Effects of two forms of combined oral contraceptives on carbohydrate metabolism in adolescents with polycystic ovary syndrome.

OBJECTIVE: To compare the effects of combined oral contraceptives (OCs) containing cyproterone acetate or desogestrel on insulin sensitivity in adolescents with polycystic ovary syndrome (PCOS). DESIGN: A prospective randomized clinical trial. SETTING: Outpatient gynecological clinic of Aretaieion University Hospital. PATIENT(S): Thirty-six adolescent girls with hyperandrogenism and six or less menses in the preceding 12 months. INTERVENTION(S): Patients were separated in two groups: group A (n = 18) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl E2 daily; and group B (n = 18) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl E2 daily, for 21 days followed by a 7-day rest, for 12 months. MAIN OUTCOME MEASURE(S): Hirsutism score, lipid, androgen, and sex hormone-binding globulin (SHBG) levels were evaluated at baseline. An oral glucose tolerance test (OGTT) was performed and metabolism indices, based on previously studied mathematical formulas, were assessed at baseline and at 12 months. RESULT(S): After 12 months of treatment, the homeostasis model assessment index of insulin resistance increased significantly in both groups. The fasting glucose-to-insulin ratio and predicted insulin sensitivity index decreased in group B. The delta of the area under the OGTT curve for insulin and predicted first and second phase insulin secretion indices increased significantly only in group B. CONCLUSION(S): We conclude that treatment of adolescent girls with PCOS with the two combined OCs administered, results in unfavorable changes of insulin sensitivity. In addition, cyproterone acetate is associated with an increase of insulin secretion and hyperinsulinemia.

Myxoid leiomyosarcoma of the uterus in a patient receiving tamoxifen therapy: a case report.

In this paper, we present a case of myxoid leiomyosarcoma development in a patient receiving tamoxifen for 3 years because of breast cancer. The myxoid leiomyosarcoma should be included in the differential diagnosis of any uterine tumor with a predominantly myxomatous composition. A review of the literature indicates that tamoxifen may increase not only the risk for endometrial cancer but also for uterine sarcoma, suggesting vigilance for uterine cancer in women who are being treated with this drug.

Frequency, histological, and immunohistochemical properties of massive inflammatory lymphocytic infiltration of leiomyomas of the uterus: an entity causing diagnostic difficulties.

Massive lymphocytic infiltration of the leiomyomas of the uterus is rare and causes diagnostic difficulties. The objective of this study is to estimate the frequency, to analyze the clinicopathologic features, to explore the possible pathogenetic factors, and to discuss the differential diagnosis of this entity. We reviewed the pathology reports of 379 patients who underwent surgery for leiomyomas at our institution, from 1999 until 2003, and we identified five cases of leiomyomas with massive lymphocytic infiltration. Thereafter, we reviewed the records of these five patients to identify the clinical, ultrasonographic, and surgical findings they had presented. Leiomyomas with lymphocytic infiltration were characterized by the presence of small lymphocytes, few plasma cells, and occasional germinal lymphocytes such as lymphoblasts confined into the leiomyoma. Immunohistochemistry was positive for desmin and leukocyte common antigen and showed a positive reaction to kappa and lambda light chains that is consistent with the polyclonal nature of an inflammatory infiltration. Gross appearance and ultrasonographic and color Doppler findings were the same as of a typical leiomyoma. Lymphocytic infiltration of leiomyomas is a rare histological entity. Although an inflammatory process seems to be the pathogenetic factor, other mechanisms such as an immunological or autoimmune response, a specific human leukocyte antigen alteration, or a viral infection could also be the cause of this entity. Differential diagnosis must be made from malignant lymphoma, pyomyoma, and inflammatory pseudotumor of the uterus, based on their special histological characteristics.

Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives.

OBJECTIVE: To compare the effects of cyproterone acetate and desogestrel, as part of combined oral contraceptives, on lipid metabolism and hirsutism of adolescents with polycystic ovary syndrome (PCOS). DESIGN: Prospective randomized clinical trial. SETTING: Outpatient gynecology clinic (referral center) of a university. PATIENT(S): Twenty-eight adolescent girls with clinical and biological hyperandrogenism and six or less menses during the past 12 months. INTERVENTION(S): Group A (n = 14) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl estradiol daily. Group B (n = 14) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl estradiol daily. Treatment was given for 21 days followed by a 7-day rest for a period of 12 months. MAIN OUTCOME MEASURE(S): Hirsutism and lipid profile were evaluated before initiation and at 3, 6, 9, and 12 months of treatment. Androgen profile was evaluated before and at 12 months of treatment. RESULT(S): A significant decline of the Ferriman-Gallway hirsutism score was observed from the sixth month of therapy in both groups. During therapy, the levels of testosterone, free testosterone, Delta(4)-androstenedione, and 17OH-progesterone decreased significantly, whereas sex hormone-binding globulin (SHBG) increased significantly in both groups. The level of total cholesterol and low density lipoprotein (LDL) cholesterol increased significantly, whereas high density lipoprotein (HDL) cholesterol and apolipoprotein A-I increased significantly from the third month of therapy in both groups. Total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios remained unchanged. The levels of triglycerides increased significantly in the cyproterone acetate-treated group after the third month. CONCLUSION(S): Treatment of adolescent girls with PCOS with the two studied formulations is comparably effective in decreasing hirsutism and androgen levels. Both combined oral contraceptives are associated with an increase of total cholesterol, LDL cholesterol, and HDL cholesterol levels and no change of the total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios. Treatment with the cyproterone acetate combined oral contraceptive is associated with a tendency toward increasing the levels of triglycerides.