Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography.

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of time-resolved MR angiography (TR-MRA) with that of conventional venography for the detection and grading of ovarian venous reflux, which aid in the diagnosis of pelvic venous congestion. METHODS: We performed a retrospective analysis of 19 consecutive patients who underwent TR-MRA and conventional venography. The images were analysed by two radiologists in a randomised "blinded" manner. With the use of conventional venography as a gold standard, the images were reviewed to determine if differences in the detection and grading of ovarian venous reflux were seen between TR-MRA and conventional venography; the sensitivity, specificity and accuracy of TR-MRA compared with that of conventional venography were evaluated. The McNemar test was performed to determine the significance of any differences. Interobserver agreement was analysed using generalised κ statistics. RESULTS: There was no significant difference between TR-MRA and conventional venography for grading ovarian venous reflux (p>0.05). The sensitivity, specificity and diagnostic accuracy of TR-MRA were found to be 66.7%, 100% and 78.9%, and 75%, 100% and 84.2%, respectively, for the two observers. The weighted κ-values indicated excellent agreement between the two observers for grading ovarian venous reflux on TR-MRA (κ = 0.894). CONCLUSION: TR-MRA is an accurate method for accessing pelvic venous congestion.

Uterine müllerian adenosarcoma with sarcomatous overgrowth and lung metastasis in a 25-year-old woman.

Uterine müllerian adenosarcoma with sarcomatous overgrowth (MASO), uncommon in premenopausal women, is a rare variant of uterine adenosarcomas characterized by a sarcomatous portion constituting >25% of the tumor. Uterine MASO often appears as a benign, protruding cervical polyp. However, in contrast to typical müllerian adenosarcomas (MAs), MASO is a highly aggressive tumor, frequently associated with a fatal outcome. Though very rare in premenopausal women, because of the high aggressiveness and malignant potential, uterine MASO should be considered, even in women of a young age with benign-appearing polypoid masses, and treated aggressively at the time of initial diagnosis without delay. We present herein a case of uterine MASO in a 25-year-old woman with lung metastasis who was lost to follow-up for one month after the initial diagnosis had been established.

Corticotropin-releasing hormone enhances the invasiveness and migration of Ishikawa cells, possibly by increasing matrix metalloproteinase-2 and matrix metalloproteinase-9.

Corticotropin-releasing hormone (CRH), synthesized in the hypothalamus, is also produced at several extrahypothalamic sites and in normal endometrial cells. CRH exerts antiproliferative activity on oestrogen-dependent tumour cell lines (Ishikawa cells and breast cancer cells) via the CRH receptor-1. This study investigated the potential role of CRH as a factor affecting endometrial migration and invasion in Ishikawa cells, and the possible mechanisms involved in this process. Increasing concentrations of CRH (1, 10 and 100 nM) significantly reduced the proliferation of Ishikawa cells but increased the invasiveness these cells compared with the control group. All three concentrations of CRH significantly increased matrix metalloproteinase (MMP)-2 and MMP-9 levels in Ishikawa cells. In conclusion, CRH inhibited the growth of Ishikawa cells but enhanced their invasiveness, possibly by increasing MMP-2 and MMP-9 levels. These findings suggest that CRH might induce invasion and migration by upregulating MMP-2 and MMP-9 in endometrial cancer.