Conclusions Systemic chemotherapy with TIP followed by salvage focal treatment is a promising therapeutic approach in selected patients, particularly in younger patients, without comorbidities, good performance status, low metastatic tumor burden, and with an objective response to chemotherapy.
Hyperplastic processes of endometrium are one of the most common pathologies of the uterus mucosa, an interest in its study is due to an increase in the frequency of occurrence, the ability to both self-healing and malignancy.Purpose of the study: to investigate the detection rate of endometrial proliferative changes depending on the age of woman.Materials and methods. A retrospective medical documentation analysis of the Department of Pathology was conducted. 2196 pathologic findings of endometrial tissue samples were investigated. 1404 specimen were hyperplastic states, 688 were endometrial polyps, and 104 others were endometrial states after total or subtotal uterine removal after surgery. Histological conditions were distributed according to patients’ age categories. Results of the study were processed statistically using variation statistics with Student's criterion, using standard computer systems.Results. The analysis shows an increase in frequency of endometrial proliferative changes in perimenopausal patients on the background of endometrial pathological changes detection in all age categories. Atypical forms of simple and complex hyperplasia of the endometrium can be traced in all age categories, with a maximum frequency of manifestation in similar age-related periods – 41–45 years and 46–50 years. Morphological signs of endometrial tissue malignancy were first established in the age group of 46–50 years, which coincides with the age of the onset of menopause in the Odesa region, with subsequent relative increase in the frequency and aggressiveness of the process with age. These age groups focus doctors to be more careful about pathological manifestations.Conclusion. As a result of retrospective analysis of histopathological examinations it was found that the main factor in detecting pathological conditions of the endometrium is a woman's age of perimenopausal period, which can be considered as an early marker of diagnosis, leading to treatment prospects and general therapeutic tactics, for the future diagnostics and detection of others immunohistochemical and molecular genetic markers in women with hyperplastic processes in endometrial tissue.
The existence of a clear tendency to increase the prevalence of hormone-dependent diseases and endometrial cancer against the background of increasing the frequency of their occurrence and rejuvenation of the age of manifestation leads to the search for new possible markers of diagnosis and prognosis of the development of pathological process. Angiogenesis is one of the forms that lead to the formation of new blood vessels, with an increased metabolic need for perfusion of existing vessels. The vascular endothelial growth factor family (VEGF) is a protein that is the major inducer of angiogenesis. The objective: To study the expression of VEGF in endometrial cells in proliferative, hyperplastic, atrophic states at women's different ages. Materials and methods. A retrospective analysis of medical records of the pathohistological bureau for the period 2014-2016 was conducted. 2196 pathomorphological findings of endometrial tissue specimens have been examined. Estimation of VEGF expression was performed in 417 endometrial specimens, in the cohorts of the study: in the reproductive, perimenopausal, postmenopausal periods, respectively, in groups with physiological endometrial proliferation phase, hyperplastic, atypical, atrophic endometrium. The results were statistically processed. Results and discussion. Analyzing the data presented, higher VEGF expression was detected in atypical hyperplasia in all age categories, but it was likely that higher rates were established in the postmenopausal period, 210 with atypical endometrial hyperplasia, suggesting physicians' alertness to the process in this category.Probably low were indexes found at atrophic endometrium in this age category, which confirms the endometrial preservation of its growth factors, and in the presence of processes that stimulate the proliferation of the organ, they can trigger at the molecular-genetic level, neoplastic mechanisms. The data of the retrospective analysis confirm the growth of atypical form of hyperplastic processes and their maximum detection in the age categories 41 -45 and 46 -50 years old, and the beginning of detection of endometrial malignancy from the age of 46 -50 years old, with a gradual increase with age. Conclusions. Expression of VEGF level in endometrial tissue cells as an inducer of angiogenesis can be a promising marker for the diagnosis of the risk of proliferative conditions and their prognosis, especially in relation to other markers characterizing immunohistochemical and molecular genetic cellular parameters.
Одеський національний медичний університет Одеський міський центр з проблем клімактерія ВЗАЄМОЗВ'ЯЗОК РОЗВИТКУ ГІПЕРПЛАСТИЧНИХ ПРОЦЕСІВ ЕНДОМЕТРІЯ З ВІКОМ ЖІНКИ Гіперпластичні процеси ендометрія-одна із найбільш поширених патологій слизової оболонки тіла матки, інтерес до її вивчення обумовлений зростанням частоти виникнення, здатністю як до самостійного виліковування, так і до малігнізації. Мета дослідження-вивчити вікову динаміку частоти виявлення проліферативних процесів ендометрія. Матеріали і методи дослідження. Проведено ретроспективний аналіз медичної документації патогістологічного бюро, що склало 1404-з аключень гіперпластичних станів. Гістологічні стани були розподіленні згідно віковим категоріям пацієнток. Результати досліджень були опрацьовані статистично за допомогою варіаційної статистики, з використанням стандартних комп'ютерних систем.
The aim of the study – to learn the expression of VEGF and HIF-1α in physiological, hyperplastic, atypical endometrium at different ages of women. Materials and Methods. Evaluation of VEGF expression and HIF-1α performed in endometrial tissue samples in 458 women of late reproductive, perimenopausal and postmenopausal age. Expression of VEGF and HIF-1α was performed at the mRNA level by polymerase chain reaction of cDNA obtained by reverse transcription. The results were processed by the method of variation statistics with the assessment of reliability according to the Student's criterion using standard computer systems. Results and Discussion. Analyzing the data of the presented work, higher VEGF expression rates were found in atypical hyperplasia in all age categories, but probably higher rates were found in the postmenopausal period, in atypical endometrial hyperplasia, which indicates the need for vigilance in detecting this process in the appropriate age category. Studies have shown that HIF-1α can potentiate the activation of vasomotor genes that are required for the vascular response to hypoxia. These studies demonstrate the informativeness of the method of determining HIF-1α in the examination of patients with endometrial hyperplastic processes (EHP). The introduction of this method in practical medicine will not only understand the details of the changes occurring in the body (pathological, physiological), but also develop strategic maneuvers for possible therapeutic or surgical treatments. Conclusions. Expression of VEGF and HIF-1α levels in endometrial tissue cells as a marker can be a promising method for diagnosing the risk of proliferative conditions and their prognosis, especially in combination with other markers that characterize immunohistochemical and molecular genetic cellular parameters. Hypoxia and its relationship with indicators of angiogenesis may have some promising significance. Because the development of pathological conditions develops at a certain stage of hypoxic conditions. Under certain conditions, as a result of disruption of tissue processes, possibly metabolic, changes in angiogenesis are reduced with increasing hypoxia, which may in the long run provoke atypical disorders.
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