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2.
Nat Commun ; 12(1): 5448, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521855

RESUMO

Mechanical forces in a constrained cellular environment were recently established as a facilitator of chromosomal damage. Whether this could contribute to tumorigenesis is not known. Uterine leiomyomas are common neoplasms that display relatively few chromosomal aberrations. We hypothesized that if mechanical forces contribute to chromosomal damage, signs of this could be seen in uterine leiomyomas from parous women. We examined the karyotypes of 1946 tumors, and found a striking overrepresentation of chromosomal damage associated with parity. We then subjected myometrial cells to physiological forces similar to those encountered during pregnancy, and found this to cause DNA breaks and a DNA repair response. While mechanical forces acting in constrained cellular environments may thus contribute to neoplastic degeneration, and genesis of uterine leiomyoma, further studies are needed to prove possible causality of the observed association. No evidence for progression to malignancy was found.


Assuntos
Aberrações Cromossômicas , Reparo do DNA , Leiomioma/genética , Complexo Mediador/genética , Paridade , Neoplasias Uterinas/genética , Adulto , Fenômenos Biomecânicos , Quebras de DNA de Cadeia Dupla , Feminino , Expressão Gênica , Humanos , Histerectomia , Cariótipo , Leiomioma/etiologia , Leiomioma/patologia , Leiomioma/cirurgia , Mutação , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Miométrio/metabolismo , Miométrio/patologia , Gravidez , Cultura Primária de Células , Estudos Prospectivos , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
5.
Pan Afr Med J ; 38: 388, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34381532

RESUMO

Introduction: myoma is commonly diagnosed in our hospital. It can be accidentally discovered or discovered due to metrorrhagia. The purpose of this study is to evaluate the association between the size of myomas and the circumstances under which they are detected and between the location of myomas and the occurrence of bleeding. Methods: we conducted a cross-sectional study including women aged 18 or older undergoing ultrasound at the University Teaching Hospital Bogodogo and who were diagnosed with at least one uterine myoma over a period of 6 years from January 2012 to December 2018. Binary logistic regression was used to assess metrorrhagia while multinomial logistic regression was used to assess circumstances under which they were detected and size. Results: we assessed 1049 women, among whom 2294 had myomas diagnosed on ultrasound. Each woman had two myomas. The average age of patients was 37 years. Women with myomas larger than 50 mm accounted for 29.7% (n=311). There was a strong association between interstitial, subserosal and submucosal myomas and the occurrence of metrorrhagias (p<0.001). A size less than 50 mm was significantly associated with fortuitous discovery (p=0.016) but not with revealing metrorrhagia (p=0.084). Women who had submucosal myomas (OR=3.13; CI95%= [1.45-6.76]), interstitial and submucosal myomas (OR=2.24; CI95%= [1.05-4.78] as well as interstitial, subserosal and submucosal myomas (OR=3.57; CI95%= [1.88-6.76]) were at higher risk of developing metrorrhagia. Myomas measuring less than 50 mm had twice the odds of revealing fortuitously (RRR=1.80; CI95%= [1.25-2.62]) or by metrorrhagia (RRR=1.75; CI95%= [1.04-2.95]. Conclusion: metrorrhagia is more common in women with myomas in specific locations.


Assuntos
Leiomioma/diagnóstico por imagem , Metrorragia/etiologia , Neoplasias Uterinas/diagnóstico por imagem , Adolescente , Adulto , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Achados Incidentais , Leiomioma/complicações , Leiomioma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologia , Adulto Jovem
6.
J Clin Pathol ; 74(10): 615-619, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34353877

RESUMO

Fumarate hydratase (FH), encoded by the FH gene, is an enzyme which catalyses the conversion of fumarate to L-malate as part of the tricarboxylic acid cycle. Biallelic germline mutations in FH result in fumaric aciduria, a metabolic disorder resulting in severe neurological and developmental abnormalities. Heterozygous germline mutations in FH result in hereditary leiomyomatosis and renal cell carcinoma, a cancer predisposition syndrome. FH deficiency has multiple oncogenic mechanisms including through promotion of aerobic glycolysis, induction of pseudohypoxia, post-translational protein modification and impairment of DNA damage repair by homologous recombination. FH-deficient neoplasms can present with characteristic morphological features that raise suspicion for FH alterations and also frequently demonstrate loss of FH immunoreactivity and intracellular accumulation of 2-succinocysteine, also detected by immunohistochemistry.


Assuntos
Fumarato Hidratase/deficiência , Fumarato Hidratase/metabolismo , Erros Inatos do Metabolismo/enzimologia , Hipotonia Muscular/enzimologia , Neoplasias/enzimologia , Transtornos Psicomotores/enzimologia , Animais , Fumarato Hidratase/genética , Regulação Enzimológica da Expressão Gênica , Predisposição Genética para Doença , Humanos , Leiomiomatose/enzimologia , Leiomiomatose/genética , Leiomiomatose/patologia , Erros Inatos do Metabolismo/genética , Hipotonia Muscular/genética , Mutação , Neoplasias/genética , Neoplasias/patologia , Síndromes Neoplásicas Hereditárias/enzimologia , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/patologia , Fenótipo , Transtornos Psicomotores/genética , Neoplasias Cutâneas/enzimologia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Neoplasias Uterinas/enzimologia , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
7.
Nature ; 596(7872): 398-403, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34349258

RESUMO

One in four women suffers from uterine leiomyomas (ULs)-benign tumours of the uterine wall, also known as uterine fibroids-at some point in premenopausal life. ULs can cause excessive bleeding, pain and infertility1, and are a common cause of hysterectomy2. They emerge through at least three distinct genetic drivers: mutations in MED12 or FH, or genomic rearrangement of HMGA23. Here we created genome-wide datasets, using DNA, RNA, assay for transposase-accessible chromatin (ATAC), chromatin immunoprecipitation (ChIP) and HiC chromatin immunoprecipitation (HiChIP) sequencing of primary tissues to profoundly understand the genesis of UL. We identified somatic mutations in genes encoding six members of the SRCAP histone-loading complex4, and found that germline mutations in the SRCAP members YEATS4 and ZNHIT1 predispose women to UL. Tumours bearing these mutations showed defective deposition of the histone variant H2A.Z. In ULs, H2A.Z occupancy correlated positively with chromatin accessibility and gene expression, and negatively with DNA methylation, but these correlations were weak in tumours bearing SRCAP complex mutations. In these tumours, open chromatin emerged at transcription start sites where H2A.Z was lost, which was associated with upregulation of genes. Furthermore, YEATS4 defects were associated with abnormal upregulation of bivalent embryonic stem cell genes, as previously shown in mice5. Our work describes a potential mechanism of tumorigenesis-epigenetic instability caused by deficient H2A.Z deposition-and suggests that ULs arise through an aberrant differentiation program driven by deranged chromatin, emanating from a small number of mutually exclusive driver mutations.


Assuntos
Montagem e Desmontagem da Cromatina , Cromatina/genética , Cromatina/metabolismo , Histonas/deficiência , Leiomioma/genética , Mutação , Neoplasias Uterinas/genética , Carcinogênese/genética , Linhagem Celular , Cromatina/química , Células-Tronco Embrionárias/metabolismo , Epigênese Genética , Feminino , Regulação Neoplásica da Expressão Gênica , Histonas/genética , Histonas/metabolismo , Humanos , Leiomioma/metabolismo , Leiomioma/patologia , Ligases/genética , Complexo Repressor Polycomb 1/genética , Proteínas do Grupo Polycomb/genética , Fatores de Transcrição/genética , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/patologia
8.
Eur J Obstet Gynecol Reprod Biol ; 265: 25-29, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34416579

RESUMO

INTRODUCTION: Serous endometrial intraepithelial carcinoma (SEIC) is a rare diagnosis, defined as an intraepithelial lesion with cells identical to serous type endometrial carcinoma. SEIC is considered to be potentially metastatic, however clear and robust data on prognosis are lacking, potentially leading to variability in clinical management. OBJECTIVE: The aim is to establish the opinion of gynecologists on the optimal management of patients with SEIC. METHODS: An online questionnaire with 15 multiple choice questions was sent to all gynecologists with expertise in gynecological oncology in 19 expert centers in The Netherlands. RESULTS: A total of 24 gynecologists participated. The majority of respondents (n = 18/24, 75%) do not consult a guideline regarding the treatment of SEIC. In current practice, 14 of the 24 respondents perform surgical staging in women with SEIC (58.3%) while seven choose hysterectomy with bilateral salpingo-oophorectomy (29.2%), and three (12.5%) have no firm preference. Eleven of the 14 respondents who perform a surgical staging procedure believe that this is certainly the optimal treatment. The majority of respondents have no firm opinion on whether lymph node sampling or lymph node dissection is preferable during surgical staging (n = 15/23, 65.2%). Most respondents do not give adjuvant therapy (n = 15/24, 62.5%), 25.0% recommend brachytherapy (n = 6/24). Follow-up is for 5 years in almost all cases (n = 23/24). CONCLUSION: There is no consensus on the optimal surgical treatment and the use of adjuvant therapy for patients with SEIC. Our research team is therefore conducting a nationwide cohort study in which treatment modality, morbidity and survival will be evaluated.


Assuntos
Carcinoma in Situ , Cistadenocarcinoma Seroso , Neoplasias do Endométrio , Neoplasias Uterinas , Carcinoma in Situ/patologia , Estudos de Coortes , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/terapia , Feminino , Humanos , Histerectomia , Excisão de Linfonodo , Estadiamento de Neoplasias , Países Baixos/epidemiologia , Neoplasias Uterinas/patologia
9.
Int J Mol Sci ; 22(16)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34445194

RESUMO

Uterine leiomyomas represent the most common benign gynecologic tumor. These hormone-dependent smooth-muscle formations occur with an estimated prevalence of ~70% among women of reproductive age and cause symptoms including pain, abnormal uterine bleeding, infertility, and recurrent abortion. Despite the prevalence and public health impact of uterine leiomyomas, available treatments remain limited. Among the potential causes of leiomyomas, early hormonal exposure during periods of development may result in developmental reprogramming via epigenetic changes that persist in adulthood, leading to disease onset or progression. Recent developments in unbiased high-throughput sequencing technology enable powerful approaches to detect driver mutations, yielding new insights into the genomic instability of leiomyomas. Current data also suggest that each leiomyoma originates from the clonal expansion of a single transformed somatic stem cell of the myometrium. In this review, we propose an integrated cellular and molecular view of the origins of leiomyomas, as well as paradigm-shifting studies that will lead to better understanding and the future development of non-surgical treatments for these highly frequent tumors.


Assuntos
Leiomioma/patologia , Neoplasias Uterinas/patologia , Útero/patologia , Animais , Epigênese Genética , Feminino , Regulação Neoplásica da Expressão Gênica , Predisposição Genética para Doença , Humanos , Leiomioma/etiologia , Leiomioma/genética , Mutação , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/genética , Útero/metabolismo
10.
Curr Issues Mol Biol ; 43(2): 802-817, 2021 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-34449552

RESUMO

Uterine fibroids are the most common mesenchymal uterine neoplasms; their prevalence is estimated in 40%-60% of women under 35 and in 70%-80% of women over 50 years of age. The current research aims to focus on the etiopathogenesis of uterine fibroids, the factors that affect their growth, and markers with diagnostic and prognostic properties. The MCM (minichromosome maintenance) protein family consists of peptides whose primary function is participation in the molecular mechanism of creating replication forks while regulating DNA synthesis. The aim of this work was to determine the proliferative potential of uterine fibroid cells based on the expression of the Ki-67 antigen and the MCMs-i.e., MCM-3, MCM-5, and MCM-7. In addition, the expression of estrogen (ER) and progesterone (PgR) receptors was evaluated and correlated with the expression of the abovementioned observations. Ultimately, received results were analyzed in terms of clinical and pathological data. MATERIALS AND METHODS: In forty-four cases of uterine fibroids, immunohistochemical reactions were performed. A tissue microarray (TMA) technique was utilized and analyzed cases were assessed in triplicate. Immunohistochemistry was performed using antibodies against Ki-67 antigen, ER, PgR, MCM-3, MCM-5, and MCM-8 on an automated staining platform. Reactions were digitalized by a histologic scanner and quantified utilizing dedicated software for nuclear analysis. Assessment was based on quantification expression of the three histiospots, each representing one case in TMA. RESULTS: In the study group (uterine fibroids), statistically significant stronger expression of all the investigated MCMs was observed, as compared to the control group. In addition, moderate and strong positive correlations were found between all tested proliferative markers. The expression of the MCM-7 protein also correlated positively with ER and PgR. With regard to clinical and pathological data, there was a negative correlation between the expression of MCMs and the number of both pregnancies and births. Significant reductions in MCM-5 and MCM-7 expression were observed in the group of women receiving oral hormonal contraceptives, while smoking women showed an increase in MCM-7, ER, and PgR. CONCLUSIONS: Uterine fibroid cells have greater proliferative potential, as evaluated by expression of the Ki-67 antigen and MCMs, than unaltered myometrial cells of the uterine corpus. The expression of MCM-7 was found to have strong or moderate correlations in all assessed relations. In the context of the clinical data, as well evident proliferative potential of MCMs, further studies are strongly recommended.


Assuntos
Proteínas de Ciclo Celular/biossíntese , Leiomioma/metabolismo , Componente 3 do Complexo de Manutenção de Minicromossomo/biossíntese , Componente 7 do Complexo de Manutenção de Minicromossomo/biossíntese , Neoplasias Uterinas/metabolismo , Adulto , Idoso , Biomarcadores Tumorais/metabolismo , Proteínas de Ciclo Celular/metabolismo , Receptor alfa de Estrogênio/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Leiomioma/patologia , Pessoa de Meia-Idade , Componente 3 do Complexo de Manutenção de Minicromossomo/metabolismo , Componente 7 do Complexo de Manutenção de Minicromossomo/metabolismo , Gravidez , Receptores de Progesterona/metabolismo , Neoplasias Uterinas/patologia
11.
Wiad Lek ; 74(7): 1763-1766, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34459784

RESUMO

OBJECTIVE: Choriocarcinoma is a rare malignant disease that is usually associated with a gestational event. Kidney metastasis might be misdiagnosed as renal cell carcinoma or kidney abscess. To the best of our knowledge, only 13 cases of cutaneous metastasis of choriocarcinoma have been reported in the literature so far. We report a case of choriocarcinoma that manifested with multiple metastases to the lung, skin, kidney and brain. Case report: We reported a case of a 37-year-old woman with a history of hydatiform mole, with symptoms of renal colic and abnormal findings on the skin. Chest X-ray revealed visible focal change 80 mm in diameter, located in the left lung area. The CT exposed in both kidneys multiple hypodense foci, 32 mm in size, suggesting multifocal abscesses with disruptions and perforation to paranephric area. Due to the presence of and temporary loss of vision in the right eye head CT was performed revealing metastatic changes in the brain. The diferential diagnosis between renal cancer, lung carcinoma and choriocarcinoma was achieved only after surgical removal skin lesion. This was the first time in our experience with choriocarcinoma. Immunohistochemically, the analysis was positive for beta hCG, cytokeratin AE1/AE, CK 8/18, CD10, EMA, alfa 1-inhibin and negative for protein 63, CD30 and CD117. Serum hCG level was 394590,0 mIU/mL. CONCLUSION: Conclusions: Choriocarcinoma should be taken into consideration when associated symptoms and significantly elevated blood levels of ß-hCG were identified.


Assuntos
Coriocarcinoma , Cólica Renal , Pele/patologia , Neoplasias Uterinas , Adulto , Coriocarcinoma/patologia , Feminino , Humanos , Neoplasias Renais/secundário , Neoplasias Pulmonares/secundário , Gravidez , Cólica Renal/etiologia , Tomografia Computadorizada por Raios X , Neoplasias Uterinas/patologia
13.
FASEB J ; 35(8): e21738, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34245615

RESUMO

The heavy metal Cadmium (Cd), a widespread environmental contaminant, poses serious hazards to human health and is considered a metallohormone and carcinogen. In women with uterine fibroids, there is a significant association between blood Cd levels and increased fibroid tumor size. The aim of this study was to determine if benign human uterine leiomyoma (fibroid) cells could be malignantly transformed in vitro by continuous Cd exposure and, if so, explore a molecular mechanism by which this could occur. We found when fibroid cells were exposed to 10 µM CdCl2 for 8 weeks, a robust and fast-growing Cd-Resistant Leiomyoma (CR-LM) cell culture was established. The CR-LM cells formed viable colonies in soft agar and had increased cytoplasmic glycogen aggregates, enhanced cell motility, a higher percentage of cells in G2/M phase, and increased expression of the proliferation marker Ki-67. NanoString analysis showed downregulation of genes encoding for extracellular matrix (ECM) components, such as collagens, fibronectins, laminins, and SLRP family proteins, whereas genes involved in ECM degradation (MMP1, MMP3, and MMP10) were significantly upregulated. A volcano plot showed that the top differentially genes favored cancer progression. Functional analysis by ingenuity pathway analysis predicted a significant inhibition of TGFB1 signaling, leading to enhanced proliferation and attenuated fibrosis. Prolonged Cd exposure altered phenotypic characteristics and dysregulated genes in fibroid cells predicative of progression towards a cancer phenotype. Therefore, continuous Cd exposure alters the benign characteristics of fibroid cells in vitro, and Cd exposure could possibly pose a health hazard for women with uterine fibroids.


Assuntos
Cádmio/toxicidade , Matriz Extracelular/metabolismo , Leiomioma/metabolismo , Transdução de Sinais/efeitos dos fármacos , Fator de Crescimento Transformador beta/metabolismo , Neoplasias Uterinas/metabolismo , Linhagem Celular Tumoral , Feminino , Humanos , Leiomioma/patologia , Neoplasias Uterinas/patologia
14.
Br J Radiol ; 94(1125): 20210283, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34289327

RESUMO

Leiomyomas are the most common benign tumors of the uterus. On the opposite side, leiomyosarcomas are rare malignant uterine tumors that account for a significant proportion of uterine cancer deaths. Especially when large and degenerated, leiomyomas and leiomyoma variants can have overlapping imaging characteristics with those of leiomyosarcomas. Although not always possible, it is paramount to be able to differentiate between leiomyomas and leiomyosarcomas on imaging, as the therapeutic management can differ. This pictorial review aims to familiarize radiologists with imaging features of leiomyomas and various types of leiomyoma degeneration and variants, together with their pathology correlates.


Assuntos
Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/patologia , Imageamento por Ressonância Magnética/métodos , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia , Diagnóstico Diferencial , Feminino , Humanos , Sistemas de Informação em Radiologia , Útero/diagnóstico por imagem , Útero/patologia
15.
Gynecol Obstet Invest ; 86(4): 408-414, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34284401

RESUMO

OBJECTIVE: The aim of this study was to evaluate the impact of initial surgical treatments and surgical re-exploration on the oncological outcomes of patients with incidentally diagnosed uterine leiomyosarcoma (uLMS). DESIGN: A retrospective analysis of 87 patients who underwent re-exploration for incidentally diagnosed uLMS at the Fudan University Shanghai Cancer Center was performed. METHODS: Kaplan-Meier and Cox proportional hazards regression models were used for analyses. RESULTS: The median age (range) at diagnosis was 49 (23-76) years. The median disease-free survival (DFS) and overall survival (OS) were 15.1 and 56.7 months, respectively. The Kaplan-Meier curves and log-rank tests showed the median DFS was longer in patients with restaging operation (N = 30) than without (N = 55) (p = 0.017) but no significant difference in median OS (p = 0.142). In patients who underwent myomectomy/subtotal hysterectomy, 5 patients (28.5%) had remnant sarcoma during re-exploration with complete uterine removal, and re-exploration was associated with longer DFS (p = 0.038) and OS (p = 0.042). LIMITATIONS: The limitation of this study is its retrospective observational design with a limited number of patients. CONCLUSION: Reoperation with total hysterectomy after incomplete surgery may be helpful in patients with incidentally diagnosed uLMS at the first treatment.


Assuntos
Leiomiossarcoma , Neoplasias Uterinas , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Histerectomia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Reoperação , Estudos Retrospectivos , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia , Adulto Jovem
16.
Am J Clin Oncol ; 44(9): 463-468, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34265785

RESUMO

OBJECTIVE: The objective of this study was to compare survival endpoints between women with uterine carcinosarcoma and those with uterine serous carcinoma utilizing matching analysis. METHODS: Patients with stages I to II who underwent hysterectomy at our institution were included in this analysis. Patients with carcinosarcoma were then matched to patients with serous carcinoma based on stage, and adjuvant management received (observation, radiation treatment alone, chemotherapy alone, or combined modality with radiotherapy and chemotherapy. Recurrence-free survival, disease-specific survival, and overall survival were calculated for the 2 groups. RESULTS: A total of 134 women were included (67 women with carcinosarcoma and 67 with serous carcinoma, matched 1:1). There was no statistically significant difference between the 2 groups regarding 5-year recurrence-free survival (59% vs. 62%), disease-specific survival (66% vs. 67%), or overall survival (53% vs. 57%), respectively. The only independent predictor of shorter recurrence-free survival for the entire cohort was the lack of adjuvant combined modality therapy, while lower uterine segment involvement was the only independent predictor for shorter disease-specific survival. Lack of lymph node dissection and lack of adjuvant combined modality therapy were independent predictors of shorter overall survival. DISCUSSION: When matched based on stage and adjuvant treatment, our study suggests that there is no statistically significant difference in survival endpoints between women with early-stage carcinosarcoma and serous carcinoma. Adjuvant combined modality treatment is an independent predictor of longer recurrence-free survival and overall survival.


Assuntos
Carcinossarcoma/mortalidade , Cistadenocarcinoma Seroso/mortalidade , Neoplasias Uterinas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinossarcoma/patologia , Carcinossarcoma/terapia , Quimioterapia Adjuvante , Terapia Combinada , Cistadenocarcinoma Seroso/terapia , Feminino , Humanos , Histerectomia , Excisão de Linfonodo , Análise por Pareamento , Pessoa de Meia-Idade , Ovariectomia , Dosagem Radioterapêutica , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia
17.
J Med Case Rep ; 15(1): 417, 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34325722

RESUMO

BACKGROUND: Metastatic choriocarcinoma in the third trimester of pregnancy is extremely rare. CASE PRESENTATION: A 25-year-old Chinese woman (gravida 3, para 0) who was 28 weeks pregnant was admitted for sudden convulsion, aconuresis, and unconsciousness. The decision was made to perform an emergency cesarean delivery and craniotomy, hematoma clearance, and decompression. Pathological examination confirmed choriocarcinoma with brain metastasis. The patient underwent chemotherapy with the etoposide, cisplatin (EP) and etoposide, methotrexate and dactinomycin alternating with cyclophosphamide and vincristine (EMACO) regimens. A satisfactory result was achieved. CONCLUSIONS: When encountering intracranial mass or bilateral pulmonary nodules in a pregnant woman, especially one in the third trimester, metastatic choriocarcinoma should be considered.


Assuntos
Neoplasias Encefálicas , Coriocarcinoma , Neoplasias Uterinas , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/secundário , Coriocarcinoma/tratamento farmacológico , Coriocarcinoma/patologia , Cisplatino/uso terapêutico , Ciclofosfamida/uso terapêutico , Dactinomicina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Humanos , Metotrexato/uso terapêutico , Gravidez , Terceiro Trimestre da Gravidez , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia , Vincristina/uso terapêutico
18.
Fertil Steril ; 116(5): 1404-1414, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34256950

RESUMO

OBJECTIVE: To compare the expression profiles of matrix metalloproteinases (MMPs) and their inhibitors (tissue inhibitors of matrix metalloproteinases, TIMPs) in the endometrium of women with and without type 3 leiomyomas and to understand their relationship with inflammatory status. DESIGN: Molecular and in silico studies. SETTING: University hospital. PATIENT(S): Patients with type 3 leiomyomas ranging from 3 to 10 cm in diameter (n = 18) and control age-matched women undergoing surgery for ovarian cysts (n = 18) who underwent endometrial biopsies. INTERVENTION(S): Endometrial biopsies. MAIN OUTCOME MEASURE(S): To evaluate the expression levels of MMPs and TIMPs in the endometrium, quantitative reverse transcriptase polymerase chain reaction and Western blot were performed. With the use of immunofluorescence analysis, the investigated proteins were localized in the tissues. The expression levels of inflammatory mediators such as IL-1ß, IL-6, IL-10, TGF, COX1, COX2, STAT3, and VEGF were evaluated by quantitative reverse transcriptase polymerase chain reaction, and their relationships were detected by the STRING approach. RESULT(S): The endometrium of women with type 3 leiomyomas exhibited differential expression of MMPs and TIMPs, particularly MMP2, MMP11, and MMP14, as well as different topographic distribution, suggesting that leiomyomas may influence the endometrial molecular profile. Significant decreases in IL-1ß, IL-6, and IL-10 expression, along with increases in COX1 and COX2, as well as VEGF, were highlighted. The STRING approach suggests that this altered gene expression profile may affect the Th17 cell differentiation pathway. CONCLUSION(S): The differential expression and localization of MMPs and TIMPs observed in women with type 3 leiomyomas, along with the reported derangement in the expression of key molecules involved in the inflammatory pathway, may contribute to changes in endometrial receptivity in these patients.


Assuntos
Citocinas/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Matriz Extracelular/metabolismo , Mediadores da Inflamação/metabolismo , Leiomioma/metabolismo , Metaloproteinases da Matriz/metabolismo , Inibidores Teciduais de Metaloproteinases/metabolismo , Neoplasias Uterinas/metabolismo , Adulto , Estudos de Casos e Controles , Citocinas/genética , Matriz Extracelular/patologia , Feminino , Imunofluorescência , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Leiomioma/genética , Leiomioma/patologia , Metaloproteinases da Matriz/genética , Inibidores Teciduais de Metaloproteinases/genética , Transcriptoma , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
19.
Taiwan J Obstet Gynecol ; 60(4): 752-757, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34247819

RESUMO

OBJECTIVE: Uterine artery ligation (UAL) at the time of myomectomy has shown to decrease blood loss during the operation. However, little is known about the efficacy and feasibility of UAL during single-port access (SPA) myomectomy. The present study was performed to investigate the clinical benefits of UAL in SPA myomectomy and to provide details of the surgical techniques. MATERIALS AND METHODS: A retrospective and comparative review on the surgical outcomes of the patients who underwent SPA myomectomy with UAL and those who underwent SPA myomectomy without UAL was conducted. UAL was performed at its origin from the internal iliac artery via a retroperitoneal approach. RESULTS: A total of 56 women who received SPA myomectomy were reviewed (24 patients received SPA myomectomy with UAL while 32 patients received SPA myomectomy only). The median weight of total resected leiomyomas was heavier for the patients who received UAL than those who did not receive UAL [210.0 g (range: 171.5-335.0 g) vs. 119.0 g (62.5-265.0 g), p = 0.023]. However, no differences in total operative time, estimated blood loss, perioperative hemoglobin changes, use of postoperative analgesics and postoperative complications between the two groups were seen. CONCLUSION: Obtaining similar surgical outcomes between the patients who received UAL with larger leiomyomas and those who did not receive UAL with smaller leiomyomas suggests that UAL is a feasible surgical approach to reduce blood loss during SPA myomectomy. Detailed descriptions of the surgical techniques are provided in the present report.


Assuntos
Laparoscopia/métodos , Leiomioma/cirurgia , Ligadura/métodos , Artéria Uterina/cirurgia , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Dispositivos de Acesso Vascular , Adulto , Perda Sanguínea Cirúrgica , Estudos de Viabilidade , Feminino , Humanos , Laparoscopia/instrumentação , Leiomioma/patologia , Ligadura/instrumentação , Pessoa de Meia-Idade , Duração da Cirurgia , Peritônio/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias Uterinas/patologia , Útero/patologia , Útero/cirurgia
20.
Tech Vasc Interv Radiol ; 24(1): 100729, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147197

RESUMO

Since the introduction of uterine artery embolization as a treatment option for symptomatic leiomyomas, there has been a growing interest in expanding the role of interventional radiology (IR) in the evaluation and treatment of obstetrics and gynecology (OBGYN) patients. This review provides an overview of opportunities for collaboration between IR and OBGYN. This can include medically and/or surgically complex patients, efforts to reduce quantitative blood loss, obstetrical emergencies, and consideration of fertility or uterine preservation. Increased collaborative efforts between IR and OBGYN would allow for patients to be fully informed regarding the complete spectrum of surgical and nonsurgical treatment options available to them. The purpose of this review is to foster opportunities to improve outcomes and respect patient values.


Assuntos
Leiomioma/terapia , Equipe de Assistência ao Paciente , Hemorragia Pós-Parto/terapia , Radiografia Intervencionista , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Comportamento Cooperativo , Feminino , Preservação da Fertilidade , Humanos , Comunicação Interdisciplinar , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Hemorragia Pós-Parto/diagnóstico por imagem , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Embolização da Artéria Uterina/efeitos adversos , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia
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