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Meng Q, Ge N, Fan Y, Li L. Analysis of ultrasonic imaging changes and factors related to malignant transformation in postmenopausal patients with endometrial polyps. Am J Transl Res 2024; 16:3055-3063. [PMID: 39114675 PMCID: PMC11301457 DOI: 10.62347/gfiu8015] [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: 04/19/2024] [Accepted: 05/31/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To examine the ultrasonic changes in postmenopausal endometrial polyps and analyze factors related to their malignant transformation. METHODS This retrospective study analyzed clinical data from 200 postmenopausal patients with endometrial polyps treated at Jinan Maternity and Child Care Hospital and Pingyin Hospital of Traditional Chinese Medicine from December 2020 to December 2023. All patients underwent pathological biopsies to diagnose the nature of the endometrial polyps. This study compared the clinical and ultrasonic imaging features of these patients and analyzed factors influencing the malignant transformation of postmenopausal endometrial polyps. RESULTS Pathological findings classified 160 patients (80.00%) into the benign group and 40 patients (20.00%) into the malignant group. Significant differences were noted in endometrial thickness, polyp diameter, heterogeneity of lesion echogenicity, and vascularization between the groups (all P<0.05). The malignant group exhibited notably higher blood flow (Grade II+III constituted 70.00% compared to 29.38% in the benign group, P<0.05). The time average velocity (TAV), pulse index (PI), and resistance index (RI) were significantly lower in the malignant group (all P<0.05). The area under curve (AUC) values for TAV, PI, and RI in diagnosing malignant endometrial polyps were 0.754, 0.713, and 0.771, respectively. Increased body mass index (BMI), irregular premenopausal menstruation, and ≥2 occurrences of postmenopausal bleeding were identified as risk factors for malignant transformation (all P<0.05). These six indicators were used to create a predictive model for malignant transformation, achieving an AUC of 0.942. CONCLUSION Malignancy in postmenopausal endometrial polyps is uncommon, yet distinct differences exist in the transvaginal color Doppler ultrasound characteristics between benign and malignant cases. Factors such as increased BMI, irregular premenopausal menstruation, and ≥2 occurrences of postmenopausal bleeding significantly contribute to the risk of malignant transformation. These findings, combined with ultrasound features, provide a robust basis for screening and monitoring these patients.
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Affiliation(s)
- Qingyou Meng
- Health Management Center, Jinan Maternity and Child Care HospitalJinan 250000, Shandong, China
| | - Na Ge
- Department of Ultrasound, Pingyin Hospital of Traditional Chinese MedicineJinan 250400, Shandong, China
| | - Yulong Fan
- Department of Ultrasound, Pingyin Hospital of Traditional Chinese MedicineJinan 250400, Shandong, China
| | - Liang Li
- Department of Medical Management, Jinan Maternity and Child Care HospitalJinan 250000, Shandong, China
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2
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Cheney M, Shihab S, Vegunta S. Postmenopausal Bleeding: Assessment and Management. J Womens Health (Larchmt) 2024; 33:692-694. [PMID: 38629289 DOI: 10.1089/jwh.2023.0878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Megan Cheney
- Obstetrics and Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | - Sara Shihab
- Division of Women's Health-Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Suneela Vegunta
- Division of Women's Health-Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
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3
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Baldini GM, Lot D, Malvasi A, Di Nanni D, Laganà AS, Angelucci C, Tinelli A, Baldini D, Trojano G. Isthmocele and Infertility. J Clin Med 2024; 13:2192. [PMID: 38673465 PMCID: PMC11050579 DOI: 10.3390/jcm13082192] [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: 02/10/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Isthmocele is a gynecological condition characterized by a disruption in the uterine scar, often associated with prior cesarean sections. This anatomical anomaly can be attributed to inadequate or insufficient healing of the uterine wall following a cesarean incision. It appears that isthmocele may impact a woman's quality of life as well as her reproductive capacity. The incidence of isthmocele can range from 20% to 70% in women who have undergone a cesarean section. This review aims to sum up the current knowledge about the effect of isthmocele on fertility and the possible therapeutic strategies to achieve pregnancy. However, currently, there is not sufficiently robust evidence to indicate the need for surgical correction in all asymptomatic patients seeking fertility. In cases where surgical correction of isthmocele is deemed necessary, it is advisable to evaluate residual myometrial thickness (RMT). For patients with RMT >2.5-3 mm, hysteroscopy appears to be the technique of choice. In cases where the residual tissue is lower, recourse to laparotomic, laparoscopic, or vaginal approaches is warranted.
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Affiliation(s)
- Giorgio Maria Baldini
- MOMO’ FertiLIFE, IVF Clinic, 76011 Bisceglie, Italy
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Dario Lot
- MOMO’ FertiLIFE, IVF Clinic, 76011 Bisceglie, Italy
| | - Antonio Malvasi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Doriana Di Nanni
- Pathology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70125 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Cecilia Angelucci
- Gynecology and Obstetrics Clinic, University of Sassari, 07100 Sassari, Italy;
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, “Veris Delli Ponti” Hospital, and CERICSAL (Centro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, 73020 Lecce, Italy;
| | | | - Giuseppe Trojano
- Department of Maternal and Child, Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Madonna Delle Grazie Hospital ASM, 75100 Matera, Italy
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4
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Shen Y, Li L, Wang H, Hu Y, Deng X, Lian X, Tan Y, Liang L, Zhang Y, Yang W. Triage method for endometrial biopsy in postmenopausal women: a multicenter retrospective cohort study. Menopause 2023; 30:1206-1212. [PMID: 38019035 DOI: 10.1097/gme.0000000000002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To identify the optimal triage procedure for endometrial biopsies in postmenopausal women. METHODS The clinical information of 470 postmenopausal women with endometrial biopsy results and postmenopausal bleeding (PMB) and/or transvaginal ultrasonography (TVU) abnormalities were collected at the gynecology departments of four general hospitals from March 2021 to March 2022. In the validation cohort, 112 women with TVU abnormalities who underwent endometrial biopsy at Xiangya hospital between May 2022 and May 2023 were enrolled. The endpoint was the final diagnosis based on hysteroscopy reports and biopsy pathology results. The sensitivity, specificity, positive predictive value, and negative predictive value were compared among the three triage methods. A nomogram prediction model was developed and validated. RESULTS Referring women with TVU abnormalities for endometrial biopsy identified 100% malignant/premalignant lesions despite low specificity (19.7%). Among women with measurable endometrial thickness (ET), we suggest that the ET cutoff value for biopsy referral should be ≥4 mm. The PMB (odds ratio [OR], 3.241; 95% confidence interval [CI], 1.073-9.789), diabetes (OR, 10.915; 95% CI, 3.389-35.156), and endometrial thickness (OR, 1.277; 95% CI, 1.156-1.409) were independent predictive factors for endometrial (pre)malignancy. A nomogram prediction model was constructed (area under curve [AUC] = 0.802, 95% CI: 0.715 to 0.889). The ideal cutoff point was 22.5, with a sensitivity of 100.0% and a specificity of 15.7%. The external validation achieved an AUC of 0.798 (95% CI, 0.685-0.911). CONCLUSIONS It was possible to refer all postmenopausal women with TVU abnormity (ET ≥ 4 mm or other abnormal findings) for endometrial biopsy. Among women with TVU abnormalities, a nomogram was constructed, and a score greater than 22.5 suggested the need for referral for endometrial biopsy, while a score less than 22.5 suggested that regular follow-up was required, further improving the triage procedure.
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Affiliation(s)
- Yufei Shen
- From the Department of Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lucia Li
- From the Department of Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hailong Wang
- Department of Gynecology, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China
| | - Yi Hu
- Department of Gynecology, Xiangdong Hospital Affiliated to Hunan Normal University, Liling, Hunan, China
| | - Xi Deng
- Department of Gynecology, Xiangya Changde Hospital, Changde, Hunan, China
| | - Xiaoling Lian
- Department of Gynecology, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China
| | - Yanlin Tan
- Department of Gynecology, Xiangdong Hospital Affiliated to Hunan Normal University, Liling, Hunan, China
| | - Liling Liang
- Department of Gynecology, Xiangya Changde Hospital, Changde, Hunan, China
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5
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Özberk H, Bilgiç D, Badem A. Menstrual cycle abnormalities in women: characteristics, perceptions, and health-seeking behaviours. EUR J CONTRACEP REPR 2023; 28:301-307. [PMID: 37910035 DOI: 10.1080/13625187.2023.2273753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES To evaluate menstruation characteristics, perceptions, and health-seeking behaviours in women. METHODS We conducted this cross-sectional study with 394 women between February 2021 and October 2021. According to the self-perception of women, menstruation characteristics were divided into two groups, including 'normal' and 'abnormal'. The data were collected using the Personal Information Form, Assessment Form of the Menstrual Cycle Characteristics, and Health-Seeking Behaviour Scale. RESULTS Among all women, 49.7% perceived their menstruation characteristics as 'normal', and 50.3% perceived them as 'abnormal'. The menstruation characteristics negatively affected the daily life of 57.6% of women in the normal group and 68.7% of women in the abnormal group. Online health-seeking behaviour was the most common behaviour of seeking remedy; however, professional health-seeking behaviour was inadequate. Among women who perceived their menstruation characteristics as 'normal', excessive menstrual bleeding, extreme pain, and adverse effects on daily life increased health-seeking behaviour. Among women who perceived their menstruation characteristics as 'abnormal', irregular cycles, frequent bleeding, low levels of bleeding, the use of too many pads, extreme pain, and adverse effects on daily life increased health-seeking behaviour. CONCLUSION The participants in this study exhibited insufficient health-seeking behaviour for abnormal menstruation characteristics. Women should be directed by health professionals to reliable online sources to seek help, and they should be encouraged to display professional health-seeking behaviour.
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Affiliation(s)
- Hülya Özberk
- Department of Gynecologic and Obstetrics Nursing, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
| | - Dilek Bilgiç
- Department of Gynecologic and Obstetrics Nursing, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
| | - Aysun Badem
- Department of Nursing, Faculty of Health Sciences, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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6
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Sakna NA, Elgendi M, Salama MH, Zeinhom A, Labib S, Nabhan AF. Diagnostic accuracy of endometrial sampling tests for detecting endometrial cancer: a systematic review and meta-analysis. BMJ Open 2023; 13:e072124. [PMID: 37355271 PMCID: PMC10314649 DOI: 10.1136/bmjopen-2023-072124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVES To determine the diagnostic accuracy of different endometrial sampling tests for detecting endometrial carcinoma. DESIGN Systematic review and meta-analysis of studies of diagnostic accuracy. DATA SOURCES Cochrane Library, MEDLINE/PubMed, CINAHL, Web of Science and Scopus, from the date of inception of the databases to 18 January 2023. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. ELIGIBILITY CRITERIA We included published cross-sectional studies that evaluated any endometrial sampling test (index tests) in women (participants) with clinical suspicion of endometrial carcinoma (target condition) in comparison with histopathology of hysterectomy specimens (reference standard). We excluded case-control and case series studies. No restrictions on language or date of publication were applied. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted study data and assessed study quality using the revised quality assessment tool for diagnostic accuracy studies (QUADAS-2). We used bivariate diagnostic random-effects meta-analysis and presented the results in a summary receiver operating characteristic curve. We assessed the certainty of evidence as recommended by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. RESULTS Twelve studies (1607 participants), published between 1986 and 2022, contributed data to the meta-analysis results. Seven studies were judged to be at a low risk of bias in all domains and all studies had low applicability concerns. The most studied index tests were Pipelle and conventional dilation and curettage (D&C). The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio (95% CIs) for Pipelle were 0.774 (0.565 to 0.900), 0.985 (0.927 to 0.997), 97.000 (14.000 to 349.000) and 0.241 (0.101 to 0.442) and for conventional D&C were 0.880 (0.281 to 0.993), 0.984 (0.956 to 0.995), 59.300 (14.200 to 153.000) and 0.194 (0.007 to 0.732), respectively. CONCLUSION High certainty evidence indicates that endometrial sampling using Pipelle or conventional D&C is accurate in diagnosing endometrial cancer. Studies assessing other endometrial sampling tests were sparse. TRIAL REGISTRATION NUMBER https://osf.io/h8e9z.
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Affiliation(s)
| | - Marwa Elgendi
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | | | - Ahmed Zeinhom
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Somia Labib
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
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Zhdanova DY, Kovalev VI, Chaplygina AV, Bobkova NV, Poltavtseva RA, Sukhikh GT. YB-1 Protein Prevents Age-Related Decline in Plasma Estradiol in Aging Female 5xFAD Transgenic Mice. J EVOL BIOCHEM PHYS+ 2023. [DOI: 10.1134/s0022093023010192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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8
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Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, Kahramanoglu I, Reyes-Muñoz E, Lin LT, Urman B, Ferrero S, Angioni S. Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality. Diagnostics (Basel) 2022; 12:diagnostics12051176. [PMID: 35626331 PMCID: PMC9140476 DOI: 10.3390/diagnostics12051176] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Abnormal uterine bleeding (AUB) is a frequent symptom in perimenopausal women. It is defined as uterine bleeding in which the duration, frequency, or amount of bleeding is considered excessive and negatively affects the woman’s quality of life (QoL) and psychological well-being. In cases of structural uterine pathology, hysterectomy (usually performed via a minimally invasive approach) offers definitive symptom relief and is associated with long-lasting improvement of QoL and sexuality. However, over the past 30 years, uterus-preserving treatments have been introduced as alternatives to hysterectomy. Hysteroscopic polypectomy, myomectomy, or endometrial resection/endometrial ablation are minimally invasive techniques that can be used as an alternative to hysterectomy to treat AUB due to benign conditions. Although associated with high patient satisfaction and short-term improvement in their QoL, hysteroscopic treatments do not eliminate the risk of AUB recurrence or the need for further intervention. Therefore, considering the impact of different treatment options on QoL and sexuality during preoperative shared decision making could help identify the most appropriate and personalized treatment options for perimenopausal women suffering from AUB.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
- Correspondence: (S.G.V.); (R.W.)
| | - Rafał Watrowski
- Faculty of Medicine (Associate), University of Freiburg, 79106 Freiburg, Germany
- Correspondence: (S.G.V.); (R.W.)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, University of Miami, Miami, FL 33146, USA;
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull HU6 7RX, UK;
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey;
| | - Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City 81362, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Pei-Tou, Taipei 11265, Taiwan
- Department of Biological Science, National Sun Yat-sen University, 70 Lienhai Rd., Kaohsiung City 80424, Taiwan
| | - Bulent Urman
- Centre for Reproductive Endocrinology and Infertility, American Hospital, 34365 Istanbul, Turkey;
- Department of Obstetrics and Gynecology, Reproductive Endocrinology, Infertility Centre Istanbul, Koc University, 34450 Istanbul, Turkey
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
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Saccardi C, Spagnol G, Bonaldo G, Marchetti M, Tozzi R, Noventa M. New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know? Cancer Manag Res 2022; 14:1331-1340. [PMID: 35401014 PMCID: PMC8985823 DOI: 10.2147/cmar.s294074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 12/21/2022] Open
Abstract
Transvaginal ultrasound (TVUS) represents an accurate and noninvasive technique to investigate endometrial thickness (ET) in the early diagnosis of endometrial cancer (EC). In the literature, for maximum ET there is no consensus on the cutoff value for normal ET in postmenopause for either symptomatic or asymptomatic women. Most patients with EC present with postmenopausal bleeding (PMB) and in these patients is necessary to perform TVUS to evaluate ET as an indicator for endometrial biopsy. On the contrary, if ET is incidentally detected in postmenopausal patients without bleeding, endometrial sampling for a postmenopausal woman without bleeding should not be routinely performed, although it is estimated that up to 15% of EC occurs in women without vaginal bleeding. The aim of our review was to give clinicians necessary and useful knowledge on the role of TVUS and ET for early detection of EC in their daily routine practice. Based on the most important studies in the literature, we summarized that in premenopausal woman with abnormal uterine bleeding, an optimal cutoff for ET has not yet been established. For postmenopausal women with PMB, at low risk, and ET <4 mm, a follow-up scan could be offered, and for women with ET ≥4 mm, office hysteroscopy-guided endometrial sampling is recommended independently of ET results. On the other hand, in postmenopausal women with PMB and at high risk of EC, office hysteroscopy-guided endometrial sampling is necessary. In postmenopausal women without PMB and ET ≥4 mm, arbitrary endometrial sampling is not recommended, but evaluated case by case based on risk factors. In conclusion, there is broad consensus on the importance of TVUS and the need for further investigation based on risk factors of EC.
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Affiliation(s)
- Carlo Saccardi
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Giulia Spagnol
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Giulio Bonaldo
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Matteo Marchetti
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Roberto Tozzi
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Marco Noventa
- Department of Women and Children’s Health, University of Padua, Padua, Italy
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Mitra S, Lami MS, Ghosh A, Das R, Tallei TE, Fatimawali, Islam F, Dhama K, Begum MY, Aldahish A, Chidambaram K, Emran TB. Hormonal Therapy for Gynecological Cancers: How Far Has Science Progressed toward Clinical Applications? Cancers (Basel) 2022; 14:759. [PMID: 35159024 PMCID: PMC8833573 DOI: 10.3390/cancers14030759] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, hormone therapy has been shown to be a remarkable treatment option for cancer. Hormone treatment for gynecological cancers involves the use of medications that reduce the level of hormones or inhibit their biological activity, thereby stopping or slowing cancer growth. Hormone treatment works by preventing hormones from causing cancer cells to multiply. Aromatase inhibitors, anti-estrogens, progestin, estrogen receptor (ER) antagonists, GnRH agonists, and progestogen are effectively used as therapeutics for vulvar cancer, cervical cancer, vaginal cancer, uterine cancer, and ovarian cancer. Hormone replacement therapy has a high success rate. In particular, progestogen and estrogen replacement are associated with a decreased incidence of gynecological cancers in women infected with human papillomavirus (HPV). The activation of estrogen via the transcriptional functionality of ERα may either be promoted or decreased by gene products of HPV. Hormonal treatment is frequently administered to patients with hormone-sensitive recurring or metastatic gynecologic malignancies, although response rates and therapeutic outcomes are inconsistent. Therefore, this review outlines the use of hormonal therapy for gynecological cancers and identifies the current knowledge gaps.
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Affiliation(s)
- Saikat Mitra
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh; (S.M.); (M.S.L.); (A.G.); (R.D.)
| | - Mashia Subha Lami
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh; (S.M.); (M.S.L.); (A.G.); (R.D.)
| | - Avoy Ghosh
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh; (S.M.); (M.S.L.); (A.G.); (R.D.)
| | - Rajib Das
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh; (S.M.); (M.S.L.); (A.G.); (R.D.)
| | - Trina Ekawati Tallei
- Department of Biology, Faculty of Mathematics and Natural Sciences, Sam Ratulangi University, Manado 95115, Indonesia;
- The University Center of Excellence for Biotechnology and Conservation of Wallacea, Institute for Research and Community Services, Sam Ratulangi University, Manado 95115, Indonesia;
| | - Fatimawali
- The University Center of Excellence for Biotechnology and Conservation of Wallacea, Institute for Research and Community Services, Sam Ratulangi University, Manado 95115, Indonesia;
- Pharmacy Study Program, Faculty of Mathematics and Natural Sciences, Sam Ratulangi University, Manado 95115, Indonesia
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health of Sciences, Daffodil International University, Dhaka 1207, Bangladesh;
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - M. Yasmin Begum
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 61441, Saudi Arabia;
| | - Afaf Aldahish
- Department of Pharmacology and Toxicology, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia; (A.A.); (K.C.)
| | - Kumarappan Chidambaram
- Department of Pharmacology and Toxicology, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia; (A.A.); (K.C.)
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
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11
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Wang J, Yang Q, Zhang NN, Wang DD. Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report. World J Clin Cases 2022; 10:275-282. [PMID: 35071528 PMCID: PMC8727278 DOI: 10.12998/wjcc.v10.i1.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/09/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postmenopausal bleeding (PMB) is a common gynecologic complaint among elderly women, and endometrial hyperplasia is a common cause of this bleeding. Ovarian fibromas are the most common type of ovarian sex cord-stromal tumor (SCST). They arise from non-functioning stroma, rarely show estrogenic activity, and stimulate endometrial hyperplasia, causing abnormal vaginal bleeding.
CASE SUMMARY We report herein the case of a 64-year-old Chinese woman who presented with recurrent PMB. A sex hormone test revealed that her estrogen level was significantly higher than normal, and other causes of hyperestrogenism had been excluded. The patient had undergone four curettage and hysteroscopy procedures in the past 7 years due to recurrent PMB and endometrial hyperplasia. The culprit behind the increase in estrogen level—an ovarian cellular fibroma with estrogenic activity—was eventually found during the fifth operation.
CONCLUSION Ovarian cellular fibromas occur insidiously, and some may have endocrine functions. Postmenopausal patients with recurrent PMB and endometrial thickening observed on ultrasonography are recommended to undergo sex hormone testing while waiting for results regarding the pathology of the endometrium. If the estrogen level remains elevated, the clinician should consider the possibility of an ovarian SCST and follow-up the patient closely, even if the imaging results do not indicate ovarian tumors. Once the tumor is found, it should be removed as soon as possible no matter the size to avoid endometrial lesions due to long-term estrogen stimulation. More studies are needed to confirm whether preventive total hysterectomy with bilateral salpingo-oophorectomy should be recommended for women with recurrent PMB exhibiting elevated estrogen levels, despite the auxiliary examination results not indicating ovarian mass. The physical and psychological burden caused by repeated curettage could be prevented using this technique.
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Affiliation(s)
- Jiao Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qing Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Ning-Ning Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Dan-Dan Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Zhang L, Wan Y, Zhang Z, Jiang Y, Lang J, Cheng W, Zhu L. FTO demethylates m6A modifications in HOXB13 mRNA and promotes endometrial cancer metastasis by activating the WNT signalling pathway. RNA Biol 2020; 18:1265-1278. [PMID: 33103587 DOI: 10.1080/15476286.2020.1841458] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although many studies have confirmed the relationship between obesity and endometrial cancer (EC), the molecular mechanism between obesity and EC progression has not been elucidated. Overexpression of fat mass and the obesity associated protein FTO leads to weight gain, although recently it has been discovered that FTO can serve as a demethylase which erases N6-methyladenosine (m6A) modification and regulates the metabolization of mRNAs. In this study, we found high expression of FTO in metastatic EC and that this action promote both metastasis and invasion in vivo and in vitro. Mechanistically, FTO can catalyse demethylation modification in 3'UTR region of HOXB13 mRNA, thereby abolishing m6A modification recognition with the YTHDF2 protein. Decreasing HOXB13 mRNA decay and increasing HOXB13 protein expression was accompanied by WNT signalling pathway activation and the expression of downstream proteins, leading to tumour metastasis and invasion. We also found the WNT signalling pathway inhibitor ICG-001 can block HOXB13 gene-induced tumour metastasis, therefore ICG-001 may be a promising molecular intervention. This study provides insight into the relationship between obesity and the pathogenesis of endometrial cancer while highlighting future areas of research.
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Affiliation(s)
- Lin Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yicong Wan
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zihan Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Jiang
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenjun Cheng
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Behnamfar F, Arshad E. Diagnostic Values of Pipelle and Standard Curettage Compared to Hysterectomy Pathology in Postmenopausal Bleeding: A Comparative Study. Adv Biomed Res 2020; 9:58. [PMID: 33457341 PMCID: PMC7792876 DOI: 10.4103/abr.abr_28_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/30/2020] [Accepted: 07/05/2020] [Indexed: 11/04/2022] Open
Abstract
Background Postmenopausal bleeding might occur due to many benign and malignant underlying diseases. Differentiating between these diseases poses a great importance. This study was designed to compare the diagnostic value of pipelle endometrial sampling and curettage in patients with postmenopausal bleeding. Further, the results were compared with hysterectomy if performed. Materials and Methods Eighty-seven patients with postmenopausal bleeding were included. Pipelle sampling endometrial biopsy was performed for patients in office, and then, patients were transferred to the operation room for dilatation and curettage. Pathology results of pipelle sampling were compared with curettage method. If hysterectomy was performed due to any reason, it was compared as well. Results The pipelle sampling biopsy diagnosed 94.1% of malignant tumors, and curettage sampling biopsy diagnosed 100% of malignant tumors. The sensitivity and specificity of pipelle compared to curettage were 94.12% and 100%, respectively, for the diagnosis of malignant tumors. Based on the Kappa test, the agreement between pipelle and curettage sampling biopsy was statistically significant (P < 0.001). Conclusion The endometrial sampling with pipelle is safe and cost-effective in patients referred with postmenopausal bleeding. This might avoid the need for general anesthesia for the detection of endometrial hyperplasia and endometrial malignancy.
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Affiliation(s)
- Fariba Behnamfar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Arshad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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