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Fujii S, Mukuda N, Yunaga H, Gonda T, Fukunaga T, Kamata Y, Ochiai R, Ozaki K. MR imaging findings of massive perivillous fibrin deposition of the placenta: A case report. Radiol Case Rep 2024; 19:2797-2800. [PMID: 38689805 PMCID: PMC11059301 DOI: 10.1016/j.radcr.2024.03.090] [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: 03/14/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Massive perivillous fibrin deposition (MPFD) of the placenta is characterized by the obliteration of the villous trophoblast with extensive deposition of fibrinoid material in the intervillous space. Here, we describe the MRI findings of a case of MPFD. The placenta demonstrates linear and geographical hypointensity on T2-weighted imaging, which is suggested to mainly reflect fibrin deposition. This finding should be noted, particularly in patients with miscarriage in their past history.
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Affiliation(s)
- Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Naoko Mukuda
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroto Yunaga
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takuro Gonda
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takeru Fukunaga
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuji Kamata
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryoya Ochiai
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kanae Ozaki
- Department of Pathology, Faculty of Medicine, Tottori University, Yonago, Japan
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Wei S, Tang W, Chen D, Xiong J, Xue L, Dai Y, Guo Y, Wu C, Dai J, Wu M, Wang S. Multiomics insights into the female reproductive aging. Ageing Res Rev 2024; 95:102245. [PMID: 38401570 DOI: 10.1016/j.arr.2024.102245] [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: 11/09/2023] [Revised: 01/22/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
The human female reproductive lifespan significantly diminishes with age, leading to decreased fertility, reduced fertility quality and endocrine function disorders. While many aspects of aging in general have been extensively documented, the precise mechanisms governing programmed aging in the female reproductive system remain elusive. Recent advancements in omics technologies and computational capabilities have facilitated the emergence of multiomics deep phenotyping. Through the application and refinement of various high-throughput omics methods, a substantial volume of omics data has been generated, deepening our comprehension of the pathogenesis and molecular underpinnings of reproductive aging. This review highlights current and emerging multiomics approaches for investigating female reproductive aging, encompassing genomics, epigenomics, transcriptomics, proteomics, metabolomics, and microbiomics. We elucidate their influence on fundamental cell biology and translational research in the context of reproductive aging, address the limitations and current challenges associated with multiomics studies, and offer a glimpse into future prospects.
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Affiliation(s)
- Simin Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Weicheng Tang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Dan Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Jiaqiang Xiong
- Department of Obstetrics and Gynecology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Liru Xue
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Yun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Yican Guo
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Chuqing Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China.
| | - Meng Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China.
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China.
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Marr EE, Isenberg BC, Wong JY. Effects of polydimethylsiloxane membrane surface treatments on human uterine smooth muscle cell strain response. Bioact Mater 2024; 32:415-426. [PMID: 37954466 PMCID: PMC10632608 DOI: 10.1016/j.bioactmat.2023.10.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
In the United States, 1 in 10 infants are born preterm. The majority of neonatal deaths and nearly a third of infant deaths are linked to preterm birth. Preterm birth is initiated when the quiescent state of the uterus ends prematurely, leading to contractions and parturition beginning as early as 32 weeks, though the origins are not well understood. To enable research and discovery of therapeutics with potential to better address preterm birth, the capability to study isolated cell processes of pregnant uterine tissue in vitro is needed. Our development of an in vitro model of the myometrium utilizing human uterine smooth muscle cells (uSMCs) responsible for contractions provides a methodology to examine cellular mechanisms of late-stage pregnancy potentially involved in preterm birth. We discuss culture of uSMCs on a flexible polydimethylsiloxane (PDMS) substrate functionalized with cationic poly-l-lysine (PLL), followed by extracellular matrix (ECM) protein coating. Previous work exploring uSMC behavior on PDMS substrates have utilized collagen-I coatings, however, we demonstrated the first exploration of human uSMC response to strain on fibronectin-coated flexible membranes, importantly reflecting the significant increase of fibronectin content found in the myometrial ECM during late-stage pregnancy. Using the model we developed, we conducted proof-of-concept studies to investigate the impact of substrate strain on uSMC cell morphology and gene expression. It was found that PLL and varied ECM protein coatings (collagen I, collagen III, and fibronectin) altered cell nuclei morphology and density on PDMS substrates. Additionally, varied strain rates applied to uSMC substrates significantly impacted uSMC gene expression of IL-6, a cytokine associated with instances of preterm labor. These results suggest that both surface and mechanical properties of in vitro systems impact primary human uSMC phenotype and offer uSMC culture methodologies that can be utilized to further the understanding of cellular pathways involved in the uterus under mechanical load.
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Affiliation(s)
- Elizabeth E. Marr
- Boston University, Division of Materials Science and Engineering, United States
- Charles Stark Draper Laboratory, Bioengineering Division, United States
| | - Brett C. Isenberg
- Charles Stark Draper Laboratory, Bioengineering Division, United States
| | - Joyce Y. Wong
- Boston University, Division of Materials Science and Engineering, United States
- Boston University, Department of Biomedical Engineering, United States
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Reddy M, Tian C, Liao CI, Winkler S, Johnson CR, Kapp DS, Darcy K, Chan JK. Exploring U.S. Hispanic origin groups diagnosed with uterine cancer - Are there disparities? Gynecol Oncol 2024; 181:118-124. [PMID: 38150836 DOI: 10.1016/j.ygyno.2023.12.015] [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: 09/25/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To evaluate patterns and trends of uterine cancer among Hispanic subgroups. METHODS The United States Cancer Statistics (USCS), National Cancer Database (NCDB), and World Population Review were used to obtain data on incidence, demographic characteristics, and cancer histology. Joinpoint regression program was used for statistical analysis. RESULTS Based on 2001-2017 USCS data, the overall incidence of uterine cancer was 27.46 vs. 23.29/100,000 in Hispanics vs. non-Hispanic Whites. There was an over 2-fold higher annual increase in the incidence in Hispanics (1.94%; p < 0.001) vs. Whites (0.85%; p < 0.001), particularly in local stage disease. There was an increase in grade 1 endometrioid carcinoma (1.48%; p < 0.001 vs. -0.52%; p = 0.1) and aggressive histologic subtypes (4.04% p = 0.000 vs. 2.53% p = 0.000) in Hispanics vs. Whites. Using the NCDB (2004-2015), we analyzed 17,351 Hispanics by subgroup (Mexican, South/Central American, Puerto Rican, Cuban, and Dominican). Over the 12 years, there was an increase in the proportion of uterine cancer diagnoses in all Hispanics (5.2% to 11.0%; p < 0.0001). Dominican patients experienced the largest increase in diagnosis (2.6% to 14.9%; p < 0.0001), the highest proportion of advanced disease at 28.0% (p < 0.0001), and the highest incidence of non-endometrioid histologies at 37.1% (p < 0.0001). World Population Review 2023 revealed the highest female obesity rates in Puerto Rico (51.4%), the Dominican Republic (34.1%), and Mexico (32.8%). CONCLUSION Uterine cancer incidence is increased in Hispanics, with the largest increase in Dominican women with more advanced stages and high-risk histologic subtypes. The impact of obesity on cancer risk, especially in Puerto Ricans, Dominicans, and Mexicans, warrants further investigation.
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Affiliation(s)
- Megan Reddy
- California Pacific Medical Center, 795 El Camino Real, San Francisco, CA 94109, USA.
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Chen-I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Stuart Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Caitlin R Johnson
- California Pacific Medical Center, 795 El Camino Real, San Francisco, CA 94109, USA
| | - Daniel S Kapp
- Stanford University School of Medicine, Department of Radiation Oncology, 875 Blake Wilbur Dr, Stanford, CA 94304, USA
| | - Kathleen Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - John K Chan
- California Pacific Medical Center, 795 El Camino Real, San Francisco, CA 94109, USA
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Bose D, Rema P, Sivaranjith J, Suchetha S. MPNST of Uterine Round Ligament: A Report of a Surgically Challenging Aggressive Rare Case and Literature Review. J Obstet Gynaecol India 2023; 73:315-318. [PMID: 38143968 PMCID: PMC10746592 DOI: 10.1007/s13224-023-01874-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/03/2023] [Indexed: 12/26/2023] Open
Abstract
MPNSTs (malignant peripheral nerve sheath tumours) arise rarely from the female genital tract, even more rarely from the uterus. A literature review showed 18 cases affecting the uterine cervix, but only four affecting the uterus per se, making our present case the fifth to be involving the uterus, specifically round ligament. It was the first time a uterine lesion (not uterine cervix) was defined in a neurofibromatosis patient. This was a young patient who initially underwent a uterus-sparing surgery for a round ligament tumour which was finally diagnosed to be MPNST. She received adjuvant chemotherapy but recurred with pelvic vascular involvement. A challenging surgery was performed, and the tumour was resected without morbidity. She was followed up with radiotherapy; however, she quickly developed extensive peritoneal disease and succumbed to the disease. High-grade nature of MPNST along with the background of NF could have made the tumour more aggressive, highlighting the importance of suspecting MPNST in spindle cell tumours of pelvis and performing total resection in the first setting.
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Affiliation(s)
- Deepak Bose
- Department of Gynecological Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - P. Rema
- Department of Gynecological Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - J. Sivaranjith
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - S. Suchetha
- Department of Gynecological Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala India
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Kinariwala DJ, Khaja MS, McCann S, Sheeran D, Park AW, Wilkins LR, Matsumoto AH, Redick DL. Pre-operative uterine artery embolization before hysterectomy or myomectomy: a single-center review of 53 patients. Clin Imaging 2023; 101:121-125. [PMID: 37329639 DOI: 10.1016/j.clinimag.2023.06.003] [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: 02/19/2023] [Revised: 05/09/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To assess outcomes of planned pre-operative uterine artery embolization (UAE) in patients with uterine fibroids at high risk for bleeding prior to hysterectomy or myomectomy. MATERIALS & METHODS A retrospective review of 53 consecutive patients who underwent planned UAE followed by surgery from 2004 to 2019 was performed in a subset of patients deemed high risk for bleeding by the referring surgeon due to bulky fibroids and/or adhesions. Characteristics of the largest fibroid, total number of fibroids, embolic agents, estimated blood loss (EBL), complications, and other factors were collected. RESULTS 53 patients (mean age = 41) had an elective UAE prior to a hysterectomy 24 (45%) or myomectomy 29 (55%). Median interval between UAE & surgery was 21.6 h (range 1.75 h-57 days). Of the myomectomies, 13 (45%) were open, 15 (52%) hysteroscopic and 1 laparoscopic. Mean number of fibroids/patient was 4.1 (SD 1.3), mean fibroid volume was 328 cm3 (range 11-741), and the mean fibroid diameter in longest dimension was 7.4 cm (range 3.2-15). Mean EBL was 90 (SD 99.5 mL). Three (10%) myomectomy patients required blood transfusion. All hysterectomies were via a laparotomy. Mean fibroid volume was 1699 cm3 (range 93-9099 cm3) with a mean maximum diameter of 16.2 cm (range 6.5-29.6) and an average of 2.4 (SD 1.7) fibroids. Mean EBL was 352 (SD 220 mL). Four (17%) hysterectomy patients required an intra- or post-operative blood transfusion. At a mean 1-year follow-up (range 1 month-14 years), 70% of UAE-myomectomy patients and 74% of UAE-hysterectomy patients reported symptom resolution. Three (6%) patients were readmitted: one for osteodiscitis, one wound dehiscence, and one for an infected retained fibroid after myomectomy. CONCLUSION Planned pre-operative UAE resulted in intraoperative blood loss similar to "all-comer" myomectomy and hysterectomy patients in the literature. Further studies may elucidate which patients would be the best candidates for this staged treatment paradigm.
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Affiliation(s)
- Dhara J Kinariwala
- Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America
| | - Minhaj S Khaja
- Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America.
| | - Sara McCann
- Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America
| | - Daniel Sheeran
- Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America
| | - Auh Whan Park
- Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America
| | - Luke R Wilkins
- Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America
| | - Alan H Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America
| | - Dana L Redick
- Department of Obstetrics and Gynecology, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America
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Pozzar RA, Hammer MJ, Paul SM, Cooper BA, Conley YP, Chen LM, Levine JD, Miaskowski C. Associations Between Distinct State Anxiety Profiles, Exposure to Stressful Life Events, Resilience, and Coping in Patients with Gynecologic Cancers Receiving Chemotherapy. Semin Oncol Nurs 2023; 39:151431. [PMID: 37164885 DOI: 10.1016/j.soncn.2023.151431] [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: 12/02/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES In a sample of patients with gynecologic cancers who are receiving chemotherapy, subgroups of patients with distinct state anxiety profiles were identified, and differences among the subgroups in demographic and clinical characteristics, stress, exposure to stressful life events, resilience, and coping behaviors were evaluated. DATA SOURCES Patients (n = 230) completed questionnaires six times over two chemotherapy cycles. State anxiety was measured using the Spielberger State Anxiety Inventory. Subgroups of patients with distinct state anxiety profiles were identified using latent profile analysis. Differences among the classes were assessed using parametric and nonparametric tests. CONCLUSION Three distinct state anxiety profiles were identified: low (55.2%), moderate (38.3%), and very high (6.5%). Compared with the low class, persons in the other two classes had lower functional status, more comorbidities, higher perceived stress, and lower resilience and were more likely to report a history of depression and to use disengagement coping strategies. Compared with the low class, the very high class was more likely to report childcare responsibilities; have a history of lung disease, stomach disease, or low back pain; have experienced physical neglect, serious money problems, a serious disaster, or foster care; or were a caregiver for someone with a severe disability. IMPLICATIONS FOR NURSING PRACTICE Nearly 45% of patients reported clinically meaningful levels of state anxiety that persisted over two cycles of chemotherapy. Experiences with a variety of stressors may be risk factors for higher levels of anxiety during chemotherapy. Clinicians need to perform comprehensive social histories and assess for anxiety in patients receiving chemotherapy.
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Affiliation(s)
- Rachel A Pozzar
- Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marilyn J Hammer
- Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lee-May Chen
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesiology, University of California, San Francisco, California, USA.
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Rybska M, Billert M, Skrzypski M, Wojciechowicz T, Kubiak M, Łukomska A, Nowak T, Włodarek J, Wąsowska B. Expression and localization of the neuropeptide phoenixin-14 and its receptor GRP173 in the canine reproductive organs and periovarian adipose tissue. Anim Reprod Sci 2023; 255:107282. [PMID: 37356348 DOI: 10.1016/j.anireprosci.2023.107282] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 06/27/2023]
Abstract
Phoenixin-14 (PNX-14) is a regulatory neuropeptide encoded by the SMIM20 gene, which has been implicated in the reproductive cycle by modulating the hypothalamic-pituitary-gonadal (HPG) axis. Recently, we showed that PNX-14 is downregulated in bitches with cystic endometrial hyperplasia and pyometra. The objective of this study was to determine the expression of Smim20, PNX-14, and its putative receptor GRP173 in the canine ovary (both healthy and those with ovarian cysts), periovarian adipose tissue (PAT) and in the endometrium during the oestrous cycle. The expression was analysed by RT-qPCR and Western blot. In tissue sections, peptides were localised by immunofluorescent assays, and blood plasma concentrations of PNX-14 were detected by EIA. The results demonstrated increased levels of PNX in bitches in the anestrus groups compared to diestrus animals. The expression of GPR173 increased in PAT during the diestrus phase and endometrial tissue in late diestrus bitches. In the ovary, strong signals of PNX-14 and GPR173 were detected in the luteal and follicular cells. Furthermore, bitches with cystic ovaries were characterised by elevated circulating PNX levels and a significantly higher expression of PNX and GPR173 in gonadal tissues, when compared with healthy animals. Moreover, a positive correlation between PNX and progesterone in the blood of healthy bitches was noted, which changed to a negative correlation in females affected by cystic ovaries. These studies expand the knowledge regarding the expression and localization of the PNX/GRP173 system in canine reproductive organs during physiological and pathological conditions.
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Affiliation(s)
- Marta Rybska
- Department of Preclinical Sciences and Infectious Diseases, Poznan University of Life Sciences, Wołynska 35, 60-637 Poznan, Poland.
| | - Maria Billert
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Wołynska 35, 60-637 Poznan, Poland
| | - Marek Skrzypski
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Wołynska 35, 60-637 Poznan, Poland
| | - Tatiana Wojciechowicz
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Wołynska 35, 60-637 Poznan, Poland
| | - Magdalena Kubiak
- Department of Internal Diseases and Diagnostics, Poznan University of Life Sciences, Wołynska 35, 60-637 Poznan, Poland
| | - Anna Łukomska
- Department of Preclinical Sciences and Infectious Diseases, Poznan University of Life Sciences, Wołynska 35, 60-637 Poznan, Poland
| | - Tomasz Nowak
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, Wołynska 33, 60-637 Poznan, Poland
| | - Jan Włodarek
- Department of Preclinical Sciences and Infectious Diseases, Poznan University of Life Sciences, Wołynska 35, 60-637 Poznan, Poland
| | - Barbara Wąsowska
- Department of Local Physiological Regulations, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, 10-747 Olsztyn, Poland
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Al-Khatlan HS, Al-Tuhoo AM, Abu-Faza M, Obaid M, Abdelazim IA, Al-Kandari IM. Intraperitoneally Retained Contraceptive Device After Uterine Perforation: A Case Report. J Mother Child 2023; 27:79-82. [PMID: 37409657 PMCID: PMC10323966 DOI: 10.34763/jmotherandchild.20232701.d-22-00054] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/02/2023] [Indexed: 07/07/2023]
Abstract
A 29-year-old parous woman with a history of a T-shaped copper intrauterine device (IUD) insertion presented 8 months later with a complaint of the contraceptive device being missing. Computed tomography with contrast turned out to be superior to the combined abdominal and pelvic X-ray and transvaginal ultrasound in providing the detailed extrauterine location of the device between the urinary bladder and uterus. A laparoscopy was successful in the atraumatic freeing of the IUD from omental and bladder adhesions, and in its final removal.
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Affiliation(s)
- Hanan S Al-Khatlan
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Aliaa M Al-Tuhoo
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Mohannad Abu-Faza
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Mariam Obaid
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Ibrahim M Al-Kandari
- Department of General and Laparoscopic Surgery, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
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10
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Eatz T, Levy A, Merenzon M, Bystrom L, Berry K, Morell A, Bhatia S, Daggubati L, Higgins D, Schlumbrecht M, Komotar RJ, Shah AH, Ivan ME. Surgically Treated Brain Metastases from Uterine Origin: A Case Series and Systematic Review. World Neurosurg 2023; 173:e91-e108. [PMID: 36775238 DOI: 10.1016/j.wneu.2023.02.007] [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: 10/25/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE We aimed to describe our institutional case series of 9 surgically treated uterine brain metastases and perform a survival analysis through a systematic review and a pooled individual patient data study. METHODS This study was divided into 2 sections: 1) a retrospective, single center patient series assessing outcomes of neurosurgical treatment modalities in patients with malignancy arising in the uterus with brain metastases and 2) a systematic review of the literature between 1980 and 2021 regarding treatment outcomes of individual patients with intracranial metastasis of uterine origin. Pooled cohort survival analysis was done via univariate and Cox regression multivariable analysis and Kaplan-Meier curves. RESULTS Final statistical analysis included a total of 124 pooled cohort patients: one hundred fifteen patients from literature review studies plus 9 patients from our institution. Median age at the time of diagnosis was 54 years. Median time from diagnosis of the primary cancer to brain metastasis was 19 months (0-166 months). Surgery and radiotherapy resulted in the highest median OS of 11 months (P < 0.001). Multivariable analyses indicated that the presence of more than one central nervous systemlesion had an increased risk on OS (P = 0.003). Microsurgery, stereotactic radiosurgery, and whole brain radiotherapy remain the evidence-based mainstay applicable to the treatment of multiple brain metastases. CONCLUSIONS Brain metastases of cancer arising in the uterus appear to result most often in multiple lesions with dismal prognosis. The seemingly most efficacious treatment modality is surgery and radiotherapy. However, this treatment is often not an option when more than 1 or 2 brain lesions are present.
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Affiliation(s)
- Tiffany Eatz
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
| | - Adam Levy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Martín Merenzon
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Lauren Bystrom
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Shovan Bhatia
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Lekhaj Daggubati
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Dominique Higgins
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Matthew Schlumbrecht
- Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Jorge Komotar
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
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11
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McMurtry V, Mahlow J, Coleman JF, Deftereos G, Jattani R, Bastien RRL, Durtschi J, Jarboe E, Lomo L, Sirohi D. Morphologic Characteristics and Mutational Analysis of Fumarate Hydratase Deficient Kidney and Smooth Muscle Tumors. Am J Clin Pathol 2023; 159:164-171. [PMID: 36495298 DOI: 10.1093/ajcp/aqac148] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Fumarate hydratase (FH)-deficient tumors can occur due to germline or somatic mutations and have distinctive morphologic features. The aims of this study are to refine morphologic criteria and identify mutations in FH-deficient smooth muscle tumors (SMTs). METHODS The morphology of SMTs and kidney tumors submitted to a national reference laboratory for FH immunohistochemistry (IHC) was reviewed by two gynecologic and two genitourinary pathologists, respectively. Fisher exact test was used for analysis. Fourteen SMTs were sequenced using the Illumina TruSight Oncology 500 Assay. RESULTS Twenty-two kidney tumors (5 FH deficient) and 51 SMTs (27 FH deficient) were reviewed. FH-deficient kidney tumors exclusively showed cord-like growth, rhabdoid change, and absence of coagulative tumor necrosis and psammoma bodies. FH-deficient SMTs were significantly more likely to have staghorn vessels, eosinophilic cytoplasmic inclusions, schwannoma-like areas, or hereditary leiomyomatosis and renal cell cancer-like nuclei (P < .05 for each). Seven of 14 sequenced SMTs showed mutations of the FH gene and no other driver mutations. CONCLUSIONS FH-deficient SMTs submitted for FH immunohistochemistry (IHC) showed distinct morphology. Although FH IHC is used for screening of FH-deficient tumors, FH mutations were identified in only 50% of FH-deficient SMTs. This highlights the need for additional exploration of mechanisms of FH protein loss in tumors lacking FH mutations.
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Affiliation(s)
- Valarie McMurtry
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - Jonathan Mahlow
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - Joshua F Coleman
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - Georgios Deftereos
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | | | - Roy R L Bastien
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA
| | | | - Elke Jarboe
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - Lesley Lomo
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - Deepika Sirohi
- The Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
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12
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Svarna A, Liontos M, Reppas G, Fiste O, Andrikopoulou A, Dimopoulos MA, Zagouri F. What to expect from paraneoplastic syndromes of the nervous system in uterine cancer: A review of the literature. Gynecol Oncol Rep 2023; 45:101136. [PMID: 36703705 PMCID: PMC9871060 DOI: 10.1016/j.gore.2023.101136] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Neurological paraneoplastic syndromes are a rare subgroup of diseases commonly related to neuroendocrine tumors. However, they have been associated with uterine malignancies (sarcomas, endometrial carcinomas, and neuroendocrine cancers). Their presentation often correlates with a cancer diagnosis or cancer recurrence underlining their clinical significance. The most common neurological paraneoplastic syndrome in uterine cancer is cerebral degeneration with a comprehensive clinical presentation of pancerebral dysfunction. However, other neurological syndromes present with various symptoms leading to delayed diagnosis. Less common paraneoplastic neurological syndromes associated with uterine cancer are encephalitis, encephalomyelitis, subacute sensory neuropathy, sensory-motor neuropathy, dermatomyositis, cancer-associated retinopathy, opsoclonus, Guillain-Barre syndrome, necrotizing myopathy, and stiff-person syndrome. Herein, we reviewed published cases of neurological paraneoplastic syndromes in uterine cancer in order to raise awareness of these rare syndromes. We recorded patients' clinical presentation, antibodies detected, treatment, and clinical outcomes.
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Affiliation(s)
- Anna Svarna
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Michalis Liontos
- Naval and Veterans’ Hospital of Athens, Athens, Greece,Corresponding author at: Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, V.Sofias 80, 11528 Athens, Greece.
| | | | - Oraianthi Fiste
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Angeliki Andrikopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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13
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Salehi AM, Jenabi E, Farashi S, Aghababaei S, Salimi Z. The environmental risk factors related to uterine leiomyoma: An umbrella review. J Gynecol Obstet Hum Reprod 2023; 52:102517. [PMID: 36481492 DOI: 10.1016/j.jogoh.2022.102517] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/14/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Uterine leiomyoma (UL) is the most common benign tumor of the reproductive period and become a major health problem. The present umbrella review assessed the environmental risk factors associated with UL based on meta-analyses studies. MATERIALS AND METHODS We searched three Major databases until February 2022. The meta-analyses that had focused on evaluating the environmental risk factors associated with the UL were included. The summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis were applied. We used A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) for assessing the quality of the meta-analyses. RESULT The risk factor of chronic psychological stress (OR 1.24, 95% CI: 1.15, 1.34) and obesity (OR 1.19, 95% CI: 1.09, 1.29) was graded as suggestive evidence (class III). The current alcohol intake (OR 1.33, 95% CI: 1.01, 1.76) was graded as the risk factor with weak evidence (class IV). Current oral contraceptive (OCP) use (RR 0.43, 95% CI: 0.25, 0.73) (class IV), and former smokers (OR 0.93, 95% CI: 0.88, 0.99) (class IV) were as the protective factors. CONCLUSION The current alcohol intake, chronic psychological stress, and obesity were risk factors for the UL, but current OCP use and former smokers were the protective factors.
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Affiliation(s)
| | - Ensiyeh Jenabi
- Mother and Child Care Research Center, Hamadan university of Medical Sciences, Hamadan, Iran.
| | - Sajjad Farashi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Soodabeh Aghababaei
- Mother and Child Care Research Center, Hamadan university of Medical Sciences, Hamadan, Iran
| | - Zohreh Salimi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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14
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Swisher AR, Ornelas D, Ornelas D, Namazi G, Theodory B, Chitkara A, Desai A, Sethi P. Venous Thromboembolism in Metastatic Uterine Leiomyosarcoma: A Case Report and Review of the Literature. Case Rep Oncol 2023; 16:900-906. [PMID: 37900811 PMCID: PMC10601721 DOI: 10.1159/000531761] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/13/2023] [Indexed: 10/31/2023] Open
Abstract
We report an unusual case of extensive deep vein thrombosis (DVT) and pulmonary embolism (PE) in the setting of metastatic uterine leiomyosarcoma. Recognition of the associated sequelae of this condition may improve short- and long-term outcomes. A 56-year-old black female with a history of uterine leiomyosarcoma diagnosed incidentally after total abdominal hysterectomy for fibroid uterus without initiation of chemoradiation treatment presented to the emergency department complaining of generalized weakness and progressively worsening stridor for 2 weeks. The patient was experiencing shortness of breath, dysphagia, and hoarseness. Physical exam was remarkable for rhonchi but was otherwise normal. Diagnostic imaging via CT of the abdomen, pelvis, and chest revealed DVTs of the left common and external iliac veins, the superior mesenteric artery, multiple pulmonary emboli of the right pulmonary artery, several nodular lesions within the lungs, and scattered peritoneal necrotic lesions, which were suspicious for metastatic disease. Additionally, CT of the neck showed an exophytic mass protruding into the airway from the subglottic region and thyromegaly with bilateral thyroid lobe nodules. The patient was subsequently started on Eliquis and chemotherapy. The rarity of this case is rooted in the extent of the patient's DVTs and PEs secondary to hypercoagulability in metastatic cancer. This presentation should be further evaluated to exclude thrombophilias or underlying malignancies. Drawing from the lessons of this case will help guide future clinical management regarding the care of metastatic uterine leiomyosarcoma.
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Affiliation(s)
- Austin R. Swisher
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Denise Ornelas
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Diana Ornelas
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Golnaz Namazi
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Bassam Theodory
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Akshit Chitkara
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Aditya Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Prabhdeep Sethi
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
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15
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Avila M, Grinsfelder MO, Pham M, Westin SN. Targeting the PI3K Pathway in Gynecologic Malignancies. Curr Oncol Rep 2022; 24:1669-1676. [PMID: 36401704 PMCID: PMC10862662 DOI: 10.1007/s11912-022-01326-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW This review explores the PI3K pathway aberrations common in gynecologic malignancies, the relevant therapeutic targets that have been explored to date particularly given their success in endometrial cancers, and predictive biomarkers of response to therapy. RECENT FINDINGS Landmark trials have been noted involving this pathway, particularly in endometrial cancers. One phase II trial of the potent orally bioavailable mTOR inhibitor, everolimus, in combination with letrozole demonstrated an unprecedented clinical benefit rate (CBR) of 40% and high objective response rate (RR) of 32% in hormone agnostic endometrial cancers. This was followed by GOG 3007 that compared everolimus and letrozole to hormonal therapy yielding similar response rates but double progression-free survival rates. The phosphoinositide 3-kinase (PI3K) signaling pathway is implicated in tumorigenesis given its regulation over cell growth, cellular trafficking, and angiogenesis. In gynecologic malignancies, alterations in PI3K signaling are common. Therefore, developing modulators of the PI3K pathway and identifying molecular markers to predict response are of great interest for these cancer types.
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Affiliation(s)
- Monica Avila
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Dr. CPB 6.3279, Houston, TX, 77030, USA
| | - Michaela Onstad Grinsfelder
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Dr. CPB 6.3279, Houston, TX, 77030, USA
| | - Melissa Pham
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Dr. CPB 6.3279, Houston, TX, 77030, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Dr. CPB 6.3279, Houston, TX, 77030, USA.
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16
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Kadour Peero E, Badeghiesh A, Baghlaf H, Dahan MH. What type of uterine anomalies had an additional effect on pregnancy outcomes, compared to other uterine anomalies? An evaluation of a large population database. J Matern Fetal Neonatal Med 2022; 35:10494-10501. [PMID: 36216352 DOI: 10.1080/14767058.2022.2130240] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database. DESIGN, SETTING, AND SAMPLE A retrospective population-based cohort study from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) included 3,846,342 births (2010-2014). Of them, 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri. MAIN OUTCOME MEASURES AND RESULTS After adjustment for confounders, women with bicornuate uteri were more likely to deliver vaginally (aOR 1.4, 95%CI: 1.1-1.9), p = .01), less likely to deliver by cesarean (CD) and had lower risk of small for gestational age (SGA) (aOR 0.8, 95%CI: 0.7-0.9, p = .03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5-0.6, p = .0001). Pregnant women with arcuate uterus had lower risks of preterm delivery (PTD) (aOR 0.6, 95%CI: 0.5-0.8, p = .0001), less chance of operative vaginal delivery (aOR 0.5, 95%CI: 0.2-0.9, p = .04), and higher risk for CD (aOR 1.6, 95%CI: 1.4-2, p = .0001). Pregnant women with didelphys uteri had higher risk of preterm premature rupture of membranes (PPROM) (aOR 1.6, 95%CI: 1.3-1.9, p = .0001), PTD (aOR 1.5, 95%CI: 1.3-1.6, p = .0001), CD (aOR 1.4, 95%CI: 1.2-1.5, p = .0001) and wound complications (aOR 1.6, 95%CI: 1.1-2.4, p = .02). Pregnant unicornuate uteri had increased risks of PTD (aOR 1.4, 95%CI: 1.1-1.6, p = .0001), CD (aOR 2, 95%CI: 1.6-2.5, p = .0001) and of SGA (aOR 1.8, 95%CI: 1.4-2.3, p = .0001). Pregnant septate uteri had higher risk of chorioamnionitis (aOR 1.5, 95%CI: 1.1-2.1, p = .048) and CD (aOR 1.4, 95%CI: 1.2-1.6, p = .0001). CONCLUSIONS We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies.
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Affiliation(s)
- Einav Kadour Peero
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Canada.,MUHC Reproductive Center, McGill University, Montreal, Canada
| | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Canada.,MUHC Reproductive Center, McGill University, Montreal, Canada
| | - Haitham Baghlaf
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Canada.,MUHC Reproductive Center, McGill University, Montreal, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Canada.,MUHC Reproductive Center, McGill University, Montreal, Canada
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17
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Bauters E, Aertsen M, Froyman W, van der Merwe J. Uterine hemangioma in pregnancy: a case report and review of the literature. J Gynecol Obstet Hum Reprod 2022; 51:102401. [PMID: 35490987 DOI: 10.1016/j.jogoh.2022.102401] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Uterine hemangioma is a rare benign vascular tumor which can cause bleeding problems in various age groups. Current knowledge on this rare condition in pregnancy is limited. We report on a recent case of uterine hemangioma in a pregnancy that was already diagnosed during her first trimester. We also provide a literature review to summarize the characteristics and outcomes of uterine hemangioma cases in pregnant women. MATERIAL AND METHODS A systematic search was done of all published literature up to February 2021 using PubMed and Scopus databases. The selection process was registered using the online tool Rayyan QCRI. All data was described in a narrative format. The protocol was prospectively registered on PROSPERO (CRD42021237519). RESULTS Fifteen case reports were included. In most cases, the diagnosis was established by antenatal ultrasound. More than half of the women developed a postpartum hemorrhage, necessitating a hysterectomy for bleeding control in half of the cases, although the risk for both seemed lower in those women in whom the hemangioma was diagnosed before delivery. One case of maternal mortality and two cases of fetal death were reported. There was one case of neonatal respiratory morbidity, although the neonatal data were not routinely reported upon. CONCLUSION Current knowledge on uterine hemangioma in pregnancy is limited, but it seems to hold substantial risks for both pregnant women and their unborn child. We recommend routine screening for this condition at the standard mid-trimester anomaly scan. Pregnant women with uterine hemangioma should ideally be cared for in centers of expertise. An international registry will help to build a better understanding of this rare pathology.
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Affiliation(s)
- Emma Bauters
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven Leuven, Belgium
| | - Wouter Froyman
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Johannes van der Merwe
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Faculty of Medicine, KU Leuven University, Herestraat 49, 3000 Leuven, Belgium.
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18
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Novotny JP, George S. Leiomyosarcoma: Does Location of Primary Help to Determine the Best Systemic Therapy Options? Curr Treat Options Oncol 2021; 22:99. [PMID: 34524549 DOI: 10.1007/s11864-021-00897-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT Management of leiomyosarcoma is based on the specifics of each individual case. Specifically, the location of the disease and whether the disease is metastatic or localized and if localized disease, whether the tumor is resectable or unresectable. In patients with recurrent or metastatic disease, factors such as disease-free interval and pattern of spread should be considered within the context of treatment planning. In general, patients with metastatic disease are typically treated with systemic chemotherapy with either an anthracycline-based regimen or gemcitabine-based regimen as first-line therapy. Additional systemic options include trabectedin, pazopanib, eribulin, and DTIC. Uterine LMS has been the most studied site-specific LMS with respect to systemic therapy. The increasing use of tumor genomics may ultimately define subsets which may benefit from tailored systemic therapies.
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Affiliation(s)
- Jan Philipp Novotny
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 20 Shattuck Street, Thorn, Boston, MA, USA
| | - Suzanne George
- Sarcoma Center, Dana-Farber Cancer Center, 450 Brookline Ave, Boston, MA, 02215, USA.
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19
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Ochiai R, Mukuda N, Yunaga H, Kitao S, Okuda K, Sato S, Oishi T, Miyoshi M, Nozaki A, Fujii S. Amide proton transfer imaging in differentiation of type II and type I endometrial carcinoma: a pilot study. Jpn J Radiol 2021. [PMID: 34524610 DOI: 10.1007/s11604-021-01197-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
Purpose This study aimed at evaluating the efficacy of amide proton transfer (APT) imaging in differentiation of type II and type I uterine endometrial carcinoma. Materials and methods Thirty-three patients diagnosed with uterine endometrial carcinoma, including 24 with type I and 9 with type II carcinomas, underwent APT imaging. Two readers evaluated the magnetization transfer ratio at 3.5 ppm [MTRasym (3.5 ppm)] in each type of carcinoma. The average MTRasym (APTmean) and the maximum MTRasym (APTmax) were analyzed. The receiver operating characteristic (ROC) curve analysis was performed. Results The APTmax was significantly higher in type II carcinomas than in type I carcinomas (reader1, p = 0.004; reader 2, p = 0.014; respectively). However, APTmean showed no significant difference between type I and II carcinomas. Based on the results reported by reader 1, the area under the curve (AUC) pertaining to the APTmax for distinguishing type I from type II carcinomas was 0.826, with a cut-off, sensitivity, and specificity of 9.90%, 66.7%, and 91.3%, respectively. Moreover, based on the results reported by reader 2, the AUC was 0.750, with a cut-off, sensitivity, and specificity of 9.80%, 62.5%, and 87.5%, respectively. Conclusion APT imaging has the potential to determine the type of endometrial cancer.
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Abstract
AIM Uterine myomas/fibroids are one of the most common benign tumors of the reproductive system in women. Given pleiotropic effects of statins, the aim of this study is to evaluate the therapeutic effects of atorvastatin on uterine fibroids in women of reproductive age. MATERIALS AND METHODS This randomized clinical study included 90 women aged 35-45 years with uterine fibroids. The patients were randomly allocated into the intervention group (received one tablet, 20 mg of atorvastatin every day for three months) and placebo. Ultrasound was performed every month, and the change in the size of fibroids was recorded for each patient. At the end of the study, the data obtained were analyzed using SPSSv22 and a p value < .05 was considered statistically significant. RESULTS The mean age in the placebo and intervention group was 39.63 ± 36.3 and 40.35 ± 3.32 years, respectively. The number and location of the tumor was comparable for the two groups. We observed a statically significant reduction in fibroid size from the treatment initiation until completion of three months, (41.06 ± 6.68 mm3 vs 35.16 ± 6.67 mm3) p = .0001. However, the decrease in fibroid size from 1st month to the 3rd month was not statistically significant, p = .189 (36.71 ± 5.54 mm3 vs 35.16 ± 6.67 mm3). CONCLUSION This study shows that treatment with atorvastatin might positively reduce the size of fibroids. The decrease was only statistically significant during the first month. Further studies with a detailed analysis of the intervention's clinical impact are required to consider statins as a therapeutic tool.
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Affiliation(s)
- Masoumeh Ghafarzadeh
- Department of Obstetrics and Gynecology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Amir Shakarami
- Department of Cardiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Yari
- Department of Reproductive Health, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Zahra Marzban Rad
- Department of Obstetrics and Gynecology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Lu KG, Sprayberry KA. Managing Reproduction Emergencies in the Field: Part 2: Parturient and Periparturient Conditions. Vet Clin North Am Equine Pract 2021; 37:367-405. [PMID: 34243878 DOI: 10.1016/j.cveq.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Selected conditions affecting broodmares are discussed, including arterial rupture, dystocia, foal support with ex utero intrapartum treatment, uterine prolapse, postpartum colic, the metritis/sepsis/systemic inflammatory response syndrome complex, and retained fetal membranes. Postpartum colic beyond third-stage labor contractions should prompt comprehensive evaluation for direct injuries to the reproductive tract or indirect injury of the intestinal tract. Mares with perforation or rupture of the uterus are typically recognized 1 to 3 days after foaling, with depression, fever, and leukopenia; laminitis and progression to founder can be fulminant. The same concerns are relevant in mares with retention of fetal membranes.
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22
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Eich ML, Morgenstern B, Puesken M, Pappesch R, Quaas A, Schoemig-Markiefka B. First description of hematogenously metastasized sclerosing epithelioid fibrosarcoma arising in the uterine cervix. Gynecol Oncol Rep 2021; 37:100801. [PMID: 34159243 DOI: 10.1016/j.gore.2021.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/31/2022] Open
Abstract
First Case of hematogenously metastasized sclerosing epithelioid fibrosarcoma arising primarily in the cervix uteri. Tumor cells were strongly and diffusely positive for MUC4. Tumor showed a rare EWSR1-CREB3L2 gene fusion.
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Tafti SZG, Javaheri A, Firoozabadi RD, Ashkezar SK, Abarghouei HF. Role of hyaluronic acid intra uterine injection in the prevention of Asherman's syndrome in women undergoing uterine septum resection: An RCT. Int J Reprod Biomed 2021; 19:339-346. [PMID: 33997593 PMCID: PMC8106814 DOI: 10.18502/ijrm.v19i4.9060] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023] Open
Abstract
Background Adhesion due to intrauterine surgery such as septal resection associated with damaged endometrium can increase the risk of Asherman's syndrome. The main goal of treatment in this syndrome is to repair the damaged endometrium for creating a physiological pregnancy. Objective To investigate the effect of intrauterine injection of hyaluronic acid on the prevention of Asherman's syndrome in women undergoing uterine septum resection. Materials and Methods In this double-blind randomized clinical trial, 65 women undergoing the uterine septum resection were divided into two groups; the case group (n = 34) and the control group (n = 31). Immediately after the septal resection with a resectoscope, 1cc of hyaluronic acid gel in the case group and 1cc normal saline solution as a placebo in the control group was injected into the uterine cavity. After two months, existence of intrauterine adhesions in the both groups was examined by the hysteroscope and assessment of menstrual patterns, according to the American Society for Reproductive Medicine criteria. Results Our results showed that after intervention, the incidence of Asherman's syndrome in the control group was higher than the case group (p = 0.012). In the case group, only four women had poor adhesion (Asherman's syndrome) at the end of the study, while the rest of them were free of any adhesions in the uterine cavity. In the control group, however, only 19 were free of intrauterine adhesions and 12 had mild symptoms. Conclusion The results of the study exhibited the hyaluronic acid capacity to reduce the risk of Asherman's syndrome in women with endometrial damage following a septal resection surgery.
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Affiliation(s)
- Seiede Zahra Ghanadzadeh Tafti
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Atiye Javaheri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Razieh Dehghani Firoozabadi
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Samane Kabirpour Ashkezar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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24
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Fujii S, Mukuda N, Ochiai R, Yunaga H, Murakami A, Gonda T, Kishimoto M, Yamaji D, Ishibashi M. MR imaging findings of unusual leiomyoma and malignant uterine myometrial tumors: what the radiologist should know. Jpn J Radiol 2021; 39:527-39. [PMID: 33517507 DOI: 10.1007/s11604-021-01096-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
Uterine sarcomas account for less than 1% of gynecological malignancies and 2-5% of all uterine malignancies. Such sarcomas mainly include leiomyosarcoma (LMS) and endometrial stromal sarcoma (ESS). Additionally, inflammatory myofibroblastic tumor (IMT) and endometrial carcinoma arising in adenomyosis can occur as uterine myometrial tumors. Their differentiation from leiomyoma (LM), particularly degenerated LM and the malignant tumors, is challenging, but preoperative diagnosis is very important for the patient's management. We demonstrate the useful and compulsory findings to differentiate between uterine myometrial malignant tumors and degenerated LM with an unusual appearance.
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Abstract
BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy. In this article, we report 4 cases of intra-abdominal hemorrhage during pregnancy, including the spontaneous rupture of uterine veins, spontaneous rupture of liver, rupture of external iliac vessel branch, and rupture of right renal hamartoma.
CASE SUMMARY The clinical manifestations of three patients lacked specificity, and the localization of the bleeding was not clear prior to surgery. All 4 pregnant women were successfully treated, while only one full-term infant survived.
CONCLUSION There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic, and it is clinically characterized by acute abdominal pain during pregnancy. Clear diagnosis before surgery is rather difficult. Early diagnosis, timely and appropriate treatment and surgery, and multidisciplinary cooperation are key to saving pregnant females’ lives and improving the outcomes of perinatal infants.
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Affiliation(s)
- Lei Yang
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China
| | - Na Liu
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China
| | - Yan Long
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China
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26
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Tang WJ, Wang YQ, Tang B. [Effect of acupoint catgut embedding on levels of PG-related factors and NF-κB proteins in ute-rine tissues of rats with primary dysmenorrhea]. Zhen Ci Yan Jiu 2020; 45:548-551. [PMID: 32705828 DOI: 10.13702/j.1000-0607.190687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To observe the effect of acupoint catgut embedding on levels of prostaglandin F2α(PGF2α), cyclooxygenase-2(COX-2) and nuclear factor kappa B(NF-κB) in the uteruses of rats with primary dysmenorrhea (PD), so as to explore its mechanisms underlying improvement of PD. METHODS Forty female SD rats were randomly divided into normal, model, acupoint catgut embedment and medication groups, with 10 rats in each group. The PD model was established by subcutaneous injection of estradiol benzoate (0.5 mg on the 1st day, and 0.2 mg thereafter) once daily for 10 days, followed by i.p. of oxytocin 2 U(0.5 mg•5 U-1•mL-1) on the 11th day. Catgut embedment was applied to "Guanyuan"(CV4) and "Sanyinjiao"(SP6) on day 1 and 5 while modeling, and rats of the medication group received gavage of ibuprofen (1.25 mg/mL, 0.8 mL/rat) once daily for 10 d. The level of PGF2αin the uterus tissuewas assayed by ELISA, and the expression levels of uterine COX-2, phospho (p)-NF-κB p65, NF-κB p65 proteins were detected by Western blot. RESULTS Compared with the normal group, the levels of PGF2α, COX-2, p-NF-κB p65 and NF-κB p65 in the uterine tissues were significantly increased in the model group (P<0.05). Compared with the model group, the levels of PGF2α and COX-2 in both catgut embedment and medication groups as well as p-NF-κB p65 in the catgut embedment group were significantly decreased (P<0.05). Compared with the medication group, the level of p-NF-κB 65 in the catgut embedment group was significantly decreased (P<0.05). CONCLUSION The analgesic effect of acupoint catgut embedding may be related to its effects in down-regulating the expression of p-NF-κB and the levels of COX-2 and PGF2αin uteruses of PD rats.
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Affiliation(s)
- Wen-Jing Tang
- Medical School, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Yi-Qin Wang
- Medical School, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Biao Tang
- Medical School, Hunan University of Chinese Medicine, Changsha 410208, China
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27
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Ersan Erdem B, Yaprak Bayrak B, Vural C, Muezzinoglu B. Non-random adenomatoid tumours of the female genital system: A comparative clinicopathologic analysis of 14 cases. Ann Diagn Pathol 2020; 47:151553. [PMID: 32580034 DOI: 10.1016/j.anndiagpath.2020.151553] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/23/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate adenomatoid tumours (AT) clinicopathologically in the female genital tract and compare the histomorphological features of ATs according to their uterine or tuba-ovarian location. Cases of AT were excised and collected from female genital tracts between the years of 2010-2017. Cases were evaluated depending on their clinical findings, localisation and pathological properties. There were 14 cases of AT. Ten cases were uterine, and 4 cases were adnexal tumours. The diagnostic ratio of uterine ATs was 64.3%, and of tuba-ovarian ATs was 21.4% (P > 0.05). The size of the largest tumour was 6 cm. Two of the uterine and one of the ovarian cases had a macrocyst; 2 uterine and one ovarian case had a microcyst; and 6 uterine had a combined microcystic/trabecular pattern. Uterine cases showed a higher number of smooth muscle component, signet-ring cells and infiltrative nature compared with other cases (P < 0.05). All uterine cases were infiltrative. Most of ATs of the female genital system were small in size and incidentally diagnosed in our cases but rarely detected as an adnexal mass forming lesion which mimics a malignancy. A comparative clinicopathologic analysis of these cases should be considered with the histomorphological and immunohistochemical features for an accurate differential diagnosis.
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Affiliation(s)
- Busra Ersan Erdem
- Department of Pathology, Faculty of Medicine, Ordu University, Ordu, Turkey.
| | - Busra Yaprak Bayrak
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Cigdem Vural
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Bahar Muezzinoglu
- Department of Pathology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.
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28
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Abstract
PURPOSE MRI is the current imaging gold standard to diagnose adenomyosis, but access is often limited by high costs and availability. Transvaginal ultrasound provides a cost-effective, accurate and readily available alternative. The objective of our study was to determine the diagnostic accuracy of commonly described sonographic findings in predicting uterine adenomyosis. METHODS This retrospective study evaluated 649 MRI studies performed to investigate adenomyosis with a preceding transvaginal ultrasound within 12 months between 2013 and 2018. Two blinded reviewers assessed the presence or absence of six sonographic features: bulky uterus, heterogeneous myometrium, streaky myometrium, myometrial cysts, endometrial-myometrial interface ill-definition, and echogenic linear striations. The sensitivity, specificity, positive and negative predictive values of these features were calculated individually and in combination when compared to MRI as the standard of reference. RESULTS Adenomyosis was found in 315 (48.5%) cases on MRI. Ultrasound had a high specificity of 91.8% (95% CI 88.4 to 94.6%) but was less sensitive (36.8% (95% CI 31.5 to 42.4%)) for detecting adenomyosis. Comorbid fibroids or focal adenomyosis did not affect diagnostic accuracy. All six variables were significantly more common in patients with adenomyosis compared to those without. Individually, 'bulky uterus' and 'heterogenous myometrium' each demonstrated a mean sensitivity and specificity > 50%. The best dual combined variables were 'bulky uterus' + 'ill definition of the endometrial-myometrial interface' (sensitivity 39%, specificity 91%). The best triple combined variables were 'bulky uterus', 'heterogeneous myometrium' + 'ill definition of the endometrial-myometrial interface' (sensitivity 38%, specificity 93%). CONCLUSION Transvaginal ultrasound is highly specific for diagnosing uterine adenomyosis, providing a cost-effective and readily available alternative to MRI.
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Affiliation(s)
- Medica Sam
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WMC 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Monique Raubenheimer
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WMC 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Florin Manolea
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WMC 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Hector Aguilar
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WMC 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Rishi P Mathew
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WMC 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Vimal H Patel
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WMC 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Gavin Low
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WMC 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
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29
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Tran LKH, Tran PMH, Mysona DP, Purohit SB, Myers E, Lee WS, Dun B, Xu D, Liu H, Hopkins D, Nechtman J, Scelsi CL, Mittal PK, Kleven D, Wallbillich JJ, Rungruang B, Ghamande S, She JX. A 73-gene proliferative transcriptomic signature predicts uterine serous carcinoma patient survival and response to primary therapy. Gynecol Oncol 2020; 157:340-347. [PMID: 32067813 DOI: 10.1016/j.ygyno.2020.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/06/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To develop a transcriptomic signature capable of predicting overall survival (OS) for uterine serous carcinoma (USC). METHODS RNAseq data for 58 USC patients were obtained from TCGA. Expression of 73 candidate genes was measured for 67 Augusta University (AU) samples using NanoString technology. RESULTS Analysis of the TCGA RNAseq data identified 73 genes that individually predict prognosis for USC patients and an elastic net model with all 73 genes (USC73) distinguishes a good OS group with low USC73 score from a poor OS group with high USC73 score (5-year OS = 83.3% and 13.3% respectively, HR = 40.1; p = 3 × 10-8). This finding was validated in the independent AU cohort (HR = 4.3; p = 0.0004). The poor prognosis group with high USC73 score consists of 37.9% and 32.8% of patients in the TCGA and AU cohort respectively. USC73 score and pathologic stage independently contribute to OS and together provide the best prognostic value. Early stage, low USC73 patients have the best prognosis (5-year OS = 85.1% in the combined dataset), while advanced stage, high USC73 patients have the worst prognosis (5-year OS = 6.4%, HR = 30.5, p = 1.2 × 10-12). Consistent with the observed poor survival, primary cell cultures from high USC73 patients had higher proliferation rate and cell cycle progression; and high USC73 patients had lower rates of complete response to standard therapy. CONCLUSIONS The USC73 transcriptomic signature and stage independently predict OS of USC patients and the best prediction is achieved using USC73 and stage. USC73 may also serve as a therapeutic biomarker to guide patient care.
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Affiliation(s)
- Lynn K H Tran
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Paul M H Tran
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - David P Mysona
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Sharad B Purohit
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Undergraduate Health Professionals, College of Allied Health Sciences, Augusta University, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Emily Myers
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Won Sok Lee
- Department of Pathology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Boying Dun
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Duo Xu
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Haitao Liu
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Diane Hopkins
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - John Nechtman
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Chris L Scelsi
- Department of Radiology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Pardeep K Mittal
- Department of Radiology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Daniel Kleven
- Department of Pathology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - John J Wallbillich
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Bunja Rungruang
- Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Sharad Ghamande
- Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA.
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Rojas C, Tian C, Powell MA, Chan JK, Bateman NW, Conrads TP, Rocconi RP, Jones NL, Shriver CD, Hamilton CA, Maxwell GL, Casablanca Y, Darcy KM. Racial disparities in uterine and ovarian carcinosarcoma: A population-based analysis of treatment and survival. Gynecol Oncol 2020; 157:67-77. [PMID: 32029291 DOI: 10.1016/j.ygyno.2020.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/30/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate racial disparities in uterine carcinosarcoma (UCS) and ovarian carcinosarcoma (OCS) in Commission on Cancer®-accredited facilities. METHODS Non-Hispanic Black (NHB) and non-Hispanic White (NHW) women in the National Cancer Database diagnosed with stage I-IV UCS or OCS between 2004 and 2014 were eligible. Differences by disease site or race were compared using Chi-square test and multivariate Cox analysis. RESULTS There were 2830 NHBs and 7366 NHWs with UCS, and 280 NHBs and 2586 NHWs with OCS. Diagnosis of UCS was more common in NHBs (11.5%) vs. NHWs (3.7%) and increased with age (P < .0001). OCS diagnosis remained <5% in both races and all ages. NHBs with UCS or OCS were more common in the South and more likely to have a comorbidity score ≥ 1, low neighborhood income and Medicaid or no insurance (P < .0001). Diagnosis at stage II-IV was more common in NHBs than NHWs with UCS but not OCS. NHBs with both UCS and OCS were less likely to undergo surgery and to achieve no gross residual disease with surgery (P = .002). Risk of death in NHB vs. NHW patients with UCS was 1.38 after adjustment for demographic factors and dropped after sequential adjustment for comorbidity score, neighborhood income, insurance status, stage and treatment by 4%, 16%, 7%, 19% and 10%, respectively, leaving 43.5% of the racial disparity in survival unexplained. In contrast, risk of death in NHBs vs. NHWs with OCS was 1.19 after adjustment for demographic factors and became insignificant after adjustment for comorbidity. Race was an independent prognostic factor in UCS but not in OCS. CONCLUSIONS Racial disparities exist in characteristics, treatment and survival in UCS and OCS with distinctions that merit additional research.
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Affiliation(s)
- Christine Rojas
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA.
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA.
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA.
| | - Rodney P Rocconi
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA.
| | - Nathaniel L Jones
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA.
| | - Craig D Shriver
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Chad A Hamilton
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, USA.
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, USA.
| | - Yovanni Casablanca
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
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Ferreira SR, Goyeneche AA, Heber MF, Abruzzese GA, Telleria CM, Motta AB. Prenatally androgenized female rats develop uterine hyperplasia when adult. Mol Cell Endocrinol 2020; 499:110610. [PMID: 31589912 DOI: 10.1016/j.mce.2019.110610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/19/2019] [Accepted: 10/03/2019] [Indexed: 12/20/2022]
Abstract
Prenatal hyperandrogenization (PH) is hypothesized as one of the main factors contributing to the development of polycystic ovary syndrome (PCOS). In this study, we aimed to investigate the impact of prenatal exposure to androgen excess on the uterus when animals reach their adulthood. We found that PH altered the morphology of the uteri that show a hyperplastic morphology with increased total uterine thickness as well as luminal epithelium thickness, with both enhanced and altered distribution of glands as compared with controls. Morphological alterations were associated with an unbalanced homeostasis as assessed by the expression of regulators of cell cycle progression and cell death dynamics. PH also causes disturbances in the cell cycle of the uterine tissue and dysregulates cell death and survival pathways leading to the development of uterine hyperplasia. These findings suggest that PH may have a deleterious effect on the uterus.
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Affiliation(s)
- Silvana Rocío Ferreira
- Laboratorio de Fisio-Patología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Argentina.
| | - Alicia Alejandra Goyeneche
- Experimental Pathology Unit, Department of Pathology, Faculty of Medicine, McGill University, 3775 University Street, Montreal, QC H3A 2B4, Canada
| | - María Florencia Heber
- Laboratorio de Fisio-Patología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Argentina
| | - Giselle Adriana Abruzzese
- Laboratorio de Fisio-Patología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Argentina
| | - Carlos Marcelo Telleria
- Experimental Pathology Unit, Department of Pathology, Faculty of Medicine, McGill University, 3775 University Street, Montreal, QC H3A 2B4, Canada
| | - Alicia Beatriz Motta
- Laboratorio de Fisio-Patología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Argentina
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Llewellyn O, Patel NR, Mallon D, Quinn SD, Hamady M. Uterine Artery Embolisation for Women with Giant Versus Non-giant Uterine Fibroids: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2020; 43:684-93. [PMID: 31792586 DOI: 10.1007/s00270-019-02359-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Evidence supporting uterine artery embolisation (UAE) for giant fibroids (≥ 10 cm and/or uterine volume ≥ 700 CC) remains sparse. We performed a systemic review and meta-analysis of UAE outcomes for symptomatic giant versus non-giant fibroids. METHODS The literature was systematically reviewed. Research studies of UAE as an adjunct to surgery, and those not using peri-operative MRI were excluded. Primary outcomes were fibroid size and uterine volume reduction, procedure time, length of hospital stay, reinterventions, patient symptom improvement/satisfaction and complications. RESULTS We identified four observational studies (839 patients; giant = 163, non-giant = 676). Both groups demonstrated reduction in fibroid size and uterine volume after UAE, with equivocal difference in uterine volume reduction (Mean difference (MD) - 0.3 95% confidence interval (CI) - 3.8 to 3.1, p = 0.86) and greater reduction in non-giant dominant fibroid size (MD - 5.9 95% CI - 10.3 to - 1.5, p < 0.01). Giant fibroids were associated with 5.6 min longer mean operative time (MD 5.6 min 95% CI 2.6-8.6, p < 0.01) and 4.8 h longer mean hospital stay (MD 4.8 h 95% CI 1.1-8.6, p = 0.01). Patient symptoms/satisfaction outcomes were summarised, but too heterogeneous for meta-analysis. Major complication and reintervention rates were low, with a statistically higher rate of major complications (Odds ratio (OR) 4.7 95% CI 1.5-14.6, p < 0.01) and reinterventions (OR 3.6 95% CI 1.7-7.5, p < 0.01) in giant fibroids. CONCLUSIONS Current evidence shows UAE is a safe and effective option to treat giant fibroids. However, the limited available data indicate a relatively higher risk of complications and reinterventions when compared with non-giant fibroids. Patients should be selected, counselled and managed accordingly. LEVEL OF EVIDENCE Level III, Systematic review of retrospective cohort studies.
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Abstract
Background Sex cord-like elements are rarely observed in uterine lesions, but these morphological patterns could appear in a variety of uterine tumors and non-tumorous lesions. In this review, we collected the literatures regarding the uterine tumorous and non-tumorous lesions containing sex cord-like elements and summarized these lesions in terms of clinicopathological, immunohistochemical, and molecular features in order to further understand these lesions and provide some new ideas for differential diagnosis. Main body This section provides a comprehensive overview of the clinicopathological, immunohistochemical, and molecular features of uterine lesions with sex cord-like architectures including uterine tumors resembling ovarian sex cord tumors, endometrial stromal tumors, adenomyosis, endometrial polyps, leiomyoma, epithelioid leiomyosarcoma, adenosarcoma, sertoliform endometrioid carcinoma, corded and hyalinized endometrioid carcinoma, mesonephric adenocarcinoma, and mesonephric-like adenocarcinoma. The differential diagnosis based on morphology, immunohistochemistry, and molecular alterations has also been discussed. Conclusion The sex cord-like areas in these lesions show heterogeneous but similar morphological features. Additionally, immunohistochemical staining plays a limited role in differential diagnosis. Furthermore, it is of significance for pathologists to better understand these lesions in order to avoid confusion and mistakes during pathological diagnosis, especially in a biopsy/curettage specimen.
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Affiliation(s)
- Meng Jia
- Department of pathology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Ping-Li Sun
- Department of pathology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China.
| | - Hongwen Gao
- Department of pathology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China.
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O'Hara AJ, Le Gallo M, Rudd ML, Bell DW. High-resolution copy number analysis of clear cell endometrial carcinoma. Cancer Genet 2019; 240:5-14. [PMID: 31678638 DOI: 10.1016/j.cancergen.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/14/2018] [Revised: 09/30/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Abstract
Uterine cancer is the 6th leading cause of cancer death amongst American women. Most uterine cancers are endometrial carcinomas (ECs), which are classified into histological subtypes including endometrioid, serous, and clear cell ECs. Somatic copy number alterations (SCNAs) are frequent in serous EC, infrequent in endometrioid ECs, and poorly defined in clear cell ECs. The purpose of this study was to evaluate the occurrence of SCNAs in clinically diagnosed clear cell ECs. Paired tumor-normal DNAs for 51 ECs were hybridized to Illumina Infinium HumanHap650Y or Human660W-Quad Beadchips. Copy number calls were made using the Hidden Markov Model based SNP-FASST2 segmentation algorithm within Nexus Copy Number software (v.6.1). High-level SCNAs were defined as gain of ≥5 copies or homozygous deletion, both <10Mb. GISTIC 1.0, in Nexus, was used to identify statistically significant SCNAs, corrected for multiple testing. One or more high-level SCNAs were detected in 50% of 6 clear cell ECs, 78.6% of 28 serous ECs, and 17.6% of 17 endometrioid ECs. A positive association was found between high-level SCNAs and TP53 mutation across ECs (two-tailed p value<0.0001). Classifying tumors according to POLE, MSI, and TP53 status yielded four molecular subgroups; copy number altered tumors were more frequent in the TP53-mutated subgroup (95.8%) than in the unspecified subgroup (22.2%), and absent from the POLE and MSI subgroups. In conclusion, our study provides evidence of inter-tumor heterogeneity in the extent to which SCNAs occur in clinically diagnosed clear cell EC, and across molecular subgroups of EC. The co-occurrence of high-level SCNAs and TP53 mutations in some clear cell ECs is consistent with the view that a subset of clinically diagnosed clear cell ECs have molecular similarities to serous ECs.
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Affiliation(s)
- Andrea J O'Hara
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Matthieu Le Gallo
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Meghan L Rudd
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daphne W Bell
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Takayanagi A, Florence TJ, Hariri OR, Armstrong A, Yazdian P, Sumida A, Quadri SA, Cohen J, Tehrani OS. Brain metastases from cervical cancer reduce longevity independent of overall tumor burden. Surg Neurol Int 2019; 10:176. [PMID: 31583173 PMCID: PMC6763668 DOI: 10.25259/sni_37_2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/05/2019] [Accepted: 07/21/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Isolated brain metastasis (IBM) from cervical cancer is a very rare encounter in neurosurgery. We sought to understand how patients with isolated brain metastases differ from those with metastases in the setting of widespread disease. Methods: A systematic review was completed using PubMed and the Cochrane Library. Patients with isolated brain metastases (IBM) and non-isolated brain metastases (NIBM, or brain metastases in the setting of disseminated disease), were compared. Two-sided statistical tests were used to determine significance. Survival function was carried out using the Kaplan–Meier method. Results: A total of 89 patients, 25 with IBM and 64 with NIBM, were identified. The time interval between initial diagnosis of cervical cancer and diagnosis of brain lesion was significantly shorter in the IBM group (median 7.5 vs. 20.05 months, and IBM vs. NIBM, respectively; P = 0.006). Overall survival from initial diagnosis of cervical cancer was significantly shorter for the IBM group versus the NIBM group (7.63 vs. 26.3 months, respectively; P = 0.0005). Data demonstrate a 3.4-fold reduction of median life expectancy to 7.63 months. Survival after diagnosis of brain metastases did not differ between groups (median, IBM 7 months vs. NIBM 4 months, P = 0.08). Conclusion: Taken together, our data suggest that for cervical cancer patients with brain metastasis intracranial metastasis itself (and not overall tumor burden) represent a sentinel event in limiting longevity. While the present study is underpowered to compare treatment options directly, further work should be focused on determining the optimal treatment for these patients.
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Affiliation(s)
- Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, USA
| | - T J Florence
- Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, USA.,Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA
| | - Omid R Hariri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA.,Department of Neurological Surgery, Kaiser Permanente Orange County, Anaheim, USA
| | - Abigail Armstrong
- Department of Obstetrics and Gynecology, University of California Los Angeles Medical Center, Santa Monica, USA
| | - Pouria Yazdian
- Department of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
| | - Andrew Sumida
- Department of Internal Medicine, Center for Medical Education and Research, University of California San Francisco, Fresno, USA
| | - Syed A Quadri
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Joshua Cohen
- Department of Neurological Surgery, Kaiser Permanente Orange County, Anaheim, USA
| | - Omid S Tehrani
- Department of Oncology, Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Background and Objectives: In the past, diagnostic hys- teroscopy was used to diagnose an intrauterine mass or abnormality and surgical hysteroscopy was used to treat a uterine polyp, uterine synechia, uterine septum, and submucosal myoma. The old hysteroscope had large diameters. Thus, general anesthesia was needed for inpatient management. However, due to the development of smalldiameter hysteroscopes, hysteroscopic diagnosis and surgery are now possible on an outpatient basis. Despite the development of small-diameter hysteroscopes, resection of submucosal myoma is possible only through resecto- scopic operation under general anesthesia, including type 0 uterine myoma. The objective of the present study was to determine the usefulness of secondary office operating hysteroscopy after cutting the pedicle of submucosal myoma via primary office operating hysteroscopy. Methods: We primarily cut the pedicle of type 0 submucosal myoma with the first rigid 5-mm operating mini- hysteroscopy in the outpatient clinic. We then expected the myoma to shrink. Two months later, we confirmed the size with use of 3-mm flexible diagnostic hysteroscopy. If the myoma was shrunk to less than one-third the original size, it was removed with the second rigid 5-mm operating mini-hysteroscopy. Results: In 14 of 24 patients, the myoma had shrunk to less than one-third the size. The rest was successfully removed with the second operating mini-hysteroscopy. In 5 of 24 patients, the myoma mass was not present in the uterine cavity. However, in another 5 of 24 patients, the myoma size had not changed significantly. The myomas were removed via resectoscopic operation under general anesthesia. Conclusions: The trial with this 2-step operation was very useful for the removal of type 0 submucosal myoma in an outpatient clinic.
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Affiliation(s)
- Sung-Tack Oh
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Kyung Ryu
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
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Wang YQ, Chen LY, Mo BQ, Wu XX, Liu Y, Xiao Y, Tang B. [Acupoint catgut embedding improves dysmenorrhea by suppressing activation of NLRP3 inflammasomes in uterine tissues in primary dysmenorrhea rats]. Zhen Ci Yan Jiu 2019; 44:481-5. [PMID: 31368277 DOI: 10.13702/j.1000-0607.180508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To observe the effect of acupoint catgut embedding on the expression of nucleotide-binding oligomerization domain (NOD)-like receptor protein 3 (NLRP3) inflammasome, interleukin (IL)-1β and IL-18 in the uterine tissue of primary dysmenorrhea (PD) rats, so as to explore its underlying mechanisms in improving PD. METHODS Forty female SD rats were randomly divided into control, model, acupoint catgut embedding and medication groups (n=10 in each group). The PD model was established by subcutaneous injection of Estradiol Benzoate (0.5 mg/rat on the 1st and 10thday, and 0.2 mg/rat from 2nd to 9thday) and Oxytocin (2 U/rat, i.p.). The catgut embedding was applied to bilateral "Sanyinjiao" (SP6) and "Guanyuan" (CV4) on the 1st and 5th day after modeling. Rats of the medication group were treated by intragastric perfusion of Fenbid (0.8 mL/rat, 125 mg/100 mL) once daily for 10 days. The body writhing times in 30 min were recorded. The histopathological changes of the uterine were observed by H.E. staining. Western blot was used to detect the expression of NLRP 3, caspase-1, IL-1β and IL-18 in uterine tissues. RESULTS The body writhing times were notably more in the model group than in the control group (P<0.01), and obviously fewer in both medication and catgut embedding groups than in the model group (P<0.05, P<0.01). After modeling, the rats' endometrium was extensively exfoliated and got swelling, the histopathological score and the expression levels of NLRP3, caspase-1, IL-1β and IL-18 proteins in the uterus tissue were evidently increased in the model group relevant to the control group (P<0.01). Following the treatment, the degree of endometrial exfoliation and edema of the uterus tissue was lightened, the pathological score was significantly reduced (P<0.01), and the expression levels of caspase-1, IL-1β and IL-18 protein in uterus tissue were markedly decreased in both acupoint catgut embedding and medication groups (P<0.01, P<0.05). The NLRP3 protein expression was significantly decreased in the acupoint catgut embedding group compared with that in the model group (P<0.01). The therapeutic effect of acupoint catgut embedding was significantly superior to that of medication in reducing writhing times and down-regulating expression of NLPR3 protein (P<0.01). No significant differences were found between catgut embedding and medication in histopathological score, and expression levels of caspase-1, IL-1β and IL-18 proteins (P>0.05). CONCLUSION The acupoint catgut embedding can significantly alleviate the symptoms and pathological damage in PD rats, which may be related to its effect in inhibiting the activation of NLRP3 inflammasome in the uterine tissue.
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Affiliation(s)
- Yi-Qin Wang
- State First-class Discipline Construction Project Group, Hunan University of Chinese Medicine, Changsha 410028, China
| | - Ling-Yu Chen
- State First-class Discipline Construction Project Group, Hunan University of Chinese Medicine, Changsha 410028, China
| | - Bin-Qian Mo
- State First-class Discipline Construction Project Group, Hunan University of Chinese Medicine, Changsha 410028, China
| | - Xiao-Xian Wu
- State First-class Discipline Construction Project Group, Hunan University of Chinese Medicine, Changsha 410028, China
| | - Yu Liu
- State First-class Discipline Construction Project Group, Hunan University of Chinese Medicine, Changsha 410028, China
| | - Yao Xiao
- State First-class Discipline Construction Project Group, Hunan University of Chinese Medicine, Changsha 410028, China
| | - Biao Tang
- State First-class Discipline Construction Project Group, Hunan University of Chinese Medicine, Changsha 410028, China
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Ruiz de Azua Unzurrunzaga G, Brewster DH, Wild SH, Sivalingam VN. Declining hysterectomy prevalence and the estimated impact on uterine cancer incidence in Scotland. Cancer Epidemiol 2019; 59:227-31. [PMID: 30836220 DOI: 10.1016/j.canep.2019.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/20/2019] [Accepted: 02/07/2019] [Indexed: 11/21/2022]
Abstract
AIM The prevalence of hysterectomy is decreasing worldwide. It is not clear whether changes in the population at risk (women with intact uteruses) have contributed to an increased uterine cancer incidence. This study aims to assess the effect of changing trends in hysterectomy prevalence on uterine cancer incidence in Scotland. METHODS The population of women aged ≥25 years with intact uteri was estimated using the estimated hysterectomy prevalence in 1995 and the number of procedures performed in Scotland (1996-2015). Age-standardized uterine cancer incidence was estimated using uncorrected (total) or corrected (adjusted for hysterectomy prevalence) populations as denominators and the number of incident cancers as numerators. Annual percentage change in uterine cancer was estimated. RESULTS Hysterectomy prevalence fell from 13% to 10% between 1996-2000 and 2011-2015, with the most marked decline (from 20% to 6%) in the 50-54-year age group. After correction for hysterectomy prevalence, age-standardized incidence of uterine cancer increased by 20-22%. Annual percentage change in incidence of uterine cancer remained stable through the study period and was 2.2% (95%CI 1.8-2.7) and 2.1% (95%CI 1.7-2.6) for uncorrected and corrected estimates, respectively. CONCLUSION Uterine cancer incidence in Scotland corrected for hysterectomy prevalence is higher than estimates using a total female population as denominator. The annual percentage increase in uterine cancer incidence was stable in both uncorrected and corrected populations despite a declining hysterectomy prevalence. The rise in uterine cancer incidence may thus be driven by other factors, including an ageing population, changing reproductive choices, and obesity.
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Abstract
BACKGROUND AND OBJECTIVE Compare operative outcomes of laparoscopic hysterectomy in an outpatient hospital setting versus freestanding ambulatory surgery center. METHODS Retrospective cohort study of two groups in an outpatient hospital surgery department and freestanding ambulatory surgical center, both serving the Washington, DC area. Women, 18 years or older, who underwent laparoscopic hysterectomy for benign conditions in an outpatient hospital setting between 2011 and 2014 (n = 821), and at an ambulatory surgery center between 2013 and 2017 (n = 1210). Laparoscopic hysterectomy with retroperitoneal dissection and early ligation of the uterine arteries at the origin, performed by gynecologic surgical specialists from a single practice. Patient characteristics, medical history, uterine weight, pathology, operating times, estimated blood loss, and complications were analyzed. RESULTS The mean uterine size between settings was not significantly different (Ambulatory Surgery Center, 349.4 g; Hospital, 329.7 g). The largest uteri removed at the surgery center was 3500 g; at the hospital it was 2489 g. The surgery center had a shorter average operating time than the hospital (53.7 and 61.3 minutes, respectively; P < .001). Intraoperative and postoperative complication rates were not significantly different between settings (2.7% and 3.7%, surgery center; 2.1% and 4.8%, hospital). There were two hospital transfers from the surgery center: 1 for blood transfusion, and 1 for low oxygen saturation. Same-day discharge occurred in 99.8% of surgery center patients versus 88% hospital patients. CONCLUSIONS Laparoscopic hysterectomy can be performed safely and effectively by skilled surgeons at a freestanding ambulatory surgery center, even in complex cases with large uteri.
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Affiliation(s)
- Paul MacKoul
- The Center for Innovative GYN Care, Rockville, MD 20852, USA
| | | | - Rupen Baxi
- The Center for Innovative GYN Care, Rockville, MD 20852, USA
| | | | - Leah Haworth
- The Center for Innovative GYN Care, Rockville, MD 20852, USA
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Ishidera Y, Yoshida H, Oi Y, Katayama K, Ando N, Shigeta H. A case of uterine carcinosarcoma which was strongly suspected to have metastases to the psoas and gluteus muscles. Int Cancer Conf J 2018; 7:121-4. [PMID: 31149529 DOI: 10.1007/s13691-018-0333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022] Open
Abstract
Metastasis to the skeletal muscles is uncommon. We report a case which was strongly suspected to have psoas and gluteus muscle metastases from uterine carcinosarcoma. A 68-year-old woman (gravida, 2; para, 0) underwent retroperitoneal endoscopic paraaortic lymphadenectomy, laparoscopic modified radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy for uterine carcinosarcoma, suspected to be stage IB. Metastasis to one right pelvic lymph node was observed. Ascites fluid cytology was negative. Postoperative pathological examination revealed stage IIIC1 (pT1bN1M0) disease. Five cycles of chemotherapy with paclitaxel + carboplatin were performed. 10 months after chemotherapy, serum cancer antigen-125 level was elevated. Computed tomography (CT) revealed a 3-cm tumor of the left psoas muscle and magnetic resonance imaging revealed a tumor of the left gluteus maximus muscle. These lesions showed fluorodeoxyglucose uptake in positron emission tomography-CT. Because we considered the tumors were metastases of uterine carcinosarcoma, we recommended her chemotherapy. However, after one cycle of chemotherapy, the patient underwent immunotherapy elsewhere with immune checkpoint inhibitors. 5 months after the recurrence, she was alive.
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Hao Y, Li SJ, Zheng P, Wu X, Sheng J, Yuan DL, Zhou Q, Wei W, Duan AH, Wu QQ, Lu D. Intraoperative ultrasound-assisted enucleation of residual fibroids following laparoscopic myomectomy. Clin Chim Acta 2019; 495:652-5. [PMID: 29763581 DOI: 10.1016/j.cca.2018.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/21/2022]
Abstract
AIM To investigate if intraoperative ultrasounds by laparoscopic and transvaginal ultrasonography (LUS and TVS) could improve enucleating the residual fibroids following laparoscopic myomectomy (LM). METHODS From March to December 2016, 78 women with uterine fibroids underwent LM, LUS and TVS were applied to detect residual fibroids and to guide surgeons to enucleate them after the visible fibroids were removed during LM operation. RESULTS The total number of residual fibroids found by LUS was 140, and the total number found by TVS was 127 following LM (P = 0.03). LUS is statistically superior to TVS in the detection of residual fibroids in the anterior wall (P = 0.004), in the detection of intramural fibroids (P = 0.002), and in the detection of fibroids with a diameter ranging from 0.5 to 1 cm (P = 0.002). According to the total number of enucleated fibroids by LM, patients were divided into three groups (Group 1: 2 to 4, Group 2: 5 to 7 and Group 3: ≥8 fibroid counts). The percentages of patients in each group with residual fibroids at the end of surgery were 22.2%, 51.9% and 66.7% respectively. CONCLUSIONS Both LUS and TVS are beneficial to surgical treatment of fibroids by assisting enucleation of residual fibroids following LM, while LUS is more effective in localizing residual fibroids than TVS.
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Murray TE, Mansoor T, Bowden DJ, O'Neill DC, Lee MJ. Uterine Artery Embolization: An Analysis of Online Patient Information Quality and Readability with Historical Comparison. Acad Radiol 2018; 25:619-625. [PMID: 29331361 DOI: 10.1016/j.acra.2017.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/02/2017] [Revised: 11/04/2017] [Accepted: 11/05/2017] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Investigators aimed to assess online information describing uterine artery embolization (UAE) to examine the quality and readability of websites patients are accessing. MATERIALS AND METHODS A list of applicable, commonly used searchable terms was generated, including "Uterine Artery Embolization," "Fibroid Embolization," "Uterine Fibroid Embolization," and "Uterine Artery Embolisation." Each possible term was assessed across the five most-used English language search engines to determine the most commonly used term. The most common term was then investigated across each search engine, with the first 25 pages returned by each engine included for analysis. Duplicate pages, nontext content such as video or audio, and pages behind paywalls were excluded. Pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features such as age, rank, author, and publisher were recorded. RESULTS The most common applicable term was "Uterine Artery Embolization" (492,900 results). Mean DISCERN quality of information provided by UAE websites is "fair"; however, it has declined since comparative 2012 studies. Adherence to JAMA Benchmark Criteria has reduced to 6.7%. UAE website readability remains more difficult than the World Health Organization-recommended 7-8th grade reading levels. HONcode-certified websites (35.6%) demonstrated significantly higher quality than noncertified websites. CONCLUSIONS Quality of online UAE information remains "fair." Adherence to JAMA benchmark criteria is poor. Readability is above recommended 7-8th grade levels. HONcode certification was predictive of higher website quality, a useful guide to patients requesting additional information.
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Affiliation(s)
| | | | | | | | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgery, Dublin, Ireland
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Abstract
Background and Objectives: Symptomatic uterine fibroids are a societal and healthcare burden with no clear consensus among medical professionals as to which procedural treatment is most appropriate for each symptomatic patient. Our purpose was to determine whether recommendations can be made regarding best practice based on review and analysis of the literature since 2006. Database: A systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was performed within PubMed, clinical society websites, and medical device manufacturers' websites. All clinical trials published in English, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered. Each article was screened and selected based on study type, content, relevance, American College of Obstetricians and Gynecologists score, and internal/external validity. Outcomes of interest were patient baseline characteristics, fibroid characteristics, procedural details, complications, and long-term follow-up. Random-effects meta-analyses were used to test the quantitative data. Assessment of 143 full-length articles through January 2016 produced 45 articles for the quantitative analysis. The weighted combined results from hysterectomy trials were compared with those from uterine-preserving fibroid studies (myomectomy, uterine artery embolization, laparoscopic radiofrequency ablation, and magnetic resonance-guided focused ultrasound). Conclusion: We explored trends that might guide clinicians when counseling patients who need treatment of symptomatic fibroids. We found that fibroid therapy is trending toward uterine-conserving treatments and outcomes are comparable across those treatments. Since minimally invasive options are increasing, it is important for the clinician to provide the patient with evidence-based therapeutic strategies.
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Affiliation(s)
- Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Robert Setton
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | | | - Barry D Shaktman
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
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Rawy M, Mido S, El-Sheikh Ali H, Derar D, Megahed G, Kitahara G, Osawa T. Effect of exogenous estradiol Benzoate on uterine blood flow in postpartum dairy cows. Anim Reprod Sci 2018; 192:136-145. [PMID: 29550273 DOI: 10.1016/j.anireprosci.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 10/30/2017] [Revised: 02/25/2018] [Accepted: 03/02/2018] [Indexed: 11/29/2022]
Abstract
The objective of this study was to assess the uterine blood flow following estradiol benzoate administration in Holstein-Friesian dairy cows by trans-rectal color Doppler ultrasonography. Six healthy lactating Holstein-Friesian cows were examined daily for 10 days starting at 4 weeks postpartum. All the cows, which were clinically healthy based on vaginal mucus scoring and endometrial cytology, were examined by trans-rectal Doppler ultrasonography to measure pulsatility index (PI), resistance index (RI), time average maximum velocity (TAMAX), blood flow volume (BFV) and diameter in the uterine arteries ipsilateral and contralateral to the previously pregnant uterine horn. On the third day of the experiment, the six cows were administered 10 mg intramuscular injection of estradiol-17β (E2).Blood samples were collected at the time of daily examination for the assessment ofE2concentrations.The PI and RI values decreased while TAMAX, BFV and diameter of uterine arteries increased in response toE2 administration (P < 0.05).There was a high correlation between both the ipsilateral and contralateral uterine arteries for all variables that were studied(r = 0.860, P < 0.0001, r = 0.922, P < 0.0001, r = 0.651, P < 0.0001, r = 0.879, P < 0.0001, r = 0.861, P < 0.0001 for the PI, RI, TAMAX, BFV and uterine arteries diameter, respectively).In conclusion, the greater blood concentrations ofE2may be responsible for the greater TAMAX, BFV, increased diameters and decreased PI and RI of the uterine arteries during the puerperium in dairy cows.
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Affiliation(s)
- Mohamed Rawy
- Laboratory of Theriogenology, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Gakuen-kibanadai Nishi 1-1, Miyazaki, 889-2192, Japan; Department of Theriogenology, Faculty of Veterinary Medicine, Assiut University, 71526, Assiut, Egypt.
| | - Shogo Mido
- Laboratory of Theriogenology, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Gakuen-kibanadai Nishi 1-1, Miyazaki, 889-2192, Japan
| | - Hossam El-Sheikh Ali
- Department of Theriogenology, Faculty of Veterinary Medicine, University of Mansoura, Mansoura, 35516, Egypt
| | - Derar Derar
- Department of Theriogenology, Faculty of Veterinary Medicine, Assiut University, 71526, Assiut, Egypt
| | - Gaber Megahed
- Department of Theriogenology, Faculty of Veterinary Medicine, Assiut University, 71526, Assiut, Egypt
| | - Go Kitahara
- Laboratory of Theriogenology, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Gakuen-kibanadai Nishi 1-1, Miyazaki, 889-2192, Japan
| | - Takeshi Osawa
- Laboratory of Theriogenology, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Gakuen-kibanadai Nishi 1-1, Miyazaki, 889-2192, Japan
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Shiva M, Ahmadi F, Arabipoor A, Oromiehchi M, Chehrazi M. Accuracy of Two-Dimensional Transvaginal Sonography and Office Hysteroscopy for Detection of Uterine Abnormalities in Patients with Repeated Implantation Failures or Recurrent Pregnancy Loss. Int J Fertil Steril 2018. [PMID: 29043704 PMCID: PMC5641460 DOI: 10.22074/ijfs.2018.5034] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We sought to compare diagnostic values of two-dimensional transvaginal sonography (2D TVS) and office hysteroscopy (OH) for evaluation of endometrial pathologies in cases with repeated implantation failure (RIF) or recurrent pregnancy loss (RPL). MATERIALS AND METHODS This prospective study was performed at Royan Institute from December 2013 to January 2015. TVS was performed before hysteroscopy as part of the routine diagnostic work-up in 789 patients with RIF or RPL. Uterine biopsy was performed in cases with abnormal diagnosis in TVS and/or hysteroscopy. We compared the diagnostic accuracy values of TVS in detection of uterine abnormalities with OH by receiver operating characteristic (ROC) curve analysis. RESULTS TVS examination detected 545 (69%) normal cases and 244 (31%) pathologic cases, which included 84 (10.6%) endometrial polyps, 15 (1.6%) uterine fibroids, 10 (1.3%) Asherman's syndrome, 9 (1.1%) endometrial hypertrophy, and 126 (15.9%) septate and arcuate uterus. TVS and OH concurred in 163 pathologic cases, although TVS did not detect some pathology cases (n=120). OH had 94% sensitivity, 95% specificity, 62% positive predictive value (PPV), and 99% negative predictive value (NPV) for detection of endometrial polyps. In the diagnosis of myoma, sensitivity, specificity, PPV, and NPV were 100%. TVS had a sensitivity of 50% and specificity of 98% for the diagnosis of myoma. For polyps, TVS had a sensitivity of 54% and specificity of 80%. Area under the ROC curve (AUROC) was 70.69% for the accuracy of TVS compared to OH. CONCLUSION TVS had high specificity and low sensitivity for detection of uterine pathologies in patients with RIF or RPL compared with OH. OH should be considered as a workup method prior to treatment in patients with normal TVS findings.
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Affiliation(s)
- Marzieh Shiva
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for
Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Firouzeh Ahmadi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive
Biomedicine, ACECR, Tehran, Iran,P.O.Box: 16635-148Department of Reproductive
ImagingReproductive Biomedicine Research CenterRoyan Institute for
Reproductive BiomedicineACECRNumber 12East Hafez AvenueBani
Hashem StreetResalat HighwayTehranIran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for
Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mansoureh Oromiehchi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for
Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Chehrazi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute
for Reproductive Biomedicine, ACECR, Tehran, Iran
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Shiva M, Ahmadi F, Arabipoor A, Oromiehchi M, Chehrazi M. Accuracy of Two-Dimensional Transvaginal Sonography and Office Hysteroscopy for Detection of Uterine Abnormalities in Patients with Repeated Implantation Failures or Recurrent Pregnancy Loss. Int J Fertil Steril 2017; 11:287-292. [PMID: 29043704 DOI: 10.22074/ijfs.2018.5134] [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] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 02/26/2017] [Indexed: 11/04/2022]
Abstract
Background We sought to compare diagnostic values of two-dimensional transvaginal sonography (2D TVS) and office hysteroscopy (OH) for evaluation of endometrial pathologies in cases with repeated implantation failure (RIF) or recurrent pregnancy loss (RPL). MATERIALS AND METHODS This prospective study was performed at Royan Institute from December 2013 to January 2015. TVS was performed before hysteroscopy as part of the routine diagnostic work-up in 789 patients with RIF or RPL. Uterine biopsy was performed in cases with abnormal diagnosis in TVS and/or hysteroscopy. We compared the diagnostic accuracy values of TVS in detection of uterine abnormalities with OH by receiver operating characteristic (ROC) curve analysis. RESULTS TVS examination detected 545 (69%) normal cases and 244 (31%) pathologic cases, which included 84 (10.6%) endometrial polyps, 15 (1.6%) uterine fibroids, 10 (1.3%) Asherman's syndrome, 9 (1.1%) endometrial hypertrophy, and 126 (15.9%) septate and arcuate uterus. TVS and OH concurred in 163 pathologic cases, although TVS did not detect some pathology cases (n=120). OH had 94% sensitivity, 95% specificity, 62% positive predictive value (PPV), and 99% negative predictive value (NPV) for detection of endometrial polyps. In the diagnosis of myoma, sensitivity, specificity, PPV, and NPV were 100%. TVS had a sensitivity of 50% and specificity of 98% for the diagnosis of myoma. For polyps, TVS had a sensitivity of 54% and specificity of 80%. Area under the ROC curve (AUROC) was 70.69% for the accuracy of TVS compared to OH. CONCLUSION TVS had high specificity and low sensitivity for detection of uterine pathologies in patients with RIF or RPL compared with OH. OH should be considered as a workup method prior to treatment in patients with normal TVS findings.
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Affiliation(s)
- Marzieh Shiva
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Firouzeh Ahmadi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mansoureh Oromiehchi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Chehrazi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Li M, Gao Y, Yong L, Huang D, Shen J, Liu M, Ren C, Hou X. Molecular signature and functional analysis of uterine ILCs in mouse pregnancy. J Reprod Immunol 2017; 123:48-57. [PMID: 28915450 DOI: 10.1016/j.jri.2017.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/29/2016] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 02/07/2023]
Abstract
In addition to natural killer cells, other innate lymphoid cells have recently been identified in the mouse and human uterus, but their roles in successful pregnancy remain poorly defined. In this study, we examined the dynamic changes of uterine innate lymphoid cells throughout pregnancy in mice. We found that the total number of uterine innate lymphoid cells markedly increased at early-gestation. Among the three groups of uterine innate lymphoid cells, the number of the group 2 uterine innate lymphoid cells increased the most during pregnancy. We also determined that the depletion of uterine innate lymphoid cells in Rag1-/- mice resulted in impaired uterine spiral artery remodeling. These results suggest that uterine innate lymphoid cells may play an important role in mouse reproduction.
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Affiliation(s)
- Minmin Li
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Yimin Gao
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Liang Yong
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Dake Huang
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Jijia Shen
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Microbiology and Parasitology, Hefei, Anhui, China
| | - Miao Liu
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Microbiology and Parasitology, Hefei, Anhui, China
| | - Cuiping Ren
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Microbiology and Parasitology, Hefei, Anhui, China
| | - Xin Hou
- Department of Microbiology and Parasitology, School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Microbiology and Parasitology, Hefei, Anhui, China.
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Abstract
Adenosarcomas are rare malignancies of the female genital tract, accounting for approximately 5 % of uterine sarcomas. Occasionally, adenosarcoma occurs in the ovaries or in extra-uterine tissue, which may be related to endometriosis. These tumors are characterized by benign epithelial elements and a malignant mesenchymal component. Pathologic diagnosis is dependent on the identification of the characteristic morphologic features. The most common immunohistochemical markers for adenosarcoma are CD10 and WT1, but these are not specific. The most frequent presenting symptom is abnormal uterine bleeding. The majority of patients present with stage I disease, with a 5-year overall survival of 60 to 80 %. Survival is influenced by the presence of myometrial invasion, sarcomatous overgrowth, lymphovascular invasion, necrosis, and the presence of heterologous elements including rhabdomyoblastic differentiation. Patients with sarcomatous overgrowth have significantly increased risk of recurrence 23 versus 77 % and decreased 5-year overall survival 50 to 60 %. Standard of care treatment is total hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy, as the incidence of lymph node metastasis is rare. Retrospective data does not support the use of adjuvant pelvic radiotherapy in uterine adenosarcomas as no survival benefit is seen. Insufficient data exists to recommend routinely neoadjuvant or adjuvant chemotherapy for uterine adenosarcomas. Limited evidence exists for the role of hormonal therapy in uterine adenosarcomas. The PIK3/AKT/PTEN pathway is mutated in ∼70 % of adenosarcomas, and this may represent a possible therapeutic target. This article reviews the current state of knowledge concerning uterine adenosarcoma and discusses the management of this rare tumor.
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Affiliation(s)
- Michael J Nathenson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Nicole Fleming
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Anthony Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
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Eze JN, Anozie OB, Lawani OL, Ndukwe EO, Agwu UM, Obuna JA. Evaluation of obstetricians' surgical decision making in the management of uterine rupture. BMC Pregnancy Childbirth 2017; 17:179. [PMID: 28595646 PMCID: PMC5465586 DOI: 10.1186/s12884-017-1367-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/22/2016] [Accepted: 06/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians’ perspectives on surgical decision making in managing uterine rupture. Methods A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Results Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients’ conditions and obstetricians’ surgical skills. Conclusion Obstetricians’ distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians’ surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician’s surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1367-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justus Ndulue Eze
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria. .,Department of Obstetrics and Gynaecology, Faculty of Medicine, Ebonyi State University, Abakaliki, Nigeria.
| | - Okechukwu Bonaventure Anozie
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.,Department of Obstetrics and Gynaecology, Faculty of Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Osaheni Lucky Lawani
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.,Department of Obstetrics and Gynaecology, Faculty of Medicine, Ebonyi State University, Abakaliki, Nigeria
| | | | - Uzoma Maryrose Agwu
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.,Department of Obstetrics and Gynaecology, Faculty of Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Johnson Akuma Obuna
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.,Department of Obstetrics and Gynaecology, Faculty of Medicine, Ebonyi State University, Abakaliki, Nigeria
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Zafarani F, Ahmadi F, Shahrzad G. Hysterosalpingography in The Assessment of Congenital Cervical Anomalies. Int J Fertil Steril 2017; 11:71-78. [PMID: 28670423 PMCID: PMC5347453 DOI: 10.22074/ijfs.2017.4716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 10/29/2016] [Indexed: 12/05/2022]
Abstract
Cervical abnormalities may be congenital or acquired. Congenital anomalies of the cervix are rarely isolated, and more commonly accompany other uterine anomalies. Various
imaging tools have been used in the assessment of Müllerian duct anomalies (MDAs).
Currently, magnetic resonance imaging (MRI) is the modality of choice for definitive
diagnosis and classification of these MDAs. Hysterosalpingography is a basic tool for
evaluation of infertility and allows us to detect a spectrum of anatomical malformations
of the utero-cervix in the setting of MDAs. It provides good outlines of the uterine cavity
and fallopian tubes, as well as the cervical canal and isthmus. However, hysterosalpingograms (HSG) cannot be performed in patients with isolated congenital maldevelopment
(agenesis/disgenesis) of the cervix. This part of pictorial review illustrates the various
radiographic appearances of congenital malformations of the utero-cervix with a brief
overview of the embryologic features. Accurate diagnosis of such cases is considered
essential for optimal treatment and categorization of each anomaly.
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Affiliation(s)
- Fatemeh Zafarani
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | - Firoozeh Ahmadi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | - Gholam Shahrzad
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
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