Does diffusion weighted imaging have a prognostic value in differentiating gynecological diseases?

INTRODUCTION: Apparent diffusion coefficient (ADC) values are effective in the diagnosis of different gynecological lesions. METHODS: A retrospective evaluation was made of 12 patients with uterine cervix carcinoma and 151 patients with uterine lesions, comprising endometrial cancer, endometrial polyps, carcinosarcoma, submucous myoma, adenomyosis, endometrial hyperplasia, gestational trophoblastic neoplasm (GTN), and leiomyomas. As a control group, 20 healthy volunteers with normal endometrium and normal cervix were also evaluated. In three series, one-shot, spin echo, echo planar, b = 1000 s/mm2 value and diffusion-weighted imaging (DWI) were applied to all subjects and ADC values were obtained. RESULTS: The mean ADC values of Group 1 (Endometrial carcinoma) were lower than those of all the other groups (P < 0.001) and the mean ADC value of group 6 (GTN) was higher than that all other groups (P < 0.001). A statistically significant difference was found between the groups in terms of the lesion-myometrium ADC ratios (P < 0.001). CONCLUSION: There are few studies in literature related to ADC measurements in GTN. The ADC values of GTN were found to be significantly higher than the other uterine lesions. These results will aid in the design of future studies and might be used to guide management of patients with GTN. IMPLICATIONS FOR PRACTICE: Diffusion-weighted MRI seems to be a promising imaging technique in differentiating different uterine lesions.

Serum oxidative stress, visfatin and apelin in healthy women and those with premenstrual syndrome.

The aim of this study was to investigate whether there is a relationship between premenstrual syndrome and oxidative stress, visfatin and apelin. The study included 40 women with premenstrual syndrome and 40 healthy women. In all subjects, serum visfatin, apelin and oxidative stress parameters were studied in venous blood samples. The oxidative stress parameters were higher in the premenstrual syndrome group than among the controls, but this difference did not reach statistical significance (p > 0.05). It was found that total antioxidant capacity was similar in both groups. For the insulin-serotonin cycle markers, no significant difference was found between groups in terms of visfatin level (p = 0.893), although apelin was found to be significantly higher in the premenstrual syndrome group when compared with the controls (p < 0.001). According to our results, apelin can be used as an ancillary laboratory test in the diagnosis of premenstrual syndrome.

Granulosa cell tumors of the ovary: review of 43 cases.

PURPOSE: Granulosa cell tumors of the ovary (OGCT) are rarely seen tumors and display a quite interesting behavior profile. The purpose of this study was to evaluate the impact of stage, histological type (juvenile or adult type) and treatment on the prognosis of this disease. METHODS: Forty-three females with OGCT operated between January 1990 and June 2007 were retrospectively evaluated. Radical surgery was performed to 37 patients (86%) without fertility desire, whereas conservative surgery was performed to 6 patients with early-stage disease and fertility desire. RESULTS: Thirty-nine (90.6%) patients had stage I disease, whereas 4 (9.4%) had advanced-disease stage (stage II 2 and stage III 2 patients). All of the patients were surgically treated, but conservative surgery was applied to only 6 cases. Postoperative chemotherapy was administered to 18 cases and the remaining 25 cases were put under follow-up without chemotherapy. Recurrence was observed in 8 cases and 1 of these cases was of juvenile type. Mean time to recurrence was 55.14±32.18 months (range 15-122). Tumor stage was the most important prognostic factor, with 5-year overall survival of 96.77% in local disease, and 66.67% in advanced-stage disease (p<0.01). CONCLUSION: OGCT can recur many years after primary therapy. Consequently these patients must be followed-up for long periods of time. Disease stage at diagnosis was the most important factor affecting the recurrence rate and prognosis. The evaluation of all factors affecting survival needs further studies with larger numbers of patients.

Oxidative stress and prolidase activity in women with uterine fibroids.

The aim of this study was to investigate oxidative stress markers and prolidase activity in serum and tissue samples of women with uterine fibroids, with further analysis on position and size. Lipid hydroperoxide, ceruloplasmin, catalase, arylesterase, free sulfhydryl group activity and prolidase activity levels were measured in fibroid tissue, myometrial tissue and serum of the same patients (n = 51), at the same time. Results show that ceruloplasmin, catalase, arylesterase, free sulfhydryl group and prolidase activities were higher in fibroid tissue than those in myometrial tissue (p = 0.003, 0.009, 0.004, 0.02, 0.008, respectively). Serum levels of catalase and prolidase were lower, and arylesterase and free sulfhydryl groups were higher in the fibroid group than those in the control group (p < 0.001 for all). Fibroid volume in submucosal subgroup of the fibroid group yield significant correlation with ceruloplasmin, catalase, arylesterase and prolidase activities (r = 0.84, p = 0.02; r = 0.93, p < 0.001; r = 0.63, p = 0.049 and r = 0.87, p = 0.01, respectively). Despite the lack of statistical significance, the highest levels of prolidase activity were found in fibroid samples, especially in submucosal ones. It is concluded that this study demonstrated increased antioxidative repair system in the fibroid tissue compared to the myometrium and serum of the same patients. Additionally, higher pathophysiological potential of the submucosal fibroids over intramural and subserosal fibroids were shown with the levels of oxidative stress markers and prolidase activity levels.

Umbilical metastasis of serous component as a first sign of mixed type epithelial ovarian cancer.

Umbilical metastasis (Sister Mary Joseph's nodule) of malignant neoplasms is a rare condition. These nodules usually arise from the gastrointestinal or genitourinary tract and may present the first sign of a previously unknown primary tumor. We describe a 49-year-old woman presenting with Sister Mary Joseph's nodule as the first sign of an extremely aggressive Stage IV mixed type epithelial ovarian carcinoma, who died 15 months after the initial diagnosis. This is the first case of a Sister Mary Joseph's nodule from a serous component of a Stage IV mixed type epithelial ovarian cancer.

Assessment of serum paraoxonase and arylesterase activities in early pregnancy failure.

QUESTIONS UNDER STUDY: Paraoxonase-1 (PON1) is an HDL-bound enzyme system which plays a key role in the protection of LDL and HDL from oxidation by hydrolysing activated phospholipids and lipid peroxide products. Oxidative stress has been involved in the pathogenesis of many complications of human pregnancy, including early pregnancy failure (EPF), preeclampsia and preterm labour. The purpose of this study was to determine serum paraoxonase/arylesterase activities and lipid hydroperoxide (LOOH) levels as an oxidative stress indicator in women with EPF. METHOD: Paraoxonase/arylesterase activities and LOOH levels were assessed in women with EPF (n = 40) and healthy continuum pregnant women without EPF (n = 38) before 12 weeks' gestation. Serum basal and salt-stimulated paraoxonase/arylesterase activities were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with a xylenol orange assay. Student's t-test and the Pearson correlation were used for statistical analysis. RESULTS: We found that basal and salt-stimulated paraoxonase/arylesterase activities were significantly lower in women with EPF than in women without EPF (all p <0.05), while LOOH levels were significantly higher (p = 0.009). CONCLUSION: Our study showed that decreased paraoxonase/arylesterase activities and increased LOOH levels may play a role in ethiopathogenesis through increased susceptibility to lipid peroxidation in women with EPF.

Assessment of serum paraoxonase and arylesterase activity in patients with endometrial cancer.

PURPOSE OF INVESTIGATION: Serum paraoxonase (PON 1) is one of the most important enzymatic antioxidants that hydrolyzes lipid peroxidation, an indicator of carcinogenic activity. The aim of this study was to compare the serum levels of paraoxonase and arylesterase activity in patients with endometrial cancer to those of healthy controls. METHODS: Serum paraoxonase and arylesterase activities, total free sulphydryl (-SH) groups and lipid hydroperoxide (LOOH) levels were measured in patients with endometrial cancer (n = 20) and controls (n = 23). RESULTS: Serum paraoxonase, arylesterase activities and total -SH group levels were significantly lower in patients compared to controls (p < 0.05, p < 0.05 and p < 0.001; respectively), while LOOH levels were significantly higher (p < 0.001). Among patients, serum paraoxonase and arylesterase activities were inversely correlated with LOOH levels (r = -0.680, p < 0.05; r = -0.708, p < 0.001; respectively), while these were positively correlated with the total -SH group (r = 0.526, p < 0.05; r = 0.508, p < 0.05; respectively). CONCLUSION: Reduced serum PON 1 activity might contribute to an impaired antioxidant defense system which plays a critical role in carcinogenesis in patients with endometrial cancer.