To externally validate the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) by examiners with different levels of sonographic experience defined by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and to assess the morphological ultrasound features of the adnexal tumors classified as inconclusive based on IOTA SR. In the two-year prospective study adnexal tumors were assessed preoperatively with transvaginal ultrasound by examiners with different levels of experience (level 1- IOTA SR1, level 2-IOTA SR2). Additionally, an expert (level 3) evaluated all tumors by subjective assessment (SA). If the rules could not be applied, the tumors were considered inconclusive. The final diagnosis was based on the histopathological result of the removed mass. The diagnostic performance measures for the assessed model were sensitivity, specificity, negative (LR-) and positive(LR+) likelihood ratios, accuracy (ACC) and diagnostic odds ratio (DOR). 226 women with adnexal tumors scheduled for surgery were included in the stutdy. The prevalence of malignancy was 36.3 % in the group of all studied tumors and was 52.5 % in the inconclusive group (n = 40) (p = 0.215). Fewer tumors were classified as inconclusive by level 2 examiners compared to level 1 examiners [20 (8.8 %) vs. 40 (17.7 %); p = 0.008], resulting from the discrepancy in the evaluation of acoustic shadows and the vascularization within the tumor. For level 1 examiners a diagnostic strategy using IOTA SR1 +MA (assuming malignancy when SR inconclusive) achieved a sensitivity, specificity and DOR of 96.3 %, 81.9 %, 13.624 respectively. For level 2 examiners the diagnostic strategy for IOTA SR2 +MA achieved a sensitivity, specificity and DOR of 95.1 %, 89.6 %, 137,143, respectively. Adding SA by an expert (or level 3 examiner) when IOTA SR were not applicable improved the specificity of the test and achieved a DOR of 505.137 (SR1 +SA) and 293.627 (SR2 +SA). The SA by an expert proved to have the best diagnostic performance with a DOR of 5768.857, and a sensitivity and specificity of 97.6 % and 99.3 % respectively. Within the inconclusive group the most common tumors were unilocular-solid (n-13), solid (n-8) and multilocular-solid (n-10) ones. All multilocular tumors were classified as inconclusive because of their size (≥ 100 mm) and were found to be benign by pathology. Most of the inconclusive tumors with cystic content presented low-level (43.75 %) echogenicity, followed by ground-glass (34.37 %), mixed (12.5 %) and anechoic (9.4 %). The study results show excellent diagnostic performance of IOTA Simple Rules followed by subjective expert assessment in inconclusive tumors irrespective of the level of experience, while subjective assessment by an expert still has the highest diagnostic odds ratio. The number of inconclusive cases seems to depend on the level of ultrasound expertise and less experienced examiners have a tendency to overestimate blood flow and a presence of acoustic shadows within the tumors. IOTA SR were not...
Introduction: Trophoblast cells cooperate with both maternal immune cells and decidual cells to help develop the suppressive microenvironment of the endometrium. The maternal immune response against hydatidiform mole depends on this suppressive endometrial profile. Since RCAS1 is one of the molecular factors participating in the development of the suppressive profile of the endometrium we decided to examine the immunoreactivity of the RCAS1 within both the trophoblast and decidual cells during the development of hydatidiform mole. Methods: We analyzed the immunoreactivity of RCAS1 on both trophoblast and decidual cells derived from patients who underwent curettage because of hydatidiform mole. These patients were then divided into two subgroups according to whether or not they required chemotherapy after the surgical procedure. Result: We observed significantly lower immunoreactivity levels of both RCAS1 within the complete molar lesions of the patients on whom surgery alone was performed when compared to the levels found in those for whom surgery was followed by chemotherapy. Conclusion: RCAS1 staining may provide information regarding the intensity of the immunosuppressive microenvironment of both the molar lesion and the endometrium. This information can prove significant in determining the clinical course of hydatidiform mole.
Endometrial cancer (EC) is treated according to the stage and prognostic risk factors. Most EC patients are in the early stages and they are treated surgically. However, some of them, including those with high grade (grade 3) are in the intermediate and high intermediate prognostic risk groups and may require adjuvant therapy. The goal of the study was to find differences between grades based on an miRNA gene expression profile. Tumor samples from 24 patients with grade 1 (n = 10), 2 (n = 7), and 3 (n = 7) EC were subjected to miRNA profiling using next generation sequencing. The results obtained were validated using the miRNA profile of 407 EC tumors from the external Cancer Genome Atlas (TCGA) cohort. We obtained sets of differentially expressed (DE) miRNAs with the largest amount between G2 to G1 (50 transcripts) and G3 to G1 (40 transcripts) patients. Validation of our results with external data (TCGA) gave us a reasonable gene overlap of which we selected two miRNAs (miR-375 and miR190b) that distinguish the high grade best from the low grade EC. Unsupervised clustering showed a high degree of heterogeneity within grade 2 samples. MiR-375 as well as 190b might be useful to create grading verification test for high grade EC. One of the possible mechanisms that is responsible for the high grade is modulation by virus of host morphology or physiology.
Rak endometrium jest jednym z najczęstszych nowotworów złośliwych u kobiet w krajach rozwiniętych. Częstość jego występowania stale rośnie. Rokowanie -szczególnie w przypadku nawrotu i w zaawansowanym stadium choroby -jest złe. Dlatego wciąż poszukuje się nowych możliwości terapeutycznych. Jednym z celów nowoczesnych metod diagnostyki oraz leczenia raka endometrium mogą być nowotworowe komórki macierzyste. Są to komórki o właściwościach komórki macierzystej szpiku, które nabyły mutację onkogenną, zyskały możliwość samoodnowy oraz różnicowania i generowania całej populacji komórek nowotworowych. Wiele badań skupia się na poszukiwaniu markera (lub markerów) nowotworowych komórek macierzystych, który pozwoliłby na ich precyzyjną identyfikację i opracowanie zindywidualizowanej terapii celowanej. Można przypuszczać, że glikoproteina CD133, znana również jako prominin-1, może być obiecującym markerem powierzchniowym do identyfikacji nowotworowych komórek macierzystych, w tym w raku endometrium. Celem pracy jest przedstawienie stanu badań nad koncepcją macierzystych komórek nowotworowych w raku błony śluzowej trzonu macicy, zwłaszcza odnoszących się do komórek CD133, które prezentują właściwości podobne do komórek pnia.Słowa kluczowe: rak endometrium, macierzyste komórki nowotworowe, prominin-1, antygen CD133 Endometrial cancer is one of the most common malignancies in women in Western Europe. Its incidence is constantly increasing. The prognosis is poor, especially in the case of recurrent and advanced stages of the disease. Therefore, new therapeutic options are constantly sought to improve the prognosis for women with this type of cancer. One of the targets of modern diagnostic and therapeutic methods for endometrial cancer may be cancer stem cells. These are cells with the properties of a bone marrow stem cell that has acquired an oncogenic mutation, gained the ability to self-renew, differentiate and generate the entire cancer cell population. Many studies are focused on searching for a marker (or markers) of cancer stem cells that would allow their precise identification and development of individualized targeted therapy. The CD133 glycoprotein, also known as prominin-1, appears to be a promising surface marker for identifying cancer stem cells, including endometrial cancer. The aim of the paper is to present studies on the concept of cancer stem cells in endometrial cancer, especially those related to CD133 cells, which display stem-like properties.
Background: (1) Endometrial cancer is one of the most common cancers affecting women, with a growing incidence. To better understand the different behaviors associated with endometrial cancer, it is necessary to understand the changes that occur at a molecular level. CD133 is one of the factors that regulate tumor progression, which is primarily known as the transmembrane glycoprotein associated with tumor progression or cancer stem cells. The aim of our study was to assess the impact of subcellular CD133 expression on the clinical course of endometrial cancer. (2) Methods: CD133 expression in the plasma membrane, nucleus, and cytoplasm was assessed by immunohistochemical staining in a group of 64 patients with endometrial cancer representing FIGO I-IV stages, grades 1–3 and accounting for tumor angioinvasion. (3) Results: Nuclear localization of CD133 expression was increased in FIGO IB-IV stages compared to FIGO IA. Furthermore, CD133 expression in the nucleus and plasma membrane is positively and negatively associated with a higher grade of endometrial cancer and angioinvasion, respectively. (4) Conclusions: Our findings suggest that positive nuclear CD133 expression in the tumor may be related to a less favorable prognosis of endometrial carcinoma patients and has emerged as a useful biomarker of a high-risk group.
Zezłośliwienie ogniska endometriozy w powłokach brzusznych jest bardzo rzadkie. W literaturze opisano dotychczas 50 takich transformacji. Niniejszy artykuł przedstawia opis przypadku 45-letniej kobiety z rakiem endometrioidalnym, który rozwinął się na podłożu ogniska endometriozy w bliźnie po cięciu cesarskim. Czas od wykonania cięcia cesarskiego do wykrycia nowotworu wynosił 22 lata. Pacjentka zgłosiła się do Poradni Ginekologii Onkologicznej Szpitala Uniwersyteckiego w Krakowie z 15-centymetrowym guzem powłok brzusznych zlokalizowanym w regionie blizny po cięciu cesarskim. W wykonanych badaniach obrazowych: tomografii komputerowej jamy brzusznej i miednicy mniejszej oraz badaniu ultrasonograficznym stwierdzono lity guz w powłokach z naciekiem na mięśnie proste brzucha oraz przerzuty do węzłów chłonnych pachwinowych i biodrowych zewnętrznych lewych. W związku ze stopniem zaawansowania u chorej włączono chemioterapię neoadiuwantową. Ze względu na rosnący odsetek cięć cesarskich należy wziąć pod uwagę również możliwość wzrostu częstości występowania transformacji nowotworowej ogniska endometriozy w powłokach brzusznych. Słowa kluczowe: endometrioza w bliźnie po cięciu cesarskim, transformacja nowotworowa, rak endometrioidalny Malignant transformation of endometriosis in the abdominal wall is very rare. Only 50 cases have been described in literature so far. We present a case of a 45-year-old woman with endometrioid cancer, which arose from focal endometriosis in a surgical scar after cesarean section. The time elapsed between cesarean section and the diagnosis of cancer was 22 years. The patient reported to the Clinic of Gynecologic Oncology of the University Hospital in Krakow with a 15-cm abdominal wall tumor located in the region of cesarean section scar. Imaging modalities (abdominal and pelvic computed tomography and ultrasound) showed a solid tumor in the abdominal wall with invasion to abdominal muscles as well as inguinal and external iliac lymph node involvement. Due to the stage of the disease, the patient was put on neoadjuvant chemotherapy. In the light of increasing rates of cesarean section, an increased risk of malignant transformation of endometriosis in the abdominal wall should be considered.
Endometrial cancer remains a common cancer affecting the female reproductive system. There is still a need for more efficient ways of determining the degree of malignancy and optimizing treatment. WNT and mTOR are components of signaling pathways within tumor cells, and dysfunction of either protein is associated with the pathogenesis of neoplasms. Therefore, the aim of our study was to assess the impact of subcellular WNT-1 and mTOR levels on the clinical course of endometrial cancer. WNT-1 and mTOR levels in the plasma membrane, nucleus, and cytoplasm were evaluated using immunohistochemical staining in a group of 64 patients with endometrial cancer of grades 1–3 and FIGO stages I–IV. We discovered that the levels of WNT-1 and mTOR expression in the cellular compartments were associated with tumor grade and staging. Membranous WNT-1 was negatively associated, whereas cytoplasmic WNT-1 and nuclear mTOR were positively associated with higher grading of endometrial cancer. Furthermore, nuclear mTOR was positively associated with FIGO stages IB–IV. To conclude, we found that the assessment of WNT-1 in the cell membrane may be useful for exclusion of grade 3 neoplasms, whereas cytoplasmic WNT-1 and nuclear mTOR may be used as indicators for confirmation of grade 3 neoplasms.
Despite extensive knowledge of the mechanisms responsible for childbirth, the course of labor induction is often unpredictable. Therefore, labor induction protocols using prostaglandin analogs have been developed and tested to assess their effectiveness in labor induction unequivocally. A total of 402 women were collected into two groups—receiving vaginal Misoprostol or vaginal Dinoprostone for induction of labor (IOL). Then, the patients were compared in groups depending on the agent they received and their gestational age. Most patients delivered within 48 h, and most of these patients had vaginal parturition. Patients who received the Dinoprostone vaginal insert required statistically significantly more oxytocin administration than patients who received the Misoprostol vaginal insert. Patients who received the Misoprostol vaginal insert used anesthesia during labor statistically more often. Patients who received Misoprostol vaginal inserts had a statistically significantly shorter time to delivery than those with Dinoprostone vaginal inserts. The prevalence of hyperstimulation was similar in all groups and remained low. Vaginal Misoprostol-based IOL is characterized by a shortened time to delivery irrespective of the parturition type, and a lower need for oxytocin augmentation, but also by an increased demand for intrapartum analgesia administration. A vaginal Dinoprostone-based IOL protocol might be considered a more harmonious and desirable option in modern perinatal care.
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