Chlamydia trachomatis Seroprevalence and Ultrasound-Diagnosed Uterine Fibroids in a Large Population of Young African-American Women.

Reproductive tract infections have long been hypothesized to increase the risk of uterine fibroids. Few studies have been conducted, even for the common infection genital Chlamydia trachomatis (gCT), and only with self-reported gCT data. Our investigation used micro-immunofluorescence serology for gCT to characterize past exposure. We used cross-sectional enrollment data from a prospective fibroid study carried out in the Detroit, Michigan, area; ultrasound examinations systematically screened for fibroids. Participants were African-American women aged 23-34 years (recruited in 2010-2012). Age- and multivariable-adjusted logistic regression models were used to estimate odds ratios. A total of 1,587 women (94% of participants) had unequivocal gCT serology results; 22% had fibroids. Those who were seropositive for gCT were less likely to have fibroids (age-adjusted odds ratio = 0.68, 95% confidence interval: 0.54, 0.87; multivariable-adjusted odds ratio = 0.80, 95% confidence interval: 0.62, 1.03). Inverse associations were similar across categories of fibroid size, number, and total volume. Participant groups likely to have had multiple or severe infections (multiple serovar groups, more sex partners, clinically diagnosed chlamydia) all showed statistically significantly reduced odds of fibroids. A protective association of gCT with fibroids was unexpected but plausible. gCT infection might increase immune surveillance and eliminate early lesions. Further investigation on the relationship between fibroid development and reproductive tract infections is needed.

[EFFECT OF LONGIDAZE ON MICROBIAL LANDSCAPE OF CERVICAL CANAL AND UTERINE CAVITY DURING THERAPY OF WOMEN WITH CHRONIC NONSPECIFIC ENDOMETRITIS AND UTERUS MYOMA].

AIM: Evaluation of microbiological effectiveness of longidaze preparation use during therapy of active non-specific endometritis in women with uterus myoma. MATERIALS AND METHODS: 2 groups of women were formed by a method of random selection. The first was composed of patients with active chronic endometritis, that had received standard etiotropic antibacterial therapy. The second included patients, that had received longidaze in addition to the standard therapy. Therapy effectiveness evaluation was carried out based on the analysis of microbial landscape of cervical canal and uterine cavity 2 months after the therapy during phase I of the menstrual cycle. RESULTS: Non-plasma-coagulating staphylococci, enterococci and anaerobes were established to be present predominately in the examined women of both the first and the second group. CONCLUSION: The application of longidaze in combination with antibacterial therapy results in the most significant improvement of microbial landscape of cervical canal and uterine cavity.

Fibroid infected with Escherichia coli requiring surgical removal following uterine artery embolization.

BACKGROUND: Uterine fibroid necrosis and infection is a rare but potentially serious event following uterine artery embolization (UAE). We describe a case of surgical removal of an infected necrotic uterine fibroid. CASE: A 31-year-old Jehovah's Witness with severe anemia presented with sepsis following UAE. The uterus was preserved by performing transvaginal surgical removal. Final pathology demonstrated Escherichia Coli infection of the necrotic fibroid. The patient improved postoperatively. CONCLUSION: Surgical removal of an infected necrotic fibroid may be a preferred option for women wishing to avoid hysterectomy following UAE. Appropriate case selection and optimization of hemoglobin concentration before UAE is important to minimize complications.

Contexte : La nécrose et l'infection d'un fibromyome utérin constituent un événement rare, mais potentiellement grave, à la suite de l'embolisation de l'artère utérine (EAU). Nous décrivons un cas de retrait chirurgical d'un fibromyome utérin nécrosé et infecté. Cas : Une témoin de Jéhovah de 31 ans connaissant une anémie grave a présenté une sepsie à la suite d'une EAU. L'utérus a été préservé au moyen de l'exécution d'un retrait chirurgical transvaginal. L'examen pathologique final a démontré la présence d'une infection à Escherichia Coli dans le fibromyome nécrosé. L'état de la patiente s'est amélioré à la suite de l'opération. Conclusion : Le retrait chirurgical d'un fibromyome utérin nécrosé et infecté pourrait constituer l'option à privilégier pour les femmes qui souhaitent éviter l'hystérectomie à la suite d'une EAU. Avant la tenue d'une EAU, il s'avère important de bien sélectionner les patientes qui pourraient en tirer avantage et d'optimiser la concentration en hémoglobine, et ce, afin de minimiser les complications.

Pyomyoma after dilatation and curettage for missed abortion.

Infection of a leiomyoma is a very rare clinical entity called pyomyoma. Pathology may be encountered during the reproductive period, pregnancy, and even postmenopausal period. In this report, we present a case of pyomyoma which developed after dilatation and curettage managed by broad spectrum antibiotics and myomectomy to preserve the fertility in a 31-year-old patient.

Conservative laparoscopic approach to a perforated pyomyoma after uterine artery embolization.

We describe a conservative laparoscopic approach to treatment of a perforated pyomyoma after uterine artery embolization. A 36-year-old woman came to our emergency department 8 weeks after undergoing uterine artery embolization. She reported painful abdominal cramps. Physical examination revealed fever, tachycardia, hypotension, abdominal pain with rebound tenderness and pain during bimanual examination. Ultrasonography showed a fundal/subserosal leiomyoma and a moderate amount of fluid in the abdominal cavity. Because the patient desired preservation of the uterus, a laparoscopic approach was used for drainage and lavage of a perforated pyomyoma. The patient had an uneventful recovery and remained well at follow-up visits. Second-look diagnostic laparoscopy enabled treatment of the adhesions formed and revealed patent fallopian tubes. Surgery has been the primary approach to pyomyoma. However, hysterectomy leads to irreversible sterility and myomectomy can be difficult to perform. Therefore, there is need for a less invasive intervention in women who seek conservative treatment. Recently, computed tomography-guided drainage was successfully performed in two patients with pyomyoma. To our knowledge, this is the first report of a successful conservative laparoscopic approach to pyomyoma.

Characterization of the endometrial, cervicovaginal and anorectal microbiota in post-menopausal women with endometrioid and serous endometrial cancers.

OBJECTIVE: To characterize the microbiota of postmenopausal women undergoing hysterectomy for endometrioid (EAC) or uterine serous cancers (USC) compared to controls with non-malignant conditions. METHODS: Endometrial, cervicovaginal and anorectal microbial swabs were obtained from 35 postmenopausal women (10 controls, 14 EAC and 11 USC) undergoing hysterectomy. Extracted DNA was PCR amplified using barcoded 16S rRNA gene V4 primers. Sequenced libraries were processed using QIIME2. Phyloseq was used to calculate α- and ß- diversity measures. Biomarkers associated with case status were identified using ANCOM after adjustment for patient age, race and BMI. PICRUSt was used to identify microbial pathways associated with case status. RESULTS: Beta-diversity of microbial communities across each niche was significantly different (R2 = 0.25, p < 0.001). Alpha-diversity of the uterine microbiome was reduced in USC (Chao1, p = 0.004 and Fisher, p = 0.007) compared to EAC. Biomarkers from the three anatomical sites allowed samples to be clustered into two distinct clades that distinguished controls from USC cases (p = 0.042). The USC group was defined by 13 bacterial taxa across the three sites (W-stat>10, FDR<0.05) including depletion of cervicovaginal Lactobacillus and elevation of uterine Pseudomonas. PICRUSTt analysis revealed highly significant differences between the USC-associated clades within the cervicovaginal and uterine microbiota. CONCLUSIONS: The microbial diversity of anatomic niches in postmenopausal women with EAC and USC is different compared to controls. Multiple bacteria are associated with USC case status including elevated levels of cervicovaginal Lactobacillus, depletion of uterine Pseudomonas, and substantially different functional potentials identified within cervicovaginal and uterine niches.

Association between the microbiota and women's cancers - Cause or consequences?

Breast, ovarian and uterine cancers are the most common neoplasms among women. Several mechanisms may be involved in oncogenesis and these include environmental and genetic factors. Bacteria may affect the development of some cancers, with bacterial components, their products and metabolites interacting with susceptible tissues. Commensalism and dysbiosis are important potential mechanisms involved in oncogenesis, and an effective strategy for diagnosis and treatment is required. The purpose of this review was to analyze the complex associations between these cancers in women, and the microbiota, specifically bacterial microbes. However, several cancers have an increased prevalence among individuals with HIV and HPV so the relationship between viral infections and malignancies in women is also referred to. We described how different phylum of bacteria, particularly in the gut, mammary tissue and vaginal microbiome may be involved in carcinogenesis; and we discuss the potential pathways involved: (I), that lead to cell proliferation, (II), immune system perturbation, (III), cell metabolic changes (e.g., hormonal factors), and (IV), DNA damage. Studies investigating the differences between the composition of the bacterial microbiota of healthy women compared to that present in various conditions, and the clinical trials are summarized for the few studies that have addressed the microbiota and related conditions, are also reviewed.

Overexpression of Clostridium perfringens enterotoxin receptors claudin-3 and claudin-4 in uterine carcinosarcomas.

PURPOSE: To evaluate the expression levels of claudin-3 and claudin-4, the low- and high-affinity receptors, respectively, for the cytotoxic Clostridium perfringens enterotoxin (CPE) in uterine carcinosarcomas and explore the potential for targeting these receptors in the treatment of this aggressive uterine tumor. EXPERIMENTAL DESIGN: We analyzed claudin-3 and claudin-4 receptor expression at mRNA and protein levels in flash frozen and formalin-fixed, paraffin-embedded carcinosarcoma specimens. Recombinant CPE was used as a novel therapy against chemotherapy-resistant carcinosarcoma cell lines in vitro. The therapeutic effect of sublethal doses of CPE was studied in severe combined immunodeficient mouse xenografts harboring large s.c. carcinosarcomas. RESULTS: All flash-frozen carcinosarcoma biopsies (12 of 12) and short-term carcinosarcoma cell lines evaluated overexpressed claudin-3 and claudin-4 by quantitative reverse transcription-PCR. Membranous immunoreactivity for claudin-4 protein expression was documented in 80% (20 of 25) of primary tumors and 100% (6 of 6) of the metastatic carcinosarcomas, whereas negligible staining was found in normal endometrial cells. Regardless of their resistance to chemotherapeutic agents, all short-term carcinosarcoma cell lines tested died within 1 h of exposure to 3.3 microg/mL of CPE in vitro. Intratumoral injections of well-tolerated doses of CPE in large s.c. carcinosarcoma xenografts led to large areas of tumor cell necrosis and tumor disappearance in all treated animals. CONCLUSIONS: Claudin-3 and claudin-4 receptors are highly overexpressed in carcinosarcoma. These proteins may offer promising targets for the use of CPE as a novel type-specific therapy against this biologically aggressive variant of endometrial cancer.

[Life-threatening intrauterine infection with Clostridium perfringens].

In this case report, a 40-year-old woman with a history of a uterine leiomyoma presented with abdominal pain and fever. Initially, her symptoms were associated with a bleeding from an ovarian cyst seen on a CT scan of the abdomen showing free intraperitoneal fluid surrounding the internal genitals. Meanwhile, her blood cultures came out positive for Clostridium perfringens, and her condition deteriorated despite intravenous antibiotics. A new CT scan revealed intrauterine gas development. A laparotomy was performed with removal of the internal genitals, and the patient improved on continuous antibiotics.

Vascular tumors induced by polyoma virus in pregnant rats.

Female R rats mated with an R male and inoculated in utero with polyoma virus after "fetectomy" developed tumors. These tumors originated in the uterus and were of fetal origin (visceral yolk sac). Histologically, they were hemangiomas or hemangiosarcomas. The latter were transplantable and grew in tissue culture. Infectious polyoma virus could not be isolated from the tumor cells kept as transplantable lines or cultured in vitro. However, the tumor cells were positive for the polyoma-specific surface antigen, polyoma tumor-specific transplantation antigen(s), and polyoma nuclear T antigen.

Expression of RNA of an endogenous replication-defective retrovirus in rat mammary adenocarcinomas induced by 7,12-dimethylbenz[a]anthracene.

An investigation into the possible relationship between chemical carcinogen induction of rat mammary tumors and the expression of an endogenous retroviral genome was initiated. Mammary tumors were induced in female SD rats with 7,12-dimethylbenz[a]anthracene (DMBA). Tumors, identified histologically as mammary adenocarcinomas, were analyzed for RNA of a replication-defective endogenous retrovirus or RNA of a helper-independent endogenous type C virus. Expression of RNA of the replication-defective virus was detected in mammary tumors weighing 0.2--2.0 g. Larger tumors, for which histologic examination revealed proportionally more fibroblastic tissue than epithelial cells, did not contain comparable concentrations of this viral RNA. RNA homologous to a helper-independent rat type C retrovirus was not detected in tumors of any size. A cell line was established from a primary DMBA-induced mammary adenocarcinoma and appeared similar to the small mammary tumors with respect to endogenous type C viral RNA expression. We discuss possible implications of the expression of endogenous replication-defective viruses for use as markers for the effects of chemical carcinogens.

HSV, CMV, and HPV in human neoplasia.

We are studying the role of sexually transmitted viruses in the development of human tumors. The persistence of herpes simplex virus, cytomegalovirus, and human papillomavirus nucleic acid sequences has been examined using cloned viral DNA sequences as probes. The relationship of the viruses to various stages in the progression of neoplasia is examined, with particular reference to the role of viral and/or cellular genes in the initiation, promotion, and maintenance of the neoplastic phenotype. The human tumors of major interest in this context are carcinomas of the cervix, vulva, and anus and Kaposi's sarcoma. The minimal fragment of HSV-2 DNA detected in cervical tumors is contained within a 656-bp sequence that can be used in transfection experiments to transform rodent cells in vitro to a malignant phenotype. However, neither this fragment nor any other is consistently retained in cervical tumors, suggesting that this viral DNA may initiate but not maintain the transformed phenotype.

In situ hybridization for human papillomavirus DNA in uterine adenosquamous carcinoma with glassy cell features ("glassy cell carcinoma").

Eighteen uterine adenosquamous carcinomas that showed focal glassy cell features (33% to 85% of tumor histology) or predominant glassy cell features (greater than 85% of tumor histology) were studied by in situ hybridization for human papillomavirus (HPV). Viral DNA was present in neoplastic cells in five cases: type 18 in four cases (two cervical adenosquamous carcinomas with predominant glassy cell features, two cervical adenosquamous carcinomas with focal glassy cell features) and type 16 in one case (cervical adenosquamous carcinoma with predominant glassy cell features). Positive intranuclear staining for HPV DNA was present within areas of squamous and glandular differentiation and within areas with glassy cell features. The mean age of HPV(+) patients was less than HPV(-) patients (mean, 57 years, compared to 67 years). No significant association between HPV status and prognosis or glassy cell features was detected. Human papillomavirus types 16 and 18 are associated with adenosquamous carcinoma with predominant glassy cell features or focal glassy cell features, "glassy cell carcinoma." Automated colorimetric in situ hybridization is an effective method to detect HPV DNA.

Isolation of Aeromonas species from clinical sources.

In a period of one year, in a general hospital, Aeromonas hydrophila was isolated from 13 patients and Aeromonas shigelloides from one patient. Eight of the patients had superficial infections, two had urinary tract infections, and four had bacteriaemia. The association of Aeromonas bacteriaemia with cirrhosis of the liver and malignant disease, which has been previously reported, was observed in three of the four bacteriaemic patients. The key to laboratory diagnosis of this genus is the routine performance of the oxidase test in bacteriological procedures for the identification of Gram-negative bacilli.

Double HPV infection in African cervical cancer detected by polymerase chain reaction.

Biopsy samples from 13 Kenyan patients with squamous cell carcinoma of the cervix were analysed for the presence of type specific HPV DNA by polymerase chain reaction (PCR). HPV 16 was confirmed in 11 (85%) and HPV 18 in 9 (69%) samples. HPV 6 DNA was detectable in only 3 (23%) samples and no HPV 33 was found. Infection with either HpV16 or 18 was seen in 12 (92%) and infection with both in 8 (62%) cases. The prevalence of double infection found is higher than in previous reports. The significance of this and possible effects of parity on cervical neoplastic changes are discussed.

Study of infection by human papillomavirus in severe dysplasias and carcinomas in situ of the uterine cervix using immunohistochemistry and in situ hybridization.

Diagnosis of human papillomavirus (HPV) infection in uterine cervical lesions is usually based on histopathological criteria and, in some cases, is confirmed by immunohistochemistry. The recent development of in situ hybridization techniques has facilitated the detection of HPV in these lesions. Consequently, we carried out a study on 18 uterine cervical biopsy specimens histopathologically diagnosed as severe dysplasias and carcinomas in situ, using an immunohistochemical method with a rabbit polyclonal antibody against the HPV common structural antigen and in situ hybridization techniques with three biotinylated DNA probes for HPV types 6/11, 16/18, and 31/35/51. By immunohistochemistry only one case (5.5%) proved to be positive, whereas by in situ hybridization 12 HPV-positive cases were obtained (66.6%), of which 7 were positive for HPV types 16/18 (38.8%) and 6 for HPV types 31/35/51 (33.3%). One case was positive with positive with both DNA probes. From our results it can be inferred that in situ hybridization is a more sensitive technique than immunohistochemistry for confirming the presence of HPV in severe dysplasias and carcinomas in situ of the uterine cervix. Furthermore, in situ hybridization provides much more information than immunohistochemistry since it permits the identification of the HPV types causing the lesion.

Bacterial flora detected of the uterine endometrial cavity of diabetic patients with myoma uteri.

Patients with diabetes frequently suffer from various postoperative complications, especially infection. Diabetic patients also have a high incidence of uterine endometrial cancer. The nature of the intrauterine bacterial flora may be related to both infection and carcinogenesis. Therefore, identification of the intrauterine bacterial flora in diabetic patients may be useful. Bacteria were detected in the uterine endometrial cavity of 100% of ten diabetic patients with myoma uteri. However, among 20 non-diabetic control patients with myoma uteri, only three 15% harbored bacteria. Members of the Enterobacteriaceae (Escherichia coli, Proteus spp., Enterobacter cloacae, and Klebsiella pneumoniae) were the predominant bacteria. We speculate that bacterial products contribute to carcinogenesis, as has been proposed for colon carcinoma. Antimicrobial agents active against Enterobacteriaceae should be used to prevent postoperative infections in gynecologic procedures in diabetic patients.

[Effect of mycoplasma contamination of the human uterine leiomyosarcoma cell line SK-UT-1B on karyotype structure]. / Vliianie mikoplazmennoi kontaminatsii kletochnoi linii leiomiosarkomy cheloveka SK-UT-1B na kariotipicheskuiu struktury.

The karyotypic variability has been investigated for human uterine leiomyosarcoma cell line SK-UT-1B, cultivated for 30-90 days after contamination with Acholeplasma laidlawii, strain PG-8. The character of cell distribution for chromosome number gradually changes in contaminated cells, comparatively to the control, with the lengthening of the term of contamination. So, in 30 days the analysed distributions do not differ in the experimental and in the control variants, the modal number of chromosomes being equal to 46. In 60 days the frequency of cells with modal number of chromosomes have a tendency to decrease, and the range of variability in the number of chromosomes tend to increase. In 90 days, the frequency of cells with modal number of chromosomes decreases significantly, and the range of variability on the number of chromosomes increases significantly. The number of chromosomal aberrations gradually increases in contaminated cells, as compared to the control, with the lengthening of the term of contamination. So, in 30 days the number of chromosomal aberrations does not increase, only the number of dicentrics (telomeric associations) has the tendency to increase. In 60 days, the number of chromosomal aberrations, mainly dicentrics, increases significantly. In 90 days, the number of chromosomal aberrations increases significantly, including both dicentrics and chromatid breaks. The possible reasons of the observed character of karyotypic variability is discussed. Our previous results make it possible to suppose that the increase in the number of dicentrics in "markerless" line SK-UT-1B with long term contamination may be an additional evidence on the role of dicentrics in cell adaptation to in vitro conditions in such lines.

[Detection of papilloma virus of the human uterine cervix by in situ hybridization method--comparison with immunohistochemistry].

The usual methods for pathological diagnosis of HPV infection of the uterine cervix include screening in cytodiagnosis and histodiagnosis and confirmation by immunohistochemistry (IHC) method. However, some institutes have recently begun to use in situ hybridization (ISH) method for definitive diagnosis using a DNA probe. We compared IHC with ISH with regards to the localization and rate of detection of HPV in lesions of the uterine cervix such as dysplasia and squamous cell carcinoma in the present study. The cases found positive by IHC showed brownish nuclei of the epithelium and those positive in ISH showed purple to purplish-black nuclei. The comparison of cases positive by both methods revealed that the number of cells positive by IHC was smaller than that by ISH, and the cells positive by IHC were localized in the superficial layer. HPV was detected by the IHC various lesions of the uterine cervix in 13 (12.3%) of 106 patients, while it was detected by the ISH in 39 (36.8%) of 106 patients. The results of both methods were in accordance in 66.0% (77 patients; positively in 8 and negatively in 62). The detection sensitivity of IHC is lower than that of ISH. IHC cannot be used to identify the type of HPV, and it is impossible to confirm the presence or absence of virus by this method in cases of malignant changes. ISH is therefore necessary for identification of HPV and investigation of a histopathological relationship between HPV type and malignant change.