Is hemoglobin A1c valuable for predicting concurrent endometrial cancer in diabetic women with endometrial intraepithelial neoplasia?

AIM

The purpose of this study was to determine the predictive value of preoperative hemoglobin A1c (HgA1c) level for endometrial cancer in diabetic women with endometrial intraepithelial neoplasia (EIN).

MATERIALS AND METHODS

Six hundred patients with EIN were retrospectively studied in a tertiary referral center in Turkey between January 2014 and December 2021. One hundred and thirteen diabetic patients with EIN who met the inclusion criteria were enrolled in the study and divided into three groups according to the final pathological results: Group 1 with benign findings (n = 29), Group 2 with EIN (n = 34) and Group 3 with endometrial cancer (n = 50). Demographic, clinical and biochemical characteristics were compared among the three groups. Receiver operating characteristic analysis (ROC) was used to evaluate the predictive value of HgA1c for concurrent endometrial cancer in EIN.

RESULTS

Mean preoperative HgA1c levels were different among three groups (5.41 ± 0.64, 6.01 ± 0.72, 6.65 ± 1.15, p < 0.001, respectively). The highest value of HgA1c level was found in cancer group and difference within pairs was statistically significant (p < 0.001). Age and duration of menopause were also different among groups (p < 0.005). After adjustment of HgA1c level for age and duration of menopause differences were maintained (p < 0.001), the cutoff value was detected as ≥6.05% for HgA1c and sensitivity, specificity was 60%, 70%, respectively (p < 0.001).

CONCLUSIONS

HgA1c could be used in prediction of endometrial cancer. The optimal cutoff value determined in our study could be considered in predicting endometrial cancer in diabetic women with EIN.

High level of visfatin and the activation of Akt and ERK1/2 signaling pathways are associated with endometrium malignant transformation in polycystic ovary syndrome

This study aimed to assess the clinicopathological significance of serum levels and endometrium tissue expression of visfatin in polycystic ovary syndrome (PCOS) patients. A total of 80 PCOS patients and 80 matching controls were included in this study. We analyzed the relationship between the expression of visfatin in endometrium and clinicopathological characteristics in PCOS patients. The correlation between the expression of visfatin and p-Akt, Akt, p-ERK1/2, and ERK1/2 in PCOS tissues was evaluated as well. Visfatin expression in PCOS endometrial tissues were significantly higher than those in controls (p = .001). The expression of phosphorylation of Akt and ERK1/2 were significantly higher in PCOS endometrium tissues compared to controls (p < .05). Moreover, a high expression of tissue visfatin in PCOS tissues was positively correlated with the expression of p-Akt (p = .015), and p-ERK1/2 (p = .013). Western blotting revealed that protein expression of visfatin in PCOS patients with endometrial hyperplasia and cancer was higher than that in patients with normal endometrium tissues, and the difference was statistically significant (p = .027). The expression of p-Akt (p = .018) and p-ERK1/2 (p = .035) in PCOS patients with endometrial hyperplasia and cancer was significantly higher than that in patients with normal endometrium tissues. Visfatin may be a potential biomarker for endometrial malignant transformation in PCOS patients.

The Effects of Folic Acid Supplementation on Recurrence and Metabolic Status in Endometrial Hyperplasia: A Randomized, Double-Blind, Placebo-Controlled Trial

BACKGROUND

Data on the effects of folic acid supplementation on clinical symptoms and metabolic profiles of patients with endometrial hyperplasia (EH) are limited. This investigation was performed to evaluate the effects of folic acid supplementation on clinical symptoms and metabolic status of patients with EH.

METHODS

This randomized, double-blind, placebo-controlled trial was conducted among 60 women diagnosed with EH. Diagnosis of EH was made based on biopsy results. Participants were randomly allocated to 2 groups to take 5 mg/d folic acid supplements (n = 30) or placebo (n = 30) for 12 weeks.

RESULTS

After the 12-week intervention, folic acid supplementation significantly decreased fasting plasma glucose (β -3.99 mg/ dL; 95% CI, -7.39, -0.59; P = 0.02), serum insulin levels (β -2.82 µIU/mL; 95% CI, -4.86, -0.77; P = 0.008), homeostasis model assessment for insulin resistance (β -0.68; 95% CI, -1.20, -0.17; P = 0.009), triglycerides (β -16.47 mg/dL; 95% CI, -28.72, -4.22; P = 0.009) and very-low-density lipoprotein (VLDL) cholesterol (β -3.29 mg/dL; 95% CI, -5.74, -0.84; P = 0.009), and significantly increased the quantitative insulin sensitivity check index (β 0.01; 95% CI, 0.004, 0.03; P = 0.01) compared with the placebo. Additionally, folic acid intake resulted in a significant reduction in serum high sensitivity C-reactive protein (hs-CRP) (β -0.36 mg/L; 95% CI, -0.52, -0.21; P < 0.001) compared with the placebo. Folic acid supplementation did not affect other metabolic parameters.

CONCLUSION

In conclusion, we found that folic acid administration for 12 weeks to subjects with EH improved glycemic control, triglycerides, VLDL-cholesterol and hs-CRP levels, but did not influence recurrence and other metabolic profiles.

Antioxidant status and sex hormones in women with complex endometrial hyperplasia

Endometrial tissue is under a strong influence of sex hormones. These hormones are considered as developmental factors of endometrial hyperplasia and endometrial cancer. We examined the influence of gonadotropins (follicle-stimulating and luteinizing hormone) and sex hormones (estradiol, progesterone) on oxidant/antioxidant parameters in blood and endometrial tissue of women with complex endometrial hyperplasia. In blood, superoxide dismutase activity was significantly higher in luteal phase and postmenopause compared to the follicular phase. A significant phase-related difference of glutathione peroxidase and glutathione reductase activity was recorded in the endometrium. Both enzymes had lower activity in luteal phase and postmenopause compared to the follicular phase. The linear regression analysis of individual hormonal variables against antioxidant parameters showed negative correlation between glutathione peroxidase activity and gonadotropin concentrations in the endometrium. The regression of hyperplastic to normal endometrium is the purpose of conservative treatment based on administration of progestogens or gonadotropin-releasing hormone analogues. Our findings indicate that gonadotropins influence the antioxidant enzymes activity in women with complex endometrial hyperplasia, which may affect disease development. Further studies are needed to clarify the molecular basis of hormone action on antioxidant system that may potentially initiate a development of treatments based on redox-dependent mechanism.

Effects of sulpiride and ethylene glycol monomethyl ether on endometrial carcinogenicity in Donryu rats

Sulpiride and ethylene glycol monomethyl ether (EGME) are known ovarian toxicants that stimulate prolactin (PRL) secretion, resulting in hypertrophy of the corpora lutea and increased progesterone (P4) production. The purpose of the present study was to investigate how the PRL stimulatory agents affected uterine carcinogenesis and to clarify the effects of PRL on endometrial adenocarcinoma progression in rats. Ten-week-old female Donryu rats were treated once with N-ethyl-N'-nitro-N-nitrosoguanidine (20 mg kg(-1) ), followed by treatment with sulpiride (200 ppm) or EGME (1250 ppm) from 11 weeks of age to 12 months of age. Sulpiride treatment inhibited the incidence of uterine adenocarcinoma and precancerous lesions of atypical endometrial hyperplasia, whereas EGME had no effect on uterine carcinogenesis. Sulpiride markedly prevented the onset of persistent estrus throughout the study period, and EGME delayed and inhibited the onset of persistent estrus. Moreover, sulpiride-treated animals showed high PRL and P4 serum levels without changes in the levels of estradiol-17β, low uterine weights and histological luteal cell hypertrophy. EGME did not affect serum PRL and P4 levels. These results suggest that the prolonged low estradiol-17β to P4 ratio accompanied by persistent estrous cycle abnormalities secondary to the luteal stimulatory effects of PRL may explain the inhibitory effects of sulpiride on uterine carcinogenesis in rats. Copyright © 2015 John Wiley & Sons, Ltd.

[Expression of epidermal growth factor receptor and plasmatic level of melatonin in simple and complex endometrial hyperplasia]

The goal of our research was to find the prognostic significance of the epidermal growth factor receptor (EGFR) in the hyperplastic endometrium. Immunohistochemical study of morphological material (endometrial scrap) was conducted in order to reveal the EGFR expression (in 35 patients). The study of consistence of melatonin (universal antiproliferative and anticancerogenic hormone) in patients' blood serum was performed as well (using ELISA method). The numeric data of investigation were processed statistically using the SPSS-12 program and IBM SPSS Statistics, 20. According to received results, the more complicated the type of endometrial hyperplasia is, the stronger EGFR expression is and the more melatonin consistence is reduced in blood plasma. However, sometimes much lower level of melatonin not only in case of complex hyperplasia (with atypia), but also in case of simple hyperplasia (without atypia) was observed. In addition, melatonin consistence is in norm not only in case of simple hyperplasia, but also in case of complex hyperplasia. Also, unimportant reduction of melatonin level is seen in plasma in case of both types of endometrial hyperplasia (without atypia): if, for example, in simple hyperplasia, this slight reduction of melatonin level in plasma is seen in condition of sharp EGFR expression, the same amount reduction of plasmatic melatonin in complex hyperplasia is seen in condition of weak EGFR expression. To sum up: in case of simple endometrial hyperplasia without atypia, reduction of plasma melatonin level should be a bad prognostic indicator and this condition can be followed by transformation of hyperplasia into atypical form; the normal plasmatic level of melatonin in complex endometrial hyperplasia without atypia (in condition of weak EGFR expression) should be a good prognostic indicator; unimportant reduction of plasma melatonin level and in addition, EGFR sharp expression in simple hyperplasia, is probably the sign, that hyperplasia can change and become complex; however, the same indicators of plasma melatonin level (on the background of weak EGFR expression) in complex hyperplasia (without atypia) should not indicate the poor prognosis.

Comparing letrozole with medroxyprogesterone acetate (MPA) as hormonal therapy for simple endometrial hyperplasia without atypia in adult and middle-aged women

BACKGROUND

The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate (MPA) in treatment of simple endometrial hyperplasia to preserve fertility in young women.

MATERIALS AND METHODS

Forty-five patients referred to Shahid Sadoughi gynecology clinics from 2009 until 2011 who suffered from abnormal vaginal bleeding or endometrial thickness, that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled. The patients were divided randomly into two groups. First group including 22 women receive ten mg MPA, for ten days during a month for three months. All cases were followed by interview, endometrial curetage, and vaginal sonography. Serum level of estradiol was checked before and after treatment. At the end of the study, biopsy was retaken in 41 patients. All the patients were under observation by two gynecologists.

RESULTS

Age range of patients was 20 to 42 years. Mean body mass index (BMI) in the MPA and letrozole groups was 29.13 +/- 4.8 and 25.42 +/- 4.2, respectively. Fifty and 34.8 percent of cases had history of obesity or polycystic ovarian syndrome (PCOS) in MPA and letrozole groups, respectively. Forty-one selected cases (20 of the MPA and 21 of the letrozole groups) continued the treatment for three months. The endometrial thicknesses decreased in both groups. Serum estradiol level also decreased in both groups. The most common complication in the MPA and letrozole groups was headache (27.3%) and flashing and dizziness, respectively. The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing.

DISCUSSION

In women suffering from simple endometrial hyperplasia without atypia, letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA. In both groups, there was no simple hyperplasia report in curettage report following treatment. It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type.

CONCLUSION

Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia: cases candidate for medical treatment. To confirm the effect and safety of letrozole, more studies with larger samples are recommended.

[Specifics of hormonal and energy balance in patients with hyperplasia and endometrial neoplasia with metabolic syndrome in the background]

We conducted a comparative investigation of the hormonal status (LH, FSH, estradiol, progesterone, testosterone, prolactin, SHBG), energy status (leptin, ghrelin, insulin), and carbohydrate and lipid metabolism in patients with endometrial hyperplasia and neoplasia (168 patients) with or without metabolic syndrome in the background. Patients with metabolic syndrome had a high frequency of elevated estrogen (72%), testosterone (65%), insulin (81%), leptin (68%). There was a marked increase in the basal level of luteinizing hormone, prolactin, index, LH/FSH, but decrease in FSH and progesterone. There were significant changes in carbohydrate and lipid metabolism. The possible mechanisms for the contribution of the investigated factors to the development of the pathological processes in the endometrium are presented.

Ovarian volume assessment in relation to histologic findings and sex hormone levels in women with postmenopausal bleeding and thickened endometrium

BACKGROUND AND OBJECTIVES

In postmenopausal women, ovarian stromal hyperplasia and endometrial cancer are often identified concurrently. The aim of the present study was to verify the association of ovarian volume with histologic findings and sex hormones levels in women with postmenopausal bleeding and thickened endometrium.

DESIGN AND SETTING

Prospective observational study conducted in a teaching hospital between March 2008 and February 2010

PATIENTS AND METHODS

Ninety women with postmenopausal bleeding and thickened endometrium (>=5 mm) were enrolled. They underwent vaginal sonography for ovarian volume measurement. Blood samples were collected for sex steroid hormones assay. In addition, endometrial sampling was done for definitive histologic diagnosis.

RESULTS

According to histologic results, 18 cases (20%) had endometrial adenocarcinoma, 24 cases (26.7%) had endometrial hyperplasia with or without atypia and 48 cases (53.3%) had benign histologic findings. Large ovaries were significantly associated with higher body mass index (BMI>=30) (P=.002) and endometrial adenocarcinoma (P < .001). After adjustment for age and BMI, increased ovarian volume in adenocarcinoma was associated with high serum level of estradiol (P < .001), serum total testosterone (P=.04) and serum free testosterone (P < .01) compared with other histologic findings.

CONCLUSIONS

Large ovaries among women with postmenopausal bleeding and thick endometrium were associated with elevated serum sex steroid hormones and represent a marker of risk for endometrial adenocarcinoma.

[Clinical value of combined detection of serum human epididymal secretory protein E4 and CA(125) in the diagnosis of endometrial carcinoma]

OBJECTIVE

To explore the clinical value of combined detection of serum human epididymal secretory protein E4 (HE4) and CA(125) in the diagnosis of endometrial carcinoma.

METHODS

From Jan 2010 to Apr 2011, the serum specimens were collected from 124 cases of endometrial carcinoma, 97 cases of benign disease of uterus and 109 cases of healthy women. HE4 levels in the serum were detected by ELISA, and CA(125) levels in the serum were detected by the electro-chemiluminescent immunoassay. Those results were shown with median level. Accuracy of the diagnosis was evaluated by the area under the receiver operating characteristic curve (ROC-AUC).

RESULTS

The median levels of HE4 and CA(125) were 78.09 pmol/L and 33.43 kU/L in serum of endometrial carcinoma group. The median levels of HE4 and CA(125) were 46.37 pmol/L and 18.26 kU/L in serum of benign disease of uterus group. The median levels of HE4 and CA(125) were 31.75 pmol/L and 12.64 kU/L in serum of healthy women group. The HE4 and CA(125) levels in serum of endometrial carcinoma group were significantly higher than those of benign disease of uterus group or healthy women group (all P < 0.05). Compared with that benign disease of uterus group, the ROC-AUC of HE4 and CA(125) in endometrial carcinoma group were 0.913 and 0.801, respectively. When the specificity was 95.0%, the sensitivities of HE4, CA(125), and combined detection of HE4 and CA(125) in endometrial carcinoma group were 41.1%, 22.6% and 46.0%, respectively. The positive rates of HE4 and CA(125) were 31% (27/86) and 12% (10/86) in stage I-II of endometrial carcinoma, while the positive rates were 63% (24/38) and 47% (18/38) in stage III-IV of endometrial carcinoma, in which there were significant difference between patients in stage III-IV and stage I-II (P < 0.01).

CONCLUSIONS

The combined detection of serum HE4 and CA(125) is helpful to the diagnosis of endometrial carcinoma. The sensitivity, specificity and early diagnosis of HE4 are better than that of CA(125). The positive rates of HE4 and CA(125) in endometrial carcinoma are related to the clinical staging.

[Activation and significance of the PI3K/Akt pathway in endometrium with polycystic ovary syndrome patients]

OBJECTIVE

To investigate activation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway in the endometrium of women with polycystic ovary syndrome (PCOS) and its role in endometrium hyperplasia and carcinogenesis, and the factors affecting the activation of the PI3K/Akt pathway.

METHODS

From Jan 2007 to Jun 2008, 52 patients with PCOS who underwent dilatation and curettage were selected as experimental group matched with 32 non-PCOS patients as control group. Serous hormonal parameters, fasting blood glucose and insulin, body mass index (BMI), and endometrium pathology were measured and evaluated in all patients. The PCOS patients were divided into insulin resistance and non-insulin resistance group according to homeostasis model assessment-insulin resistance index (HOMA-IR). Meanwhile, the PCOS patients were grouped as normal, endometrial hyperplasia and carcinoma depending on outcome of pathology. The expression of Akt and phosphorylated Akt (p-Akt) were determined by western blot.

RESULTS

(1) The expression of p-Akt was significantly higher in PCOS group [(46 ± 18)%] than that in control [(33 ± 9)%, P < 0.01)]. (2) The expression of p-Akt was significantly higher in group of endometrial hyperplasia and carcinoma [(56 ± 19)%] when compared with those in normal endometria group [(31 ± 12)%, P < 0.05]; the expression of p-Akt was significantly higher in group of insulin resistance [(50 ± 19)%] compared with that in non-insulin resistance group [(34 ± 10)%, P < 0.01]. (3) There was a positive correlation between the expression level of p-Akt in endometrium with PCOS and HOMA-IR and BMI respectively (r = 0.400, 0.326, both P < 0.05).

CONCLUSIONS

The PI3K/Akt pathway was over activated in endometrium with PCOS which may be associated with the formation of endometrial hyperplasia and carcinoma in PCOS patients. Insulin resistance and obesity may be high risk factors for over-activation of the PI3K/Akt pathway in endometrium with PCOS.

[Evaluation of risk of progression of endometrial hyperplasia in patients with metabolic syndrome]

A mathematical model based on principles of multifactor analysis was developed to predict clinical outcome of endometrial hyperplasia (EH) in patients with metabolic syndrome (80). Seventy-seven factors--anthropometric, clinical, anamnestic, hormono-metabolic, immunohistochemical, etc.--were included. Evaluation of the most informative indices integrated with the discriminative model showed that anthropometric (waist and hip circumference, sagittal diameter, etc.) and clinico-anamnestic (age, age of secondary sexual characters appearance, body weight at birth, suckling pattern, etc.) ones are of similar significance. A profile of hormono-metabolic parameters (cholesterol-low density lipoprotein, leptin, testosterone, progesterone and fasting glucose levels) helped identify a wide range of EH-related disorders in patients with metabolic syndrome. Consistently with the literature data, level of PTEN expression pointed to the presence of this tumor's suppressor in most EH cases which was matched by absence of its expression in endometrial carcinoma. Our model provided high sensitivity (89%) and specificity (82%) in predicting risk of progression in patients with endometrial hyperplasia and metabolic syndrome.

[Expression and activation of insulin receptor substrate-1 in endometrial carcinoma]

OBJECTIVE

To investigate the mRNA, protein expression and tyrosine phosphorylation of insulin receptor substrate-1 (IRS-1) in endometrial carcinoma.

METHODS

Sixty-three endometrial carcinoma (EC) patients, 21 endometrial atypical hyperplasia (AHE) patients and 22 normal control (NE) entered this study. Their clinical information were collected. Fasting serum C-peptide concentration was measured. Expression of IRS-1 in endometrium was examined by RT-PCR and western blot. Immunoprecipitation was used to measure the tyrosine phosphorylation of IRS-1.

RESULTS

C-peptide concentration in EC group was higher than that in NE group [(3.2 +/- 1.1) vs (2.5 +/- 0.7) microg/L, P=0.007]. There were no significant differences in IRS-1 mRNA and protein expression among the three groups. Tyrosine phosphorylation of IRS-1 in EC group [(62 +/- 36) %] was higher than that in AHE and NE groups [(53 +/-34)% and (35 +/- 33)%; P=0.048, 0.002]. IRS-1 activation in AHE group was also higher than normal control (P=0.045). IRS-1 activation in endometrioid carcinoma [(69 +/- 33) %] was higher than that in other histological types [(34 +/- 31)%; t=2.300, P=0.025]. IRS-1 tyrosine phosphorylation was significantly higher in patients with advanced stage, high grade, deep myometrial invasion and pelvic lymph node metastasis. IRS-1 activation in endometrium was positively correlated with fasting serum C-peptide concentration (r=0.491, P=0.001).

CONCLUSIONS

There is excessive activation of IRS-1 in endometrial carcinoma and atypical hyperplasia. Activation of IRS-1 in endometrial carcinoma is related with poor clinical-pathologic features and may be a prognostic predictor for this tumor. Over-activation of IRS-1 may be an intermediate event linking the hyperinsulinemia and endometrial carcinoma.

[Sex hormones in the systemic and local circulation in endometrial hyperplasia and neoplasia: correlation with the activity of estrogen-metabolizing enzymes]

Sex hormone profile was investigated in uterine systemic and local blood flow in endometrial hyperplasia and carcinoma. The results were compared with levels of aromatase and steroid sulfatase - estrogen metabolism enzymes. Local hyperestradiolemia and hyperestronemia were detected in cancer patients. Estradiol and estrone in endometrial hyperplasia were lower than in cancer which conforms to estrogen theory of hormonal carcinogenesis. There was no evidence for the role of hyperestrogenemia in endometrial hyperplasia development. Aromatase was a factor of intensified estrogen synthesis in altered and hyperplastic endometrium. There was an inverse correlation between intratumoral steroid sulfatase levels and those of estrone in uterine local blood flow.

Serum adiponectin in relation to endometrial cancer and endometrial hyperplasia with atypia in obese women

OBJECTIVES

The aim of this work was to compare concentrations of adiponectin in the serum of obese women with endometrial cancer, endometrial hyperplasia with atypia, and normal endometrium.

METHODS

We enrolled 105 obese women treated at the Department of Gynecological Surgery and Oncology of Adults and Adolescents. The patients were allocated to groups depending on the histological diagnosis (R - endometrial cancer, P - polyps, K - normal endometrium). We subdivided group R depending on the stage and grade of cancer.

RESULTS

Significantly lower concentrations of adiponectin were found in patients with endometrial cancer (mean 15.28 microg/ml) as compared with polyps (29.94 microg/ml, p < 0.001) or normal endometrium (22.7 microg/ml, p < 0.05). Stage of cancer had no significant effect on the adiponectin level. When cancer grade was compared, lower levels of adiponectin were observed in patients with G3 (12.86 microg/ml) than G1 (19.04 microg/ml, p < 0.05).

CONCLUSION

Reduced levels of adiponectin may represent an independent risk factor for endometrial cancer.

Lipid peroxidation and antioxidant status in blood of patients with uterine myoma, endometrial polypus, hyperplastic and malignant endometrium

Oxidative stress is considered to be involved in pathogenesis of many disorders of the female genital tract. In this study, we explored the lipid peroxidation levels and antioxidant enzyme activities in women diagnosed with different forms of uterine diseases in order to evaluate the extent of oxidative stress in blood of such patients. Blood samples of healthy subjects and gynecological patients were collected and subjected to assays for superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and lipid hydroperoxides. The results show that alterations of measured parameters vary with the enzyme type and diagnosis. However, both reduction in antioxidants and elevation of lipid peroxidation were observed in general. Lipid hydroperoxides level was negatively correlated to superoxide dismutase and glutathione peroxidase activities, as well as positively correlated to catalase activity. In addition, the lipid hydroperoxides/ glutathione peroxidase ratio was found to be increased, according to the type of uterine disease. The obtained results show that perturbation of antioxidant status is more pronounced in blood of patients with premalignant (hyperplastic) and malignant (adenocarcinoma) lesions, compared to those with benign uterine changes such as polypus and myoma.

Clinical evaluation of the use of aglepristone, with or without cloprostenol, to treat cystic endometrial hyperplasia-pyometra complex in bitches

The aim of the study was to evaluate the efficacy of aglepristone (10 mg/kg on days 1, 2 and 8) for the treatment of metritis or pyometra in bitches (n = 67) either alone for cases of metritis (n = 15), or in cases of pyometra (n = 52) with (n = 32) or without (n = 20) the addition of low doses (1 microg/kg) of cloprostenol for 5 days (days 3-7). Examinations performed on day 90, in addition to days 8, 14 and 28, determined that treatments had been curative in the long term in 54/67 bitches (80.6%). Bitches in whom pyometra did not resolve, were given additional aglepristone on day 14 (n = 38) and day 28 (n = 20). Aglepristone alone was curative in 15/15 bitches with metritis. In 17/17 bitches with closed pyometra, cervical opening occurred within 48 h of aglepristone administration. Amongst the 52 bitches with open (n = 35) or closed (n = 17) pyometra, the additional treatment with cloprostenol from days 3 to 7, significantly improved the overall success rate at day 90, which was 27/32 (84.4%), compared to 12/20 (60.0%) in bitches without cloprostenol (P < 0.05). The leucocyte count and plasma progesterone concentrations significantly decreased over the course of treatment. Thirteen of 15 bitches in whom plasma progesterone concentrations were initially low (< 3.18 nmol/L) were cured. The recurrence rate after 12 and 24 months was 13.0% (3/23) and 19.0% (4/21), respectively.

Leptin levels in serum depending on Body Mass Index in patients with endometrial hyperplasia and cancer

Leptin levels in serum depending on Body Mass Index (BMI) in patients with endometrial hyperplasia and cancer.

OBJECTIVES

Concentrations of leptin, a hormone secreted by white adipose tissue, correlate strongly with body mass. Leptin interacts with several other hormones, modifies the activities of some enzymes and proinflammatory cytokines, participates in hematopoiesis, thermogenesis, and angiogenesis, and is involved in the control of carbohydrate and lipid metabolism. This study was undertaken to determine whether serum concentrations of leptin in obese patients with endometrial hyperplasia and cancer deviate from values in patients with normal endometrium.

STUDY DESIGN

We enrolled 86 obese postmenopausal women, including 40 with endometrial cancer and hyperplasia and 46 with normal endometrium. Depending on BMI, three subgroups were formed: I<30; II = 30-40; III > 40. Leptin concentrations were measured with immunoenzymatic test kits from IBL. Statistical comparison was done with the chi square (chi(2)) test and Statistica software package.

RESULTS

Mean serum concentration of leptin in endometrial cancer and hyperplasia was 16737.1 pg/ml as opposed to 9048.7 pg/ml in patients without endometrial pathology (p<0.0001). Significantly, higher concentrations of leptin were noted in every BMI subgroup of patients with endometrial pathology in comparison to controls (p<0.005).

CONCLUSIONS

Leptin appears to participate in proliferative processes of the endometrium. Obesity is an important risk factor in endometrial cancer.

Differentiation between pyometra and cystic endometrial hyperplasia/mucometra in bitches by prostaglandin F2alpha metabolite analysis

Bitches with pyometra are potential emergency cases which may be clinically difficult to differentiate from cases of cystic endometrial hyperplasia (CEH) in combination with mucometra. In the present study plasma prostaglandin F(2alpha), as measured by its main metabolite 15-keto-13,14-dihydro-PGF(2alpha) (PG-metabolite) concentrations, blood biochemical and hematological parameters were measured in 59 bitches with pyometra, 10 bitches with CEH and nine controls to determine if PG-metabolite could differentiate between the three uterine conditions. Bitches with pyometra had significantly higher plasma levels of PG-metabolite than bitches with CEH (P=0.002) and the controls (P=0.002). PG-metabolite analysis alone had a high sensitivity (98.3%) and a high specificity (80.0%) for the differentiation of pyometra versus CEH in bitches where fluid in the uterus was diagnosed. When a combination of PG-metabolite and percentage band neutrophils (PBN) was used for differentiation of the two diagnoses, a sensitivity of 100% and specificity of 90.0% was obtained. This means that the combination of PG-metabolite and PBN analysis allows for differentiation between cases of pyometra and CEH. If the PG-metabolite level in a bitch is >or=4,524 pmol l(-1), there is a 99% probability of the diagnosis pyometra versus CEH. Levels of PG-metabolite >or=3,054 pmol l(-1), >or=2,388 pmol l(-1) or>or=1,666 pmol l(-1) indicates a 95%, 90% or 80% probability of pyometra, respectively. At high PG-metabolite levels (above about 3,000 pmol l(-1)), PG-metabolite alone is enough for differentiation of pyometra versus CEH. The results of the present study showed that PG-metabolite analysis is valuable in the diagnosis and prediction of severity of uterine diseases.

Differences in serum bisphenol a concentrations in premenopausal normal women and women with endometrial hyperplasia

Exposure to endocrine disrupting chemicals (EDCs) has been raised in relation to its potential for adverse health outcomes. Bisphenol A (BPA) is an estrogenic EDC widely found in plastic products. We determined BPA concentrations in premenopausal women by an enzyme-linked immunosorbent assay and evaluated possible linkage between its contamination levels and endometrial hyperplasia, an estrogen-related disorder of the uterus. It has been implied that higher levels of BPA, which binds to estrogen receptor and plays estrogenic roles may, enhance endometrial hyperplasia. Serum BPA was detectable in all subjects and its concentrations in healthy controls with normal endometrium were 2.5 +/- 1.5 ng/ml (mean +/- SD). BPA levels in patients with simple endometrial hyperplasia with benign nature were 2.9 +/- 2.0 ng/ml and were not significantly different from the controls. Unexpectedly, BPA levels in patients with complex endometrial hyperplasia with malignant potential were 1.4 +/- 0.4 ng/ml and significantly lower compared to both control and simple endometrial hyperplasia groups. In addition, we measured the serum BPA levels in postmenopausal endometrial cancer patient (1.4 +/- 0.5 ng/ml), which were also significantly lower than control and simple endometrial hyperplasia groups. These findings suggest the presence of associations between BPA exposure and complex endometrial hyperplasia and endometrial cancer. The mode of action of BPA may be more complex than expected and the contradictory results may serve as a clue to addressing the mechanisms of linkage between occurrence of estrogen-dependent diseases and endocrine disruption.

C-reactive Protein in the Differentiation of Pyometra From Cystic Endometrial Hyperplasia/Mucometra in Dogs

Hematological parameters, plasma C-reactive protein (CRP), and tumor necrosis factor αwere analyzed in 64 dogs with a presumptive diagnosis of pyometra. Final diagnosis (i.e., pyometra or cystic endometrial hyperplasia [CEH]) was determined by histopathology. As a single test, the percentage of band neutrophils had the highest sensitivity in the prediction of pyometra (sensitivity, 94%). The combination of percentage of bands and CRP had the highest sensitivity (97.7%; specificity, 75%) in predicting the presence of pyometra. The most common clinical signs noted in the study were vaginal discharge, polyuria, polydipsia, lethargy, and gastrointestinal signs. A combination of three or more of these clinical signs was significantly associated with pyometra.

[Distribution of fatty acids of plasmalogenic phospholipids in human erythrocytes and endometrium in hyperplasia of various type]

It is shown that development of hyperplasia of endometrium (PPPE) is accompanied by the valid decrease of plasmenyl-phosphatidylethanolamine (PL PhEA) amount both in the blood erythrocytes and human endometrium and by the increase of diacylglycerophosphoethanolamin (DG PhEA). Data obtained evidence for the development of the state of plasmalogenic phospholipids insufficiency in the organism. When investigating the composition and quantity of fatty acids of plasmalogenic phospholipids of PhEA in the blood erythrocytes of patients it was established that the amount of arachidonic (C 20:4 omega-6) and docosahexaenoic (C 22:6 omega-3) reliably decreases more than by 50%. At the same time one can observe the reliable increase of palmitic (C 16:0) and stearic (C 18:0) fatty acids. Under these conditions the ratios omega-6/omega-3 of both arahidonic and docosahexaenoic (AA/DHA) PL PhEA in the composition of erythrocyte PhEA increase with hyperplasia development 4 and 2 times respectively, but in DPhG the above ratios decreased 1.5 times. The decrease of PUFA in erythrocytes evidences for the increase of their use for restoration of their level disturbances in the organism. As a result of analysis of fatty acids content in tissues at hyperplasia development, considerable decrease of AA and DHA was established in one group of examined patients compared with the control, as well as the increase of omega-6/omega-3 2.8 times, and AA/DHA 2 times. Reliable double increase of AA and eicosatrienoic acid and decrease of DHA and linolenic acid was observed in group 2 of the patient with adenomatosic hyperplasia. The ratio omega-6/omega-3 and AA/DHA decreased twice in the both groups as compared with the control, that evidenced for development of hyperplasia of different origin. Specific distribution of arachidonic acid in plasmalogenic phospholipids at adenomatosic hyperplasia is connected with decrease of plasmalogens content and increase of formation of prostaglandin E2.

Decreased Apoptotic Polymorphonuclear Leukocyte Rate in Dogs with Pyometra

Polymorphonuclear neutrophil (PMN) apoptosis was examined in three dogs with pyometra by TUNEL assay in a 24-hr incubation period and compared with that in healthy control dogs (n=5). The incidence of apoptotic PMNs in dogs with pyometra was 26.4 +/- 5% and that in healthy dogs was 54.3 +/- 7%. The results indicated that apoptotic PMN rates in dogs with pyometra were significantly lower than those in control dogs (p<0.05), suggesting the prolongation of PMN survival.

The use of epostane in an attempt to reproduce cystic endometrial hyperplasia in the bitch

The aetiology and pathogenesis of spontaneous cystic endometrial hyperplasia (CEH) in the bitch is not yet completely understood. Recent research based on the expression of uterine sex hormone receptors in spontaneous cases of CEH suggested that a temporary progesterone deficiency during late oestrus-early metoestrus may be responsible for the onset of CEH development. In the present study a temporary progesterone deficiency during late oestrus-early metoestrus was experimentally created using an inhibitor of progesterone synthesis, epostane. At day 49 of metoestrus, there was a significant reduction in the size of the uterine wall, mainly due to endometrial atrophy, and there was also a significant increase in the mucus-filled uterine lumen in the bitches that had been treated with epostane compared to the control bitches. No significant differences in the expression of sex hormone receptors was observed between the two groups. As no CEH developed in the epostane-treated bitches, an additional oestrogenic stimulus may be required to stimulate endometrial proliferation. Therefore, it is suggested that deficient luteinization of the corpus luteum may be the trigger in the pathogenesis of CEH, as the secretion of varying amounts of sex steroids depends on the degree of luteinization.

[Use of hysteroscopy, ultrasonography and selected hormonal tests for diagnosis of hyperplastic endometrial changes]

THE PURPOSE OF THE STUDY

1. Diagnostic value of ultrasonic endometrium thickness measurement and estimation of ultrasonic endometrium qualitative features in detecting of pathological changes at women in perimenopausal period. 2. Estimation of comparative estrogens and testosterone level in diagnostic of endometrial changes at women in postmenopausal period. 3. Qualification usefulness of analysis of macroscopic hysteroscopy uterine cavity image in detecting of pathological changes at women in perimenopausal period. 4. Comparative analysis of fractional curettage and hysteroscopy as a method of receiving material from uterus to histological estimation at women in perimenopausal period. Material to investigations consist of 242 patients in age 40-86 years, which were divided into groups in dependence from obtained diagnosis on the ground histological estimation sampling received from uterus (BZ--"without changes", M--submucosus myomas, P--endometrial polyps, H--endometrial hyperplasia, CA--endometrial carcinoma). In all of women transvaginal ultrasonic estimation of endometrium (TVS) and fractional curettage were executed. In 160 from them also hysteroscopy with endometrial biopsy was performed. In 53 women in postmenopausal period not using of hormonal replacement therapy one marked concentration estron (E1), estradiol (E2) and testosterone (T) in serum of blood. TVS were performed using a transducer with an emission frequency of 7.0 MHz (B & K Medical 3535). Serum concentration of testosterone and estradiol were executed with EIA assay, however concentration of estron with RIA assays. To endoscopic investigations diagnostic and operative hysteroscops and resectoscope were used. Average thickness of endometrium in group CA, H and P (properly 8.96 and 6.09 and 5.02 mm) showed essential differences in comparison with group BZ (3.38 mm, Tab. 1). In group CA and H greatest cumulation of abnormal features of TVS image (endometrial thickness > 2.5 mm, hyperechoic, heterogeneous and containing cystic spaces endometrium, deformation of middle echo, indistinctness of endo-myometrial border, presence of focal changes in structure of endometrium and presence of fluid in uterine cavity > 1 cm3) was ascertained (Tab. 2, 3, 4). Hysteroscopic macroscopic image showed conformity with histological estimation in groups BZ, M, P, H and CA properly in 78.35, 93.75, 88.33, 22.22 and 88.33% (Tab. 7). On base of histological estimation 159 (65.7% of chances) of pathological changes (P-68, CA-37, M-32, H-22 chances) were detected (Tab. 8). Among them were 41 of asymptomatic chances (P-24, M-7, H-6, CA-4 chances). In hysteroscopy, all but one chance of pathological changes were detected, however curettage skipped most of focal changes.

CONCLUSIONS

1. Ultrasonic measurement of endometrial thickness is sensitive index in detecting cancer and pathological endometrial hyperplasia, instead possesses smaller value in detecting of endometrial polyps and endometrial myomas. 2. Connection of measurement of endometrial thickness with estimation of qualitative features of endometrial and uterine cavity TVS image improves results of detecting all of types intrauterine pathology. 3. Dependence between estrogens level and with thickness of endometrium was confirmed. Practical value of hormonal estimations in diagnostics of endometrial pathological changes is however not large. 4. Analysis of hysteroscopic picture is characterised high agreement with histological investigation with reference to endometrial cancer, endometrial polyps and submucosus myomas. 5. Hysteroskopy with direct biopsy possesses superiority over curettage in detecting all of types of intrauterine pathology, in particular focal changes. 6. Hysteroscopy should determine method of choice at women with recurrent bleedings from uterus, which with curettage pathological changes did not detect.

Function of insulin-like growth factor (IGF-I) and its binding protein (IGFBP-1) in pathological proliferation of endometrium

The purpose of this project was the investigation of insulin, IGF-I and IGFBP-1 concentrations in the serum of patients with pathological changes in endometrium. IGF-I and its binding protein (IGFBP-1) stimulate cell growth and differentiation of the normal and neoplastic endometrium. The mean values of IGF-I concentrations in the group of patients with atypical hyperplasia and endometrial carcinoma were significantly higher than in the control group with normal endometrium. Significantly higher IGFBP-1 concentrations were found in the serum of patients with the atypical hyperplasia of endometrium and endometrial carcinoma. The correlation between insulin concentration and changes in endometrium in the examined groups was not found.

[Histone H3 gene expression level as markers of hyperplasia simplex of endometrium]

SUBJECT

The excessive proliferative activity of endometrial cells drives to hyperplasia, via states: simplex hyperplasia, complex and atypical hyperplasia, and finally preneoplastic state may arise. New molecular markers and their ability to differentiate physiological and pathological states are described.

DESIGN

The aim of this study was to evaluate the usefulness of histone H3 gene expression level as a marker of hyperplasia of endometrium.

MATERIAL AND METHODS

The level of H3 mRNA was estimated using RT-QPCR method in proliferative phase (n = 5) and endometrial hyperplasia simplex (n = 8). Differences in expression level of H3, were evaluated by Student's t-test (t-test for independent samples).

RESULTS

In our experiments the average mRNA H3 expression was significantly higher(p < 0.05, p = 0.03) in case of hyperplasia simplex in comparison to H3 expression in proliferative state of endometrium.

CONCLUSION

The results confirm advantage of estimation of H3 mRNA level as a marker of cell proliferation in endometrium.

[Effect of gestagen therapy on clinical and biochemical parameters in patients with atypical endometrial hyperplasia]

The investigation involved 22 reproductive and menopausal women (aged 30-48) with atypical endometrial hyperplasia. In addition to general clinical examination, all the patients underwent ultrasound scanning of the organs of the small pelvis, hysteroscopy and diagnostic curettage for morphological examination both before and after treatment. All tissue samples taken before and after treatment were assayed for cytoplasmic and plasma-membrane receptor levels and a number of biochemical parameters of plasma membranes. Hormone therapy with prolonged-release gestagen-based drugs pointed to changes which occurred in: (1) sex steroid reception at cytosol and plasma-membrane levels; (2) the lipids profile of plasma membranes, and (3) activity of membrane-related enzymes. Among the beneficial results of gestagen treatment was coming most of lipid profile parameters and plasma-membrane enzymes back to normal. However, a decrease in the progesterone reception level in target tissue after 3-6 month treatment may suggest a likelihood of development of tolerance to gestagen. The data also suggest that further research continue in this area of endometrial precancer.

Cystic endometrial hyperplasia/pyometra in dogs: a review of the causes and pathogenesis

In this review the roles of endogenous and exogenous steroid hormones, steroid receptors, spontaneously occurring and experimentally induced genital tract infection, and endometrial trauma in the cause and pathogenesis of cystic endometrial hyperplasia/pyometra in bitches are considered. It is postulated that intrauterine bacteria, which ascend from the vagina during pro-oestrus and oestrus, induce the disease during metoestrus by acting on the progesterone-primed endometrium directly via toxin production, or indirectly by the release of inflammatory mediators. The lesion can be produced by endometrial trauma in a sterile uterus without the systemic effects associated with the disease. There is no association with premature or increased progesterone concentrations at the time that the disease is normally diagnosed in mid- to late metoestrus; however, such aberrant endocrine changes cannot be excluded from involvement in the pathogenesis of this disease, as there are no data from bitches preceding the onset of clinical signs. Expression of oestrogen and progesterone receptors are modified by endogenous steroid hormones but there is no clear evidence that changes in these receptors are involved in the pathogenesis of the disease; receptor expression can be modified by exogenous hormones.

[The correction of the immunohormonal disorders in patients with hyperplastic processes in the endometrium]

Effects were studied of extremely high-frequency electromagnetic radiation (EHF ER) on indices for the immune and endocrine systems in 48 patients with hyperplastic processes in the endometrium. It is ascertain that along with the established normalization of parameters characterizing the above systems there occurs a return of correlations back to normal, which fact permits using EHF ER as an immunocorrective factor.

Treatment of pyometra (cystic endometrial hyperplasia) in bitches with an antiprogestin

On the basis of a previous study showing the effectiveness of an antiprogestin treatment on the involution of the pyometric uterus and general health of bitches, in the present open clinical study seven bitches with pyometra and progesterone concentrations > or = 2 ng ml-1 were treated with the antiprogestin RU 46534. The dose selected was 5 or 6 mg kg-1 body mass s.c., on the first day of treatment and 3 mg kg-1 body mass on days 2, 3, 4, 8, 12 and 16. Antibiotics were administered until day 16. A vulval discharge was observed within 12-24 h. In one bitch the dose of the antiprogestin had to be increased after day 4. In six bitches the uterine lumen became ultrasonographically undetectable between days 8 to 12; in one bitch some luminal material could still be detected on day 28. The number of blood leucocytes tended to increase after the onset of treatment but had returned to the upper normal range by day 16. In all dogs general condition and feed consumption improved rapidly and were normal within 8 days. No side effects were noted. Two of the dogs were mated subsequently and produced two healthy litters. These observations confirm those of a preceding study and show that the treatment of pyometra with an antiprogestin may lead to a clinical recovery. These results justify further studies to enable the optimum treatment regimen to be established.

Estrogen and progesterone receptor expression in postmenopausal tamoxifen-exposed endometrial pathologies

Assessment of receptor levels in tamoxifen-exposed endometrial pathologies may indicate endometrial cells potential for interaction with tamoxifen. To assess this assumption, we analyzed estrogen receptor (ER) and progesterone receptor (PR) expression by an immunohistochemical technique in endometrial specimens with benign hyperplasia, benign polyps, and carcinoma obtained from postmenopausal breast cancer patients treated with tamoxifen (study group) and from age-matched healthy postmenopausal women treated with estrogen replacement therapy (control group I) and not treated with estrogen replacement therapy (control group II). Overall gland and stromal ER expression of benign endometrial hyperplasia and of benign endometrial polyps was significantly higher in control groups I and II than that obtained from the study group (endometrial hyperplasia: P = 0.0274 and 0.00093, respectively, and P = 0.00003 and 0.00001, respectively; benign endometrial polyps: P = 0.02889 and 0.00596, respectively; and P = 0.00228 and 0.00005, respectively), while there were no differences between the two control groups. Overall gland and stromal PR expression was nearly similar in all the three groups (P = NS). There was no correlation between the length of tamoxifen treatment and the presence of ER and PR in various endometrial pathologies in the tamoxifen-treated patients. The significantly lower ER expression in most benign endometrial pathologies obtained from postmenopausal tamoxifen treated patients may further support the weak estrogen-like effect of tamoxifen on the endometrium in the menopause.

Time-dependent effect of tamoxifen therapy on endometrial pathology in asymptomatic postmenopausal breast cancer patients

Various endometrial lesions were more frequent among asymptomatic postmenopausal breast cancer patients who were treated with tamoxifen for > 48 consecutive months (30.8%) when compared with similar patients who were treated for 6-24 months or for 25-48 months (20.8% and 12.5%, respectively). However, this difference was not statistically significant. There were also no significant differences in the frequency of the various endometrial lesions between these three groups, although endometrial polyps were more frequently found among those treated for > 48 months. Overall, 20.7% of the 164 tamoxifen-treated patients in the study had an endometrial pathology. It can be concluded that there is a slight tendency among those postmenopausal patients who have been treated for > 48 consecutive months to have a higher frequency of endometrial lesions.

Maternal placenta-like endometrial hyperplasia in a beagle dog (Canine deciduoma)

Three thumb-sized segmental swellings were found in both uterine horns of a 15 month-old, non-pregnant and non-pseudopregnant female beagle dog. Histopathological examination of the uterus revealed a marked proliferation of the endometrium that was characterized by two distinct parts, an inner tightly-folded banded layer and an outer dilated spongy layer, quite similar to the maternal placenta except for the fetus and chorion in the lumen. Because the plasma level of progesterone was unusually high at autopsy, this hormonal disorder might be related to the pathogenesis of the endometrial hyperplasia in the present case.

[Structural chromosome aberrations in the peripheral blood lymphocytes in patients with precancer and endometrial cancer]

The level of chromosomal aberrations in cultured blood lymphocytes from patients with hyperplasia, atypical hyperplasia of endometrium and endometrial cancer was studied. Chromosomal aberration frequency significantly increased up to 5.000 +/- 00.47% in patients with atypical and endometrial hyperplasia and to 5.21 +/- 00.53% in patients with endometrial cancer in comparison to 0.67 +/- 0.21% in the control. All indices were more pronounced in endometrial cancer patients with pathology in pedigree.

[Anomalous uterine bleeding in the perimenopause: fibromatosis, hyperplastic endometriopathy and GnRH analogs]

In the light of recent reports, the authors used GnRH analogues to treat 18 perimenopausal women with anomalous uterine bleeding, fibromatosis and endometrial hyperplasia. The aim of the study was to avoid the recurrence of anomalous bleeding, reduce hyperplastic endometriopathy and, having attained stable amenorrhea, avoid resorting to traditional surgical treatment. At the end of the study 9 women had reached the pre-established objective, 4 recommended regular menstruation, 2 reported an episode of metrorrhagia due to endometrial atrophy, and a further 2 suffered a recurrence of the initial problem and underwent hystero-annexiectomy. One patient interrupted the therapy due to the onset of arterial hypertension.

Serum tumour necrosis factor alpha levels in benign and malignant lesions of the endometrium in postmenopausal women. A preliminary study

Tumour necrosis factor alpha (TNF alpha) concentration was determined by a solid phase immunoradiometric assay in sera of 20 healthy postmenopausal women (reference group), 10 women suffering from postmenopausal bleeding with histologically confirmed cystic glandular hyperplasia, and 10 postmenopausal bleeding patients with histologically confirmed endometrial adenocarcinoma. In cases of endometrial adenocarcinoma serum TNF alpha (157.6 +/- 28 pg/ml) was found to be significantly higher than in controls (80.6 +/- 4.1 pg/ml). The rate of abnormally high values of serum TNF alpha increased with advancing stage of the disease. On the other hand, serum TNF alpha level in cases of endometrial hyperplasia (38 +/- 6 pg/ml) was significantly lower than in healthy individuals. It seems that the rise of serum TNF alpha in cases of endometrial carcinoma represents a possible mechanism of immune surveillance. The results suggest clinical usefulness of serum TNF alpha estimations for the differential diagnosis of benign and malignant lesions of the endometrium in women with postmenopausal bleeding.

[The role of prolactin in endometrial lesions]

The Authors examine serum levels of HPRL in basal conditions and after TRH and sulpiride test in 15 patients with endometrial lesions (hyperplasia) and in 15 patients with endometrial adenocarcinoma included in a age range between 44 and 62 years, in which 7 patients present obesity, 10 patients present hypertension and 2 patients are hyperglycemic. The same examination is carried out in a control group of 30 healthy patients. Then the 15 patients with adenocarcinoma and 3 patients with adenomatosa hyperplasia are subjected to surgery and they estimate HPRL levels in endometrium. The results prove that there is no correlation between HPRL plasma levels and endometrium lesions and between endometrium HPRL. The Authors conclude that HPRL does not play a significant role in the pathogenesis of endometrial lesions; use of HPRL plasma levels as a marker of endometrial lesions is not possible.

[Medium-weight molecules in the blood serum of patients with hyperplastic processes in the endometrium and benign and malignant ovarian tumors]

Measurements of blood serum medium mass molecule (MMM) levels in patients with benign and stages III-IV malignant tumors of the ovaries have shown that MMM levels are significantly elevated in the patients with the hyperplastic processes in the endometrium, malignant and benign ovarian tumors. In health MMM level is 0.238 U, in patients with the endometrial hyperplasia and benign ovarian tumors it has been found to make up 0.358 U, in Stage III malignant epithelial tumors this value has been 0.439 U, and in Stage IV tumors 0.366 U. After therapy, resulting in a prolonged remission, MMM level reduced to 270 U on an average. Therefore MMM measurements in the blood serum may be recommended as a test for monitoring the course of a malignant process and the treatment results.

The role of androgens in the late-premenopausal woman with adenomatous hyperplasia of the endometrium

To examine the possible role of androgens in hyperplasia of the endometrium, the concentrations of testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin (SHBG), estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH), were measured in peripheral venous serum obtained from 42 premenopausal women with adenomatous hyperplasia of the endometrium (group A) and from 18 women without hyperplasia (group B). In patients with hyperplasia of the endometrium, significantly higher peripheral venous concentrations were found for all androgens (P less than 0.05) and estradiol (P less than 0.001) than in control patients. In contrast, there was no statistically significant difference in the mean serum values of SHBG as well as in gonadotropins among the population of compared groups. We conclude that apart from the increased estrogenic activity in patients with adenomatous hyperplasia of the endometrium, androgens may play a significant role.

Multiple serum markers in patients with endometrial cancer

Serum levels of carcinoembryonic antigen (CEA), CA 125 and CA 15-3 were measured in 47 patients with endometrial cancer and 20 with endometrial hyperplasia. Before treatment elevated serum levels of CEA, CA 125 and CA 15-3 were found in 14, 43 and 32% of cancer patients, respectively. In the 20 patients with endometrial hyperplasia, CEA and CA 15-3 values were normal, while elevated CA-125 titers were detected in 1 case. There was an increasing incidence of abnormal levels of all markers in relation to a higher tumor stage (stage I: 36%; II: 66%; III: 100%). The percentage of positive marker values increased in case of deep myometrial infiltration (greater than M1) and/or poorer tumor differentiation (greater than G1). However, only percent increase in CA 15-3 positivity was significantly higher in more infiltrating (greater than M1, 7 vs. 65%, p less than 0.01) and less differentiated (greater than G1, 0 vs. 47%, p = 0.01) tumors. These findings suggest that CA 15-3 is in some way associated with the prognostic factors of the disease. All patients except 2 with no evidence of disease after surgery had normal serum marker values. Moreover, CA 125 and CA 15-3 levels reflected the clinical course of the disease during chemotherapy and seemed to be useful for monitoring response to treatment.

[Treatment of hyperplasias of the endometrium]

The treatment of endometrial hyperplasias must be, as a rule, medical and more precisely with the use of progestative drugs. A simple hysterectomy must be proposed for hyperplasias with atypia in women around the time of menopause.

The characteristic pattern of aspartate aminotransferase and alanine aminotransferase in the bitch with the cystic hyperplasia-pyometra complex: effect of medical or surgical treatment

In 75 clinically normal unspayed female control dogs between two and eleven years old the average plasma level of aspartate aminotransferase (AST) was 21.6 +/- 5.7 (+/- SD) IU/l, of alanine aminotransferase (ALT) 40.4 +/- 13.0 IU/l and of the AST/ALT ratio 0.6 +/- 0.2. These values showed only minor changes over years. In 96 bitches with the cystic hyperplasia-pyometra complex there was a very significant increase of the AST, decrease of the ALT and increase of the AST/ALT ratio. The changes were more pronounced in 62 clinically ill bitches with typical endometritis post oestrum, in 18 dogs with gram negative organisms in the uterus and in 53 bitches with white blood cell (WBC) levels higher than 40 X 10(9)/1. Renal failure had no influence on the specific changed values. The changed values returned either temporarily to normal after prostaglandin (PGF2 alpha)-treatment or definitely after ovariohysterectomy.

The role of hormones in the etiology and prevention of endometrial cancer

Unopposed estrogens, both exogenous and endogenous, increase the risk of endometrial cancer although the magnitude of the association between estrogen replacement therapy and adenocarcinoma has been exaggerated by the epidemiologic case-control studies. Not all postmenopausal women need estrogen replacement therapy since some produce sufficient endogenous estrogens to remain asymptomatic and prevent atrophic vaginitis, osteoporosis and atherosclerosis. However, within this group may be those at risk for endometrial cancer, so they need to be identified and treated with cyclic progestogens. Sequential oral contraceptives did not protect young women from adenocarcinoma of the endometrium because of too little progestogen for too short a duration in view of the relatively high dosage of estrogen. However, combination birth control pills significantly decrease the risk for endometrial carcinoma. Endometrial hyperplasia is a precancerous lesion in some women and can be effectively reversed with 10-13 days of progestogen monthly in at least 98% of patients. The progestogen challenge test has been devised to identify postmenopausal women at greatest risk for adenocarcinoma. It should be administered to all postmenopausal women with an intact uterus. This includes asymptomatic women, patients receiving estrogen replacement therapy and women being evaluated for hormone therapy. If there is a positive response to the progestogen challenge, as manifested by withdrawal bleeding, then the progestogen should be continued for 13 days each month for as long as withdrawal bleeding results. If there is no response then the progestogen challenge test should be repeated at each annual examination. Universal use of the progestogen challenge test should prevent nearly all endometrial cancers.

Treatment of endometrial hyperplasia with cyproterone acetate histological and hormonal aspects

A regime of cyproterone acetate (CPA) (300 mg/day by the oral route for 30 days) has been used in 10 post-menopausal women with endometrial hyperplasia (8 atypical and 2 adenomatous). Androstenedione (A), estrone (E1), testosterone (T) and estradiol (E2) plasma levels were determined before and at the end of treatment. The regression of endometrial hyperplasia was ascertained histologically in all patients after 30 days of therapy. All steroids showed a significant decrease (p less than 0.05) as compared with their corresponding basal values. Moreover, the E1/A ratio was significantly lowered (p less than 0.01) following CPA administration (5.9 + 2.9% to 2.5 + 0.6%). From these data it is evident that CPA can not only act as a progestin, but may also reduce the endogenous estrogen production, lowering either the adrenal production of A (the most important estrogen precursor in the post-menopause) or the A to E1 peripheral conversion.

An intrauterine progesterone contraceptive system (52 mg) used in pre- and peri-menopausal patients with endometrial hyperplasia

An intrauterine progesterone contraceptive system (IPCS) (52 mg) was inserted in 25 women with cystic endometrial hyperplasia. Among these women, 11 complained of heavy climacteric symptoms and also received an oestrogen replacement therapy consisting of conjugated oestrogens (0.625 mg/day) administered cyclically for 3 out of 4 wk. Prior to the therapy and after 6 mth of treatment, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), oestrone (E1) and oestradiol (E2) plasma levels were measured and endometrial histology was evaluated. In the women receiving IPCS treatment alone, there were no significant changes in FSH, LH, PRL, E1 and E2 plasma levels. However, there were remarkable changes found in their endometrial histology. In the remaining women receiving both treatments there was a sharp decrease in FSH and LH plasma levels and an increase in E1 and E2 plasma levels, while the prolactin levels remained unchanged. With the exception of two of these women, the endometrial histology changed remarkably. The endometrial morphology of the two exceptions remained unchanged. All climacteric symptoms disappeared after the administration of both IPCS and the oestrogen replacement therapy. The remarkable changes which did occur in the endometrial histology resulted in a less active glandular epithelium and stromal decidual formation, thus proving a useful effect of treatment.