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Vimercati A, Cirignaco F, De Nola R, Cerbone M, Difonzo T, Quarto P, Fascilla FD, Cicinelli E, Resta L, Cazzato G. Tracking Endometrial Malacoplakia Through the Evolution of 2D and 3D Ultrasound and Histopathological Features. Cureus 2024; 16:e52268. [PMID: 38352078 PMCID: PMC10864011 DOI: 10.7759/cureus.52268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Malacoplakia is an uncommon disease characterized by chronic and granulomatous inflammation, which rarely involves the female genital tract. We describe the ecographic and histological evolution of the first case of a patient developing endometrial malacoplakia as a complication after a cesarean section. The patient, a 43-year-old woman, presented with pelvic pain one month after delivering by cesarean section and the initial suspicion was of retention of placental rests. We discuss the diagnostic challenges for this rare disease, highlighting the importance of considering endometrial malacoplakia as a possible diagnosis in patients with similar clinical presentations and the important role of 2D and 3D ultrasound in the diagnostic pathway. In literature, ultrasound findings in cases of endometrial malacoplakia are represented by hypoechoic thickening of the endometrial lining; hyperechoic thickening of the myometrium, and the presence of masses, nodules, cystic areas, or anechoic fluid within the endometrium. For the first time, we describe the evolution of endometrial malacoplakia through both ultrasound, 2D and 3D, and histopathological findings, from the acute to chronic stage of the disease.
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Affiliation(s)
- Antonella Vimercati
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, ITA
| | - Francesca Cirignaco
- Department of Interdisciplinary Medicin, University of Bari Aldo Moro, Bari, ITA
| | - Rosalba De Nola
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, ITA
| | - Marco Cerbone
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, ITA
| | - Tommaso Difonzo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, ITA
| | - Pietro Quarto
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, ITA
| | | | - Ettore Cicinelli
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, ITA
| | - Leonardo Resta
- Department of Pathology, University of Bari Aldo Moro, Bari, ITA
| | - Gerardo Cazzato
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, ITA
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Di Gennaro F, Guido G, Frallonardo L, Segala FV, De Nola R, Damiani GR, De Vita E, Totaro V, Barbagallo M, Nicastri E, Vimercati A, Cicinelli E, Liuzzi G, Veronese N, Saracino A. Efficacy and safety of therapies for COVID-19 in pregnancy: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:776. [PMID: 37946100 PMCID: PMC10634005 DOI: 10.1186/s12879-023-08747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Clinical evidence suggests that pregnant women are more vulnerable to COVID-19, since they are at increased risk for disease progression and for obstetric complications, such as premature labor, miscarriage, preeclampsia, cesarean delivery, fetal growth restriction and perinatal death. Despite this evidence, pregnant women are often excluded from clinical trials, resulting in limited knowledge on COVID-19 management. The aim of this systematic review and meta-analysis is to provide better evidence on the efficacy and safety of available COVID-19 treatment in pregnant women. METHODS Four authors searched major electronic databases from inception until 1 st November-2022 for controlled trials/observational studies, investigating outcomes after the administration of anti-SARS-CoV-2 treatments in pregnant women affected by COVID-19. The analyses investigated the cumulative incidence of delivery and maternal outcomes in pregnant women, comparing those taking active medication vs standard care. Risk ratios (RRs) with 95% confidence intervals were calculated. Statistical significance was assessed using the random effects model and inverse-variance method. This systematic review and meta-analysis was conducted in accordance with the updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol has been registered in Prospero (number registration: CRD42023397445). RESULTS From initially 937 non duplicate records, we assessed the full texts of 40 articles, finally including ten studies. In six studies, including 1627 patients, the use of casirivimab/imdevimab (CAS/IMD), remdesivir, and IFN-alpha 2b significantly decreased the need of cesarean section ((RR = 0.665; 95%CI: 0.491-0.899; p = 0.008; I 2 = 19.5%;) (Table 1, (Fig. 1). Treatments did not decrease the risk of preterm delivery, admission to neonatal ICU, or stillbirth/perinatal loss (p-values > 0.50 for all these outcomes) and did not prevent the progression of disease towards severe degrees (k = 8; 2,374 pregnant women; RR = 0.778; 95%CI: 0.550-1.099; p = 0.15; I 2 = 0%). Moreover, the use of medications during pregnancy did not modify the incidence of maternal death in two studies (Table 2). CONCLUSIONS To our analysis, CAS/IMD, remdesivir, and IFN alpha 2b reduced the number of cesarean sections but demonstrated no effect on disease progression and other obstetric and COVID-19 related outcomes. The inability to evaluate the influence of viral load on illness development in pregnant women was attributed to lack of data. In our systematic review, no major side effects were reported. Though, it is essential for the medical community to focus more on clinical trials and less on episodic case reports and case series, with standardization of fetal and maternal outcomes.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy.
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Rosalba De Nola
- Clinic of Obstetrics & Gynaecology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Elda De Vita
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Valentina Totaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Mario Barbagallo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Antonella Vimercati
- Clinic of Obstetrics & Gynaecology, University of Bari "Aldo Moro", Bari, Italy
| | - Ettore Cicinelli
- Clinic of Obstetrics & Gynaecology, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
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Antonella V, De Nola R, Battaglia S, Di Mussi R, Cazzato G, Resta L, Chironna M, Loconsole D, Vinci L, Chiarello G, Marucci M, Cicinelli E. Adverse Maternal Outcomes in Pregnant Women Affected by Severe-Critical COVID-19 Illness: Correlation with Vaccination Status in the Time of Different Viral Strains' Dominancy. Vaccines (Basel) 2022; 10:vaccines10122061. [PMID: 36560471 PMCID: PMC9783263 DOI: 10.3390/vaccines10122061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
This is a monocentric and cross-sectional study conducted at the COVID-19 Division of the Obstetrical and Gynecological Unit and Intensive Care Units (ICUs) of Policlinico di Bari, in Bari, Italy, between September 2020 and April 2022. This study aimed to identify the prevalence of severe-critical COVID-19 illness requiring access to the Intensive Care Unit (ICU) among 287 pregnant patients, and possible correlations between the SARS-CoV-2 variants, the specific pandemic wave (dominated by wild, Alpha, Delta, and Omicron strains), and severe-critical adverse maternal outcomes. The prevalence of severe-critical COVID-19 illness was 2.8% (8/287), reaching 4.9% (8/163) excluding the 4th wave (Omicron dominant). The Delta variant determined the highest risk ratio and odds for access to the ICU due to severe-critical COVID-19-related symptoms compared to the other variants (wild, Alpha, Omicron). During the third wave (Delta), the ICU cases underwent a higher rate of hyperimmune plasma infusion (75%), antibiotic therapy (75%), and remdesivir (33%); all of the patients were intubated. During the Omicron wave, the patients were asymptomatic or with few symptoms: most of them (70%) were vaccinated with a median of two doses. The maternal outcome worsened in the case of Alpha and, especially, Delta variants for severe-critical COVID-19-related symptoms and ICU access.
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Affiliation(s)
- Vimercati Antonella
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Rosalba De Nola
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- Correspondence:
| | - Stefano Battaglia
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Rossella Di Mussi
- Department of Emergency and Organ Transplantation, Anaesthesia and Resuscitation Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplant, Pathology Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Leonardo Resta
- Department of Emergency and Organ Transplant, Pathology Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Chironna
- Department of Interdisciplinary Medicine (Laboratory of Molecular Epidemiology and Public Health), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Daniela Loconsole
- Department of Interdisciplinary Medicine (Laboratory of Molecular Epidemiology and Public Health), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Lorenzo Vinci
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giulia Chiarello
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Massimo Marucci
- Department of Emergency and Organ Transplantation, Anaesthesia and Resuscitation Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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Vimercati A, De Nola R, Trerotoli P, Metta ME, Cazzato G, Resta L, Malvasi A, Lepera A, Ricci I, Capozza M, Laforgia N, Cicinelli E. COVID-19 Infection in Pregnancy: Obstetrical Risk Factors and Neonatal Outcomes-A Monocentric, Single-Cohort Study. Vaccines (Basel) 2022; 10:vaccines10020166. [PMID: 35214625 PMCID: PMC8879809 DOI: 10.3390/vaccines10020166] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
The effects of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 on pregnant women and neonates are mainly unknown, since limited data are available in the literature. We conducted a monocentric and cross-sectional study enrolling 122 un-vaccinated pregnant women with COVID-19 infection tested by RT-PCR nasopharyngeal swab. Only 4.1% of the patients had severe COVID-19 symptoms together with major respiratory symptoms and intensive care unit admission, whereas 35.25% of women had comorbidities and two-thirds of them were overweight or obese. COVID-19 was detected mainly in the third trimester (98.36%) and multiparous women (59.02%). The mode of delivery was influenced by mild-severe COVID-19 symptoms, with a higher number of urgent or emergent cesarean sections than spontaneous or operative vaginal births. Preterm births were associated with high BMI, mode of delivery (higher among cesarean sections), nulliparity, and severe COVID-19 symptoms. In cases of severe COVID-19 symptoms, there was a higher rate of respiratory distress syndrome among newborns. In the end, only the presence of a severe COVID-19 infection worsened the obstetrical and neonatal outcomes, with higher rates of urgent or emergent cesarean section, preterm births, and neonatal respiratory distress syndrome.
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Affiliation(s)
- Antonella Vimercati
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (A.V.); (A.M.); (A.L.); (I.R.); (E.C.)
| | - Rosalba De Nola
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (A.V.); (A.M.); (A.L.); (I.R.); (E.C.)
- Correspondence:
| | - Paolo Trerotoli
- Medical Statistics, Department of Biomedical and Human Oncologic Science, University of Bari, 70121 Bari, Italy; (P.T.); (M.E.M.)
| | - Maria Elvira Metta
- Medical Statistics, Department of Biomedical and Human Oncologic Science, University of Bari, 70121 Bari, Italy; (P.T.); (M.E.M.)
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplant, University of Bari, 70121 Bari, Italy; (G.C.); (L.R.)
| | - Leonardo Resta
- Department of Emergency and Organ Transplant, University of Bari, 70121 Bari, Italy; (G.C.); (L.R.)
| | - Antonio Malvasi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (A.V.); (A.M.); (A.L.); (I.R.); (E.C.)
| | - Archiropita Lepera
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (A.V.); (A.M.); (A.L.); (I.R.); (E.C.)
| | - Ilaria Ricci
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (A.V.); (A.M.); (A.L.); (I.R.); (E.C.)
| | - Manuela Capozza
- Unit of Neonatology and Intensive Care, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy; (M.C.); (N.L.)
| | - Nicola Laforgia
- Unit of Neonatology and Intensive Care, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy; (M.C.); (N.L.)
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (A.V.); (A.M.); (A.L.); (I.R.); (E.C.)
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De Nola R, Loizzi V, Cicinelli E, Cormio G. Dynamic crosstalk within the tumor microenvironment of uterine cervical carcinoma: baseline network, iatrogenic alterations, and translational implications. Crit Rev Oncol Hematol 2021; 162:103343. [PMID: 33930531 DOI: 10.1016/j.critrevonc.2021.103343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
Uterine cervical cancer is the fourth most frequent gynecological tumor worldwide. The tumor microenvironment of cervical cancer is the result of persistent high-risk human papillomavirus infection together with stromal activation of estrogen receptor alpha and the pro-angiogenic and pro-inflammatory activity of immune cells, mainly T-helper 17 cells and tumor-associated macrophages. Therapeutic management (e.g., immunotherapy, especially in advanced cases) may be influenced by the translational implications of tumoral stroma crosstalk and an abundance of tumor-infiltrating lymphocytes within the tumor microenvironment. The prognosis of cervical cancer is inversely correlated with microvessel density, making anti-angiogenic strategies with agents such as bevacizumab crucial for improving both progression-free survival and overall survival in patients with advanced and recurrent tumors.
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Affiliation(s)
- Rosalba De Nola
- Department of Tissues and Organs Transplantation and Cellular Therapies, D.E.O.T., University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico, 70124, Bari, Italy; Department of Biomedical and Human Oncological Science, Division of Obstetrics and Gynecology, University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico, 70124, Bari, Italy; Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142, Bari, Italy.
| | - Vera Loizzi
- Department of Biomedical and Human Oncological Science, Division of Obstetrics and Gynecology, University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico, 70124, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science, Division of Obstetrics and Gynecology, University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico, 70124, Bari, Italy
| | - Gennaro Cormio
- Department of Biomedical and Human Oncological Science, Division of Obstetrics and Gynecology, University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico, 70124, Bari, Italy; Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142, Bari, Italy
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Brindisi G, De Vittori V, De Nola R, Di Mauro A, De Castro G, Baldassarre ME, Cicinelli E, Cinicola B, Duse M, Zicari AM. The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice. J Asthma Allergy 2021; 14:265-274. [PMID: 33790581 PMCID: PMC8006956 DOI: 10.2147/jaa.s275692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background Allergic rhinitis (AR) and asthma are two common atopic diseases, often associated with a common ethiopathogenesis characterized by a Th2 inflammatory response with the release of many biomarkers, such as nitric oxide (NO). Purpose To evaluate and compare inflammatory (nFeNO and eFeNO) and functional (mNF and FEV1) parameters in AR children with or without asthma in comparison to controls. Secondly, we aimed to identify nFeNO cut-off values and verify their reliability to predict the presence of rhinitis or asthma alone or in combination. Patients and Methods We enrolled 160 children (6-12 years of age) with AR and/or asthma divided into four groups: controls, AR, asthma, and AR + asthma. All children underwent the following inflammatory and functional measurements: nFeNO, eFeNO, mNF and FEV1. Results We observed that levels of nFeNO were extremely higher in children with AR and even more in those with AR + asthma in respect to controls. Notably, all the pathological conditions, especially AR + asthma, showed significantly lower values of mNF compared to healthy children. A negative correlation linked mNF and nFeNO. Then, we found eFeNO values significantly higher in all the pathological groups compared to controls, with major values of this marker in patients affected by asthma and AR + asthma, as well as FEV1 values significantly lower in all the disease groups, especially in children with asthma and AR+ asthma. ROC curve analysis showed that nFeNO was a great predictor for rhinitis alone or with asthma, revealing an accurate cut-off of 662 ppb. Conclusion nFeNO measurement is non-invasive, easy to perform, economic and a valuable test in case of AR alone or in association with asthma. Thus, it should be used in patients with rhinitis, together with anterior active rhinomanometry (AAR) to diagnose and estimate the degree of nasal obstruction but also in children with asthma to assess their nasal involvement and improve the therapeutic management.
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Affiliation(s)
- Giulia Brindisi
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Valentina De Vittori
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Rosalba De Nola
- Department of Biomedical Science and Human Oncology, Gynecology and Obstetrics Section, "Aldo Moro" University of Bari, Bari, 70124, Italy.,Department of Tissues and Organs Transplantation and Cellular Therapies, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Antonio Di Mauro
- Department of Biomedical Sciences and Human Oncology-Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Giovanna De Castro
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Maria Elisabetta Baldassarre
- Department of Biomedical Sciences and Human Oncology-Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Ettore Cicinelli
- Department of Biomedical Science and Human Oncology, Gynecology and Obstetrics Section, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Bianca Cinicola
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Marzia Duse
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Anna Maria Zicari
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
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Pirtea P, Cicinelli E, De Nola R, de Ziegler D, Ayoubi JM. Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fertil Steril 2021; 115:546-560. [PMID: 33581856 DOI: 10.1016/j.fertnstert.2020.12.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/19/2022]
Abstract
Chronic inflammatory processes affecting the endometrium, as encountered in endometriosis, adenomyosis, and chronic endometritis, alter endometrial receptivity. These disorders are associated with early pregnancy losses and possibly recurrent pregnancy losses (RPL). In the cases of endometriosis, other factors associated with the disease also are susceptible of causing miscarriages and possibly RPL, such as an impact of intrapelvic inflammatory processes affecting the oocyte and embryo in case of natural conception. Conversely these latter effects obviously are bypassed in case of assisted reproductive technology. Chronic inflammation of the endometrium in the condition known as chronic endometritis also causes early pregnancy losses and RPL with beneficial effects achieved when specific treatment is undertaken.
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Affiliation(s)
- Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France.
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy; Piazza Giulio Cesare, Policlinico, Bari, Italy
| | - Rosalba De Nola
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy; Piazza Giulio Cesare, Policlinico, Bari, Italy
| | - Dominique de Ziegler
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France
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De Nola R, Menga A, Castegna A, Loizzi V, Ranieri G, Cicinelli E, Cormio G. The Crowded Crosstalk between Cancer Cells and Stromal Microenvironment in Gynecological Malignancies: Biological Pathways and Therapeutic Implication. Int J Mol Sci 2019; 20:ijms20102401. [PMID: 31096567 PMCID: PMC6567055 DOI: 10.3390/ijms20102401] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 12/31/2022] Open
Abstract
The tumor microenvironment plays a pillar role in the progression and the distance dissemination of cancer cells in the main malignancies affecting women-epithelial ovarian cancer, endometrial cancer and cervical cancer. Their milieu acquires specific properties thanks to intense crosstalk between stromal and cancer cells, leading to a vicious circle. Fibroblasts, pericytes, lymphocytes and tumor associated-macrophages orchestrate most of the biological pathways. In epithelial ovarian cancer, high rates of activated pericytes determine a poorer prognosis, defining a common signature promoting ovarian cancer proliferation, local invasion and distant spread. Mesenchymal cells also release chemokines and cytokines under hormonal influence, such as estrogens that drive most of the endometrial cancers. Interestingly, the architecture of the cervical cancer milieu is shaped by the synergy of high-risk Human Papilloma Virus oncoproteins and the activity of stromal estrogen receptor α. Lymphocytes represent a shield against cancer cells but some cell subpopulation could lead to immunosuppression, tumor growth and dissemination. Cytotoxic tumor infiltrating lymphocytes can be eluded by over-adapted cancer cells in a scenario of immune-tolerance driven by T-regulatory cells. Therefore, the tumor microenvironment has a high translational potential offering many targets for biological and immunological therapies.
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Affiliation(s)
- Rosalba De Nola
- Department of Tissues and Organs Transplantation and Cellular Therapies, D.E.O.T., University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico 70124 Bari, Italy.
| | - Alessio Menga
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Via E. Orabona, 4, 70125 Bari, Italy.
| | - Alessandra Castegna
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Via E. Orabona, 4, 70125 Bari, Italy.
| | - Vera Loizzi
- Department of Biomedical and Human Oncological Science, 2nd Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico 70124 Bari, Italy.
| | - Girolamo Ranieri
- Interventional Oncology Unit with Integrate Section of Translational Medical Oncology, IRCCS, Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy.
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science, 2nd Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico 70124 Bari, Italy.
| | - Gennaro Cormio
- Department of Biomedical and Human Oncological Science, 2nd Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Piazza G. Cesare, 11-Policlinico 70124 Bari, Italy.
- Gynaecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
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De Nola R, Schönauer LM, Fiore MG, Loverro M, Carriero C, Di Naro E. Management of placental site trophoblastic tumor: Two case reports. Medicine (Baltimore) 2018; 97:e13439. [PMID: 30508960 PMCID: PMC6283185 DOI: 10.1097/md.0000000000013439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to a family of pregnancy-related illnesses, called gestational trophoblastic diseases (GTD). Less than 300 cases of PSTT have been reported in literature, with an incidence of ≈ 1/50,000-100,000 pregnancies representing only 0.23% to 3.00% of all GTDs. PATIENT CONCERNS Our report describes 2 additional cases of PSTT outlining their main diagnostic features and the subsequent management. The first case presented contemporary to a persistent hydatidiform mole in a 37-year-old woman, para 2042; whereas the second one originated 5 years after a miscarriage in 43-year-old woman, para 1031 with a previous diagnosis of breast cancer, and shared some features with placental site nodule (PSN), a benign condition. DIAGNOSIS The first case had a difficult diagnosis because there was an amenorrhea of 11th week with high serum beta-human chorionic gonadotropin (beta-HCG) and an initial ultrasound image of vesicular mole. After the Dilatation and Curettage, histology confirmed the previous hypothesis. However, the final histology of PSTT was obtained after major surgery. On the contrary, the diagnosis of the second case was less challenging but surprising, thanks to a routine trans-vaginal ultrasound showing a suspicious endometrial thickness positive for PSTT at a subsequent hysteroscopic guided biopsy. INTERVENTIONS The treatment consisted of hysterectomy and subsequent follow up. Lymphadenectomy or lymph node sampling were not performed due to the initial stage of the disease. OUTCOMES In the first case, there were high values of serum beta-HCG that plummeted after the surgery, whereas in the second one they had been always negative. Hereafter, both went through a follow up with periodic serum oncological markers, imaging studies and clinical evaluation, which have showed negative result for 3 years and 15 months, respectively. LESSONS A detailed gynecological ultrasound examination could be extremely helpful to understand the next diagnostic step of echo-guided D&C or hysteroscopic biopsy and for a pre-operative staging assessment. On the contrary, determining the serum beta-HCG's curve is crucial just in case of an initial positive value to pursue clinical evaluation and follow-up. In case of good prognostic factors, the main therapy remains hysterectomy.
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Affiliation(s)
- Rosalba De Nola
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Luca Maria Schönauer
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Maria Grazia Fiore
- Department of Emergency and Organ Transplantation, Pathology Unit, University of Bari, Bari, Italy
| | - Matteo Loverro
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Carmine Carriero
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Edoardo Di Naro
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
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Mazzocca A, Schönauer LM, De Nola R, Lippolis A, Marrano T, Loverro M, Sabbà C, Di Naro E. Autotaxin is a novel molecular identifier of type I endometrial cancer. Med Oncol 2018; 35:157. [PMID: 30374843 DOI: 10.1007/s12032-018-1222-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
Endometrial cancer is the most common cancer of the female genital tract in Western Countries, with an incidence of 150.000 new cases/year. Despite high incidence, little is known about the molecular pathogenesis of this tumor. Phospholipids including lysophosphatidic acid (LPA) are involved in proliferation and dissemination of cancer. LPA is a potent bioactive phospholipid synthesized by autotaxin (ATX) through its lysophospholipase D activity. Recent evidence suggests that the ATX/LPA signaling axis plays a role in endometrial cancer. We carried out a prospective study involving two groups of patients classified in accordance to hysteroscopic-guided biopsy. Patients with histological diagnosis of endometrial cancer were enrolled into group one, whereas control patients with pelvic organ prolapse were assigned group two. Both groups underwent hysterectomy, with either open or laparoscopic surgery. After uterine extraction, a second endometrial biopsy was performed to collect tissues. Real-Time PCR was performed to evaluate ATX gene expression in collected tissues. Statistical analysis including unpaired two-way or one-way Student's t test and ANOVA was performed. We found ATX gene expression significantly higher in neoplastic endometrium compared with normal tissue (P value = 0.0002). In particular, the expression of ATX was significantly elevated in type I endometrial cancer (i.e., endometrioid histotype) compared to type II, in premenopausal women and in patients affected either by obesity (BMI > 30) or diabetes. We propose ATX as a novel potential biomarker particularly implicated in the pathobiology of type I endometrial cancer. Also, we propose ATX as a useful theranostic target in endometrial cancer.
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Affiliation(s)
- Antonio Mazzocca
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy.
| | - Luca Maria Schönauer
- Interdisciplinary Department of Medicine, Gynaecology and Obstetrics Clinic, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Rosalba De Nola
- Interdisciplinary Department of Medicine, Gynaecology and Obstetrics Clinic, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
- Department of Tissues and Organs Transplantation and Cellular Therapies, D.E.O.T, School of Medicine, University of Bari, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Antonio Lippolis
- Interdisciplinary Department of Medicine, Gynaecology and Obstetrics Clinic, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Teresa Marrano
- Interdisciplinary Department of Medicine, Gynaecology and Obstetrics Clinic, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Matteo Loverro
- Interdisciplinary Department of Medicine, Gynaecology and Obstetrics Clinic, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Edoardo Di Naro
- Interdisciplinary Department of Medicine, Gynaecology and Obstetrics Clinic, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
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De Nola R, Di Naro E, Schonauer LM, Lucarelli G, Battaglia M, Fiore MG, Mastrolia SA, Loverro G. Clinical management of a unique case of PNET of the uterus during pregnancy, and review of the literature. Medicine (Baltimore) 2018; 97:e9505. [PMID: 29480840 PMCID: PMC5943895 DOI: 10.1097/md.0000000000009505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms characterized by small round cells of neuroepithelial origin. They usually involve bone and soft tissues, and have a higher incidence in childhood. PATIENT CONCERNS In this case report, we describe the obstetric and oncological outcome of a huge mass diagnosed as a leiomyoma in a 39-year-old pregnant woman who complained of low back pain, dysuria, and urinary frequency at 22 weeks of gestation. DIAGNOSES During the 25th week of pregnancy, the patient was referred to our hospital at night with severe anemia and suspected hemoperitoneum. She underwent an emergency caesarean section, delivering a female fetus weighing 400 g, with an Apgar score of 7 at 1 minute and 9 at 5 minutes. INTERVENTION During surgery, we found a huge uterine sarcoma-like metastatic tumor, invading the pelvic peritoneum and parametria bilaterally; the adnexae seemed disease-free. We performed a type B radical hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, omentectomy, appendectomy, and excision of a bulky lymph node. Seven days after delivery, staging computed tomography (CT) scan demonstrated a large lombo-aortic lymph node compressing the left renal vein and we completed debulking with a second surgery, including diaphragmatic peritonectomy and excision of a huge lymph node by lombo-aortic lymphadenectomy, requiring partial reconstruction of an infiltrated renal vein. OUTCOME Ten days after the second surgery, echo-color Doppler showed a regular microcirculation in the left kidney. The patient was discharged after 10 days, and the baby after 1 month, both in good health.Histological examination revealed a uterine body cPNET (central primitive neuroectodermal tumor) orienting the clinical management toward chemotherapy with cisplatin and etoposide. LESSONS PNETs are aggressive neoplasms, usually diagnosed at an advanced stage. Due to their low incidence, universally accepted guidelines are still unavailable. Radical surgery leaving no macroscopic residual disease is mandatory in advanced stages. A good fertility-sparing procedure can be performed only in young women at early stages of disease, when the wish for childbearing is not yet fulfilled.
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Affiliation(s)
- Rosalba De Nola
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Luca Maria Schonauer
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | | | | | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
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