A body shape index (ABSI) and endometrial pathology.

A body shape index (ABSI) is an anthropometric measure that allows evaluating abdominal adiposity. Obesity is considered a risk factor for endometrial cancer (EC). Due to the increase in EC's incidence, identifying risk factors for endometrial pathology is essential in women's health. The study aimed to identify an association between EC/endometrial pathology and ABSI. We identified well-known risk factors for endometrial cancer and calculated ABSI in 408 women who were admitted to the Polish Mother's Memorial Hospital Research Institute between January 2016 and December 2017. Patients were divided into four subgroups: no endometrial pathology, endometrial polyps, hyperplasia without atypia, and hyperplasia with atypia/cancer. Statistical analysis showed a correlation between ABSI and the presence of cancer/atypical hyperplasia (Kruskal-Wallis test, p = .042). Additional multivariate analysis revealed that both ABSI and body mass index (BMI) z scores might potentially be associated with EC presence (ABSI z score quintiles Q1, Q2, Q3 vs. Q4, Q5: p = .039; BMI z score quintiles Q1, Q2, Q3 vs. Q4, Q5: p = .038). We found an association between cancer/atypical hyperplasia and ABSI. Further studies on ABSI are needed to establish ABSI as a risk factor for EC fully.

Is serum anti-Müllerian hormone (AMH) assay a satisfactory measure for ovarian reserve estimation? A comparison of serum and peritoneal fluid AMH levels.

BACKGROUND: Clinical cases have been reported with women who got pregnant with confirmed low serum anti-Müllerian hormone (AMH) concentrations, thus demonstrating that low serum AMH concentration cut-points could be fairly specific for poor ovarian response (POR) to gonadotrophin stimulation, but not for pregnancy. That observation prompted the question whether serum AMH concentration accurately corresponded to the whole amount of AMH secreted by granulosa cells. OBJECTIVES: To measure AMH levels in peritoneal fluid and their correlations with serum AMH concentrations. MATERIAL AND METHODS: The reported study involved 48 female patients, aged 18-40 years, diagnosed with benign ovarian cysts and qualified for a laparoscopic cystectomy. Prior to surgery, the ovarian reserve was assessed using serum AMH concentration assay. The peritoneal fluid was also collected during the laparoscopy and AMH concentrations in peritoneal fluid were measured. RESULTS: The AMH present in the peritoneal fluid strongly correlated with AMH levels in blood serum (r = 0.54; p < 0.001) and higher serum AMH concentrations corresponded to higher AMH concentrations in the peritoneal fluid. There was also a significant correlation between AMH levels in serum and in peritoneal fluid, collected from patients with endometrioma and other benign cysts (r = 0.61; p = 0.001 vs r = 0.43; p = 0.03). CONCLUSIONS: The AMH is present in the peritoneal fluid and its concentrations significantly correlate with AMH levels in serum. The assessment of AMH concentration in the peritoneal fluid may be a valuable complement to the evaluation of ovarian reserve and the diagnosis of infertility after adnexal surgery.

Retrospective analysis of transvaginal ultrasound-guided aspiration of simple ovarian cysts.

BACKGROUND: The widespread availability of ultrasonography means that transvaginal ultrasonography has become a routine procedure during gynecological examinations, even in asymptomatic patients. Nowadays the imaging technology offered by ultrasonography and tumor biomarkers give us an opportunity to implement transvaginal ultrasound-guided aspiration as a less radical treatment of simple ovarian cysts (SOC). OBJECTIVES: The aim of the study was a retrospective evaluation of the diagnostic and therapeutic efficacy of transvaginal ultrasound-guided aspiration of SOC in postmenopausal and premenopausal patients. MATERIAL AND METHODS: A total of 84 women, divided into a premenopausal group (38/84) and a postmenopausal group (46/84), underwent transvaginal ultrasound-guided aspiration of small SOC (40-80 mm in diameter). Simple cysts were defined ultrasonographically according to the International Ovarian Tumor Analysis (IOTA) guidelines as cysts with negative risk of ovarian malignancy algorithm (ROMA) scores and CA125 levels. Simple ovarian cyst-related data was obtained from medical documentation (diagnostic tests, medical reproductive and surgical history, and clinical status during SOC aspiration). Follow-up data was collected by means of a telephone interview and medical database. The survey included questions focused on cyst recurrence during the 24-month period following the aspiration of SOC. RESULTS: We had 100% compatibility with ultrasound diagnosis and cytological examination of aspirated fluid. The cumulative rate of cyst recurrence among 84 patients was 20.2% (17/84). There was a higher percentage of cyst recurrence in the premenopausal group: 27% (10/38) vs 15.2% (7/46) in the postmenopausal group, but the difference was not statistically significant (hazard ratio (HR) = 1.89, 95% confidence interval (95% CI) = 0.72-4.97; p = 0.19). Recurrent cysts were treated with laparoscopic cystectomy, adnexectomy or a second aspiration in accordance with individual indications. CONCLUSIONS: Ultrasound-guided aspiration of small (<80 mm) adnexal SOC is a diagnostic and alternative therapeutic procedure, which allows cytological examination and may reduce the need for surgery, which is especially beneficial for women of reproductive age.

The presence of A5935G, G5949A, G6081A, G6267A, T9540C mutations in MT-CO1 and MT-CO3 genes and other variants of MT-CO1 and MT-CO3 gene fragments in the study population diagnosed with endometrial cancer.

OBJECTIVES: The specific purpose of this study was the assessment of A5935G, G5949A, G6081A, G6267A mutations in MT-CO1 and T9540C in MT-CO3, and alterations detected during the analysis of MT-CO gene fragments in subject and control groups. A secondary aim was to assess the relationship between MT-CO1 and MT-CO3 gene alterations and endometrial cancer incidence and evaluation of the prognostic value of MT-CO1 and MT-CO3 gene alterations. MATERIAL AND METHODS: In this study, we investigated A5935G, G5949A, G6081A, G6267A mutations in MT-CO1 and T9540C in MT-CO3, and alterations detected during the analysis of MT-CO gene fragments in formalin-fixed, paraffin-embedded endometrial and benign endometrial hyperplasia of a cohort of 125 subjects. RESULTS: The T9540C mutation in MT-CO3 was detected in one patient from the subject group. None of the remaining muta-tions were detected. The research showed that the presence of alterations in MT-CO1 and MT-CO3 typical of other types of cancer is not a risk factor for endometrial cancer. Analysis of MT-CO1 and MT-CO3 gene fragments revealed 10 alterations (6 and 4 respectively). The alterations detected were identified in 10% of the tested group and 8% of the control group. CONCLUSIONS: The research showed that the presence of alterations in MT-CO1 (A5935G, G5949A, G6081A, G6267A) typical of other types of cancer is not a risk factor for endometrial cancer. Three new alterations detected in this study (A6052G, A9545G, G9575A) were described for the first time.

The role of angiogenic factors in endometrial cancer.

Endometrial cancer is the most common malignancy within the female reproductive system (37.7%). The incidence increases with age. Frequently this type of cancer is diagnosed in peri- and post-menopausal women. 60-70% of cancers occur in women over 60 years of age, and less than 5% in women below 40 years of age. Angiogenesis is a process of formation of new microvessels from existing capillaries. There are four different mechanisms of new vessel growth: sprouting, intussusception, vessel elongation and incorporation of endothelial progenitor cells into new microvessels. Angiogenesis plays important roles in growth of endometrial cancers. This process is controlled by many angiogenic factors, for example vascular endothelial growth factor (VEGF). VEGF is the most powerful and most specific endothelial cell growth factor. It plays a crucial role in the initiation of physiological and pathological angiogenesis, lymphangiogenesis, and vasculogenesis. The VEGF family consists of VEGF-A, VEGF-B, VEGF-C, VEGF-D, VEGF-E, VEGF-F and PLGF (placental growth factor). The effects of VEGF are mediated through binding to the two specific and homologous receptors VEGFR-1 (FLT-1) and VEGFR-2 (KDR). Placental growth factor (PLGF) belongs to the VEGF family and it is also a very important growth factor. So far four isoforms of PLGF have been identified: PLGF-1 (PLGF131), PLGF-2 (PLGF152), PLGF-3 (PLGF203) and PLGF-4 (PLGF224).

Detection of intracavitary lesions in 820 infertile women: comparison of outpatient hysteroscopy with histopathological examination.

OBJECTIVES: The aim of the study was to compare the results of a diagnostic hysteroscopy with a histopathology examination (referential test) in a group of infertile women. MATERIALS AND METHODS: Eight hundred and twenty infertile patients were included in the study The subjects with intracavitary lesions underwent operative hysteroscopy to enable the removal of polyps and intracavitary myomas. Endometrial biopsy was performed in all patients with no pathologies in hysteroscopy. The removed tissue underwent histopathological examination. RESULTS: The mean age was 32.9 +/- 4.1. A total of 648 (79%) patients were diagnosed with primary and 172 (21%) with secondary infertility; 542 (66.1%) hysteroscopies were performed with no anesthesia and 278 (33.9%) hysteroscopies were performed in short total intravenous anesthesia. Sensitivity and specificity accuracy, error positive predictive value (PPV) and negative predictive value (NPV) of hysteroscopy in detecting endometrial lesions were 99.6%, 96.6%, 97.4%, 2.6%, 92.2% (PPV) and 99.8% (NPV), respectively. The agreement between hysteroscopy and pathology report was very high (kappa K = 0.94). In case of normal uterine cavity 562 of the 563 endometrial samples showed evidence of normal endometrium. In all 32 cases of resected submucosal myomas histopathology confirmed the hysteroscopic findings (sensitivity 100%, specificity 100%, accuracy 100%, error 0%, kappa K = 1.0). Both, hysteroscopy and histopathology confirmed the presence of endometrial polyps in 199 cases. The diagnosis of a polyp was not confirmed in histopathological findings (false-positive results) in 20 hysteroscopies. No endometrial polyps were missed during hysteroscopy Sensitivity specificity accuracy error positive and negative predictive values in detecting endometrial polyps were 100%, 96.8%, 97.6%, 2.4%, 90.9% (PPV) and 100% (NPV), respectively. The Kappa coefficient agreement between hysteroscopy and histopathology for endometrial polyps was 0.91. CONCLUSIONS: Hysteroscopy is a method of high sensitivity and specificity in detecting pathologies, but in case of a pathology it cannot replace histological examination. Our result show that a routine endometrial biopsy performed in infertile patients with no pathology in hysteroscopy should not be recommended.

IL-18 and IL-18 binding protein concentration in ovarian follicular fluid of women with "tubal factor" subjected to in vitro fertilization.

INTRODUCTION: Composition of follicular fluid is also regarded to be linked to quality of oocytes, fertilization and quality of the embryo. The aim of this study was to investigate the concentration of IL-18 and IL18BP in follicular fluid (FF) in a homogeneous group of women with sterility caused by "tubal factor" subjected to in vitro fertilization (IVF) and the relation between concentrate of this cytokine and IVF outcome. MATERIALS/METHODS: The study group consisted of 83 non-smoking women aged 30.9 ± 3.2 (23.0-43.0) with confirmed (hysterosalpingography and/or laparoscopy) bilateral complete tubal impermeability. Follicular fluid levels of IL-18 and IL18BP were evaluated in 83 patients undergoing in vitro fertilization (IVF). Ovarian hormonal stimulation was conducted according to a GnRH antagonist protocol. The measurement of IL-18 and IL18BP in follicular fluid was done using the ELISA method. RESULTS: The mean follicular levels of IL-18 and IL18BP were 468.5 ± 357.4 pg/ml and 8611.3 ± 534 pg/ml. The biochemical pregnancy rate was 39.7% (33/83); 22 women became clinically pregnant (26.5%). The implantation rate was 26.7% (36/135). No significant correlation was found between follicular concentrations of IL-18 and age of the patients (r = 0.13 p>0.05), number of metaphase II oocytes collected (r = -0.11 p>0.05), number of 3-day embryos (r = -0.157 p>0.05), biochemical pregnancies (r = 0.03 p>0.05), or clinical pregnancies (r = -0.06 p>0.05). Also there was no significant correlation between IL18BP and age of the patients (r = 0.21 p>0.05), number of metaphase II oocytes collected (r = 0.08 p>0.05), number of 3-day embryos (r = -0.19 p>0.05), biochemical pregnancies (r = 0.11 p>0.05) and clinical pregnancies (r = -0.34 p>0.05). CONCLUSION: IL-18 and IL18BP are detectable in follicular fluid but do not determine IVF outcome in women with "tubal factor". IL-18 and IL18BP are not promising prognostic markers for IVF success in this subgroup of patients.

[Ovarian tumors in pregnancy--proposals of diagnosis and treatment]. / Nowotwory jajnika u kobiet ciezarnych--propozycje postepowania diagnostyczno-terapeutycznego.

We present the review of the literature and the proposals of the exact diagnosing and therapy of the ovarian tumors complicating pregnancy. The incidence of ovarian tumors in pregnant women is estimated on 1/1000 deliveries. The coexistence of an ovarian tumor with pregnancy presents problems to both the clinician (obstetrician, oncologist) and the patient. Depending of the increasing uterus during pregnancy, the appropriate diagnosis of adnexal mass is based on the initial pelvic and ultrasound examination. Most of ovarian tumors in pregnant women are asymptomatic and when they are unsuspicious simple cysts or cystic teratomas the conservative management is recommended. In cases of complex masses and/or torsion, rupture, hemorrhage the surgical intervention by laparotomy (in some cases laparoscopy) is required. The possibility of malignancy and its therapeutic implications (hysterectomy, salpingo-oophorectomy, delay to delivery) must be discussed with the patient and her family (the lives of two human beings together are affected).

[Ovarian tumors in the reproductive age group]. / Guzy jajników u kobiet w okresie rozrodczym.

OBJECTIVES: Analysis of the type and localization of the ovarian tumors in the reproductive age group of women. MATERIALS AND METHODS: The study group consisted of all women operated on Gynecologic Surgery Department of Polish Mothers's Memorial Hospital-Research Institute due to ovarian tumors in 1996-99. As the reproductive age we defined 18-39 year, when the majority of deliveries occurs. RESULTS: We analyzed 326 patients operated on the ovarian tumors. In 60 cases (18.4%) we noticed ovarian malignant tumors, in 7 (2.1%) borderline tumors and in 259 (79.5%) benign cysts. In the reproductive age (130 women) the incidence of ovarian malignancies was significantly lower (4.6%), higher for benign tumors (93.1%) and constant for borderline malignancy (2.3%), p < 0.005. The most common malignancy among all patients was epithelial cancer--83.4% (germ cell and metastatic--8.3%, both), but in the reproductive age group (6 cases) germ cell tumors were the majority--66.8% (epithelial and metastatic--16.6%, both), p < 0.005. In women aged 18-39 yr. with ovarian malignancies 4 of them had I stage of the disease and 2 were in the stage III. 121 women in the reproductive age were operated on the benign ovarian tumors; 107 (88.4%) had unilateral cysts and 14 (11.6%) had tumors in both ovaries. On histology we revealed 31.1% of endometrioid cysts, 28.9%--teratomas, 19.3%--serous, 3.7%--mucinous and others (hemorrhagic, functional, sex cord, inflammatory) in the remaining 17%. CONCLUSION: In the reproductive age ovarian tumors are mainly unilateral benign cysts. Only a few of ovarian tumors were malignant but the majority of them were in the early stage of the disease.