Comparison of Tissue Mismatch Repair Protein Deficiency between Early- and Advanced-Stage Endometrial Cancer.

OBJECTIVE: ESGO/ESTRO/ESP guidelines recommend that DNA mismatch repair (MMR) proteins or microsatellite instability tests should be performed in all cases of endometrial cancer. This study aims to clarify the relationship of MMR protein deficiency (dMMR) between early and advanced stages of endometrial cancer. Secondary objective is to identify dMMR affecting factors in endometrial cancer. METHODS: This cross-sectional study was conducted on endometrial cancer patients who underwent surgery at HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, between May 2013 and April 2021. Patients with endometrial cancer whose tumor tissue was available for analysis were identified. The expression of MMR proteins was assessed by immunohistochemistry, including MLH1, MSH2, MSH6, and PMS2. Then, the pathological specimens were reviewed. RESULTS: A total of 207 patients with endometrial cancer were assessed for data analysis. MMR deficiency was observed in 92 cases (44.4%). We found patients with dMMR in both the early and advanced stages of endometrial cancer-68/155 cases (43.9%) and 24/52 cases (46.2%), respectively (P = 0.774).  Statistically significant differences were found only in myometrial invasion (adjusted prevalence odds ratio 2.35, 95% CI 1.21 to 4.57, P = 0.012). CONCLUSION: Our study showed no difference in tissue dMMR between early- and advanced-stage endometrial cancer. The dMMR was not associated with improved outcomes in patients with endometrial cancer. Even though ESGO/ESTRO/ESP guidelines recommend the performance of MMR IHC or MSI tests in all endometrial cancer cases, we can select the appropriate patients those categorized as "advanced stage" or "recurrent"-who may gain the most benefits from the immunotherapy modality of treatment.

Accuracy of CCL20 expression level as a liquid biopsy-based diagnostic biomarker for ovarian carcinoma.

Objective: The study aimed to investigate the potentiality of chemokines, including MCP-1, CCL15, CCL20, and CXCL14, as biomarkers for differential diagnosis between benign tumors and ovarian cancer (OC). Methods: A cross-sectional study was conducted in women aged >18 years who had adnexal masses treated with elective surgery at the HRH Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, between 2020 and 2021. The preoperative MCP-1, CCL15, CCL20, and CXCL14 serum levels were measured using a sandwich enzyme-linked immunosorbent assay. Preoperative diagnosis was defined according to the risk of malignancy index. The histological diagnosis and cancer subtype were confirmed using pathological specimens. Results: Ninety-eight participants were preoperatively diagnosed with malignant tumors. The pathological diagnosis confirmed OC in 33 patients and disclosed 27 misdiagnosed cases, of which endometriotic cyst was the most common (44.44%). CCL20 and CA125 serum levels were significantly higher in the patients with cancer than in those with benign. In addition, CCL20 level could differentiate between benign and early-stage malignancy. Furthermore, only CCL20 levels could distinguish endometriotic cysts from OC, whereas CA125 levels could not. Concordant with the serum protein level, the increased mRNA level of CCL20 was observed in ovarian cancers comparing with that in benign tissues. We found that CCL20 levels could differentiate between benign tumors and OC with 60.61% sensitivity and 75.44% specificity at the optimal cutoff value of 38.79 pg/ml. Finally, the logistic regression model integrating CCL20, CA125, and menopause status promoted diagnostic accuracy by increasing the specificity to 91.23%. Conclusions: Our study revealed the potential usefulness of CCL20 level as a biomarker for diagnosing early-stage OC with endometriosis differentiation. We recommend further studies to confirm the accuracy of CCL20 levels with the current diagnosis in a large patient sample.

Laparoscopic sacrocolpopexy in a patient with vault prolapse of the sigmoid stump after vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: A case report.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly that results in Müllerian agenesis that affects the uterus and upper two-thirds of the vagina. Sigmoid vaginoplasty is a surgical treatment option; however, vaginal prolapse may result as a complication of the sigmoid neovagina. There are no standards for treatment due to the rarity of this condition. We present the case of a 59-year-old woman with a history of sigmoid vaginoplasty who underwent laparoscopic sacrocolpopexy (LSC) for grade IV sigmoid stump prolapse. The patient had a successful outcome and no evidence of recurrent prolapse. This clinical case reveals the feasibility of LSC as a surgical treatment for sigmoid stump prolapses in patients with MRKH syndrome.

Comparison of detection rate of high risk HPV infection between self-collected HPV testing and clinician-collected HPV testing in cervical cancer screening.

OBJECTIVE: to correlate the detection rate of high risk HPV (HR-HPV) DNA between self-collected and clinician-collected testing. MATERIALS AND METHODS: A cross-sectional analytic study was conducted in 400 women undergoing cervical cancer screening program during February and May 2015. The procedure began with self-collected method and then clinician-collected method. Then, the specimens were processed and interpreted with the same technique. If the results from either methods were positive for HPV genotype 16 or 18, colposcopy was performed. We also conducted cytology testing for the participants. If the results were abnormal (ASC-US+), colposcopy was also performed. RESULTS: The detection rate of HR-HPV DNA was 10.0% and 7.5% by self-collected and clinician-collected specimen, respectively (kappa = 0.73). HR-HPV positive rate in cytology ASC-US+ was no significantly different between groups. HR-HPV DNAs were positive in every HSIL (100% detection rate). HPV DNA test positive for detection CIN+ was not significantly different between self-collected and clinician-collected testing. CONCLUSION: self-collected HPV testing can be used as an alternative option for primary cervical screening program. Detection rate of high grade lesion is similar to clinician-collected test.

A randomized, double-blind, placebo-controlled trial of oral pregabalin for relief of shoulder pain after laparoscopic gynecologic surgery.

STUDY OBJECTIVE: To investigate the efficacy of pregabalin for the relief of postoperative shoulder pain after laparoscopic gynecologic surgery. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I). SETTING: Tertiary referral center, university hospital. PATIENTS: Fifty-six women undergoing elective laparoscopic gynecologic surgery between June 2012 and March 2013. INTERVENTIONS: Women in the study group received 75 mg pregabalin 2 hours before surgery and then every 12 hours for 2 doses, and women in the control group received an identical capsule and the same dosage of placebo. MEASUREMENTS AND MAIN RESULTS: Visual analog scale (VAS) scores for shoulder pain and surgical pain at 24 and 48 hours after surgery were evaluated as primary outcome. Postoperative analgesics used and drug-related adverse events were also monitored. Patients in the pregabalin group had significantly lower postoperative VAS scores for shoulder pain at 24 hours, compared with the placebo group (median, 23.14 [range, 13.67-32.61] vs. 37.22 [27.75-46.64]; p = .04), and required less analgesic (p = .01). There were no significant differences in VAS scores for surgical pain and adverse events between the 2 groups (p = .56). CONCLUSIONS: Perioperative administration of 75 mg pregabalin significantly reduced postoperative laparoscopic shoulder pain and amount of analgesic used.