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Background and Objectives: Mutations in succinate dehydrogenase (SDH) and fumarate hydratase (FH) give rise to various familial cancer syndromes, with these alterations being characteristic of certain types of histomorphologically specific leiomyomas that hold significant predictive value. Materials and Methods: This study presents two cases of uterine leiomyomas exhibiting rare histomorphological and genetic characteristics, which are crucial for prognosis and further treatment. Results: Distinct histopathological features such as marked nuclear atypia, intracellular eosinophilic globules, and abnormal intratumoral vessels raise suspicion for specific leiomyoma subtypes, which carry predictive significance for additional hereditary cancer syndromes. Immunohistochemical analysis confirmed FH/SDH deficiency in both patients, who underwent careful follow-up. Conclusions: This study describes two cases involving unusual leiomyomas, the histopathological characteristics of which may easily go unrecognized. These features hold predictive significance because their specific mutations point to additional hereditary cancer syndromes, highlighting the need for further examinations.
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Fumarato Hidratase , Leiomioma , Succinato Desidrogenase , Neoplasias Uterinas , Humanos , Feminino , Fumarato Hidratase/deficiência , Fumarato Hidratase/genética , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia , Succinato Desidrogenase/deficiência , Succinato Desidrogenase/genética , Adulto , Leiomioma/genética , Leiomioma/patologia , Pessoa de Meia-IdadeRESUMO
Background and Objectives: The uterine smooth muscle tumors of uncertain malignant potential (STUMP) are tumors with pathological characteristics similar to leiomyosarcoma, but that do not satisfy histological criteria for leiomyoma. These are problematic lesions with intermediate morphologic features; thus, diagnosis and treatment are difficult. This narrative review aims to review data in the literature about STUMPs, particularly focusing on management and therapeutic options and strategies for women who desire to preserve fertility. Material and Methods: authors searched for "uterine smooth muscle tumor of uncertain malignant potential" in PubMed and Scopus databases, from 2000 to March 2023. Pertinent articles were obtained in full-text format and screened for additional references. Only articles in English language were included. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: The median age was 43 years old. Symptoms are similar to those of leiomyomas, with a mean diameter of 8.0 cm. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard care for women if fertility desire is satisfied. Myomectomy alone can be considered for young patients. Although these tumors have not a high malignant potential, several studies described recurrence and metastases. Conclusions: STUMPs are complex uterine smooth muscle tumors, with a rare but reasoned clinical-diagnostic management. Considering the high clinical and histological complexity of these tumors, high level of expertise is mandatory.
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Leiomioma , Tumor de Músculo Liso , Miomectomia Uterina , Adulto , Feminino , Humanos , Bases de Dados Factuais , Leiomioma/diagnóstico , Tumor de Músculo Liso/diagnóstico , ÚteroRESUMO
We evaluated factors influencing long-term health-related quality of life (HRQoL) after excisional treatments of low- and high grade squamous intraepithelial cervical lesions (SIL) in three groups of women (n = 160): nulliparas interested in reproduction (A), parous women interested in reproduction (B) and women without pregnancy desire (C). The HRQoL was assessed using the disease-specific FACIT-CD and the generic SF36v2 questionnaires. Anxiety and depression were evaluated by Beck's inventories. After median follow-up of 5 (2-18) years, FACIT-CD total score and the score for Emotional Well-Being (EWB) were significantly lower in group A. The total, EWB and REL (Relationships) scores of FACIT-CD were the highest in group B. Women operated for HSIL demonstrated lower REL quality in comparison to those with LSIL. Neither SF36v2 nor FACIT-CD total scores differed in relation to SIL grade or type of excision. 'SF36v2 Mental Component Summary Score' and 'being parous and interested in fertility' were independent predictors of disease-specific FACIT-CD score.Impact StatementWhat is already known on this subject? Long-term consequences of excisional treatments for cervical dysplasia on health-related quality of life (HRQoL) are not well reported.What do the results of this study add? Our study provides data on HRQoL in women treated with large loop excision of the transformation zone (LLETZ) or cold knife conization (CKC) obtained during the longest (median 5 years) follow-up as reported to date. We were able to show that having children and planning further pregnancies positively influenced HRQoL in these patients. In addition, we identified nulliparas with pregnancy desire as psychologically the most vulnerable group within the studied cohort.What are the implications of these findings for clinical practice and/or further research? Even several years after LLETZ or CKC, women may suffer from impaired Emotional Well-Being and reduced HRQoL. Awareness and assessment of these long-term consequences should be part of surveillance after excisional treatments for cervical dysplasia.
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Displasia do Colo do Útero , Neoplasias do Colo do Útero , Gravidez , Criança , Humanos , Feminino , Qualidade de Vida/psicologia , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/cirurgia , Displasia do Colo do Útero/patologia , Colo do Útero/cirurgia , Colo do Útero/patologia , ConizaçãoRESUMO
To compare the effects of organic selenium nanoparticles (SeNPs, Se0) and inorganic sodium selenite (NaSe, Na2SeO3, Se4+) on the antioxidant response in maternal and fetal rat liver, pregnant females were treated with two forms of selenium (Se) at equivalent doses during gestation (0.5 mg SeNPs or 0.5 mg NaSe/kg body weight/day). Structural parameters of the liver of gravid females and their fetuses were examined in a sex-specific manner. The oxidative stress parameters superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GR), glutathione S-transferase (GST), total glutathione (GSH) and sulfhydryl groups (SH) were established. In addition, the Se concentration was determined in the blood, liver, urine and feces of the gravid females and in the liver of the fetuses. The structure of the liver of gravid females remained histologically the same after supplementation with both forms of Se, while the oxidative stress in the liver was significantly lower after the use of SeNPs compared to NaSe. Immaturity of fetal antioxidant defenses and sex specificity were demonstrated. This study provides a detailed insight into the differences in the bioavailability of the nano form of Se compared to sodium selenite in the livers of pregnant females and fetuses.
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OBJECTIVE: To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients. METHODS: Demographic information, surgical history, symptoms, and postoperative outcome of women and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in women with previous UR. RESULTS: Uterine rupture was significantly associated with previous uterine surgery, occurring, on average, at 36 weeks of pregnancy in women also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to UR. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several women. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy. CONCLUSION: Data analysis showed that previous laparoscopic and abdominal myomectomies were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contraindication to future pregnancies.
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Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Ruptura Uterina , Feminino , Humanos , Recém-Nascido , Leiomioma/cirurgia , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/cirurgia , Ruptura Uterina/epidemiologia , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgiaRESUMO
Purpose: To investigate the long-term psychosexual outcomes in women following excisional cervical treatment. Materials and methods: Women with cold-knife conization (CKC) or large loop excision of the transformation zone (LLETZ) treatment were interviewed after a follow-up colposcopy visit. Their demographics, treatment and psychosexual characteristics were recorded. Results: One hundred and forty six women with a mean age of 35.2 ± 5.4 years underwent either LLETZ (68.5%) or CKC (31.5%) treatment within 4.7 ± 2.7 years (range: 2-15) before the interview. 27.4% of women were less interested in sexual intercourse following treatment in comparison with their interest before. Those women with less interest in sexual intercourse after treatment had higher anxiety and depression scores and were more worried about disease progression. Women with post-treatment complications were at risk of less interest in sexual intercourse and of greater anxiety and depression. Women with abnormal smears at follow-up were at risk of greater anxiety. The type of treatment and grade of dysplasia did not affect their interest in sexual intercourse or the anxiety and depression scores. Conclusions: Approximately, one-third of women at more than two years post-treatment may suffer from less interest in sexual intercourse, have relatively greater anxiety and depression, and might still be concerned about the possibility of disease progression.
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Ansiedade/psicologia , Colo do Útero/cirurgia , Conização/efeitos adversos , Depressão/psicologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Disfunções Sexuais Psicogênicas/psicologia , Displasia do Colo do Útero/cirurgia , Adulto , Ansiedade/etiologia , Estudos Transversais , Depressão/etiologia , Feminino , Seguimentos , Humanos , Disfunções Sexuais Psicogênicas/etiologiaRESUMO
OBJECTIVES: The FACIT-CD (Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia) questionnaire is a disease-specific instrument for assessing the health-related quality of life (HRQoL) in women with cervical dysplasia. Our aim was to perform a cross-cultural adaptation and psychometric evaluation of the FACIT-CD scale in Serbian women with cervical squamous intraepithelial lesions (SIL). STUDY DESIGN: Our study included women of reproductive age diagnosed with SIL in a single university-affiliated hospital. A total of 160 participants with histologically confirmed low-grade (LSIL) or high-grade (HSIL) squamous intraepithelial lesions responded to the Serbian version of the FACIT-CD instrument, the Short Form-36v2 questionnaire (SF-36v2), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI). Women also participated in an interview regarding their socio-demographic data. We evaluated the validity and reliability of the Serbian version of FACIT-CD. RESULTS: The Cronbach's alpha coefficient was 0.710 for the entire sample (0.702 for LSIL and 0.711 for HSIL). We found numerous correlations between the FACIT-CD scores and SF-36v2 scores, as well as between the BAI and BDI scores for both the total score and most of the domain scores. The mean FACIT-CD total score was high (114.47⯱â¯13.25 out of 136.00 which is the maximum score). There were no significant differences in the mean scores between the LSIL and HSIL groups. CONCLUSIONS: Our study demonstrated that the Serbian FACIT-CD has overall good psychometric properties in women with both LSIL and HSIL. We propose the use of the FACIT-CD questionnaire as an indicator for HRQoL in women with cervical dysplasia.