Distribution pattern and marker profile show two subpopulations of reserve cells in the endocervical canal.

SUMMARY: A previous immunophenotyping study in the fetal uterine cervix provided evidence for the existence of 2 subpopulations of reserve cells, one giving rise to glandular epithelium and the other to squamous epithelium (5). In this study, we investigated whether the adult uterine cervix also harbors different populations of reserve cells on the basis of their marker profile and distribution pattern. Sagittal sections from 10 normal uteri, comprising the region from ectocervix to lower uterine cavity, were histologically examined and immunostained for p63, bcl-2 and cytokeratins (CKs) 5, 7, 8, and 17. The endocervical canal consists of three regions, that is, a part lined with squamous epithelium, a part lined with endocervical cells and a part lined with tubal type epithelial cells. Histologically, we found reserve cells in all 10 investigated cervices, with an abundancy in the area beneath the endocervical columnar epithelium close to the squamo-columnar junction, and high in the endocervical canal where the invaginations consist of tubal type epithelium. In between, an area lined with endocervical columnar cells without reserve cells was identified. No reserve cells were detected in the endometrial epithelium. We defined the end of the endocervix as the point where the surface of the cervical canal and the invaginations are completely lined with tubal type epithelium. From this point, reserve cells were no longer found. Reserve cells show strong expression for p63, CKs 5 and 7, and moderate expression for bcl-2. CK17 is strongly expressed in the reserve cells at the squamo-columnar junction and to a lesser extent in the reserve cells close to the endometrium. Endocervical columnar cells usually express CKs 7 and 8 and sporadically also p63 and CK5. CK17 was only found in endocervical cells in the vicinity of CK17-positive subcolumnar reserve cells. Tubal-type epithelium was present in all samples and contained bcl-2, along with CKs 5, 7, and 8. As a result, bcl-2 and CK5 expression distinguishes tubal epithelium from endocervical columnar cells. We conclude that reserve cells are present in all investigated cervices along the entire cervical canal. The concentration of subglandular reserve cells is highest close to the squamo-columnar junction and in the upper third of the cervix. The marker profile of reserve cells is the same in all parts of the cervix, except for CK17, which shows a decreasing gradient from distal to proximal, indicating a subpopulation of distal reserve cells as progenitor for squamous and columnar epithelium, and proximal reserve cells that can serve as progenitor cells for columnar epithelium.

Differences in screening history, tumour characteristics and survival between women with screen-detected versus not screen-detected cervical cancer in the east of The Netherlands, 1992-2001.

OBJECTIVE: In The Netherlands, despite a national screening programme since 1996, invasive cervical cancers have been detected in screened and non-screened women. The aim of this study was to determine differences between Pap-smear history, tumour characteristics and survival of patients with a tumour detected by the screening programme (SP) or outside the screening programme (OSP) in the region of the Comprehensive Cancer Centre Stedendriehoek Twente in the period 1992-2001. STUDY DESIGN: In this period, 263 cervical cancer cases in women aged 30-60 were selected from the regional cancer registry. Patient and tumour characteristics, treatment and follow-up data were extracted. Also, detection modality of the tumour and Pap score of the smear which led to the diagnosis ('diagnostic smear') and the 'previous smear' were registered. RESULTS: Thirty-five percent were SP tumours and 65% were OSP tumours. SP tumours had a lower stage (FIGO I) than OSP tumours: 84% versus 57%. The OSP group exhibited a twofold increase in risk of death (p<0.05) compared to the SP group. Subsequently 61 women (23%) and 46 (17%) women had an abnormal Pap smear (Pap II or higher) 5 and 3 years before the 'diagnostic smear', respectively. Furthermore, 37 women (14%) and 23 women (9%) had a normal smear 5 and 3 years before diagnosis, respectively. CONCLUSION: SP tumours have a lower stage and a better prognosis, probably due to the fact that the screening programme detects the slow growing tumours which in general have a better prognosis. Furthermore, detection and treatment of patients with suspicious smears have been suboptimal and attention should therefore be paid to prompt follow-up of suspicious smears.

Renal pelvis rupture during pregnancy: diagnosing a confusing source of despair.

We present an impressive case of a pregnant woman presenting with severe right flank pains. A rare rupture of the right renal pelvis turned out to be the cause of her problems. Renal pelvis rupture in pregnancy is difficult to diagnose. It is easily confused with other more prevalent diagnoses, like hydronephrosis, ureteral distension, renal calculus and pyelonephritis. Ultrasonography is not always conclusive. Pyelography seems to be a good diagnostic tool, this case shows that MRI is another option. Renal pelvis rupture can be effectively treated with the insertion of a JJ-stent.

Cytokeratin 17 and p63 are markers of the HPV target cell, the cervical stem cell.

BACKGROUND: Basic research on HPV has focused on identifying the genetic changes that lead to cervical carcinoma. However, while focusing on the molecular biology of the cancer, understanding of its cellular biology has lagged: the target cell of the HPV infection is unknown. MATERIALS AND METHODS: In this study we identified the stem cell population of the cervical epithelium by monoclonal antibodies against p63, a homologue of the tumor suppressor gene p53 and cytokeratin 17 (CK17). RESULTS: We noted p63 expression consistently in the nuclei of reserve cells, hyperplasia of the reserve cells and the basal layer of the ectocervical epithelium, while CK17 only stained endocervical reserve cells and reserve cell hyperplasia. CONCLUSION: We conclude that both p63 and CK17 are suitable markers for cervical stem cell identification. Both markers, therefore, qualify for the identification of the HPV target cell.

Uterine preservation in pelvic organ prolapse using robot assisted laparoscopic sacrohysteropexy: quality of life and technique.

OBJECTIVE: Measuring quality of life of women with disorders of the pelvic floor is crucial when evaluating a therapy. The aim of this study is to profile health related quality of life of women with pelvic organ prolapse who are treated with robot assisted laparoscopic sacrohysteropexy (RALS). We also compare the operative characteristics and learning curve in this study with the current literature and describe the surgical technique. STUDY DESIGN: A prospective cohort study in a teaching hospital in The Netherlands. Fifty women with uterovaginal prolapse were treated with RALS. This study presents the largest cohort in Europe treated by RALS to date. Quality of life was assessed pre- and post-operatively using the UDI/IIQ validated self-questionnaire designed for Dutch-speaking patients. Clinical and operative data were prospectively collected up to 29 months. RALS was performed with preservation of the uterus. Statistical analysis of categorical data was performed with the paired T-test. Descriptive statistics were computed with the use of standard methods for means, median and proportions. RESULTS: Before operation, overall wellbeing was scored at 67.7% and after surgery this improved to 82.1% (p=0.03). Feelings of nervousness, frustration and embarrassment reduced significantly. Sexual functioning improved, but not significantly. The mean operative time was 223 (103-340) min. Operative time decreased significantly with gained experience and became comparable to the operative time for abdominal sacrocolpopexy and classic laparoscopy. Average blood loss was less than 50 ml and patients had a mean hospital stay of 2 days. Of all women, 95.2% were very satisfied with the result after RALS. CONCLUSION: Health related quality of life improves significantly after RALS. There are high rates of patient satisfaction. RALS proves to be a safe and effective treatment of pelvic organ prolapse. Operative time is comparable to abdominal sacrocolpopexy and classic laparoscopy in the current literature.

[Resuscitation of a pregnant patient--don't hesitate to perform a perimortem caesarean section]. / Reanimatie van een zwangere patiënt. Aarzel niet met het verrichten van een perimortem sectio.

Cardiac arrest is a rare and life-threatening complication during pregnancy. We present the case of a 26-year-old patient in her first pregnancy who during induction of labour at 41 weeks had a cardiac arrest caused by an amniotic fluid embolism. As part of the resuscitation procedure, a perimortem caesarean section was performed in the delivery room within five minutes. Following the caesarean section, she developed diffuse intravascular coagulation and massive, life-threatening haemorrhage which necessitated supravaginal uterus amputation. Afterwards mother and son recovered well and were discharged from hospital in good condition after 13 days. Pregnancy-induced changes in anatomy and physiology warrant a different approach during resuscitation. All medical personnel involved in the care of pregnant women should be trained to act promptly in acute situations. Training should increase knowledge of the aforementioned changes and stress the importance of performing a perimortem caesarean section, when necessary, on site and without hesitation.

Reserve cells in human uterine cervical epithelium are derived from müllerian epithelium at midgestational age.

The role of endocervical reserve cells in squamous metaplasia and neoplasia is still debated. Their origin in the cervix is open to speculation and it is unclear how they are targeted during carcinogenesis. To further understand the primary characteristics of reserve cells, we phenotyped them in the developing human cervix. In 13 perinatal autopsies of fetuses between 16 and 40 weeks of gestation, the human fetal cervix was evaluated in serial sections. Immunostaining comprised a panel of antibodies for cytokeratins, p63, and bcl-2; then, the sections were stained with Alcian blue and periodic acid-Schiff before and after diastase treatment. Reserve cells are first identified at approximately 20 weeks of gestation. They are first noted under müllerian-type columnar cells lining the developing uterine cavity. There is considerable overlap in the expression profiles of müllerian cells and reserve cells for p63, bcl-2, and cytokeratins 5, 8, and 18 at this stage of development, with increasing gestational age expression localized to respective cell compartments. Eventually, the phenotype of these cells correspond fully with that described for adult reserve cells and endocervical cells. Müllerian epithelial cells are the stem cell for endocervical reserve cells and endocervical columnar cells. They have the capacity to transform into both endocervical columnar and squamous-type epithelium in the endocervix during early cervical development.