Influence of uterine manipulator use on the incidence of lymphovascular propagation in the treatment of endometrial cancer.

BACKGROUND: Endometrial cancers are among the epithelial malignancies of the lining of the uterine cavity. The invasion of carcinoma into the lymphovascular space (LVSI) is considered a risk factor for the course of the disease. MATERIAL AND METHODS: We evaluated 170 female patients. Our primary objective was to find any difference in the incidence of LVSI in female patients treated with and without an intrauterine manipulator. In addition, we analyzed the effect of the type of intrauterine manipulator used on the incidence of LVSI, tumor grading, myometrial invasion, and the method of obtaining primary histology with regard to the incidence of LVSI. RESULTS: Using a manipulator during surgery was not associated with LVSI (with a manipulator vs. without, 11.5 vs. 21.7%; OR 1.8; 95% CI 0.73-4.39; p = 0.199). However, the method used to obtain the primary histology had a statistically significant effect on the incidence of LVSI in our set (p-value = 0.011). CONCLUSIONS: In our study, we did not confirm the effect of a uterine manipulator on the possible increase of LVSI positive cases. The secondary analysis indicated a higher incidence of LVSI in the female patients diagnosed with curettage than in those who underwent hysteroscopy. Trail registration: Trail is registered in ClicincalTrails.gov with identifier: NCT05261165.

Liver injury associated with the use of selective androgen receptor modulators and post-cycle therapy: Two case reports and literature review.

BACKGROUND: Muscle growth promoters are being developed for the treatment of disease-induced loss of muscle mass. Ligandrol and ostarine are selective androgen receptor modulators (SARMs) with a non-steroidal structure and a presumably more favorable side effect profile. In recent years, these substances with or without "post-cycle therapy" (PCT) are often misused by amateur athletes aiming to promote muscle growth. At the same time, reports on their toxic effects on organ systems are emerging. CASE SUMMARY: We report two cases of liver injury in young men who used ligandrol and/or ostarine for a few weeks followed by the use of substances for PCT. Acute liver injury occurred in both cases after stopping SARMs while on PCT. The clinical picture was dominated by jaundice and fatigue. The biochemical pattern showed a mixed type of injury with normal alkaline phosphatase and high concentrations of bilirubin and serum bile acids. Histological evidence showed predominantly cholestatic injury with canalicular bile plugs, ductopenia, and mild hepatocellular damage without significant fibrosis. The patients recovered from the condition after 3 mo. The off target effects of SARMs were likely idiosyncratic, but our report highlights the yet unrecognized effects of other toxic substances used for PCT, supra-therapeutic doses, and the complete absence of monitoring for adverse effects. CONCLUSION: Among muscle-building amateur athletes, SARMs (ligandrol or ostarine) and/or substances in PCT may cause cholestatic liver injury with prolonged recovery.

HPV 16 in Pathogenesis of Upper Aerodigestive Tract Tumors.

INTRODUCTION: Human papillomavirus (HPV) is the worlds most widely sexually transmitted disease. HPV infection play also an important role in the etiopathogenesis of head and neck cancers, especially oropharynx. MATERIAL AND METHODS: In a prospective study of 236 patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract (oral cavity, oropharynx, hypopharynx, and larynx), the incidence of p16 positivity in tumor tissue and its relationship to tumor localization, occurrence of risk factors (smoking, alcohol, and sexual behavior), histopathological findings, and stage of disease were analyzed. RESULTS: Smoking and alcohol abuse were observed in 72% of patients with SCC of the upper aerodigestive tract. Risky sexual behavior was present only in the group of patients with orofaryngeal SCC (42%). Immunohistochemical staining revealed that p16 was present in 20% tumors of upper aerodigestive tract, most frequently in the oropharynx (30%). Patients with p16 positive orofaryngeal SCC were younger, and 94% of these pateints admitted risky sexual behavior. Smoking and regular alcohol consumption were more common in patients with p16 negative SCC of the oropharynx (90%). CONCLUSION: HPV 16 infection plays a role in the etiopathogenesis of oropharyngeal carcinoma. In other locations of the upper aerodigestive tract, smoking and alcohol abuse are major risk factors. Determination of HPV status in oropharyngeal SCC is an integral part of histopathological examinations. Immunohistochemical detection of p16 protein expression in tumor tissue is considered sufficient to stratify patients into HPV positive/negative groups of oropharyngeal carcinoma. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.