Ovarian endometrioma in an 11-year-old girl before menarche: a case study with literature review

BACKGROUND

To date, a limited number of endometriosis cases occurring before or around the time of menarche have been documented.

CASE

An 11-year-old adolescent underwent an emergency operation for left ovarian endometrioma. Her menarche occurred spontaneously 6 months after surgery.

RESULTS AND CONCLUSIONS

We discuss the above mentioned case and consider data published in the literature. Endometrioma should be considered even in premenarcheal girls with ovarian cysts, regardless of their size.

Synchronous adult-type granulosa cell tumor of the ovary with ovarian fibroma: a case report

The coexistence of two different types of sex-cord stromal tumors, with various clinical symptoms, is extremely rare. We report a case of a 73-year-old woman showing coexistence of adult-type granulosa cell tumor in one ovary with ovarian fibroma in the other. Simultaneously, she was affected by Meigs' syndrome and simple endometrial hyperplasia without nuclear atypia. The different clinical symptoms of the disease according to the available literature are discussed.

Giant uterine leiomyomas causing bilateral hydronephrosis coexisting with endometrial cancer in polyp: a case study

Multiple uterine leiomyomas are present in a large population of women and may cause several uncommon clinical symptoms, including disseminated vein thrombosis and hydronephrosis. We report a case of giant uterine leiomyomas causing bilateral hydronephrosis coexisting with endometrial cancer (EC) deriving from a uterine polyp. A 50-year-old woman was admitted due to bilateral hydronephrosis caused by monstrous abdominal tumor to the IInd Department of Gynecology, Lublin Medical University, Lublin, Poland. A bilateral double-J catheter was inserted. Pelvic examination revealed a huge, rough tumor, originating from the uterus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, and a giant uterus weighing 15.2 kg and measuring 35 x 29 x 18 cm was removed. Histopathological examination revealed multiple uterine leiomyomas with calcification and partial necrosis, and well-differentiated (G1), endometrioid-type EC (Stage IA) concomitant with atypical endometrial hyperplasia, deriving from a uterine polyp. The postoperative recovery was without complications, and the patient was discharged on postoperative day 10. In conclusion, giant uterine leiomyoma may incidentally compress the urinary tract organs, causing hydronephrosis.

Cytokines and endometriosis

INTRODUCTION

Abnormal expression of cytokines is considered to be involved in the pathogenesis of endometriosis.

MATERIAL AND METHODS

In 63 women with various stages of endometriosis preoperative levels of cytokines, including IL-6, IL-8, BVEGF, b-FGF, of TNF RI and TNF RII were analysed employing ELISA tests (R&D kits).

RESULTS

In the sera of endometriosis patients significantly augmented levels of IL-6 and of b-FGF were detected as well as a trend for elevated IL-8 levels.

CONCLUSION

Elevated serum levels of cytokines may show poor correspondence to the localized pathological process. Endometriosis would find a stricter reflection in cytokine levels in fluids or tissues of the pelvis minor.

[Identification of dendritic cells subsets in peritoneal fluid]

Dendritic cells (DC) play a crucial role in the activation of naive T lymphocytes and in the generation of primary T cell responses. DC are present in lymphoid and non lymphoid tissues. Our previous data have shown, that DC are present in peritoneal fluid (PF). There is no other data in literature on this subject. The aim of our study was identification of DC in peritoneal fluid and peripheral blood patients with infertility (n = 5) and benign noninflammatory ovarian tumor (n = 16). Mononuclear cells from PF and peripheral blood were isolated on gradient density centrifugation (Lymphoprep, Nycomed-Norway). Isolated cells (106 of cells per tube) were incubated with mAbs. We collected 300.000 cells using a FACSCalibur flow cytometer and analysed with CellQuest Software. The following directly conjugated monoclonal antibodies were used: anti-BDCA-1(CD1c) FITC, anti-BDCA-2 FITC (Miltenyi Biotec) and anti-CD19 CyChrome, anti-CD123 PE (Pharmingen, USA). The concentrations of peritoneal fluid leukocytes in infertility patients and women with ovarian tumor approximated 6.8 x 10(6) and 7.76 x 10(6), respectively. Using this method, myeloid DC comprised 8.08 +/- 2.69% mononuclear cells PF in infertile women and 11.23 +/- 6.59% mononuclear cells PF in patients with ovarian tumor. The average mean of lymphoid DC was 0.63 +/- 0.33% mononuclear cells PF in infertile women and 0.59 +/- 0.33% mononuclear cells PF in patients with ovarian tumor. The percentage of dendritic cells in peritoneal fluid was significantly higher than in peripheral blood in both studied groups (p < 0.05).

[Differences in human and rat FSH receptors promote activity as a result of the transcriptional factors: E2F1, E2F4 and E2F5 overexpression]

FSH-R expression in granulosa cells varies during the course of ovarian ontogenesis, as well as, during each menstrual cycle. Expression of follicle-stimulating hormone receptors (FSH-R) on Sertoli cells of the testis and ovarian granulosa cells depend on many paracrine and autocrine factors. The modulation of FSH-R synthesis is accomplished via a number of mechanisms including regulation of the promoter activity. Little is known about factors involved in control of FSH-R transcription in different species. The aim of the present study was to investigate differences in the regulation of human and rat FSH-R promoter activity by E2F transcriptional factors.

MATERIAL AND METHODS

The 5'-flanking regions of human and rat FSH receptor gene subcloned in the pGL3 plasmid were transiently transfected into cultured CHO cells and rat granulosa cells. Rat granulosa cells were obtained by puncturing ovaries from DES primed immature Sprague-Dawley rats. Promoter activity was determined by measuring firefly luciferase luminescence of the cell lysate. Transfection efficiency was normalized by the renilla luciferase activity generated by co-transfected pRL-CMV vector. In order to determine the influence of E2F1, E2F4 and E2F5, on FSH-R promoter activity, cells were transfected either with promoter construct alone or with its mixture with selected expression vector.

RESULTS

Rat FSH-R promoter construct (-1033/+6 bp) and human FSH-R promoter construct (-1485/-1 bp) were both active in transfected cells. Overexpression of E2F1 protein decreased both, human and rat wild type FSH-R promoter activity. Overexpression of E2F4 did not affect neither rat nor human FSH-R gene transcription. Expression vector for E2F5 increased both, human and rat, FSH-R promoter activity. Folds of increase were markedly higher in case of rat FSH-R construct transfection, comparing to human FSH-R promoter.

CONCLUSIONS

Results suggest, that the E2F1 and E2F5 factors might play an opposite role in the regulation of FSH-R promoter activity. More pronounced stimulatory effect of E2F5 on the rat FSH-R can be explained by the presence of E2F site in the promoter. Since there is no E2F sensitive element in the human FSH-R promoter sequence, E2F1 and E2F5 can also indirectly influence FSH-R promoter activity.

Peritoneal fluid leptin concentration in infertile patients

Leptin may play a role in the regulation of menstrual cycle acting either directly on ovaries or at the level of the hypothalamic-pituitary axis. Peritoneal fluid is a biologically active environment that influences ovarian function but, on the other hand, concentration of many substances in peritoneal fluid can reflect the functional status of ovaries. In our study, we estimated leptin concentration in peritoneal fluid in relation to serum leptin concentration in infertile patients. A study group consisted of 31 infertile patients that underwent laparoscopy. In 15 patients, laparoscopy did not solve the problem and they were grouped as unexplained infertility, in eight patients we found endometriosis and eight patients were diagnosed as polycystic ovary syndrome (PCOS). We found significantly higher peritoneal fluid leptin concentrations in patients with unexplained infertility and endometriosis compared to those with PCOS. The plasma leptin concentration did not differ between the groups studied. There was no correlation between peritoneal fluid and plasma leptin concentrations in any patient group. Taking into account our results, the role of leptin in reproduction should be emphasized but further investigation is needed to determine its mechanism of action.

[The assessment of dendritic cells cultured from peritoneal fluid macrophages: first report and new perspectives in the treatment of endometriosis]

Dendritic cells represent discrete leukocyte subpopulation of specialist or "professional" antigen-presenting cells (APC). They play a crucial role in the activation of naive T cells "in vivo" They have monocyte/macrophages origin. There are no data in literature on the presence of dendritic cells derived from peritoneal fluid monocytes/macrophages. In our study we tried to culture PF macrophages from patients who undergone surgery so that to obtain dendritic cells. PF was aspirated during laparoscopy from patients with endometriosis, unexplained infertility or benign noninflammatory ovarian tumor. Peritoneal macrophages were isolated using adherence method then were cultured and stimulated with GM-CSF and IL-4. Phenotype of cultured cell was estimated using flow cytometry after incubation with monoclonal antibodies CD45/14, CD 40/HLA-DR, CD28/3, CD3/40L, CD25/5 and CD69/HLA-DR. Morphology of cultured cells was confirmed microscopically after May-Grunvald-Giemsa staining. PF leukocytes concentration varied from 1.2 x 10(6) cells/mm3 to 22.6 x 10(6) cells/mm3. Cultured monocytes/macrophages from PF had morphology typical for dendritic cells. We also found that only dendritic cells from patients with endometriosis had higher expression HLA-DR antigen (93.6% of cells) and low expression of CD40 (2.7% of cells) on their surface in comparison to reference group. It is worthy to notify that dendritic cells from patients with endometriosis expressed also CD25 antigen characteristic for T leukocytes. To our data it is the first report in literature on dendritic cells obtained from PF macrophages.

[Phagocyte activity of macrophages in the peritoneal fluid of patients with endometriosis]

Phagocytic activity of macrophages isolated from peritoneal fluid (PF) was estimated using flow cytometry. Study group consists of 28 patients with endometriosis and 19 patients with benign noninflammatory tumour of adnex(is) served as reference group. Macrophages were processed in two ways: fresh cells were obtained from women with endometriosis (n = 7) and reference group (n = 10) and frozen cells derived from patients with endometriosis (n = 21) and reference group (n = 9). Phagocytic activity of macrophages was measured against opsonized and conjugated with FITC E. coli. It is worth to notify that phagocytosis was determined in PF environment in the study. Percentage of phagocytosing fresh macrophages did not differ (p = 0.05) between subjected groups of patients and was respectively 64.3% +/- 17.3% vs 49.0 +/- 4.0%. Phagocytic activity of frozen macrophages derived from patients with endometriosis was significantly higher (p < 0.02) in comparison to reference group (14.3 +/- 9.1% vs 5.2 +/- 2.8%).

[Concentrations of MMP-1, TIMP-1, MMP-1/TIMP-1 and I CTP complexes in follicular fluid as related to fertilization rate in women treated with in-vitro fertilization]

OBJECTIVES

Metalloproteinases and their inhibitors appear to control connective tissue remodelling during follicular rupture. The aim of the study was to establish if oocytes fertilisation rate after ovulation induction depends on the concentrations of MMP-1, its inhibitor TIMP-1, MMP-1/TIMP-1 complex and I CTP in follicular fluid (FF).

MATERIAL AND METHODS

FF were collected from 37 infertile patients undergoing ovulation induction using either short or long protocol. FF was obtained 36 hours after administration of hCG (Pregnyl). The level of MMP-1, TIMP-1, MMP-1/TIMP-1 complex were measured using ELISA kits and I CTP, E2, FSH, LH, using RIA assay kits.

RESULTS

Statistically significant (p < 0.05) difference was found in TIMP-1, E2, and FSH concentration, being higher in the group with more than 75% fertilisation rate: TIMP-1 728.8 + 100.1 ng/ml vs 666.3 + 94.5 ng/ml; E2 477.3 +/- 160.0 ng/ml vs 368.0 +/- 190.0 ng/ml and FSH 7.27 +/- 1.45 mIU/ml vs 6.24 +/- 1.6 mIU/ml.

CONCLUSIONS

Statistically significant increase in TIMP-1 concentration observed among patients with fertilisation rate above 75% indicates an important role of this substance in ovulation process.

Total antioxidant status of peritoneal fluid in infertile women

OBJECTIVE

To determine whether impairment of the antioxidant systems of peritoneal fluid might be a factor responsible for infertility.

STUDY DESIGN

Total antioxidant status was measured in peritoneal fluid obtained from 18 infertile women suffering from minimal or mild endometriosis, 23 patients with unexplained infertility, 12 women with tubal infertility and 13 fertile women.

RESULTS

Total antioxidant status was significantly lower in peritoneal fluid from women with unexplained infertility (0.49+/-0.21 mmol/l) compared to both fertile patients (0.67+/-0.24 mmol/l, P=0.02) and women with tubal infertility (0.76+/-0.26 mmol/l, P=0.001). Peritoneal fluid total antioxidant status did not differ significantly between patients with endometriosis (0.61+/-0.2 mmol/l), tubal infertility and the fertile group (P>0.05).

CONCLUSIONS

Our results suggest that low antioxidant status in peritoneal fluid may play a role in the pathogenesis of infertility.

[Total antioxidant status and activity of an extracellular superoxide dismutase in peritoneal fluid and plasma from women with unexplained infertility]

OBJECTIVES

To evaluate the activity of an extracellular superoxide dismutase (EC SOD) and total antioxidant status in peritoneal fluid (PF) and plasma from women with unexplained infertility (UI).

MATERIALS AND METHODS

PF and plasma samples were collected from 10 women with UI and 10 patients with tubal infertility (reference group). TAS was measured using Randox diagnostic reagent system. The activity of EC SOD was estimated using Calbiochem assay kit.

RESULTS

TAS was significantly lower in PF from women with UI. Plasma TAS did not differ significantly between the groups. Peritoneal TAS was significantly lower compared to plasma TAS and there was a positive correlation between PF and plasma total antioxidant status. Activity of EC SOD did not differ significantly between the groups in either PF and plasma samples.

CONCLUSIONS

These data demonstrate that low antioxidant status of PF but not that of blood may be responsible for idiopathic infertility. The activity of EC SOD doesn't appear to play a role in UI.

[Malonyldialdehyde and total antioxidant status in the peritoneal fluid of infertile women]

OBJECTIVE

To estimate the concentration of malonyldialdehyde (MDA) and total antioxidant status in the peritoneal fluid (PF) of patients with unexplained infertility (UI) and infertile women with minimal and mild endometriosis.

MATERIALS AND METHODS

PF was obtained during laparoscopy from 8 women with UI, 12 infertile women with endometriosis (I degree and II degrees rAFS) and 10 women with benign noninflammatory ovarian tumours. All laparoscopies were performed in the follicular phase of the cycle. MDA concentration was measured according to Ledwozyw method, TAS was measured spectrophotometrically using RANDOX diagnostic reagent system.

RESULTS

We found significantly higher concentration of MDA in PF from both patients with UI (p = 0.03) and with endometriosis (p = 0.046) compared to the control group. TAS was significantly (p = 0.027) higher in PF of women with UI but did not differ significantly (p = 0.49) between patients with endometriosis and controls.

CONCLUSIONS

Our results show that an imbalance between lipid peroxides and the antioxidant system in PF environment may be one of the main factors responsible for the UI. In the group with endometriosis a marginally significant difference in MDA levels, no significant differences in TAS and data from the literature, suggest that accelerated lipid peroxidation in PF doesn't appear to play a role in the endometriosis associated infertility.

[The concentration of interleukin-2 and interleukin-2 soluble receptors in peritoneal fluid of patients with unexplained infertility]

OBJECTIVES

We measured the concentration of interleukin-2 (IL-2) and interleukin-2 soluble receptor (sIL-2R) in peritoneal fluid (PF) of patients with unexplained infertility.

MATERIALS AND METHODS

PF was obtained during laparoscopy from 7 women with unexplained infertility (UI) and 11 women with benign noninflammatory ovarian tumors. All laparoscopies were performed in follicular phase of the cycle. IL-2 and sIL-2R concentrations were measured in PF supernate stored in -70 degrees C until analysis using ELISA method (ENDOGEN).

RESULTS

We found significantly (p = 0.009) lower concentration of sIL-2R in PF from patients with UI (303.844 U/ml) than in reference group (556.385 U/ml). The level of IL-2 was not detectable in 2 cases from women with UI and 5 cases from reference group. The concentration of IL-2 in PF did not differ (p = 0.135) between patients with UI (2.346 pg/ml) and those from reference group (1.064 pg/ml).

CONCLUSIONS

The concentration of sIL-2R in PF of patients with UI was lower than in those from reference group. This may be the factor responsible for insufficient local immunosuppression, affecting reproduction.

[Hysterosalpingographic evaluation of tubal patency in women treated for anovulatory infertility]

During therapy of anovulatory infertility, percentage of pregnancies is lower than the ovulation rate. Cause of this phenomenon is connected as well with the inadequate corpus luteum as others anomalies of the genital tract. Hysterosalpingography was performed in 120 infertile women in whom pregnancy did not occur in spite of effective induction of ovulation. Patency of both tubes was observed in 79 percent of patients. Occlusion of right tube has occurred in 8 percent, left tube in 5 percent, and both tubes in 8 percent of women. Authors suggest that laparoscopy should be obligatory as diagnostic and therapeutic procedure in woman with concomitant ovarian failure and abnormal HSG results.