Insulinlike growth factor-1Ec (MGF) expression in eutopic and ectopic endometrium: characterization of the MGF E-peptide actions in vitro.

The transcription of the insulinlike growth factor 1 (igf-1) gene generates three mRNA isoforms, namely IGF-1Ea, IGF-1Eb and IGF-1Ec (or MGF [mechano growth factor]). Herein, we analyzed the expression of IGF-1 isoforms in eutopic and ectopic endometrium (red lesions and endometriotic cysts) of women with endometriosis, and we characterized the actions of a synthetic MGF E-peptide on KLE cells. Our data documented that all three igf-1 gene transcripts are expressed in the stromal cells of the eutopic and ectopic endometrium; however, endometriotic cysts contained significantly lower IGF-1 isoform expression, both at the mRNA and protein level, as was shown using semiquantitative PCR and immunohistochemical methods. In addition, the glandular cells of the eutopic endometrium did not express any of the IGF-1 isoforms; however, the glandular cells of the ectopic endometrium (red lesions) did express the IGF-1Ec at mRNA and protein level. Furthermore, synthetic MGF E-peptide, which comprised the last 24 amino acids of the MGF, stimulated the growth of the KLE cells. Experimental silencing of the type 1 IGF receptor (IGF-1R) and insulin receptor expression of KLE cells (siRNA knock-out methods) did not alter the mitogenic action of the synthetic MGF E-peptide, revealing that MGF E-peptide stimulates the growth of KLE cells via an IGF-1R-independent and insulin receptor-independent mechanism. These data suggest that the IGF-1Ec transcript might generate, apart from mature IGF-1 peptide, another posttranslational bioactive product that may have an important role in endometriosis pathophysiology.

The clinically suspicious cervix--how often is it cancer?

OBJECTIVE: To evaluate the outcome of women referred to colposcopy with the clinical finding of suspected cancer ("clinically suspicious cervix"). MATERIALS AND METHODS: A prospective cohort study of women referred to a dedicated colposcopy clinic serving a regional population with a clinically suspicious cervix was conducted. All referral letters were reviewed, and women were identified prospectively when the letter stated "referral for a clinically suspicious cervix." Relevant data were collected subsequently by case note review. RESULTS: One hundred four women were identified, and 95 attended for colposcopy from September 2006 to January 2008. Nine women defaulted. Seventy-six (80%) had a normal cervix or a benign cervical pathological result. Cervical intraepithelial neoplasia was detected in 15 patients (16%), and only 4 women (4%) had invasive cancer confirmed. CONCLUSIONS: We believe that women referred with a clinically suspicious cervix should be assessed in a general gynecology clinic rather than colposcopy because most will not have cancer. The small number of women with a clinical cancer can then be referred onto colposcopy, whereas women with benign pathological result can be treated appropriately in the general clinic.

Three surgically managed ipsilateral spontaneous ectopic pregnancies.

BACKGROUND: Recurrence of ectopic pregnancy is usually associated with assisted reproductive techniques, being less likely to occur after natural conception. CASE: We report the case of a patient who had three consecutive ectopic pregnancies on the ipsilateral side after natural conception and was treated surgically in each case with partial salpingectomy, removal of tubal stump, and resection of the uterine cornua, respectively. The contralateral normal tube was resected at the time of last operation. CONCLUSION: We indicate the high risk for tubal rupture and bleeding and the need for appropriate surgical intervention when managing recurrent ectopic pregnancies. Furthermore, care should be undertaken not to leave a long tubal stump when performing salpingectomy for ectopic pregnancy, to decrease risk of recurrence.