Ovarian Sertoli-Leydig cell tumour with α-fetoprotein-producing intestinal glandular cells. Clinical case and short review of basic literature.

Sertoli Leydig cell tumor of the ovary, is a rare neoplasm from the group of sex cord-stromal tumors of the ovary, accounting for less than 1% of all ovarian tumors. Among the Sertoli Leydig cell tumors, we distinguish a separate group of tumors secreting α-fetoprotein (AFP). The young 24-year-old woman presented to the Clinical Department of Gynaecological Endocrinology at the University Hospital in Krakow due to secondary amenorrhea, hirsutism and worsening abdominal pain for several months. During the admission draws attention was drawn to the abnormal level of testosterone, AFP and the revised structure of the ovary in the ultrasound. After a preliminary diagnosis, expanded pelvic MRI was performed, which found an isolated tumor derived from Sertoli Leydig cells. The patient was enrolled to unilaterally remove the right ovary by laparotomy. Histopathological examination and immunohistochemical staining confirmed the diagnosis of Sertoli Leydig cells tumor, and in pathological examination we found glandular mucosa cells of the colon. Owing to scientific reports on the stromal tumors of the ovary, we decided to perform genetic testing and verify the patient's karyotype. In the follow-up 90 days after the surgery, levels of testosterone and AFP were correct. In case of Sertoli Leydig cell tumors, especially in young women of childbearing potential, special attention should be paid to Anti-Mullerian hormone testing before surgery, as well as genetic diagnostics to exclude disorders of sex development.

Markers of implantation in ectopic and high-risk early eutopic pregnancies.

INTRODUCTION: This study focused on the assessment of HSP-10, HSP-27 and PSG-11 which are one of the first detectable serum pregnancy proteins. Contrary to ultrasound imaging, biochemical methods allow to clarify the pathogenesis and pathomechanism of high-risk pregnancies, fetal anomalies, and abnormal fetal implantation. Early serum concentration estimation of HSP-10, HSP-27 and PSG-11 may be very useful not only in prognosis of pregnancies of unknown localization (PUL), but also as markers of ectopic pregnancies. OBJECTIVES: The aim of the study was to evaluate the expression of HSP-10, HSP-27, PSG-11 implantation proteins in ectopic and eutopic pregnancies, and their mutual correlations. PATIENTS AND METHODS: The study involved 42 healthy women who were hospitalized, due to symptoms of imminent miscarriage, risk of spontaneous abortion, or the diagnosis of an ectopic pregnancy. The subjects were subdivided into two equal groups of 21 women who consented to participate in this clinical trial. Biochemical assays were performed involving PSG-11, HSP-27, and HSP-10 serum concentration. RESULTS: Serum concentration levels of HSP-10, HSP-27, and PSG-11 were significantly higher in pregnancies at risk of spontaneous abortion as compared to ectopic pregnancies. CONCLUSIONS: The results of the study indicate high value of PSG-11, HSP-27 and HSP-10 serum concentrations as predictors of correct implantation site. This may be very useful in prognosis of pregnancies of unknown localization (PUL) and early conservative/surgical ectopic pregnancies treatment if necessary to preserve maximum fertility.

[Hormonal contraception in autoimmpne diseases]. / Antykoncepcja hormonalna w wybranych chorobach autoimmunologicznych.

The onset and the course of autoimmune diseases is influenced among other factors by the sex hormones. Hormonal contraception might affect the course of the autoimmune disease. The paper summarises the manner of save application of hormonal contraception in patients with autoimmune disease.

Reduction in the level of antibodies against heat shock proteins 60 during different hormonal protocols in postmenopausal women.

INTRODUCTION: In current literature, the immune-inflammatory theory of atherosclerosis is widely discussed. The role of how heat shock proteins 60 (HSP60) lead to the development of the atheromatous plaque is especially underlined. The aim of the study is to estimate the influence of three hormonal protocols on behavior of antibodies against HSP60. It determines the state of endothelium in postmenopausal women. MATERIAL AND METHODS: The study was carried out on 90 women between 2007 and 2012. All the women were in their menopausal age (51 ± 3 years), from the south region of Poland, with a follicle stimulating hormone (FSH) level above 25 mIU/ml, and with menopausal symptoms disturbing their normal daily activity. The study was done for a period of 6 months. Three groups of 30 randomized patients were formed. In the first group we used transdermal estrogen therapy in a 37.5 µg/24 h dose combined with a 10 mg dose of dydrogesterone. In the second group we applied transdermal estrogen therapy in a 50 µg/24 h dose with 2.5 mg of oral medroxyprogesterone. In both these groups, gestagens were administered continuously. In the third group, we prescribed continuous, oral, low-dose combined estrogen-gestagen therapy with 1 mg of ethinyl estradiol and 0.5 mg of norethisterone acetate. The control group consisted of 30 volunteers who were also from the south region of Poland, in good health, with menopausal symptoms, no menstrual period for the last 12 months, selected considering their age and weight, with an FSH level above 25 mIU/ml and with normal levels of thyroid stimulating hormone (TSH) and prolactin. All patients treated and in the control group were seronegative to Chlamydia pneumonia for the entire duration of the study. In the analysis conducted, nonparametric tests were used (Mann-Whitney U test, Wilcoxon test, Kruskal-Wallis test - ANOVA). RESULTS: After 6 months of hormonal therapy, we found that all schemes of treatment promote a significant reduction in antibodies against HSP60 in all treated groups vs. the control group. CONCLUSIONS: All of the investigated estrogen protocols have a favorable impact on the blood level of HSP60 antibodies in early postmenopausal women who have no cardiovascular risk factors. It triggers a better condition of endothelium.

High live birth rate after conservative treatment of ectopic pregnancy with methotrexate.

OBJECTIVES: The aim of the study was to assess fertility in patients diagnosed with ectopic pregnancy and treated with methotrexate, as well as safety and efficacy of conservative treatment. Also, risk factors of recurrent ectopic pregnancies were determined. MATERIAL AND METHODS: The study included 86 female patients with ectopic pregnancy hospitalized and treated in the clinic of Gynecological Endocrinology, UJCM, Cracow, between 2007 and 2011. A total of 73 patients received a single dose of MTX in the amount of 50 mg/m2 of body surface area. Serum b-hCG concentration was measured on days 4 and 7. The treatment was considered successful when b-hCG concentrations dropped to less than 0.2 mIU/ml without surgery. RESULTS: Among 34 patients on follow-up, 8 (23.5%) did not attempt to conceive again, whereas 26 patients declared their wish to conceive again. The attempt proved to be successful in case of 16 women (61.53%), and they gave birth to healthy children. Average time to pregnancy was 14.9 months (SD +/- 10.9). The first pregnancy occurred after 6 months and the last after 35 months. No congenital birth defects were found in the newborns. CONCLUSIONS: Systemic, conservative treatment with methotrexate is an effective and safe way of managing ectopic pregnancy even in cases with higher b-hCG concentrations. Most patients can be successfully treated without surgery thus they may even be treated in outpatient settings. High fertility can be maintained and is independent of the skills of the operators and access to laparoscopic techniques. Conservative treatment does not increase the risk of recurrent ectopic pregnancy but should be offered in wards that provide 24-hour surgical care.

Markers of insulin resistance in perimenopausal women with endometrial pathology.

OBJECTIVES: To determine and compare the prevalence of insulin resistance and carbohydrate metabolism parameters in women with endometrial pathology MATERIAL AND METHODS: 100 perimenopausal women with abnormal uterine bleeding and/or abnormal endometrium were included into the study. Hysteroscopy with biopsy was performed. The study population was divided into four groups according to histopathological results of the endometrium: non-atypical endometrial hyperplasia, endometrial polyp, endometrial cancer and controls. Fasting glucose and insulin levels and OGTT, IR indexes, occurrence of diabetes, pre-diabetic state, overweight, obesity and hypertension were assessed. RESULTS: Insulin resistance was diagnosed in 41.0% of the patients. The prevalence of markers of insulin resistance increased to 57.1% in cases with confirmed endometrial pathology compared to 31.8% in histologically normal endometrium (p<0.01). The frequency of insulin resistance was 52.6% (p=0.059) and 55.5% (p=0.04), respectively in women with non-atypical hyperplasia and patients with endometrial polyps when compared to the control group. Abnormal parameters of carbohydrate metabolism indicate little sensitivity and specificity in predicting endometrial hyperplastic lesions. The insulin levels at 120 minutes of OGTT correlate best with such changes (concentration >57 microU/ml in case of hyperplasia and >61 microU/ml in endometrial polyps). CONCLUSION: Insulin resistance and carbohydrate metabolism disturbances are common in women with endometrial pathologies. In these patients there is clinical basis for recommending lifestyle modification (change of diet, more physical activity), or for introduction of pharmaceutical insulin-sensitizing agents.

Beneficial influence of postmenopausal estrogen therapy on serum adhesion molecules is independent of the route and dose of administration.

OBJECTIVE: In current literature, the immune-inflammatory theory of atherosclerosis is widely discussed. The role of how adhesion molecules contribute to the development of atheromatic plaques is especially underlined. MATERIAL AND METHODS: 120 females in menopausal age were included in the study between 2004 and 2009. All the women were of menopausal age (51±3 years), from southern Poland, with FSH levels above 30 mIU/ml, and complaining of menopausal symptoms that disturbed normal daily activity. The study was conducted over a 6 month period. Three groups of 40 randomized patients were selected. The control group consisted of 40 volunteers, who were also from southern Poland, in good health, without menopausal symptoms, or menstrual periods in the last 6 months. Control subjects were match according to age and weight, with FSH levels above 25 mIU/ml and normal TSH and prolactin values. All patients, in the treatment and control groups were seronegative for Chlamydia pneumonia throughout the duration of the study. RESULTS: After 6 months, hormonal therapy was found to significantly reduce levels of sICAM-1 and sVCAM-1 in all treated groups compared to the control group and the results were statistically significant. Alternatively, in the latter group, we observed increased levels of the investigated adhesion molecules (group I: 37.5 µg/24h transdermal estradiol + dydrogesteron; group II 50 µg/24h transdermal estradiol + medroxyprogesteron; group III 1mg of oral estradiol + noretisteron sICAM-1 and control group; using paired Wilcoxon test). CONCLUSION: All of the investigated estrogen therapy schemas have a favorable impact on the blood levels of sICAM-1 and sVCAM-1 in postmenopausal women without cardiovascular risk factors, reducing their concentration.

[The incidence of neoplasm in women using contraceptives]. / Czestosc nowotworów u kobiet stosujacych doustne srodki antykoncepcyjne.

Contraceptive is an important issue of women's life. In the present times there are many methods to prevent unwanted pregnancy. Each of them has its advantages and disadvantages and an appropriate choice of the method determines its promotion high efficiency and comfort its application. Today there is no method of contraception, which would not be charged some risk for the application. Following the review will allow literature to analyze impact of the various methods for the development of cancer control means diseases which may constitute a serious threat to health and life women.