Microvesicles released from ectopic endometrial foci as a potential biomarker of endometriosis

OBJECTIVES

Angiogenesis is engaged in endometriosis. It is regulated by regulatory factors and cytokines, transported in microvesicles. The purpose was to investigate the presence of MVs with vascular endothelial growth factor (VEGF) and metalloproteinase-9 (MMP-9) in peripheral blood and peritoneal fluid of women operated on for endometrioma or teratoma Material and methods:Microvesicles (MVs) were determined in blood samples and peritoneal fluid samples collected from women aged 20-60 years operated on for endometriosis (test group) and teratoma (control group). The final investigations were performed on 47 patients, who qualified for the study based on the meticulous inclusion criteria. MVs were analyzed by flow cytometry (FACS) using annexin V, antibodies for molecules characteristic of cells from endometriosis foci (keratin 18 (K18), CD105, CD146), and antibodies for intraepithelial vascular growth factor VEGF and metalloproteinase-9 (MMP-9). The sample was double "reading" using flow cytometry (FACSCantoII).

RESULTS

Cytometry analysis confirmed MVs' presence in plasma and peritoneal fluid collected from patients with both endometriosis and teratomas. A statistically significant higher level of AnnexinV (+) MVs were observed in plasma samples of endometriosis patients. In the control group, there was a higher percentage of double-positive VEGF (+)/MMP-9 (+) and single MMP-9 (+) positive MVs in the serum. In the peritoneal fluid higher frequency of double-positive VEGF (+)/MMP-9 (+) MVs were found in the control group. However, the amount of VEGF (+) / MMP-9 (+) MVs object did not enable to differentiate between the test and control groups. The study was the first, in which MVs were confirmed in plasma and peritoneal fluid in benign adnexa tumors.

CONCLUSIONS

Microvesicles are present in peripheral blood and peritoneal fluid samples collected from patients with endometriosis and teratomas. Microvesicles with proangiogenic factors (VEGF and MMP-9) are more abundant in blood and peritoneal fluid samples from patients with teratomas.

Is serum anti-Müllerian hormone (AMH) assay a satisfactory measure for ovarian reserve estimation? A comparison of serum and peritoneal fluid AMH levels

BACKGROUND

Clinical cases have been reported with women who got pregnant with confirmed low serum anti-Müllerian hormone (AMH) concentrations, thus demonstrating that low serum AMH concentration cut-points could be fairly specific for poor ovarian response (POR) to gonadotrophin stimulation, but not for pregnancy. That observation prompted the question whether serum AMH concentration accurately corresponded to the whole amount of AMH secreted by granulosa cells.

OBJECTIVES

To measure AMH levels in peritoneal fluid and their correlations with serum AMH concentrations.

MATERIAL AND METHODS

The reported study involved 48 female patients, aged 18-40 years, diagnosed with benign ovarian cysts and qualified for a laparoscopic cystectomy. Prior to surgery, the ovarian reserve was assessed using serum AMH concentration assay. The peritoneal fluid was also collected during the laparoscopy and AMH concentrations in peritoneal fluid were measured.

RESULTS

The AMH present in the peritoneal fluid strongly correlated with AMH levels in blood serum (r = 0.54; p < 0.001) and higher serum AMH concentrations corresponded to higher AMH concentrations in the peritoneal fluid. There was also a significant correlation between AMH levels in serum and in peritoneal fluid, collected from patients with endometrioma and other benign cysts (r = 0.61; p = 0.001 vs r = 0.43; p = 0.03).

CONCLUSIONS

The AMH is present in the peritoneal fluid and its concentrations significantly correlate with AMH levels in serum. The assessment of AMH concentration in the peritoneal fluid may be a valuable complement to the evaluation of ovarian reserve and the diagnosis of infertility after adnexal surgery.

2D/3D ultrasonography for endometrial evaluation in a cohort of 118 postmenopausal women with abnormal uterine bleedings

OBJECTIVES

2D/3D transvaginal ultrasonography in evaluation of endometrium in postmenopausal women with abnormal uterine bleedings (AUB).

MATERIAL AND METHODS

2D/3D transvaginal ultrasonography (TVU) was performed in 118 menopausal women with AUB. Endometrial volume and thickness, uterine volume and endometrial vascularity were evaluated. Complete histologic evaluation of the endometrium was obtained through dilatation & curettage (D&C) and/or hysteroscopy. Accordingly, patients were divided into 3 groups: controls (no endometrial pathology, n = 49), GI (benign endometrial pathology, n = 37), GII (endometrial carcinoma, n = 32).

RESULTS

GII had greater thickness and volume of the endometrium, compared to GI and controls. The presence of arterial vascular flow was identified only in GI and GII (51.35% and 93.75%, respectively). Endometrial volume merged together with uterine volume measurements (TVU-3D) showed a strong, statistical significance between GI and GII, allowing differentiation of begin and malignant endometrial pathologies in postmenopausal women.

CONCLUSIONS

In TVU diagnostics of postmenopausal women with AUB the following play the most significant role: 1) endometrial thickness (TVU-2D); 2) endometrial volume (TVU-3D); 3) uterine plus endometrial volume (TVU-3D); 4) vascularization within the endometrium, allowing to differentiate between pathological and normal endometrium (TVU-2/3D). Evaluation of the endometrial vascularity, both in TVU-2D and TVU-3D technique, does not allow for reliable differentiation between benign lesions and endometrial cancer.

Metastases of renal clear cell carcinoma to ovary--case report and review of the literature

In the literature the renal-ovarian axis has been demonstrated. Although, kidney and ovary are in a very distant anatomic position, they are supposed to have a lot of in common. This unusual connection begins from embryology, vascularization, and metastasizing tumors to each other. In the present systemic review the authors showed 24 case reports published in the literature, describing the metastases of primary renal cancer to ovary and only four cases reporting primary ovarian cancer metastases to kidney. Finding primary origin of the tumor is crucial in diagnostic process and subsequent therapy. The present case is a 25th case of renal cell carcinoma (RCC) metastasizing to ovary. The authors report the case of 51-year old woman with a four-year history of metastatic renal clear cell carcinoma (MRCC) presented in the present hospital with contralateral metastasis in right ovary.

The use of panniculectomy in morbidly obese patients undergoing gynecological surgery

Panniculectomy is a surgical procedure that involves removal of the skin and fat excess which facilitates access to the peritoneal cavity. In the paper we present three cases of morbidly obese women (BMI: 46.3-59.5) who were treated in the Department of Gynecology and Oncological Gynecology in Lodz. One of the patients underwent an operation due to the presence of a large cervical myoma. Two another women were treated for endometrial cancer. During all of the three procedures panniculectomy was the first stage of the operation.

DNA damage and repair in children with Down's syndrome

Down's syndrome (DS) is associated with the presence of a third 21 chromosome and is generally considered as a non-cancer-prone genetic disease. However, leukaemias occur more frequently in children with the syndrome than in general population and there is an open question, whether the presence of an additional chromosome may contribute to genomic instability, which, in turn, may play a role in a higher susceptibility to cancer and leukaemias in particular. In order to assess genomic instability associated with the presence of a third 21 chromosome, we determined the level of endogenous DNA damage and susceptibility to a genotoxic stress-inducing factor, hydrogen peroxide and N-methyl-N'-nitro-N-nitrosoguanidyne (MNNG) as well as the ability to remove DNA damage in the peripheral blood lymphocytes of children with DS and healthy kids. The level of DNA damage and the kinetics of DNA repair were evaluated by alkaline comet assay. Oxidative DNA damage was assayed with DNA repair enzymes: endonuclease III-like NTH1 and formamidopyrimidine-DNA glycosylase. The cells taken from children with DS did not display an effective DNA repair after treatment with 10 mM hydrogen peroxide. No difference in the sensitivity to DNA-damaging agents and the efficacy of DNA repair due to age and gender in DS children was observed. These results suggest that children with DS may be characterized by the increased sensitivity to the DNA-damaging agents impaired cellular reaction to DNA damage, which, in turn, may increase the probability of cancers in these children. Therefore, a special care to avoid exposure to potential mutagenic factor my be considered in these children.

The role of BRCA1 gene mutations and apoptosis phenomenon in sporadic breast cancer

BRCA1 tumor suppressor gene encodes an 1863-amino acid gene product that is implicated in many cellular pathways including transcription, cell-cycle checkpoint control, apoptosis and DNA repair. A role of apoptosis and BRCA1 germ-line mutation in breast cancer appearance was investigated in this study by both apoptosis frequency analysis and mutation screening of BRCA1 among breast cancer cases. Blood was obtained from 40 women with node-negative and node-positive ductal breast carcinomas with uniform tumor size. The blood samples from age matched healthy women (n=42) served as control. BRCA1 gene mutations were determined by PCR-RFLP methods. The apoptotic peripheral blood cells were detected by agarose gel electrophoresis. The apoptotic cells were identified in 30% (12/40) of the patients. There were no significant differences in apoptosis frequencies between patients and controls (P > 0.05). Three mutations of BRCA1 gene were identified in apoptosis positive samples from breast cancer women; one Ex20insC and two ExII17delA. Our study implies that apoptosis may be involved not only in sporadic breast carcinoma without BRCA1 mutations, but also in BRCA1-associated breast carcinoma.

[Evaluation of endometrial biopsy in postmenopausal women before HRT]

One of the reasons for not commencing or withdrawal of HRT in women is their fear for breast and endometrial cancers. Does ultrasonographic valuation guarantee sufficiently patient's safety? Most investigators do not recommend further endometrial diagnostics with endometrial thickness less than 4 mm. Endometrial biopsy is advised in cases of irregular uterine bleedings with normal endometrial image or when any endometrial pathology is suspected. In Poland the most frequently performed procedure of endometrial diagnostics is D&C. Our proposition was to offer endometrial biopsies to all patients who were taken HRT for more than 5 years or, despite having strong climacteric ailments, refused to take it because of their cancerophobia.

AIM OF STUDY

To evaluate the usefulness of aspiration endometrial biopsy in women after menopause qualified for HRT.

MATERIAL AND METHODS

In 84 females, being postmenopausal (amenorrhoeic for at least 12 months) and qualified for HRT, aspiration endometrial biopsies were performed in outpatient clinics. Age of women ranged 46-63 years, mean 57.3. Attained results were compared to ultrasonographic endometrial evaluation. Such factors as patient's age, menopausal age (years from last menstrual period) and previous administration of HRT were taken into our account (maintaining a 3-month wash-out interval). In 74% of women we have got a material being sufficient for histological evaluation. Form clinical point of view the most important for us was to exclude a proliferative or neoplastic process within endometrium. One of endometrial polyps was omitted in USG study, we were surprised also while detecting endometrial carcinoma cells in endometrium below 3.5 mm. In one postoperative slide the cells of endometrial ovarian carcinoma (with infiltrated Fallopian tube) were detected.

CONCLUSION

Endometrial biopsy seems to be a useful, effective and cheap method of endometrial diagnostics also in women after menopause.

[Evaluation of the effect of obesity on selected haemostatic and fibrinolytic parameters in peri- and postmenopausal women]

Localization of adipose tissue influence on obesity-dependent diseases. In obese people many abnormalities are observed connected with coagulation factors and fibrinolysis. We studied 47 peri- and postmenopausal female patients, who were operated on for benign changes within the pelvis minor. The patients were divided according to BMI (group I--BMI < 25 kg/m2, group II--BMI > 29 kg/m2). In obese women lower SHBG concentration, higher insulin and glucose fasting blood levels, higher LDL, higher total fatty tissue content, higher fibrinogen level and elevated PAI-1 activity were found. A positive correlation between area under insulin curve and PAI-1 activity and a negative correlation between fasting insulin levels and tPA were also observed. Based on the studies performed it can be said that: 1. Fatty tissue content in postmenopausal women exerts an influence on PAI-1 activity. 2. Obesity influences coagulation and fibrinolysis system in peri- and postmenopausal women. 3. Carbohydrate metabolism disturbances have influence on PAI-1 activity in peri- and postmenopausal women.

[Studies on the incidence and clinical significance of the metabolic syndrome in postmenopausal women in Lodz region]

In menopausal period increased prevalence of lipid metabolism disorders, atherosclerosis, carbohydrate metabolism disorders, cardiovascular diseases is observed.

AIM OF STUDY

Evaluation of prevalence of obesity, overweight, hypertension, carbohydrate and lipid metabolism disorders in population of women aged 45-65, treated in Menopause Diagnostic and Treatment Center Polish Mother's Memorial Hospital--Research Institute in Lodz. 2081 women, aged 45-65 were studied. In all of them diseases history, body mass index (BMI), blood pressure (twice), total cholesterol, triglycerides, fasting blood glucose levels were obtained. The highest percentage of obese women was noted in small villages (39%), whereas 21% of women from cities have BMI > or = 30 kg/m2. On the other side only 18.4% women living in cities have normal body weight, although in small villages there are 34.6% women from this group. Overweighted women percentage is similar among women living in small villages and cities. Hypertension prevalence did not depend on place of living, but obese women have hypertension more frequently. In study group diabetes mellitus was diagnosed in 4.8% of women and impaired glucose tolerance in 7%. Almost 2/3 of diabetes mellitus cases was first time diagnosed. Fasting blood glucose (FBG) level > or = 125 mg/dl was noted in 62 women (3%), values 111-124 mg/dl in 124 (6%), and in other 1895 women (91%) FBG was < or = 110 mg/dl. FBG level over 124 mg/dl and diabetes mellitus was more frequent in obese women. Women with hypercholesterolemia mostly (63.2%) have BMI > 25 kg/m2. Our study revealed that hypercholesterolemia prevalence did not differ with no statistical significance between women living in cities, towns and small villages. Elevated triglycerides level over 2.26 mmol/l was noted in 14.5% studied women, whereas there was no correlation between triglycerides level and body weight and place of living. Main health problem of women in perimenopausal period is obesity and lipid metabolism disorders detected in significant number of studied patients. Most cases of undiagnosed diabetes mellitus indicate that complex evaluation of health status of women in perimenopausal period is obligatory procedure.

[Evaluation of selected X syndrome factors during hormonal replacement therapy]

Estrogen deficiency after menopause leads to characteristics changes in the hormonal profile, which may influence lipid carbohydrate and calcium-phosphate metabolism and some elements of homeostasis.

AIM OF STUDY

To evaluate the influence of hormone replacement therapy with 2 mg estradiol valerate and 0,15 mg levonorgestrel on carbohydrate and lipid metabolism in women after menopause during 12 months of follow-up. We examined 101 women, mean age 52.9 +/- 4.6 years (range from 44 to 65). HRT was applied in 67 women whereas 34 women were without treatment. All of them had no carbohydrate disturbances. All women underwent clinical examination, and body mass index (BMI), fasting blood glucose, insulin, total cholesterol and triglycerides levels were obtained. At 1 and 2 hours after 75 g glucose challenge (75OGTT) glucose and insulin levels were obtained. During hormone replacement therapy all women noted release or significant decrease of climacteric symptoms. Total cholesterol level was decreased, whereas triglycerides did not change. After 12 months of treatment there was also a significant decrease of all factors relating to carbohydrate metabolism--fasting glucose and insulin, insulin/glucose ratio and area under glucose and insulin curves. In our study--after 6 months of follow-up fasting insulin level, area under glucose and insulin curves were increased whereas fasting blood glucose level remained unchanged. Among women without HRT there were no significant changes in selected lipid parameters and BMI. Triglyceride levels decreased (albeit insignificantly) but, total cholesterol levels did not change. After 12 months glucose level did not change, although other carbohydrate parameters were increased. 1) In the study group there was a statistically significant decrease in total cholesterol levels whereas triglycerides remained unchanged. 2) HRT we significantly decreased of insulin resistance and fasting blood glucose levels as compared with non-group HRT. 3) The present results indicate HRT-induced improvement of lipid and carbohydrate metabolism. 4) Long-term HRT is necessary to improve carbohydrate metabolism.

[Assessment of fat tissue distribution impact on selected prothrombin and fibrinolytic factors in pre- and postmenopausal women]

OBJECTIVES

Objective was to examine the relationship of obesity, body fat distribution fasting plasma insulin concentrations and triglycerides of pro-thrombotic and fibrinolitics factors in pre and postmenopausal women.

MATERIAL AND METHODS

We assessed 24 (13 nonobese and 11 obese) postmenopausal and 44 (15 obese and 29 non obese) premenopausal women. Plasma concentration of PAI-1 ag,PAI-1 activity, fibrinogen, tPA-1 akt, tPA ag, von Willebrand factor, fasting plasma insulin, and the lipid pattern (cholesterol, TG, HDL, LDL) was measured. The body fat distribution was assessed by waist-to-hip circumference measuring.

RESULTS

Postmenopausal subjects had higher PAI-1 act. and PAI-1 ag (p < 0.05 and 0.001 respectively), vWf and lower ATIII. There was direct correlation between PAI-1 act., Fibrinogen and BMI in both groups of patients together and in premenopausal group PAI-1 act correlated directly and tPA ag/act. indirectly with plasma insulin concentrations.

CONCLUSIONS

Plasma concentrations of the pro-thrombotic factors are increased in obese and postmenopausal women and correlate directly with BMI and indirectly with plasma insulin concentrations. Plasma concentrations of anti thrombotic factors indirectly correlated with WHR and with plasma insulin concentrations.