Neutrophil-to-Lymphocyte Ratio (NLR) for Preoperative Differentiation between Uterine Leiomyosarcoma (LMS) and Uterine Leiomyoma: A Case-Controlled Study.

BACKGROUND: Differentiating uterine LMS from uterine leiomyoma is difficult. Therefore, this study aimed to compare preoperative NLR of uterine leiomyosarcoma (LMS) with leiomyoma and secondary objective aimed to identify the clinical characteristics to distinguish between uterine LMS and uterine leiomyoma including the appropriate NLR cut off value to differentiate LMS from leiomyoma. METHODS: This was a matched case-controlled study with 1:4 ratio. We collected data of patients with uterine LMS and leiomyoma from 2011 to 2020 at King Chulalongkorn Memorial Hospital. Patients with uterine LMS (case group) and leiomyoma (control group) were matched in terms of year of the surgery and size of the uterine mass. Statistical analysis was conducted using SPSS version 22.0 and STATA version 17. Conditional logistic regression analysis with a p-value of <0.05 was used. RESULTS: Twenty-seven patients who were diagnosed with uterine LMS met the inclusion criteria; 13 patients who had incomplete data and one patient who was had concurrent breast cancer were excluded. Thirteen patients were included in the final analysis. From 2,587 patients in control group; 52 patients were matched. The baseline characteristics in both groups were comparable except for menopausal status Women with uterine LMS had a higher NLR than those with leiomyoma (mean, 4.56 ± 2.5 and 2.4 ± 1.15 in the case and control groups, respectively). Conditional logistic regression determined that the NLR cut-off value of 2.8 was a statistically significant factor for determining uterine LMS (OR = 3.24; 95% CI 1.01-10.43). No significant difference was found in the other factors. CONCLUSIONS: Patients who were diagnosed with uterine LMS had a significantly higher NLR than those diagnosed with leiomyoma. The NLR is a simple and effective method for predicting the presence of a uterine LMS in patients who are pre-operatively diagnosed with a uterine mass.

Efficacy of Curcuminoids in Managing Postoperative Pain after Total Laparoscopic Hysterectomy: A Randomized Controlled, Open-Label Trial.

BACKGROUND AND AIMS: Curcuminoids, which are substances extracted from turmeric (Curcuma longa), have anti-inflammatory and analgesic effects and a good safety profile. This study aimed to evaluate the clinical efficacy of curcuminoid extracts on reducing pain among patients who underwent laparoscopic hysterectomy. EXPERIMENTAL PROCEDURE: From November 2016 to December 2017, 98 participants were included in this clinical trial, and they were randomly assigned to the experimental and control arms according to blocks of four. The intraoperative findings did not significantly differ between the two groups. The experimental group received one tablet of curcuminoid extract 250 mg four times a day on postoperative days 1-3. Pain was evaluated at 24 and 72 h postoperatively using a 10-point visual analog scale (VAS). RESULTS AND CONCLUSION: The mean VAS scores at 24 h after surgery were 4.9 in the experimental group and 4.3 in the control group. Hence, the results did not significantly differ (p = 0.129). The mean VAS scores at 72 h after surgery were 1.8 in the experimental group and 2.8 in the control group (p = 0.001). The side effects in both groups were similar. Hence, curcuminoids can be an effective supplement for reducing pain after laparoscopic hysterectomy. The conclusion from this study is that curcuminoids may be an effective supplement to reduce postoperative pain following laparoscopic hysterectomy.

Lynch Syndrome in Thai Endometrial Cancer Patients.

BACKGROUND: Lynch syndrome increases lifetime risk of endometrial cancer to 40-60%. Screening with molecular tumor testing for mismatch repair (MMR) proteins have been recommended. This study aims to evaluate the incidence of MMR deficiency and germline mutation in endometrial cancer Thai patients. METHODS: Immunohistochemistry for MMR proteins, including MLH1, MSH2, MSH6 and PMS2 were tested in 166 surgical specimens. Patients who had MMR deficiencies were offered genetic counseling and a germline testing using gene-panel next generation sequencing. RESULTS: Fifty-eight of 166 patients (34.9%) had one or more MMR deficiencies which were: MLH1 and PMS2 in 42 patients (25.3%), MSH2 and MSH6 in 11 patients (6.6%), and MSH6 in 5 patients (3.0%). Of the 40 patients (24.1%) who met the revised Bethesda guidelines, 19 patients (47.5%) had MMR deficiency. In contrast, MMR deficiency was found in 39 of the 126 patients (31.0%) who did not meet the revised Bethesda guidelines. A total of 27 patients with MMR deficiencies agreed to have germline genetic testing. Germline MMR mutations were detected in 5 patients (18.5%) including MSH6 (n=2), PMS2 (n=2), and MLH1 mutations (n=1). Incidental germline mutations in other genes were detected in 3 patients (1 BRCA1, 1 PTEN, and 1 BARD1). Among 5 Lynch syndrome patients, 2 patients (40%) did not meet the revised Bethesda guidelines. Eight patients who met the revised Bethesda Guidelines but having MMR proficiency had genetic testing, but no germline mutation was detected. CONCLUSION: MMR deficiencies were detected in 34.9% of the endometrial cancer patients. Germline mutations were diagnosed in 3.0% of this cohort (5/166 patients). Lynch syndrome screening with MMR immunohistochemistry should be considered in all patients regardless of personal or family history of Lynch syndrome-related cancers.

Neovaginal and Anal High-Risk Human Papillomavirus DNA Among Thai Transgender Women in Gender Health Clinics.

BACKGROUND: Although human papillomavirus (HPV)-related lesions in the neovagina of transgender women have been well documented, information on high-risk HPV (hrHPV) in the neovagina has been very limited. The objective of this study was to determine hrHPV DNA detection rate in the neovagina of transgender women. METHODS: Neovaginal and anal swab were collected in liquid-based cytology fluid from transgender women visiting Gender Health Clinic and Tangerine Community Health Clinic in Bangkok, Thailand. Samples were processed for hrHPV DNA (reported as subtypes 16 and 18 or the pooled result of subtypes 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) by automated real-time polymerase chain reaction and for neovaginal cytology according to the Bethesda system. Demographic data and sexual history were obtained, and physical examination was conducted. HIV status was obtained from existing medical records. RESULTS: Samples were collected from 57 transgender women (mean age, 30.4 years [interquartile range, 8 years]). From 35 of 57 valid neovaginal samples, 8 (20%) tested positive for hrHPV DNA. From 30 of 57 valid anal samples, 6 (19.4%) tested positive for hrHPV DNA. HIV status was known for 52 transgender women, 1 of which were HIV infected; neovaginal hrHPV was invalid in that patient. CONCLUSIONS: One of 5 transgender women visiting sexual health clinics in Bangkok was found to have hrHPV DNA in neovaginal and anal compartments. Studies are needed to look at incidence and persistence of hrHPV infection to inform anogenital precancerous and cancerous screening programs for transgender women.

Adenomatoid Tumor of the Uterus: A Report of 6 Unusual Cases With Prominent Cysts Including 4 With Diffuse Myometrial Involvement, 4 With Uterine Serosal Involvement, and 2 Presenting in Curettage Specimens.

We evaluated the clinicopathologic features of 6 adenomatoid tumors of the uterus with unusual features. All the tumors differed grossly from the usual adenomatoid tumor, typically being ill-defined and occupying >50% of the myometrium, essentially replacing it in 4. The neoplasm extended to the endometrium in 2 cases and in one of these it formed an intracavitary mass; in both the tumor was first diagnosed in a curettage. In the other 4 cases, the adenomatoid tumor was discovered in a hysterectomy specimen performed for irregular vaginal bleeding (3 patients), and the finding of a pelvic mass on a computed tomography scan in a patient with right lower quadrant pain. The tumors extended to the uterine serosa in the form of small grape-like vesicles or cysts in 4 cases. All tumors contained the typical small often irregularly shaped spaces but also had prominent cysts. When cysts involved the serosa, the microscopic appearance mimicked that of peritoneal inclusion cysts. In one case with serosal involvement, a prominent papillary pattern was also present. The cysts were typically closely packed with minimal intervening stroma but were occasionally separated by conspicuous smooth muscle bundles. The stroma in one case was extensively hyalinized. Two tumors were focally infarcted. A striking, but minor, solid growth in which the tumor cells were arranged in tightly packed nests or interanastomosing cords and trabeculae was seen in 2 tumors. The unusual gross and microscopic features of these tumors can cause significant diagnostic difficulty and bring into the differential diagnosis entities that are usually not realistic considerations. The presentation of 2 tumors in a curettage specimen represents an unusual clinical aspect.

Effects of vaginal administration of conjugated estrogens tablet on sexual function in postmenopausal women with sexual dysfunction: a double-blind, randomized, placebo-controlled trial.

BACKGROUND: Female sexual dysfunction (FSD) is prevalent in women with genitourinary syndrome of menopause (GSM). Vaginal estrogen is effective GSM treatment. This study was primarily aimed to evaluate the effects of vaginal administration of conjugated estrogens tablet on postmenopausal FSD using the Female Sexual Function Index (FSFI). Secondary aims were to evaluate vaginal pH, Vaginal Maturation Value (VMV), Normal Flora Index (NFI) and Most Bothersome Symptoms (MBS) changes. METHODS: A double-blind trial was conducted in postmenopausal women with FSD (FSFI ≤26.55). Sixty-seven participants were randomized into two arms; vaginally administered conjugated estrogens tablet (0.625 mg, daily for 3 weeks then twice weekly for 9 weeks, n = 33), or placebo (n = 34). RESULTS: There was no significant improvement of FSFI observed in estrogens arm compared to placebo in each domain and overall index (p = 0.182). The estrogens significantly improved vaginal pH and VMV, toward more acidity (p = < 0.001), higher VMV (p = < 0.001) and more superficial cells (p = < 0.001). We observed no significant difference in NFI and MBS between arms (p = 0.282, 0.182). CONCLUSION: We found no significant changes in FSFI, NFI, and MBS, but significant improvement in vaginal pH and VMV in postmenopausal women with FSD treated with vaginally administered conjugated estrogens tablet. Few side-effects were reported. TRIAL REGISTRATION: Thai Clinical Trial Registry identification number TCTR20180219001 , prospectively registered since 2018-02-19 11:33:21.

Efficacy of curcuminoids for reducing postoperative pain after laparoscopic gynecologic surgery: A pilot randomized trial.

Background Curcuminoids, which are substances extracted from turmeric, have been proved to have anti-inflammatory and analgesic effects along with a good safety profile. This study aimed to evaluate the clinical efficacy of curcuminoids for reducing postoperative pain in patients who undergo laparoscopic gynecologic surgery. Methods From November 2016 to December 2017, participants were randomly assigned, by blocks of four, to the intervention and control arms of the study. Altogether, 60 patients who were to undergo laparoscopic gynecologic surgery at our institution were enrolled. Intraoperative findings were not significantly different between the two groups. One tablet of curcuminoid extract 250 mg was given to patients in the intervention group four times a day on postoperative days 1-3. Pain was evaluated at 24 and 72 h postoperatively using a 10-point visual analog scale (VAS). Results The median VAS score 24 h after surgery was 3 (1-6) in the intervention group and 4.5 (3-7) in the control group, with the difference reaching statistical significance (p=0.001). The median VAS at 72 h after surgery was 1 (0-2) in the intervention group and 2 (1-5) in the control group (p<0.001). Conclusion Curcuminoids may be an effective supplement to reduce pain severity postoperatively following laparoscopic gynecologic surgery. Trial Registration TCTR20180215001 www.clinicaltrials.in.th.