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1.
Medicine (Baltimore) ; 99(8): e19281, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080141

RESUMO

BACKGROUND: The aim of this meta-analysis was to assess the clinicopathological features and to confirm prognostic value of POLE exonuclease domain mutations (EDM) in endometrial carcinoma patients. METHODS: The PubMed, Web of Science, the data of China National Knowledge Infrastructure, and Wan fang Medical Network were systematically searched for relevant articles without a cut-off date. The keywords for the search were "endometrial cancer," "endometrial carcinoma," "EC," "POLE mutations," "POLE exonuclease domain mutations," "POLE-mutant," "clinical characteristics" "prognostic." Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by using Review manager 5.3 and Stata 14.0 statistical software. RESULTS: Six cohort studies assessing 179 EC patients with POLE EDMs were included. The results indicated a favorable progression-free survival in POLE-mutant patients (HR = 0.32; 95% CI: = [0.09-1.18]). Furthermore, the overall survival was great in patients with POLE-mutant (HR = 0.68; 95% CI = [0.41-1.13]). It was shown that a significantly higher incidence of POLE mutations with Federation of International of Gynecologists and Obstetricians (FIGO) I group compared to FIGO II-IV group (pooled ORs: 0.34, 95% CI: [0.12-0.94], P = .04), POLE-mutant EC was not significantly associated with histology (OR = 0.56,95% CI: 0.29-1.23), tumor grade (OR = 1.22,95% CI:0.85-1.74), lymph-vascular space invasion (OR = 0.40,95% 0.06-2.42), depth of myometrial invasion (OR = 0.70,95% CI: 0.41-1.18), lymph node status (OR = 0.41, 95% 0.04-4.50), and European Society for Medical Oncology risk groups (OR = 0.68,95% CI: 0.37-1.26). CONCLUSION: This meta-analysis has confirmed POLE EDMs may serve as a predictive biomarker of favorable prognosis. Further studies are needed to explore the appropriate clinical utility of POLE EDMs in EC.


Assuntos
DNA Polimerase II/genética , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/mortalidade , Mutação , Proteínas de Ligação a Poli-ADP-Ribose/genética , Biomarcadores Tumorais/genética , Neoplasias do Endométrio/patologia , Feminino , Humanos , Linfonodos/patologia , Miométrio/patologia , Invasividade Neoplásica , Prognóstico , Intervalo Livre de Progressão
2.
Medicine (Baltimore) ; 99(2): e17908, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914010

RESUMO

This study is to determine accuracy of abdominal ultrasound and nuclear magnetic resonance imaging (MRI) for placenta accreta in the second and third trimester of pregnancy and to define the most relevant features of abdominal ultrasound and MRI for placenta accreta prediction.Between September 2012 and September 2018, 245 high risk of placenta accreta in the second trimester of pregnancy were prenatal diagnosed by abdominal ultrasound and MRI and they were followed up until the end of pregnancy.Forty-six patients at the second trimester of pregnancy and 40 patients at the third trimester of pregnancy were confirmed as placenta accreta. For the second and third trimester of pregnancy, the sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) of abdominal ultrasound were 95.65% versus 97.50%, 91.78% versus 90.70%, 88% versus 83%, and 97% versus 99%, respectively, while the Se, Sp, PPV, and NPV of MRI were 89.13% versus 92.50%, 87.67% versus 8721%, 82% versus 77%, and 93% versus 96%, respectively. Five features having significant statistical differences between normal placentation women and placenta accreta patients in second or third trimester of pregnancy, including loss of the normal retroplacental clear space, thinning or disappearance of the myometrium, increased vascularization at the uterine serosa-bladder wall interface, and vascularization perpendicular to the uterine wall on abdominal ultrasound, and uterine bulging and dark intraplacental bands on MRI.Abdominal ultrasound and MRI for placenta accreta in the second and third trimester of pregnancy could provide meaningful imaging evidences.


Assuntos
Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Placenta/anormalidades , Ultrassonografia/métodos , Útero/diagnóstico por imagem , Adulto , Feminino , Humanos , Miométrio/patologia , Placenta Acreta/patologia , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/normas , Ultrassonografia Pré-Natal/estatística & dados numéricos , Útero/irrigação sanguínea , Útero/patologia
3.
BMC Med Genet ; 20(1): 178, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718582

RESUMO

BACKGROUND: Oxytocin receptor (OXTR) gene variants have been shown to affect the prevalence of preterm birth, mode of delivery and oxytocin (OXT) requirements for labor induction and augmentation. We hypothesized that this might be associated with different myometrium responses to oxytocin. Our aim was to investigate the influence of a selection of eight OXTR gene single nucleotide variants on oxytocin-induced stimulation of human myometrium contractility in vitro. METHODS: Human myometrium biopsies were collected during elective cesarean sections at term, if patients had given informed consent. Myometrial strips were submerged under tension in an organ bath and allowed to contract; the remaining material was stored at - 80 °C for further determination of relevant genetics and mRNA level. The area under the curve (AUC) of all contractions taking place in the absence of OXT and of those occurring upon OXT addition (for 30 min each) was measured. OXT stimulation, defined as the ratio between AUC measurements after OXT addition and those in the absence of OXT was calculated for each strip. TaqMan™ Assays were used to detect the allele distribution of the eight OXTR variants and to determine the relative amounts of OXTR-mRNA in the samples. For each variant, oxytocin stimulation of contractility was compared between samples homozygous for the reference allele (reference group) and samples with at least one variant allele (variant group) by linear regression. RESULTS: Sixty samples were included in the present study. For rs1042778, rs11706648, rs4686301, rs53576, rs237895, and rs237902, OXT stimulation was similar in the reference and in the variant groups. However, the values of OXT stimulation differed significantly between the reference and the variant groups for rs4686302 (3.1 vs. 4.1 times; p = 0.022) and rs237888 (3.2 vs. 5.5 times; p = 0.001). No significant differences between the levels of OXTR-mRNA in the various reference and corresponding variant groups were detected. CONCLUSIONS: Patients with variant alleles of rs237888 and/or rs4686302 may be more sensitive to oxytocin stimulation, explaining why these sequence variants have been associated with lower cesarean section prevalence and premature birth, respectively.


Assuntos
Contração Miocárdica/genética , Polimorfismo de Nucleotídeo Único , Receptores de Ocitocina/genética , Adulto , Alelos , Biópsia , Feminino , Humanos , Técnicas In Vitro , Miométrio/metabolismo , Miométrio/patologia
4.
Medicine (Baltimore) ; 98(41): e17565, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593140

RESUMO

RATIONALE: Invasive moles occur in the fertile period, with about 95% occurring after previous mole removal and the remaining 5% occurring after several other pregnancies. PATIENT CONCERNS: A 27-year-old patient developed a rare invasive mole two months after a missed abortion. DIAGNOSES: A transvaginal ultrasound scan revealed a 3.6 × 2.9 × 2.4 cm sized lesion with cystic vascular areas within it, within the myometrium of the right fundal posterior region of the uterus. There was no metastasis to other organs. INTERVENTIONS: After administration of methotrexate, the level of beta-human chorionic gonadotropin (ß-hCG) was elevated and liver enzymes were also markedly elevated. She wanted to retain fertility for future pregnancies. After laparoscopic removal of the myometrial invasive mole, the incision site was sutured with a 3-0 V-Loc. OUTCOMES: One year later, a natural pregnancy occurred and a cesarean section was performed at 36 weeks. LESSONS: This is the first reported case of its type. Our case demonstrated that pelviscopic removal of an invasive mole is possible if there are no other metastases, and that future pregnancy and childbirth are still feasible in women of reproductive age.


Assuntos
Mola Hidatiforme Invasiva/cirurgia , Miométrio/cirurgia , Pelve/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Adulto , Gonadotropina Coriônica/análise , Feminino , Humanos , Mola Hidatiforme Invasiva/diagnóstico por imagem , Mola Hidatiforme Invasiva/patologia , Laparoscopia/métodos , Metotrexato/administração & dosagem , Miométrio/patologia , Gravidez , Resultado do Tratamento , Ultrassonografia/métodos , Neoplasias Uterinas/patologia
5.
Nat Commun ; 10(1): 3554, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391455

RESUMO

ARID1A and PI3-Kinase (PI3K) pathway alterations are common in neoplasms originating from the uterine endometrium. Here we show that monoallelic loss of ARID1A in the mouse endometrial epithelium is sufficient for vaginal bleeding when combined with PI3K activation. Sorted mutant epithelial cells display gene expression and promoter chromatin signatures associated with epithelial-to-mesenchymal transition (EMT). We further show that ARID1A is bound to promoters with open chromatin, but ARID1A loss leads to increased promoter chromatin accessibility and the expression of EMT genes. PI3K activation partially rescues the mesenchymal phenotypes driven by ARID1A loss through antagonism of ARID1A target gene expression, resulting in partial EMT and invasion. We propose that ARID1A normally maintains endometrial epithelial cell identity by repressing mesenchymal cell fates, and that coexistent ARID1A and PI3K mutations promote epithelial transdifferentiation and collective invasion. Broadly, our findings support a role for collective epithelial invasion in the spread of abnormal endometrial tissue.


Assuntos
Transformação Celular Neoplásica/genética , Classe I de Fosfatidilinositol 3-Quinases/genética , Proteínas de Ligação a DNA/genética , Neoplasias do Endométrio/genética , Transição Epitelial-Mesenquimal/genética , Proteínas Nucleares/genética , Fosfatidilinositol 3-Quinases/genética , Fatores de Transcrição/genética , Animais , Linhagem Celular , Movimento Celular/genética , Cromatina/metabolismo , Classe I de Fosfatidilinositol 3-Quinases/metabolismo , Proteínas de Ligação a DNA/metabolismo , Modelos Animais de Doenças , Neoplasias do Endométrio/patologia , Endométrio/patologia , Feminino , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Haploinsuficiência , Humanos , Mutação com Perda de Função , Camundongos , Camundongos Transgênicos , Miométrio/patologia , Invasividade Neoplásica/genética , Proteínas Nucleares/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Transdução de Sinais/genética , Fatores de Transcrição/metabolismo
6.
Eur Radiol ; 29(12): 6971-6981, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31264010

RESUMO

OBJECTIVES: To assess the diagnostic accuracy of a junctional zone (JZ) thickness of ≥ 12 mm and morphological features of the JZ in MRI in diagnosing adenomyosis in a premenopausal study population. METHODS: This single-center, prospective observational study consecutively enrolled 93 premenopausal women suffering from a benign gynecological condition, from September 2014 to August 2016. Institutional review board approval and written consent were obtained. All participants underwent MRI and hysterectomy with a histopathological examination. MR images were evaluated in a blinded fashion by two independent readers. The maximum junctional zone thickness (JZmax), presence of JZmax ≥ 12 mm, and any irregular appearance of the JZ (defined as irregular outer or inner borders, focal thickening, presence of high-intensity signal foci, or fingerlike indentations at the inner border) were documented, and the diagnostic performance was evaluated with the AUC, chi-square test, and multiple regression. RESULTS: Adenomyosis was histopathologically confirmed in 57 (61%) of the women. JZmax was not positively correlated with adenomyosis diagnosis (AUC = 0.57, p = 0.26) and did not differ significantly between those with and without adenomyosis (10.3 vs 10.1 mm, p = 0.88), nor was a cutoff of JZmax ≥ 12 mm (n = 30/57 (53%) vs n = 16/36 (44%), p = 0.29). The presence of an irregular JZ showed the best association with adenomyosis among the evaluated signs (sensitivity 74% (95% CI, 60, 85); specificity 83% (95% CI, 67, 94) (p < 0.001)). CONCLUSIONS: JZmax was not correlated with adenomyosis in the present premenopausal study population, but direct signs of adenomyosis such as irregularities of the JZ provided a good diagnostic accuracy. KEY POINTS: • Measuring the junctional zone thickness is of limited value for diagnosing adenomyosis with MRI and should not be used for diagnosing adenomyosis in premenopausal women with moderate disease severity. • An irregular appearance of the junctional zone, the presence of myometrial cysts, and adenomyoma appear to provide the highest specificity for diagnosing adenomyosis. • A consensus for the definition and reading of the junctional zone is needed.


Assuntos
Adenomiose/diagnóstico , Adenomioma/diagnóstico , Adenomioma/cirurgia , Adenomiose/cirurgia , Adulto , Diagnóstico Diferencial , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Histerectomia/métodos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Miométrio/patologia , Pré-Menopausa , Estudos Prospectivos , Sensibilidade e Especificidade , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
7.
Exp Oncol ; 41(2): 138-143, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31262163

RESUMO

AIM: To analyze copy number variations of HER-2/neu, c-MYC and CCNE1 oncogenes and their protein expression in endometrioid endometrial carcinomas in relation to the degree of tumor progression and presence of a family history of cancer in cancer patients. MATERIALS AND METHODS: The study was conducted on endometrial cancer (EC) samples from 68 patients with I-II FIGO stages of disease. Copy number analysis of HER-2/neu, c-MYC and CCNE1 genes was performed by quantitative PCR. Protein expression was analyzed using immunohistochemistry. RESULTS: Assessment of copy number variations of HER-2/neu, c-MYC and CCNE1 genes revealed their amplification in the tumors of 18.8, 25.0 and 14.3% of EC patients, respectively. High expression of corresponding proteins was detected in 14.6, 23.5 and 65.6% of patients, respectively. It was established that HER-2/neu gene amplification is more common in the group of tumors of low differentiation grade than in moderate grade EC (35.7 and 5.5% of cases, respectively, p < 0.05). Also, high expression of c-Myc protein was more frequently observed in low differentiated tumors compared to the moderately differentiated EC (36.6 and 13.2% of cases, respectively, p < 0.05). Expression of HER-2/neu and cyclin E proteins was found to be dependent on the depth of tumor invasion into the myometrium. High expression of HER-2/neu protein was observed in 25.0 and 4.1% of EC patients with tumor invasion > ½ and < ½ of the myometrium, respectively, and cyclin E - in 86.7 and 46.6% of cases, respectively, p < 0.05. It was shown that among patients with a family history of cancer, a larger proportion of cases with high expression of c-Myc protein was observed compared to the group of patients with sporadic tumors (43.8 and 17.3%, respectively; p < 0.05). CONCLUSIONS: Amplification of HER-2/neu gene, along with high expression of c-Myc, HER-2/neu and cyclin E proteins, are associated with such indices of tumor progression as a low differentiation grade and deep myometrial invasion, suggesting the potential possibility of including these markers in the panel for determining the molecular EC subtype associated with an aggressive course of the disease. In a certain category of EC patients, there is a relationship between a family history of cancer and high expression of c-Myc protein.


Assuntos
Carcinoma Endometrioide/genética , Ciclina E/genética , Neoplasias do Endométrio/genética , Proteínas Oncogênicas/genética , Proteínas Proto-Oncogênicas c-myc/genética , Receptor ErbB-2/genética , Sequência de Bases , Biomarcadores Tumorais/genética , Carcinoma Endometrioide/patologia , Variações do Número de Cópias de DNA/genética , Neoplasias do Endométrio/patologia , Endométrio/patologia , Feminino , Amplificação de Genes/genética , Humanos , Pessoa de Meia-Idade , Miométrio/patologia , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia
8.
Pathol Res Pract ; 215(8): 152465, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31176573

RESUMO

Mesenchymal tumours of the corpus uteri comprise common benign lesions - leiomyomas and very rare malignant variants - sarcomas. It can be difficult to distinguish between the particular types of mesenchymal tumours pre-surgically. Primarily, leiomyomas and the very aggressive leiomyosarcomas can be easily misdiagnosed when using only imaging devices. Therefore, a reliable non-invasive marker for these tumour types would provide greater certitude for patients that the lesion remains benign. Our collection comprises 76 native leiomyomas, an equal number of healthy myometrium samples and 49 FFPE samples of various types of sarcomas. The methylation level was assessed by MS-HRM method and we observed differences in the methylation level between healthy, benign and (semi)malignant tissues in the KLF4 and DLEC1 genes. The mean methylation levels of leiomyomas compared to myometrium and leiomyosarcomas were 70.7% vs. 6.5% vs. 39.6 % (KLF4) and 66.1% vs. 14.08% vs. 37.5% (DLEC1). The ATF3 gene was differentially methylated in leiomyomatous and myometrial tissues with 98.1% compared to 76.6%. The AUC values of the predictive logistic regression model for discrimination between leiomyomas and leiomyosarcomas based on methylation levels were 0.7829 (KLF4) and 0.7719 (DLEC1). Finally, our results suggest that there should be distinct models for the methylation events in benign leiomyomas and sarcomas, and that the KLF4 and DLEC1 genes can be considered potential methylation biomarkers for uterine leiomyomas.


Assuntos
Fator 3 Ativador da Transcrição/genética , Fatores de Transcrição Kruppel-Like/genética , Leiomioma , Miométrio/patologia , Proteínas Supressoras de Tumor/genética , Neoplasias Uterinas/genética , Adulto , Biomarcadores Tumorais/metabolismo , Metilação de DNA , Diagnóstico Diferencial , Feminino , Genes Supressores de Tumor , Humanos , Leiomioma/genética , Leiomioma/patologia , Leiomiossarcoma/patologia , Pessoa de Meia-Idade , Sarcoma/genética , Sarcoma/patologia , Neoplasias Uterinas/patologia
9.
Taiwan J Obstet Gynecol ; 58(3): 324-327, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31122517

RESUMO

OBJECTIVE: Endosalpingiosis rarely occurs in the uterus. We report a case and review literature to explore its current clinical diagnosis and treatment. CASE REPORT: A 31-year-old woman was admitted to the hospital for suspected uterine leiomyoma with cystic degeneration based on ultrasound and magnetic resonance imaging and surgical treatment. Laparoscopy revealed a large cystic mass protruding from the posterior uterine wall. The mass was resected, and a histologic examination showed that the cyst wall was lined with benign fallopian tube-type ciliated epithelium surrounded by normal myometrium, consistent with the diagnosis of endosalpingiosis of the uterus (also known as a Müllerian cyst). Currently, there are 18 cases (including ours) in the literature. Of these, two had a uterine malignancy, one endometrioid endometrial carcinoma, and another cervical adenocarcinoma. The age at diagnosis varied from 31 to 73, with a mean of 47 ± 8. The typical clinical manifestations were a palpable low abdominal mass, abnormal menstrual bleeding, and pelvic pain. Overall, 75% (12 of 16) of patients underwent a total hysterectomy, while 62.5% (10 in 16) had a concomitant bilateral salpingo-oophorectomy for nonmalignancy. No recurrence was reported. CONCLUSION: We describe the youngest patient with tumor-like uterine endosalpingiosis. The preoperative diagnosis is challenging because of its rarity. Most patients had a hysterectomy with castration, which may have resulted in overtreatment. Awareness of this lesion is necessary for the differential diagnosis of uterine and adnexal tumors. Review of relevant literature has shown a relationship between endosalpingiosis progression and cancer development, indicating an uncertain and complicated pathology.


Assuntos
Cistos/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Cistos/patologia , Cistos/cirurgia , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/patologia , Feminino , Humanos , Miométrio/patologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
10.
Int J Med Robot ; 15(4): e2006, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31050158

RESUMO

PURPOSE: Endometrial cancer is a surgically staged cancer. We examined our preliminary experience with sentinel lymph node (SLN) mapping in early stage endometrial cancer using methylene blue dyes. METHOD: Retrospective review of all clinically stage 1 endometrial cancer staged surgically using the robotic platform. Logistic regression models were built to predict nodal metastasis taking into account age, grade, histology, depth of myometrial invasion, cervical involvement, and use of SLN mapping. RESULTS: Four hundred sixty-nine patients were reviewed. Sixty patients had SLN mapping (13%). Four hundred nine patients underwent standard lymphadenectomy with five documented nodal metastasis (1.2%). Five nodal metastasis (8.3%) were seen in the SLN patients. In the logistic model, the application of SLN mapping was significantly associated with diagnosed nodal metastasis (OR 7.74; 95% CI, 2.04-29.3; P = .003) together with nonendometroid histology (OR 5.05; 95% CI, 1.27-20.12; P = .022). CONCLUSION: SLN mapping protocol using methylene blue significantly identifies more nodal metastasis than standard lymphadenectomy.


Assuntos
Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Azul de Metileno/química , Procedimentos Cirúrgicos Robóticos/métodos , Linfonodo Sentinela/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Corantes , Feminino , Humanos , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Metástase Linfática/patologia , Pessoa de Meia-Idade , Miométrio/patologia , Metástase Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos
11.
Ginekol Pol ; 90(3): 128-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30950001

RESUMO

OBJECTIVES: To examine the performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen sectioning in the assessment of myometrial invasion during the early stages of endometrial cancer. MATERIAL AND METHODS: This retrospective study employed data from patients with endometrial cancer who were operated on between January 2013 and November 2018. Patients who underwent preoperative MRI and were of FIGO 2009 stage I were included in the study. Radiological staging and intraoperative staging by frozen sectioning were carried out. The data were analyzed to assess agreement of the overall results concerning myometrial invasion. RESULTS: In total, 222 patients were enrolled. Their mean age was 58.3 ± 8.5 years. The accuracy of MRI for the detection of myometrial invasion was 88.7% and its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.6%, 82.1%, 92.2%, and 80.9%, respectively, with a kappa coefficient of 0.734 (95% confidence interval [CI], 0.684-0.784; p < 0.001). The accuracy of intraoperative frozen sectioning was 94.4%, and its sensitivity, specificity, PPV, and NPV were 97.7%, 85.7%, 94.7%, and 93.4%, respectively, with a kappa coefficient of 0.856 (95% CI, 0.812-0.900; p < 0.001). No significant difference in accuracy was observed between MRI and frozen sectioning (p = 0.057). MRI and frozen sectioning were sensitive for the detection of myometrial invasion, according to receiver operating curve analyses (areas under the curve, 0.869 and 0.917, respectively; p < 0.001). CONCLUSIONS: The assessment of myometrial invasion by preoperative MRI and intraoperative frozen sectioning during the early stages of endometrial carcinoma was highly accurate.


Assuntos
Neoplasias do Endométrio , Secções Congeladas/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Miométrio , Idoso , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Pessoa de Meia-Idade , Miométrio/diagnóstico por imagem , Miométrio/patologia , Cuidados Pré-Operatórios/métodos , Curva ROC , Estudos Retrospectivos
12.
Int J Gynecol Pathol ; 38(3): 205-215, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30958427

RESUMO

Uterine carcinosarcomas are rare aggressive biphasic neoplasms. Because of its rarity, limited data are available on potential prognostic parameters. While several studies support that carcinomatous components predict outcomes, others do not. In this study, we evaluated the clinical and histopathologic features of 196 uterine carcinosarcomas to identify potential prognostic factors. Patients' ages ranged from 34 to 95 yr (median, 68 yr). Seventy-three (38%) patients experienced tumor recurrence during follow-up. Tumors ≥5 cm, outer half myometrial invasion, lymphovascular invasion, lymph node metastasis, advanced stage (International Federation of Gynecology and Obstetrics stages III-IV), sarcomatous component on recurrence, sarcoma dominance, and positive cytology were significantly associated with shorter disease-free interval (P<0.05). In addition, serous histology and rhabdomyoblastic differentiation was significantly associated with worse 3-yr overall survival. Our data supports that both carcinomatous and sarcomatous components play a role in tumor progression and survival of uterine carcinosarcoma patients, suggesting their equal importance in guiding management decisions.


Assuntos
Carcinossarcoma/patologia , Sarcoma/patologia , Neoplasias Uterinas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinossarcoma/diagnóstico , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Pessoa de Meia-Idade , Miométrio/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/diagnóstico , Neoplasias Uterinas/diagnóstico , Útero/patologia
13.
Med Sci Monit ; 25: 2024-2031, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30883538

RESUMO

BACKGROUND To evaluate the diagnostic performance of MRI and 3D-TVS for assessment of deep myometrial invasion (MI), cervical involvement (CI), and Lymph node metastases (LNM) in endometrial cancer staging before surgery. MATERIAL AND METHODS From January 2016 to December 2017, we reviewed data from 314 women with endometrial cancer who underwent preoperative MRI and 3D-TVS before surgery. The diagnostic sensitivity, specificity, PPV, NPV, and accuracy in detecting MI, CI, and LNM were estimated based on ultimate pathology results. RESULTS The sensitivity, specificity, PPV, NPV, and accuracy of MRI in the diagnosis of MI were 89.19%, 88.97%, 67.35%, 97.99%, and 89.01%, respectively, and the indexes of 3D-TVS for MI were 86.36%, 91.07%, 79.17%, 94.44%, and 89.74%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of MRI for CI were 75% and 92.35%, 40.9%, 98.13%, and 91.2%, respectively. The indicators of 3D-TVS were 77.78%, 94.29%, 63.63%, 97.06%, and 92.4%, respectively. There were no significant differences in sensitivity, specificity, NPV, and accuracy between MRI and 3D-TVS in the diagnosis of MI and CI. For MI and CI, the sensitivity of combined MRI and 3D-TVS was higher than any other single method (P<0.05). For LNM, the sensitivity, specificity, PPV, NPV, and accuracy of MRI were 58.33%, 96.26%, 63.63%, 95.37%, and 92.43%, respectively. CONCLUSIONS 3D-TVS is equivalent to MRI in predicting MI and CI. Combined MRI and 3D-TVS can improve the assessment sensitivity, and they are useful in optimizing individualized surgical procedures. The sensitivity of MRI for LNM prediction needs to be improved.


Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ultrassonografia/métodos , Adulto , Idoso , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Endossonografia/métodos , Feminino , Humanos , Imagem Tridimensional/métodos , Metástase Linfática/patologia , Pessoa de Meia-Idade , Miométrio/diagnóstico por imagem , Miométrio/patologia , Invasividade Neoplásica/patologia , Cuidados Pré-Operatórios/métodos , Cintilografia , Sensibilidade e Especificidade , Vagina/diagnóstico por imagem , Neoplasias Vaginais/diagnóstico por imagem
14.
Gynecol Obstet Invest ; 84(6): 521-547, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30889596

RESUMO

BACKGROUND: We reviewed published cases of uterus-like mass (U-LM), endomyometriosis, polypoid adenomyoma (PA), adenomyomatous polyp, atypical PA (APA), and adenomyoma. SEARCH METHODS: PubMed, Medline, and Scopus searches of all cases published in the databases till November 26, 2018. RESULTS: We identified 45 case reports of U-LM in the pelvis, 10 cases of endomyometriosis, 44 cases of adenomyomatous polyp, 466 cases of APA and case series of adenomyoma and PA. Most case reports focused on histological description of removed lesions with no or very limited clinical correlates. Histological descriptions were often used interchangeably, which creates considerable confusion. It is unclear if endomyometriosis warrants inclusions as a distinct entity, since the distinction is blurred between adenomyomatous polyp and PA. The glandular epithelium in atypical polypoid adenomyoma exhibits atypia and the lesions have a tendency to recur with a risk of malignant transformation. Smooth muscle metaplasia and Müllerian fusion defects have been proposed as etiology, but it is possible that the lesions do not share a common origin. CONCLUSION: There is need for more detailed and structured description of reported cases including clinical presentation and associated pathology.


Assuntos
Neoplasias do Endométrio , Miométrio , Adenomioma/patologia , Adulto , Neoplasias do Endométrio/patologia , Endometriose/patologia , Endométrio/patologia , Epitélio , Feminino , Humanos , MEDLINE , Miométrio/patologia , Recidiva Local de Neoplasia/patologia , Pólipos/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
15.
Int J Mol Sci ; 20(5)2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845657

RESUMO

Uterine leiomyomas (LMs), currently the most common gynecological complaint around the world, are a serious medical, social and economic problem. Accurate diagnosis is the necessary prerequisite of the diagnostic-therapeutic process. Statistically, mistakes may occur more often in case of disease entities with high prevalence rates. Histopathology, based on increasingly advanced immunohistochemistry methods, is routinely used in the diagnosis of neoplastic diseases. Markers of the highest sensitivity and specificity profiles are used in the process. As far as LMs are concerned, the crux of the matter is to identify patients with seemingly benign lesions which turn out to be suspicious (e.g., atypical LM) or malignant (e.g., leiomyosarcoma (LMS)), which is not uncommon. In this study, we present the current state of knowledge about the use of immunohistochemical markers in the differential diagnosis of LM, atypical LM, smooth muscle tumors of uncertain malignant potential (STUMP), and LMS, as well as their clinical predictive value.


Assuntos
Biomarcadores Tumorais/metabolismo , Leiomioma/diagnóstico , Leiomiossarcoma/diagnóstico , Miométrio/patologia , Neoplasias Uterinas/diagnóstico , Biomarcadores , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Leiomioma/metabolismo , Leiomiossarcoma/metabolismo , Miométrio/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Neoplasias Uterinas/metabolismo
17.
Int J Gynaecol Obstet ; 145(2): 199-204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30801700

RESUMO

OBJECTIVE: To evaluate transvaginal repair versus laparoscopic repair of cesarean scar defects (CSDs). METHODS: A retrospective cohort study was conducted among 67 symptomatic women with CSDs who attended a tertiary hospital in Beijing, China, between July 1, 2013, and March 31, 2017. The participants underwent either transvaginal repair (n=31) or laparoscopic repair (n=36). Medical costs, perioperative outcomes, and surgical outcomes were compared. RESULTS: No statistically significant between-group differences were found at baseline. The mean thickness of the residual myometrium increased from 1.71 ± 0.67 mm before surgery to 4.41 ± 2.09 mm after surgery in the transvaginal repair group (P<0.001), and from 1.81 ± 0.93 to 4.68 ± 1.96 mm in the laparoscopic repair group (P<0.001). The duration of menses after surgery was less than 10 days in both the transvaginal repair group (n=30, 96.3%) and the laparoscopic repair group (n=30, 83.9%; P=0.113). Operative time and medical costs were both lower in the transvaginal repair group than in the laparoscopic repair group (P<0.001). Conception rates for the two groups were similar among women who desired fertility. CONCLUSION: Transvaginal repair of CSD was associated with reduced operative times and medical costs when compared with laparoscopic repair.


Assuntos
Cicatriz/cirurgia , Laparoscopia/métodos , Adulto , Cesárea/efeitos adversos , China , Cicatriz/patologia , Feminino , Humanos , Laparoscopia/economia , Miométrio/patologia , Duração da Cirurgia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
18.
Curr Microbiol ; 76(4): 510-519, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30805699

RESUMO

Brucellosis is the most common zoonotic disease that caused by intracellular parasitic bacteria Brucella. The survival and replication of Brucella in the host depend on the type IV secretion system (T4SS). The T4SS system of Brucella has many components and secreted proteins. But the mechanism helped Brucella to evade the host defense is still not clear. The objective of the present study was to investigate the effects of VceA on autophagy and apoptosis in Brucella-infected embryonic trophoblast cells. We constructed the VceA mutant strain (2308ΔVceA) and complementary strain (2308ΔVceA-C) of Brucella abortus 2308 (S2308). The human trophoblast cells (HPT-8 cells) and mice were infected by S2308, 2308ΔVceA and 2308ΔVceA-C. The cell autophagy and apoptosis were detected. The Atg5, LC3-II and Bcl-2 mRNA expression were significantly increased in 2308ΔVceA group than the S2308 group, and mRNA expression of P62 and Caspase-3 were significantly decreased than the S2308 group. Western blotting, qPCR and flow cytometry analysis showed that 2308ΔVceA promoted autophagy and inhibited apoptosis. Mouse immunohistochemistry experiments showed that P62 protein was scattered coloring and Cytochrome C protein was scarcely in 2308ΔVceA group at the myometrium. These results indicated that 2308ΔVceA promoted autophagy and inhibited apoptosis in HPT-8 cells during Brucella infection.


Assuntos
Apoptose/genética , Proteínas de Bactérias/genética , Brucella abortus/genética , Brucelose/microbiologia , Brucelose/patologia , Trofoblastos/patologia , Sistemas de Secreção Tipo IV/genética , Animais , Autofagia/genética , Proteínas de Bactérias/metabolismo , Brucella abortus/metabolismo , Brucelose/metabolismo , Linhagem Celular , Feminino , Teste de Complementação Genética , Humanos , Imuno-Histoquímica , Camundongos Endogâmicos BALB C , Miométrio/metabolismo , Miométrio/patologia , RNA Mensageiro/metabolismo , Deleção de Sequência , Trofoblastos/metabolismo
20.
Int J Gynecol Cancer ; 29(1): 113-118, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640692

RESUMO

OBJECTIVE: Endometrial carcinoma (EC) with deficient mismatch repair (dMMR) protein has been reported to have increased tumor infiltrating lymphocytes (TILs) and programed cell death ligand-1 (PD-L1) expression. TILs and PD-L1 expression are compared between two main types of dMMR ECs (epigenetic dMMR due to MLH1 promoter methylation vs mutated dMMR due to genetic mutation). METHODS: Immunohistochemistry for PD-L1 was performed in triplicate on tissue microarray sections. TILs were semi-quantitatively evaluated on whole-slide images of whole histologic sections. The clinicopathologic characteristics together with PD-L1 expression and TILs were analyzed between mutated and epigenetic dMMR ECs. RESULTS: Of the 162 dMMR ECs identified, 126 had epigenetic dMMR and 36 had mutated dMMR. Univariate analysis demonstrated mutated dMMR ECs showed younger age, less myometrium invasion of >50%, less lymphovascular invasion, and more TILs than epigenetic dMMR ECs. Multivariate analysis demonstrated significantly younger age and more TILs in mutated dMMR ECs than in epigenetic ECs. PD-L1 expression did not show any significant difference between these two groups. Seventeen (13.5%) patients with epigenetic dMMR EC had recurrence and 13 (10.3%) patients died of disease. In contrast, only one patient with mutated dMMR EC had recurrence (3%) and died of disease (3%). CONCLUSION: ECs with mutated dMMR demonstrated significantly increased TILs than ECs with epigenetic dMMR, suggesting a stronger immune reaction and potential response to immunotherapy in these tumors.


Assuntos
Antígeno B7-H1/metabolismo , Biomarcadores Tumorais/análise , Enzimas Reparadoras do DNA/deficiência , Neoplasias do Endométrio/patologia , Linfócitos do Interstício Tumoral/imunologia , Miométrio/patologia , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno B7-H1/genética , Enzimas Reparadoras do DNA/genética , Neoplasias do Endométrio/imunologia , Neoplasias do Endométrio/metabolismo , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Mutação , Miométrio/imunologia , Miométrio/metabolismo , Invasividade Neoplásica , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/metabolismo , Prognóstico , Taxa de Sobrevida
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