading to ectopic pregnancies may contribute to our knowledge of the pathogenesis of tubal disorders and infertility and to the prevention of tubal ectopic pregnancy.

Role of sonography in the diagnosis of ectopic pregnancy

This review addresses the use of sonography in the evaluation of patients suspected of having ectopic pregnancy. The use of transvaginal and transabdominal sonography and the role of Doppler imaging in the early diagnosis of ectopic pregnancy are discussed. Various sonographic findings and pitfalls of ectopic pregnancy are analyzed, with emphasis on their diagnostic efficacies.

Primary leiomyoma of the fallopian tube: preoperative ultrasound findings

Leiomyoma of the fallopian tube is extremely rare. Most cases are asymptomatic and found incidentally at autopsy or unrelated operation. These leiomyomas tend to be singular, small, and unilateral, with a resultant rare preoperative diagnosis. They are often managed with laparotomy, as seen in the literature review. Therefore, preoperative imaging is never reported. We describe a case of leiomyoma of the fallopian tube, which was suspected before operation and treated by laparoscopic approach. Transvaginal ultrasound clearly showed a hypoechoic solid mass separate from the left ovary and uterus in a 44-year-old woman. Color Doppler ultrasound detected low impedance flow in this mass. Diagnostic laparoscopy and the follow-up laparoscopic salpingoectomy revealed a primary leiomyoma of the fallopian tube. We conclude that powerful ultrasound could be helpful in diagnosing rare gynecologic disorders but laparoscopy can be used for definite diagnosis and management of such disorders.