The Efficacy and Safety of Transvaginal Ethanol Sclerotherapy in the Treatment of Endometrial Cysts-A Systematic Review

Endometriosis, as a chronic disorder that is a source of severe pain ailments and infertility, requires a comprehensive therapeutic approach. Sclerotherapy, consisting of the administration of sclerosing agents into the cyst, is a constantly evolving minimally invasive treatment method for this disease. Hence, the main objective of this systematic review was to evaluate the impact of its most often used variant, transvaginal ethanol sclerotherapy, on endometriosis-related symptoms, endometrial cyst recurrence rate, ovarian reserve, assisted reproductive technology (ART) outcomes, and pregnancy outcomes, as well as to assess potential complications resulting from this treatment. This systematic review was undertaken using PubMed, Scopus, Web of Science, and Cochrane Library databases on 24 November 2023. The risk of bias in included studies was assessed with the use of the Newcastle-Ottawa scale (NOS) and the revised Cochrane risk of bias 2.0 tool for randomized controlled trials. From the 1141 records obtained from all databases, 16 studies have been included in this review. The use of ethanol sclerotherapy was characterized by a low rate of post-procedural complications. The recurrence rate of endometrial cysts after the procedure depended on the ethanol instillation time within the cyst. Although ethanol sclerotherapy had negligible influence on ovarian reserves when compared to laparoscopic cystectomy, the effects of both these methods on pregnancy outcomes were comparable. This review identifies that sclerotherapy is safe, provides significant relief of symptoms, and does not impair the reproductive potential of the patients.

How Can Selected Dietary Ingredients Influence the Development and Progression of Endometriosis?

Endometriosis is a chronic, hormone-dependent disease characterized by the presence of endometrial tissue in ectopic locations. Since the treatment options for this disease are still limited, and the cure rate is unsatisfactory, the search for ways to treat symptoms and modify the course of the disease is of key importance in improving the quality of life of patients with endometriosis. So far, the literature has shown that nutrition can influence endometriosis through hormonal modification and altering the inflammatory or oxidative response. Since the importance of nutrition in this disease is still a subject of scientific research, we aimed to summarize the current knowledge on the role of dietary modifications in endometriosis. Our review showed that nutrients with anti-inflammatory and antioxidant properties, including most vitamins and several trace elements, may influence the pathogenesis of endometriosis and can be considered as the nutrients preventing the development of endometriosis. However, despite the many discoveries described in this review, further interdisciplinary research on this topic seems to be extremely important, as in the future, it may result in the development of personalized therapies supporting the treatment of endometriosis.

Time Perspective as a Mediator of Depressive Symptoms in Patients with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a chronic endocrinopathy characterized by oligo- or anovulation, clinical and/or biochemical markers of hyperandrogenism, and polycystic ovaries, and it is associated with an increased prevalence of depression. Research conducted on psychiatric patients has shown correlations between depression and decreased cognitive function. The aim of this study was to examine the possible mediation of the time perspective (TP) in the development of depressive symptoms in patients with PCOS. Methods: A study was conducted on 83 patients with PCOS and 65 healthy women. Standardized questionnaires were used to assess depressive symptoms (Beck Depression Inventory—BDI-II) and time perspective (Zimbardo Time Perspective Inventory—ZTPI). Results: Our study revealed an indirect influence of depressive symptoms on PCOS through the positive future time perspective. In the logistic regression model, which included depression and a given time perspective as predictors of PCOS, only the future TP (β = −0.004, p < 0.003, OR = 1.004, 95% CI [1.001, 1.008]) was significantly independently related to the occurrence of PCOS. Conclusions: Our result is another argument for the role of psychoeducation and appropriate communication with a patient from the risk group in a way that builds hope and allows to regain influence on life situation.

Expression of Gal-9 on Dendritic Cells and Soluble Forms of TIM-3/Gal-9 in Patients Suffering from Endometriosis

Immune system dysregulation is clinically evident in the pathogenesis of endometriosis (EMS). Changes in the dendritic cells (DCs) activity or phenotype may be involved in the implantation and growth of endometrial tissue outside the uterus in the disease. The TIM-3/Gal-9 axis is implicated in the development of immune tolerance. However, the knowledge about the exact role of this pathway in the EMS is extremely poor. In the present study, we evaluated the expression of Gal-9 on myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) in the peripheral blood (PB) and peritoneal fluid (PF) of both EMS patients (n = 82) and healthy subjects (n = 10) via flow cytometry. We also investigated the concentrations of soluble Gal-9 and TIM-3 in the plasma and PF of EMS patients and the control group using ELISA. We showed significantly elevated percentages of mDCs-Gal-9⁺ and pDCs-Gal-9⁺, and significantly higher concentrations of the soluble form of Gal-9 and TIM-3 in the PF of EMS patients than in circulation. Our results led us to conclude that the accumulation of Gal-9 expressing mDCs and pDCs in the PF and high sTIM-3/Gal-9 production in the peritoneal cavity could represent the hallmark of immune regulation in EMS patients, which may augment the inflammatory process and development/maintenance of local immunosuppression.

The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions

Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention.

Clinical Value of the PD-1/PD-L1/PD-L2 Pathway in Patients Suffering from Endometriosis

The interaction between dendritic cells (DCs) and T cells mediated by the programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1)/programmed cell death ligand 2 (PD-L2) pathway is the most important point in regulating immunological tolerance and autoimmunity. Disturbances in the quantity, maturity, and activity of DCs may be involved in the implantation and growth of endometrial tissue outside the uterus in endometriosis (EMS). However, little is known about the role of the immune checkpoint pathways in EMS. In our study, we examined the expression of PD-L1/PD-L2 on myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) in the peripheral blood (PB) and peritoneal fluid (PF) of both EMS patients (n = 72) and healthy subjects (n = 20) via flow cytometry. The concentration of soluble PD-L1 and PD-L2 in the plasma and PF of EMS patients and the control group were determined using ELISA. We demonstrated an elevated percentage of mDCs, mDCs and pDCs with the PD-L1or PD-L2 expression, and a higher concentration of the soluble forms of PD-L1 and PD-L2 in the PF than in the plasma of EMS patients. We conclude that the peritoneal cavity environment and the PD-1/PD-L1/PD-L2 axis may play an important role in the modulation of immune response and the development and/or progression of EMS.

P1 promoter IGF-1 polymorphism and IGF-1, IGF-R, LSF, and TSG 101 expression profile in endometriosis

OBJECTIVES

The presence of the endometrium outside the uterine cavity affects about 10% of women of childbearing age. Studies of the progression of endometriosis to cancer have been supported by numerous evidences of gene expression or gene defect caused by oxidative stress and inflammation. We decided to check the expression of selected factors responsible for the proliferation, as in the stages of neoplasia.

MATERIAL AND METHODS

A group of 80 women with ovary localization of endometriosis was qualified for research. The control group was 90 patients with ovarian simplex or follicular cysts. The DNA isolation, immunohistochemical analysis of IGF 1, IGF-R, TSG 101, and LSF expressions with a quantitative scoring of slides and electron microscopy was performed.

RESULTS

The IGF-1-immunopositive cells in the reference group were in statistically significantly higher number compared to the cells forming the foci of endometriosis (p = 0.0282). However, the number of IGF-R-immunopositive cells was comparable to the endometriosis (p = 0.1264). In the control group, the number of LSF-immunopositive cells was statistically significantly higher in comparison to endometriosis foci (p = 0.000001), but the number of TSG 101-immunositive cells was comparable to endometriosis foci (p = 0.3834). A weak negative correlation between the number of cells expressing the TSG 101 factor and the IGF-1 receptor was found in the endometriosis group (r = -0.26, p = 0.0196). The analysis of CA single nucleotide polymorphism in the DNA isolated from both groups showed a comparable incidence of MSS and MSI-L genotypes (chi2 p = 0,9160).

CONCLUSIONS

How these factors affect the development of endometriosis and whether they could be helpful in the diagnosis requires further research.

Neuropilin 1 in uterine leiomyosarcoma. Clinical and pathological analysis

OBJECTIVES

The role of angiogenesis in leiomyosarcomas still remains unclear. The aim of this study was to evaluate the NRP1 expression in the leiomyosarcoma tissues and to find the relations between its expression and the clinical features.

MATERIAL AND METHODS

The study group consisted of 50 patients with diagnosis of the uterine leiomyosarcoma. Clinical and follow up data were collected. Using immunohistochemical methods the expression of NRP1 was detected.

RESULTS

The lack of NRP1 expression was found in 14 cases, positive (weak or moderate) expression was noted in 36 cases. The significantly higher expression of NRP1 was observed in more severe clinical stages in comparison to lower stages of the disease. The significantly shorter survival of patients with the positive expression of NRP1 in leiomyosarcoma was observed.

CONCLUSIONS

The expression of NRP1 is associated with clinical advancement and worse prognosis in uterine LMS. Neuropilin 1 can be widely used as a postoperative survival predictor for the patients suffering from uterine LMS.

Disrupted iron metabolism in peritoneal fluid may induce oxidative stress in the peritoneal cavity of women with endometriosis

INTRODUCTION

Data on the possible role of peritoneal fluid free radical-mediated oxidative damage in the pathogenesis of endometriosis still remains inconsistent. The aim of the study was to determine iron metabolism markers and their influence on oxidative stress arameters in the peritoneal fluid of women with endometriosis.

MATERIAL AND METHODS

110 women with endometriosis and 119 patients with benign ovarian cysts were included in the study. All visible peritoneal fluid was aspirated during laparoscopy from the anterior and posterior cul-de-sacs. under direct vision to avoid blood contamination. Haemoglobin, iron, total oxidative status, and total antioxidant status were measured using standard colourimetric kits.

RESULTS

Haemoglobin, iron levels, as well as total oxidative status values were significantly higher, whereas total antioxidant status values were significantly lower in the peritoneal fluid of patients with endometriosis, in comparison to the reference groups. No differences were observed in peritoneal fluid concentrations of all parameters measured in relation to the phase of the menstrual cycle.

CONCLUSIONS

Peritoneal fluid of women with endometriosis is characterized by disrupted iron metabolism. This is most likely related to an increased number of erythrocytes in the peritoneal cavity of endometriotic women, which leads to a higher concentration of haemoglobin in this environment. Impaired iron homeostasis may have a significant influence on the pathophysiology of peritoneal endometriosis by the direct impact of haemoglobin derivatives and/or formation of the pro-inflammatory and pro-oxidative environment. Peritoneal cavity oxidative stress occurs predominantly in women in advanced stages of the disease.

Does the patients age at cancer diagnosis affect microvessels density in uterine sarcoma tissues?

OBJECTIVES

The objective of the study was to retrospectively evaluate the density of vessels exhibiting positive glycoprotein CD34 expression in the uterine leiomyosarcoma tissues and their correlation with the age of patients at the time of tumor diagnosis.

MATERIAL AND METHODS

The archival paraffin blocks with the cancer tissues collected from 50 patients suffering from uterine leiomyosarcoma were used together with their clinical and demographic data. The immunohistochemical peroxidase-de-pendent methods were used to detect microvessels with positive CD34 expression. The glycoprotein CD34 expression was evaluated as a density of microvessel showing the positive immunohistochemical reaction (MVDCD34).

RESULTS

The negative, statistically significant correlation between the age of patients (at the moment diagnosis) and the MVDCD34+ (R = -0.289, p = 0.042) was found.

CONCLUSIONS

The study's findings may suggest that the tissues of younger people constitute a permissive environment for pro-angiogenic factors.

Original paper. Assessment of the need for information about planned gynecologic surgery

The objective of the study was to assess the level of patients' need for information about the planned gynecologic surgery.

Material and Methods. The number of 173 patients preparing to undergo planned gynecological procedure were qualified for the study. The participation in the survey was entirely voluntary. Each patient was asked to fulfill the survey conducted using the Amsterdam Preoperative Anxiety and Information Scale- APAIS that enables the estimation of the patient’s need for surgery-related information. Furthermore patients’ clinical and demographic data was collected. Results were analyzed using appropriate statistical tools: the Shapiro-Wilk W-test (for distribution of the studied parameters) and the Mann-Whitney U-test (for comparing two independent groups). P value less than 0.05 was considered statistically significant.

Results. It was shown that premenopausal women have a greater need for information about the planned surgery than postmenopausal patients (p<0.05). Patients, who have never been operated, displayed a significantly greater need (p=0.04) for information about their planned surgery in relation to women who have already undergone surgery. The patient’s age, the phase of the menstrual cycle, the education level, the marital status, as well as the preoperative diagnosis and the type of the planned surgery did not affect the level of the preoperative information requirement (p>0.05).

Conclusions. The high level of the need for information about the planned surgery characterizes premenopausal patients and those operated for the first time.

[Why ovarian cancer cells escape from immune surveillance?]

Ovarian cancer is a malignancy of high mortality rates. In respect of the number of deaths caused by cancers it occupies the fourth place among women in Poland. Recent studies are focusing on the role of immune system in ovarian cancer pathogenesis. It has been reported that immune response against ovarian cancer cells may be inhibited by a number of immunosuppressive mechanisms active in cancer microenvironment. It causes difficulties in recognizing and destroying cancer cells by immune system which leads to the development of immune tolerance and is associated with a low efficacy of standard therapeutic strategies. In the presented paper we have described selected, new immunosuppressive mechanisms in ovarian cancer patients. They may be a novel, additional and relevant criterion that should be considered whilst developing new therapeutic strategies. Possibly, modulation of immunosuppressive mechanisms could contribute to modifying standard therapies and in consequence improve treatment outcome in ovarian cancer patients.

Tumor-Associated Macrophages and Myeloid-Derived Suppressor Cells as Immunosuppressive Mechanism in Ovarian Cancer Patients: Progress and Challenges

Cancers are complex masses of malignant cells and nonmalignant cells that create the tumor microenvironment (TME). Non-transformed cells of the TME such as tumor-associated macrophages (TAMs) and myeloid-derived suppressor cells (MDSCs) have been observed in the TME of ovarian cancer (OC) patients. Although these subsets may contribute to each step of carcinogenesis and are commonly associated with poor prognosis, still little is known about creation of the protumor microenvironment in OC. In this review, we focused on the nature and prognostic significance of TAMs and MDSCs in OC patients. Moreover, we discuss the main problems and challenges that must be overcome by researchers and clinicians to enrich our knowledge about the immunosuppressive microenvironment of cancers.

Anti-Müllerian hormone: a critical factor for female fertility and reproductive health

Anti-Müllerian hormone (AMH) is a glycoprotein produced by the granulosa cells of preantral and small antral follicles. AMH concentrations reflect ovarian physiology with high precision, thus serving as a more sensitive marker of the ovarian re-serve than chronological age. This hormone plays a role in the pathogenesis of menstrual disorders and fertility in both obesity and polycystic ovary syndrome. The evaluation of AMH may also be useful in diagnosing or monitoring therapy of granulosa cell ovarian tumors.

Molecular bases of aberrant miR-182 expression in ovarian cancer

The molecular bases of miR-182 deregulation in epithelial ovarian cancers (EOCs) remain unknown and its diagnostic or prognostic role in EOCs is still unclear. We performed miR-182 expression analysis using a microarray approach and real-time PCR (qPCR). We also used array comparative genomic hybridization and methylated DNA immunoprecipitation to study copy number changes and methylation aberrations within coding locus/promoter sequences of miR-182 in EOC tissues, respectively. We have found that miR-182 expression is significantly increased in EOC (P < 0.00001) and that higher miR-182 expression in EOC is linked with significantly shorter overall survival (P = 0.026). The methylation of miR-182 promoter was significantly associated with lower miR-182 expression in EOC tissues (P = 0.045). miR-182 over-expression is connected with copy number (CN) gains of this miRNA coding sequences in EOC (P = 0.002), and the number of PRDM5 copies is significantly and inversely correlated with miR-182 expression evaluated by qPCR (R = -0.615, P = 0.009). We conclude that the aberrant miR-182 expression in EOC may be due to CN gains within its coding locus. The miR-182 promoter is rarely methylated in EOC, and its methylation status is associated with lower miR-182 expression. Deletion of the PRDM5 locus may play a supportive role in miR-182 overexpression in EOC. miR-182 is an unfavorable prognostic factor in EOC. © 2016 Wiley Periodicals, Inc.

Microsatellite polymorphism in the P1 promoter region of the IGF‑1 gene is associated with endometrial cancer

Endometrial carcinoma (EC) is the most common type of gynecological malignancy. Studies have demonstrated that the insulin growth factor (IGF) pathway is implicated in the development of endometrial tumors and that the serum levels of IGF-1 are affected by estrogen. Most EC cells with high microsatellite instability (MSI-H) accumulate mutations at a microsatellite sequence in the IGF-1 gene. The present study investigated the CA repeat polymorphism in the P1 promoter region of the IGF-1 gene among Caucasian females with endometrial hyperplasia, EC and healthy control subjects, whose blood serum and surgical tissue specimens were analyzed. Differences or correlations between the analyzed parameters [serum levels of IGF-1 and IGF binding protein (IGFBP)-1 and IGFBP-3 as well as estrogens among the polymorphisms] were verified using the χ², Mann-Whitney U, Kruskal-Wallis or Spearman's rank correlation tests. A PCR amplification and DNA sequencing analysis was used for identification of (CA)_n repeats in the P1 region of IGF-1. ELISA was used to determine the blood serum levels of IGF-1, IGFBP-1, IGFBP-3 and estrogens. Furthermore, IGF-1 was assessed in endometrial tissues by immunohistochemical analysis. The present study indicated no statistically significant differences between serum levels of IGF-1, IGFBP-1, IGFBP-3 and estrone, estriol and estradiol in the control and study groups. A significant correlation was identified between the IGF-1 levels and estrone levels in the MSI-H polymorphism (r=−0.41, P=0.012) as well as a highly negative correlation between IGF-1 levels and the estradiol levels in the MSI-H polymorphism (r=−0.6, P=0.002). Genotypes without the 19 CA allele were predominantly found in EC. Furthermore, statistical analysis indicated that the number of IGF-1-expressing cells was significantly elevated in MSI-H type 18-20 (P= 0.0072), MSI-L type 19-20 (P=0.025) and microsatellite-stable MSS type 19-19 (P=0.024) compared with those in the MSI-H 20-20 genotype. The present study suggested that it is rather likely that the polymorphisms in the IGF-1 promoter are associated with EC in Caucasian females with regard to its development. In the present study, polymorphisms of the IGF-1 promoter may have been introduced during the genesis of EC and contributed to it by leading to aberrant expression of IGF-1.

Management of uterine leiomyosarcoma

The low incidence of uterine sarcomas requires many issues associated with its biology and clinical course to be followed with more research. Unsatisfactory surgical outcomes and a high risk of cancer dissemination make it worthwhile to consider the feasibility of supplementary systemic treatment. The currently employed chemo- and hormonal therapy is characterised by low efficacy. There is some hope in reports on targeted treatment. However, a comprehensive assessment of the efficacy of this kind of therapy is restricted by a small number of patients using it. Moreover, clinical studies using targeted therapies involve patients with a highly advanced disease, and the therapeutic results are assessed mainly via analysis of progression-free survival but not the clinical response.

Macrophage-derived chemokine CCL22 and regulatory T cells in ovarian cancer patients

The study was undertaken to evaluate macrophage-derived chemokine (CCL22) levels in the peritoneal fluid (PF) and plasma of patients with ovarian cancer (n = 93) in relation to regulatory T cells (Tregs; n = 75). The peritoneal fluid CCL22 concentrations were significantly higher in epithelial ovarian cancer (EOC) patients than in patients with benign tumors-serous cystadenoma (n = 32). There was no difference in plasma levels of CCL22 in EOC patients compared with the non-cancer and healthy volunteers (n = 10). There were no significant differences in the plasma and PF CCL22 levels based on tumor grade. However, women with stage IV FIGO (International Federation of Gynecologists and Obstetricians) had significantly higher plasma CCL22 levels than patients with stages I and III. Women with stage I FIGO had significantly higher PF CCL22 levels than patients with stages II and III. Women with endometrioid cystadenocarcinoma had higher PF CCL22 levels than women with undifferentiated carcinoma. The percentage of tumor-infiltrating Tregs (11.06 %) was significantly higher compared to PF (3.05 %) and peripheral blood (PB) (2.01 %). Moreover, the percentage of Tregs was higher in the PF than in the PB of EOC patients. There were no significant differences in the PB, PF, and tumor-infiltrating Tregs percentage based on tumor stage, grade, or histology. Elevated levels of CCL22 found in the ascites could create a chemokine gradient aiding in Treg cells migration. Increased Tregs percentage in the local microenvironment of ovarian cancer might be an important mechanism of immunosuppression.

Analysis of cytosine-adenine repeats in P1 promoter region of IGF-1 gene in peripheral blood cells and cervical tissue samples of females with cervical intraepithelial lesions and squamous cervical cancer

High oncogenic risk human papillomaviruses (HPVs) are closely associated with cancer of the cervix. However, HPV infection alone may not be sufficient to cause cervical cancer, and other factors or cofactors may have a cumulative effect on the risk of progression from cervical HPV infection to cancer. The present study investigates the cytosine-adenine (CA) repeat polymorphism in the P1 promoter region of the insulin-like growth factor-1 (IGF-1) gene among cervical precancerous and cancer patients and healthy control females. The association between these polymorphisms, tissue and blood serum levels of IGF-1, and cervical cancer risk and progression is evaluated. The material for analysis consisted of blood cells and postoperative tissues from patients diagnosed with low-grade squamous intraepithelial lesions (L-SILs), high-grade squamous intraepithelial lesions (H-SILs) and invasive cervical cancer (ICC). A polymerase chain reaction amplification and the sequencing of DNA were used for the identification of (CA)_n repeats in the IGF-1 P1 region and detection of HPV DNA. The blood serum concentration of IGF was determined by enzyme-linked immunosorbent assay. The identification of the IGF-1 protein in the cervical tissues was performed by immunohistochemical analysis. The range of the length of the CA repeats in the study DNA was 11 to 21. However, the most common allele length and genotype in the control and study patients from serum and tissues was 19 CA repeats and a homozygous genotype of CA19/19. Statistically significant differences in the concentration of IGF-1 in the blood serum were observed between H-SILs and controls, only (p=0.047). However, the concentration of IGF-1 in the group of females with CA19/19, CA19<19 and CA19>19 was significantly higher in the group of patients with H-SIL (P=0.041) and ICC (P=0.048) in comparison with the control group. An association was detected between CA repeat length <19 and/or >19, IGF concentration in blood serum and tissues and the development of cervical cancer.

[Expression of caspase 9 and p53 in uterine leiomyosarcomas]

Uterine sarcomas are heterogeneous malignancies, both clinically and histologically. The process of oncogenesis depends on gene mutations and uncontrolled mitotic cell division that is promoted by blocking pathways of apoptosis. Caspase 9 and p53 protein play an important role in the process of cell apoptosis.

OBJECTIVES

The aim of the study was to assess the expression of selected apoptosis proteins (caspase 9 and p53) using immunohistochemistry.

MATERIAL AND METHODS

A total of 28 tissue samples diagnosed in postoperative histopathological examination as leiomyosarcoma were tested. Twenty eight samples of leiomyomas were used as the control group. Colorful reactions with appropriate antibodies were performed to assess the expression of caspase 9 and p53. From every section 5 fields on view were chosen, in each one 100 cells were assessed using 400x magnification. T-Student parametric test and U Mann-Whitney test were used for statistical analysis.

RESULTS

Expression of caspase 9 was significantly lower (p < 0.05) in leiomyosarcoma tissues (33.2%) as compared to leiomyomas (60.4%). Expression of p53 protein was significantly lower in leiomyosarcoma tissues than in leiomyomas (30.1% vs. 51.3%, p < 0.001).

CONCLUSIONS

Significantly lower expression of caspase 9 and p53 in leiomyosarcoma tissue samples suggests that impaired deregulation of apoptosis mechanisms plays a role in the development of these tumors.

[Mesothelin in ovarian cancer]

Ovarian cancer is a neoplasm with high mortality rate. Its progression is mostly asymptomatic, which results in its first diagnosis in a late stage of the disease. Currently there are no reliable diagnostic methods for early detection of ovarian cancer. Molecular mechanisms leading to its development are not yet fully discovered. Recent studies show that mesothelin gene is up-regulated in patients with serous ovarian cancer. Mesothelin is a glycoprotein found in cell membranes of mesothelial cells lining the peritoneum, pericardium and pleura. Association of mesothelin in the development of ascites, intraperitoneal spread of the neoplasm, and its capability to modulate immune response have been show. It has been found that patients diagnosed with ovarian cancer have elevated serum mesothelin specific IgG levels. Mesothelin is also able to induce a cellular immune response, which is used in researches of ovarian cancer vaccines. High mesothelin expression in cancer tissues and its regular low expression in physiologic ones makes the glycoprotein a worthy candidate for the purpose of ovarian cancer treatment. Current studies assess the use of mesothelin as a target antigen as well as its immunogenicity. The methods of treatment include the use of recombined immunotoxin synthesized from the Pseudomonas exotoxin A (SSIP), MORAb-009 - chimeric monoclonal antibody, immunoconjugates (antibody - drug conjugates), cancer vaccines and gene therapy. The results of these studies are promising but further trials in larger population are required to confirm this.

[The role of iron metabolism and oxidative stress in the pathogenesis of endometriosis]

Despite many years of extensive investigations and increasing number of studies, the pathogenesis of endometriosis remains unclear Accumulated data suggests that disrupted iron metabolism may induce oxidative stress in the peritoneal cavity of endometriosis patients.

[Endometriosis in adolescents]

The majority of adult women with endometriosis report that their symptoms started in adolescence. Early diagnosis and optimal treatment prevent disease progression and mitigate long-term morbidities, such as infertility and chronic pelvic pain.

Evaluation of IL-10 and TGF-β levels and myeloid and lymphoid dendritic cells in ovarian cancer patients

AIM

The aim of the study was to evaluate IL-10 and TGF-beta levels in the peritoneal fluid (PF) and plasma of patients with ovarian cancer (n=104), serous cyst (n=32) or normal controls (n=20). IL-10 and TGF-beta levels were correlated to myeloid (M) and lymphoid (L) dendritic cells (DC).

MATERIAL AND METHODS

IL- 10 and TGF-beta concentrations were evaluated using the enzyme linked immunosorbent assay (ELISA). The percentage of DC in mononuclear cells was quantified by using flow cytometry.

RESULTS

The PF and plasma IL-10 concentrations were significantly higher in epithelial ovarian cancer (EOC) patients when compared to the women with serous cyst (the reference group). Plasma levels of IL-10 were elevated in EOC patients in comparison with the reference and control groups. There were significant differences in the PF and plasma IL-10 levels with respect to tumor stage, grade and histology Significant negative correlations were found between the plasma IL-10 levels, MDC and LDC in the peripheral blood. TGF-beta levels were detected in PF of all EOC patients and were significantly lower when compared with plasma. Plasma levels of TGF-beta were elevated in EOC patients compared with the control group. No significant differences in the PF and plasma TGF-beta levels were noted between EOC patients and the reference group. The authors did not find a correlation between the plasma and PF TGF-beta levels and the percentage of MDC and LDC.

CONCLUSIONS

IL-10 production in EOC patients depends on the tumor stage, grade and histological type of the tumor cells. IL-10 may have impact on the percentage of dendritic cells in EOC patients.

SDF-1alpha/CXCL12 and dendritic cells in ovarian cancer microenvironment

AIM

To evaluate the a-chemokine stromal cell-derived factor-1 (SDF-1)/CXCL12 levels in the peritoneal fluid (PF) and plasma of patients with epithelial ovarian cancer (EOC, n=101), serous cyst (n=34) or normal controls (n=20). SDF-1alpha concentrations were correlated to myeloid (M) and lymphoid (L) dendritic cells (DC).

MATERIAL AND METHODS

SDF-1alpha levels were analysed using a sensitive enzyme-linked immunosorbent assay (ELISA). DC were evaluated by flow cytometry.

RESULTS

The SDF-1alpha concentrations in peritoneal fluid were elevated in the EOC patients in comparison to the patients with serous cyst (the reference group). The PF SDF-1alpha levels were significantly higher in FIGO III and IV patients than in FIGO stage I. There were no significant differences in the PF SDF-1alpha levels with respect to tumor grade or histology Additionally there were no significant differences in the plasma SDF-1alpha levels in EOC patients in comparison with the reference and control groups. The SDF-1alpha levels in the plasma of FIGO stage III patients were significantly higher than that of stage I. Patients with undifferentiated carcinoma had significantly higher plasma SDF-1alpha levels than patients with serous cystadenocarcinoma. No significant differences were noted in the plasma SDF-1alpha levels within different tumor grades. There was no significant correlation between PF and plasma SDF-1alpha levels and the percentage of myeloid and lymphoid DC in the PB and PF of EOC patients.

CONCLUSION

SDF-1alpha production in EOC patients may depend on the clinical stage of the tumor. Increased levels of SDF-1alpha and lymphoid DC in the PF of EOC patients may play an important role in the pathogenesis of this disease.

[Treatment of cervical pregnancy with systemic methotrexate and KCI solution injection into the gestational sac--case report and review of literature]

We report a case of a 6-week cervical pregnancy successfully treated with systemic methotrexate and gestational sac biopsy with 15%-calcium chloride solution injection. Serial monitoring of human chorionic gonadotropin levels, combined with ultrasound examinations, confirmed spontaneous miscarriage. Applied treatment allowed to avoid hysterectomy and preserve the patient's fertility.

[Increased oxidized LDL cholesterol levels in peritoneal fluid of women with advanced-stage endometriosis]

INTRODUCTION

Proinflammatory and prooxidative environment in the peritoneal cavity may be involved in the pathogenesis of endometriosis. Imbalance between reactive oxygen species levels and the antioxidant capacity leads to oxidation of low-density lipoproteins (LDL). The importance of oxidized LDL (Ox-LDL) in the development of atherosclerosis is well recognized.

AIM

The aim of our study was to evaluate for the presence of ox-LDL in the peritoneal fluid (PF) of women with and without endometriosis.

MATERIAL AND METHODS

A total of 60 women who underwent laparoscopy were divided into groups: endometriosis sufferers with minimal to mild (n 20) and moderate to severe (n 20) stages, and the reference group (n 20) with functional follicle ovarian cysts. Oxidized LDL levels were determined in the PF using enzyme immunoassay

RESULTS

Oxidized LDL levels were detectable in all peritoneal fluid samples. Significantly increased levels of ox-LDL were observed in PF of women with stage III/IV endometriosis compared to the reference group (p = 0.03). However peritoneal fluid ox-LDL concentrations did not differ significantly between patients with minimal/mild and women with moderate/severe stage of the disease (p = 0.2). No significant difference in the PF ox-LDL concentrations was also found between women with stage I/II endometriosis and patients with follicle cysts (p = 0.3).

CONCLUSIONS

Increased peritoneal fluid ox-LDL levels observed in women with advanced-stage endometriosis suggest the important role of oxidative stress in the pathogenesis of the disease.

[Total oxidative status of peritoneal fluid in women with endometriosis]

Pathophysiology of endometriosis remains enigmatic despite extensive investigations. Accumulating data suggest that oxidative stress in the peritoneal cavity may be implicated in the pathogenesis of endometriosis.

AIM

The aim of our study was to evaluate the oxidative status of peritoneal fluid (PF) in women with and without endometriosis.

MATERIAL AND METHODS

Sixty-five women participated in the study 40 women with endometriosis constituted the study group and 25 patients with functional follicle ovarian cysts comprised the reference group. Total oxidative status of PF was determined using a commercially available colorimetric assay kit (Immundiagnostic AG, Cat. nr. KC5100).

RESULTS

Women with endometriosis had significantly higher PF oxidative status compared to women with follicle ovarian cysts. No significant difference in the peritoneal oxidative status was found between patients with stage I/II endometriosis, and women with stage III/IV endometriotic disease.

CONCLUSIONS

Disrupted oxidative status in the peritoneal cavity of women with endometriosis plays a role in the pathogenesis of the disease.

[Peritoneal fluid iron levels in women with endometriosis]

AIM

Endometriosis is characterized by a cyclic hemorrhage within the peritoneal cavity. Accumulating data suggests that iron homeostasis in the peritoneal cavity may be disrupted by endometriosis. The aim of our study was to evaluate iron levels in peritoneal fluid (PF) of women with and without endometriosis.

MATERIAL AND METHODS

Seventy-five women were studied: 50 women with endometriosis and, as a reference group, 25 patients with functional follicle ovarian cysts. Iron concentrations in the PF were measured using a commercially available colorimetric assay kit.

RESULTS

Iron concentrations were significantly higher in PF from women with endometriosis as compared to the reference group. Patients with stages III/IV endometriosis had significantly higher PF iron concentrations than women with stages I/II of the disease.

CONCLUSIONS

Disrupted iron homeostasis in the peritoneal cavity of women with endometriosis plays a role in the pathogenesis of the disease.

Dendritic cell subsets in the peritoneal fluid and peripheral blood of women suffering from ovarian cancer

BACKGROUND

Evaluation of immature myeloid and lymphoid dendritic cells (DCs) in the peritoneal fluid (PF) and peripheral blood (PB) mononuclears of women with ovarian carcinoma (n = 47) and benign ovarian tumors (n = 37).

METHODS

Mononuclear cells were isolated from PF and PB, stained with monoclonal antibodies (mAbs) against DC antigens (anti-BDCA-1, anti-BDCA-2), and estimated using flow cytometry.

RESULTS

The percentage of PF myeloid DC (MDC) in mononuclears was significantly lower in patients with ovarian cancer in comparison to the group of nonmalignant ovarian tumors (0.65% and 6.95%). The percentage of PF lymphoid DCs (LDCs) was higher in patients with ovarian cancer than in the reference group (0.64% and 0.09%). The percentage of PB MDCs and LDCs did not differ significantly between studied groups. In women suffering from ovarian cancer the percentage of both MDCs and LDCs was higher in the PF than in the PB. In the reference group the percentage of MDCs was higher but that of LDCs was lower in the PF than in the PB. In women with ovarian cancer, PF MDCs/LDCs ratio was lower in comparison to patients with serous cystadenoma. In PB the ratio of MDCs to LDCs did not differ significantly between studied groups.

CONCLUSIONS

We concluded that MDCs population may be affected by the presence of malignant disease. LDC subsets may have influence on the local immune response in the PF of women with malignant tumors of the ovary. (c) 2008 Clinical Cytometry Society.

[Subpopulations of peripheral blood dendritic cells during chemotherapy of ovarian cancer]

OBJECTIVES

Ovarian carcinoma (OVC) is often diagnosed at an advanced stage and requires effective chemotherapy as a first-line treatment. However, chemotherapy may be associated with significant side-effects, like nausea, vomiting, hair loss, cognitive dysfunction, fatigue and changes in sexual functioning. Leucopenia is one of the most common and dangerous side effects of chemotherapy. Little is known about possible effects of chemotherapy on dendritic cells (DCs) counts and function, although it is well documented that primary and secondary cell-mediated immune response are suppressed during this treatment.

DESIGN

In this study we evaluated the myeloid and lymphoid DCs in the peripheral blood (PB) of 37 women with OVC before and after first-line based on platin and taxane chemotherapy, and in 24 healthy blood donors. Patients received 6 courses of treatment, administered at 21-day intervals.

MATERIAL AND METHODS

The myeloid (M) and lymphoid (L) DCs were estimated by flow cytometry before and after 9th and 15th week of treatment.

RESULTS

The percentage of both MDCs and LDCs was significantly lower (0.09% and 0.04%) in PB of patients with ovarian cancer comparing to healthy women (0.25% and 0.33%). The percentage of both, myeloid and lymphoid DCs after 9th and 15th week (0.08% vs 0.08% and 0.06% vs 0.08%) of chemotherapy did not differ from that found before treatment (0.09% and 0.04%). The Myeloid to Lymphoid DCs ratio was significantly lower in patients receiving chemotherapy.

Decreased lactoferrin levels in peritoneal fluid of women with minimal endometriosis

OBJECTIVE

The aim of the study was to evaluate for the presence of lactoferrin (LTF) in peritoneal fluid (PF) of women with and without endometriosis.

PATIENTS

Seventy-eight women were studied, including 49 women with endometriosis and, as a reference group, 29 patients with functional follicle ovarian cysts.

RESULTS

Lactoferrin levels were detectable in all peritoneal fluid samples. Women with minimal endometriosis had lower PF lactoferrin concentrations compared to both patients with high revised American Fertility Society classification scores and women with follicle ovarian cysts. No significant difference in the peritoneal LTF levels was found between patients with stage II endometriosis, stage III or IV endometriotic disease and women with functional cysts of ovaries.

CONCLUSIONS

Owing to its antibacterial properties lactoferrin is probably an important defense factor in the peritoneal cavity, however its role in the pathogenesis of endometriosis remains enigmatic.

[YB-1 protein expression in ovarian cancer]

OBJECTIVES

Unfavourable prognosis of ovarian cancer is due to prompt progression, advanced stage at time of diagnosis and chemoresistance. No protein tissue prognosticators of ovarian cancer are in clinical use yet. YB-1 belongs to a family of "cold shock proteins" and participates at gene expression control at several levels. High expression of YB-1 in tumour tissue correlates with unfavourable prognosis and chemoresistance in some malignant neoplasms.

THE AIM

of this study was to determine the expression of YB-1 in benign and malignant ovarian neoplasms and to correlate the expression of YB-1 with clinical indicators of cancer progression.

METHODS

Specimens of 11 benign ovarian cysts and 14 cystadenocarcinomas of the ovary were obtained.YB-1 expression was determined by immunohistochemistry. Staging of ovarian cancer was performed according to FIGO.

RESULTS

Mean YB-1 expression levels in benign and malignant tumours were 5.36 +/- 4.1 and 2.86 +/- 4.18 points respectively and were not significantly different (p=0.18). No correlation between FIGO stage and expression of YB-1 was found in the group of ovarian cancers, either (p=0.32).

CONCLUSIONS

This study demonstrates that YB-1 is expressed both in benign and malignant ovarian tumors. Although there we didn't found any correlation between YB-1 expression and FIGO stage, YB-1 could be useful in the prognosis recurrence after chemotherapy.

[Ferritin levels in the peritoneal fluid--a new endometriosis marker?]

Accumulating data suggests that iron homeostasis in the peritoneal cavity may be disrupted by endometriosis. Increased iron metabolism induce proinflammatory and prooxidative environment in the peritoneal fluid (PF), thus may be involved in the pathogenesis of the endometriotic disease. Ferritin, a protein consisting of 24 subunits, may represent 25% of the total iron found in the organism. The aim of the study was to estimate the levels of ferritin in peritoneal fluid of women with endometriosis.

MATERIALS AND METHODS

Forty women were studied, including 15 patients with minimal/ mild endometriosis, 15 patients with moderate/ severe stage of the disease and 10 women without the disease. Ferritin concentrations were measured in the PF using a commercially available ELISA kit.

RESULTS

Ferritin levels were significantly higher in PF from both women with stages I/II (p=0.003) and III/IV (p=0.0007) endometriosis as compared to the reference group. No significant difference in the PF ferritin levels was found between women with stages I/II and stages III/IV endometriotic disease (p=0.98).

CONCLUSIONS

Increased ferritin levels, observed in peritoneal fluid, may reflect disrupted iron metabolism in the peritoneal cavity of endometriosis women.

Myeloid and lymphoid dendritic cells in the peritoneal fluid of women with ovarian cancer

PURPOSE

The aim of the study was to estimate the myeloid and lymphoid subpopulation of dendritic cells (DCs) in the peritoneal fluid (PF) of women with ovarian tumors.

MATERIAL AND METHODS

We studied 34 patients with serous cystadenocarcinoma and 29 women with serous cystadenoma. Dendritic cells were isolated from peritoneal fluid, stained with monoclonal antibodies anti-BDCA-1 and anti-BDCA-2 and estimated using flow cytometry.

RESULTS

Peritoneal fluid myeloid DCs constituted 0.59% of mononuclear cells in patients with ovarian cancer and 7.2% in women with serous cystadenoma. Lymphoid DCs constituted 0.39% of PF mononuclears in women with ovarian cancer and 0.07% in patients with serous cystadenoma. The percentage of lymphoid DCs was higher in patients with ovarian cancer than in women with serous cystadenoma. The BDCA-1/BDCA-2 DCs ratio in peritoneal fluid of patients with serous cystadenoma was significantly higher in comparison to ovarian cancer.

CONCLUSIONS

Decreased BDCA-1/BDCA-2 DCs ratio in patients with ovarian cancer may favour Th2 lymphocyte differentiation and/or induction of immunological tolerance.

Leptin is not involved in the pathophysiology of endometriosis-related infertility

OBJECTIVE

Changes in peritoneal fluid (PF) composition may affect fertilization as well as early embryonic development. Leptin, an adipocyte hormone, has been shown to act as a link between adipose tissue and the reproductive system. Therefore, we decided to assess peritoneal and serum leptin levels in infertile endometriotic patients.

PATIENTS

Seventy-two women were studied, including 30 fertile and 18 infertile women with ovarian endometriotic cysts and, as a reference group, 24 patients with unexplained infertility.

RESULTS

No significant difference in the peritoneal and leptin levels was found between the studied groups. Significantly higher PF leptin concentration was observed in patients with stages III and IV of endometriosis as compared to those with minimal stage of the disease. In fertile patients with endometriosis a positive correlation has been found between PF and serum leptin concentrations.

CONCLUSIONS

No differences in peritoneal or serum leptin levels between infertile and fertile women with endometriosis suggest that this cytokine is not involved in pathophysiology of endometriosis-related infertility.

Serum acute phase protein concentrations after hysterectomy with and without low-molecular-weight heparin thrombosis prophylaxis

Background. Low-molecular-weight heparin (LMWH) is recommended for venous thrombosis prophylaxis. There are several lines of evidence that heparins exhibit anti-inflammatory properties in addition to their anticoagulant activity. Therefore, we decided to estimate the concentrations of C-reactive protein (CRP) and haptoglobin, as acute-phase proteins, in the blood serum of patients who underwent total abdominal hysterectomy with and without the LMWH administration. Method. Forty-two women were studied, including 26 patients treated with enoxaparin and a group of 16 women without thrombosis prophylaxis. Haptoglobin and CRP concentrations were measured in serum samples obtained before the operation and also 8, 24, 48, 72, 96, and 192 hr after surgery. Results. Serum CRP level measured 8 hr after the operation was significantly higher in the group without thrombosis prophylaxis, however, no statistically significant differences in the concentration of CRP between studied groups in the other time periods were found. There were no statistically significant differences in serum haptoglobin levels between the groups of patients in all time periods. Conclusion. Administration of low-molecular-weight heparin may affect CRP production, however, further studies are still needed in order to clarify the exact immunosuppressive action of heparins.