Why Does Your Uterus Become Malignant? The Impact of the Microbiome on Endometrial Carcinogenesis

The aim of this review was to describe the uterine microbiome composition that has been analyzed so far and describe potential pathways in the carcinogenesis of the endometrium. The microbiome in the uterine environment is involved in apoptosis and proliferation during the menstruation cycle, pregnancy maintenance, and immune system support. However, bacteria in the uterus could stimulate inflammation, which when chronic results in malignancy. An altered gut microbiota initiates an inflammatory response through microorganism-associated molecular patterns, which leads to intensified steroidogenesis in the ovaries and cancers. Moreover, intestinal bacteria secreting the enzyme β-glucuronidase may increase the level of circulating estrogen and, as a result, be influential in gynecological cancers. Both the uterine and the gut microbiota play a pivotal role in immune modulation, which is why there is a demand for further investigation from both the diagnostic and the therapeutic perspectives.

Cognitive decline and dementia in women after menopause: Prevention strategies

Worldwide, cognitive decline and dementia are becoming one of the biggest challenges for public health. The decline in cognition and the development of dementia may be caused by predisposing or trigger factors. There is no consensus over whether the drop in estrogen levels after menopause is a risk factor for cognitive decline and dementia. This article discusses the prevention of cognitive decline and dementia in women after menopause, both primary prevention (essentially pharmacological intervention) and secondary prevention (chiefly diet and weight reduction). Further study is required to clarify whether menopausal hormone therapy (MHT) has a role in dementia.

A Rare Case of HELLP Syndrome with Hematomas of Spleen and Liver, Eclampsia, Severe Hypertension and Prolonged Coagulopathy-A Case Report

The HELLP syndrome (hemolysis, liver damage and thrombocytopenia) is a rare (0.5−0.9%) but serious complication of pregnancy or puerperium associated with a higher risk of maternal and fetal mortality and morbidity. Liver and spleen hematomas rarely entangle (<2%) HELLP cases, but rupture of the hematomas presents an immediate threat to life. We present the history of a 35-year old pregnant woman (at the 31st week) admitted to our hospital due to the risk of premature delivery. On the first day, the patient did not report any complains, and the only abnormality was thrombocytopenia 106 G/L. However, within several hours, tests showed platelet levels of 40.0 G/L, LDH 2862.0 U/L and AST 2051.6 U/L, and the woman was diagnosed with severe HELLP syndrome, complicated by hematomas of the liver and spleen, seizures (eclampsia), severe arterial hypertension and coagulation disorders. The purpose of this article is to highlight the need for early investigation of the causes of thrombocytopenia and the differentiation of HELLP from other thrombotic microangiopathies (TMAs).

Genomic markers of ovarian adenocarcinoma and its relevancy to the effectiveness of chemotherapy

Ovarian cancer is the eighth most common cancer and the seventh highest cause of cancer-associated mortality in women worldwide. It is the second highest cause of mortality among female reproductive malignancies. The current standard first-line treatment for advanced ovarian cancer includes a combination of surgical debulking and standard systemic platinum-based chemotherapy with carboplatin and paclitaxel. Although a deeper understanding of this disease has been attained, relapse occurs in 70% of patients 18 months subsequent to the first-line treatment. Therefore, it is crucial to develop a novel drug that effectively affects ovarian cancer, particularly tumors that are resistant to current chemotherapy. The aim of the present study was to identify genes whose expression may be used to predict survival time or prognosis in ovarian cancer patients treated with chemotherapy. Gene or protein expression is an important issue in chemoresistance and survival prediction in ovarian cancer. In the present study, the research group consisted of patients treated at the Surgical Clinic of the Gynecology and Obstetrics Gynecological Clinical Hospital, Poznan University of Medical Sciences (Poznan, Poland) between May 2006 and November 2014. Additional eligibility criteria were a similar severity (International Federation of Gynecolgy and Obstetrics stage III) at the time of diagnosis, treatment undertaken in accordance with the same schedule, and an extremely good response to treatment or a lack of response to treatment. The performance of the OncoScan^® assay was evaluated by running the assay on samples obtained from the four patients and by following the recommended protocol outlined in the OncoScan assay manual. The genomic screening using Affymetrix OncoScan Arrays resulted in the identification of large genomic rearrangements across all cancer tissues. In general, chromosome number changes were detected in all examined tissues. The OncoScan arrays enabled the identification of ~100 common somatic mutations. Chemotherapy response in ovarian cancer is extremely complex and challenging to study. The present study identified specific genetic alterations associated with ovarian cancer, but not with response for treatment.

Genomic mapping of pathways in endometrial adenocarcinoma and a gastrointestinal stromal tumor located in Meckel's diverticulum

The present study reports the case of a 71-year-old female patient diagnosed with endometrial adenocarcinoma, which was confirmed by histopathology. In the course of performing an elective hysterectomy with adnexa removal, a solid tumor located in Meckel's diverticulum (MD) was identified and excised. Due to the unique nature of the lesion, the tumor tissue underwent broad mapping of any genomic alterations once the histopathological examination was completed. The genetic testing was conducted using a high-resolution microarray and resulted in the identification of 45 genomic abnormalities, including 4 chromosomal aneuploidies. Within those regions, alterations of 87 known cancer genes were assigned. The involvement of v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog gene alteration was noted to be a key player for triggering gastrointestinal stromal tumor transformation for this unusual case. A total of 12 genes, showing mutual interaction in different cancer types or involved in diverse cellular processes, were identified. These reported data may shed light on the carcinogenesis of a rare MD tumor.

The diagnostic value of evaluating the maximum velocity of blood flow in the uterine arteries of women with postmenopausal bleeding

PURPOSE

The aim was to evaluate the utility of ultrasonographic examinations, such as the Doppler technique, in diagnosing women with postmenopausal bleeding.

METHODS

Specifically, maximum end-diastolic velocity of blood flow (MEDV), time-averaged maximum velocity of blood flow (TAMXV) and peak systolic velocity of blood flow (PSV) were evaluated. Data were obtained and analyzed from a group of 100 female patients diagnosed and treated because of abnormal bleeding from the genitals in the Gynecological-Obstetrics Clinical Hospital of Poznan University of Medical Sciences. The following packages were used for statistic analyses: STATISTICA v 7.1 (StatSoft, Inc. 2005), StatXACT v.5.0.3, CYTEL SOFTWARE CORPORATION and Analyse-it Software v.1.68.

RESULTS

The parameters evaluated were highest in the carcinoma group, lower when proliferation was diagnosed and the lowest in the control group.

CONCLUSIONS

Transvaginal ultrasonography diagnostics using the Doppler technique was found to play an important role in the diagnostic process of pathologies within the endometrium.

Clinical usefulness of evaluation of quality parameters of blood flow: pulsation index and resistance index in the uterine arteries in the initial differential diagnostics of pathology within the endometrium

Detection of neoplastic changes in the pelvis minor in early stages is a critical prognostic factor for patients suffering from uterine carcinoma. Due to the problem presented, the evaluation of clinical usefulness of ultrasonographic examination including color Doppler in the process of detecting pathologic changes within the endometrium was the main aim of this paper. Quality parameters of blood flow in the uterine arteries, such as the pulsation index (PI) and resistance index (RI) were evaluated. A group of 100 female patients diagnosed with and treated for abnormal genital bleeding in the Clinic of Gynecological Surgery, Gynecological-Obstetrics Clinical Hospital, Poznań University of Medical Sciences from December 2005 until January 2007 constituted the subjects for this work. Analyzing patients with pathology of the endometrium, we obtained lower values of quality parameters of blood flow in the terine arteries in comparison to the control group. Reduction of the resistance and pulsation indexes of the uterine arteries may be useful elements in the process of differentiating pathological changes within the endometrium.

Evaluation of preoperative diagnosis with results of histopathological examinations of ovarian tumors in women of reproductive age

Ovarian tumors are the most frequent lesions encountered by gynecologists. Ovarian carcinoma most often develops asymptomatically and until now no sufficient screening diagnostic methods have been developed, which is why various diagnostic methods are being tried concurrently to increase diagnostic sensitivity. The aim of this paper was to evaluate the compliance of the preoperative diagnoses with the results of histopathological examinations of ovarian tumors and to determine the usefulness of simultaneous application of gynecological, ultrasonographic, and Doppler examinations together with determination of CA-125 antigen in the diagnostic process of ovarian tumors. The study comprised a group of 250 women in reproductive age who were operated on for tumors of the ovary. Results of histopathological examinations were compared with the preoperative diagnosis based on the above-mentioned examinations and prognostic indicators: sensitivity, specificity, negative and positive prediction value as well as accuracy were determined. The results showed that combining the four diagnostic methods is a useful research panel in the preoperative diagnostic process of ovarian tumors and makes selecting the appropriate procedure and surgical treatment viable.

[Clinical value of the measurement of blood flow in uterine arteries and endometrial vessels in women with postmenopausal bleeding using "power" angio Doppler technique]

OBJECTIVES

The aim of the study was the measurement of blood flow in uterine arteries and endometrial vessels in women with postmenopausal bleeding using "power" angio Doppler technique

MATERIALS AND METHODS

256 patients diagnosed and treated because of postmenopausal bleeding participated in this study. Using doppler technique blood flow indices: pulsatility index (PI), resistance index (RI) and time average maximal velocity were measured.

RESULTS

Neovascular arteries in endometrium were found in 87,7% patients with endometrial carcinoma, 21,9% cases of endometrial hyperplasia and in 5,7% women with normal endometrium. A significantly lower PI and RI in endometrial vessels and uterine arteries were obtained in endometrial cancer cases than in patients with endometrial hyperplasia. TAMXV measured in endometrial vessels and uterine arteries was significantly higher in patients with endometrial cancer when compared to the patients with endometrial hyperplasia.

CONCLUSIONS

Transvaginal ultrasonography with the "power" angio Doppler is a valuable diagnostic method in cases of early endometrial pathologies. The measurement of blood flow indices in endometrial vessels and uterine arteries is useful to differentiate benign and malignant endometrial pathologies.

[Clinical value estimation of the Doppler indicies: PI, RI and PSV, TAMXV and MEDV in early differentiation of the ovarian tumors malignancy]

THE OBJECTIVES: The aim of this study was to evaluate the clinical value of blood flow indicies for differentiating between benign and malignant ovarian tumours.

MATERIALS AND METHODS

Realisation of the aim was based on the analysis of examinations' results of 686 ovarian tumors. For each recorded blood flow wave the followind parameters of examined tumor vessels were analysed: pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), time-averaged maximum velocity (TAMXV) and maximum and diastolic velocity (MEDV). Apart from conditional probabilities we also presented assessing areas under the ROC curves, which introducted information over practical usefulness of each test.

RESULTS

Vascular perfusion was observed in 100% of malignant tumors and 92% of non-malignant tumors. In group of patients with malignant tumors PI and RI were significantly lower; and PSV, TAMXV and MEDV were higher than in group with non-malignant tumors. (p<0.05)

CONCLUSIONS

Transvaginal ultrasonography with the Doppler technique is valuable diagnostic method in preoperative differentiation of tumor malignancies. The best predictive value in analysed group was observed for PI (AUROC=o.87) and MEDV (AUROC=0.86). Similar correlation was observed for premenopausal patients. In group of postmenopausal patients the best predictive value was for RI (AUROC=0.90) and MEDV (AUROC=0.88).

[The influence of ovarian tumour histopathological diagnosis on prognostic values of the sonomorphological index]

OBJECTIVES

The purpose of the study was to evaluate the helpfulness of sonomorphological index in preoperative diagnosis of ovarian tumours.

MATERIAL AND METHOD

686 patients diagnosed and treated because of adnexal tumours were analyzed. At the admission day the patient underwent an ultrasonographical examination that stated morphology of tumour using the sonomorphological index (SM).

RESULTS

The sonomorphological index demonstrated high prognostic values: accuracy - 80.6%; sensivity - 86.7%; specifity - 77.0%. During the study, histopathological types of ovarian tumours with the lowest prognostic values were appointed. Among malignant tumours the lowest sensitivity of the test corresponded with: dysgerminoma and folliculoma. Among benign tumours the lowest helpfulness in preoperative diagnosis of ovarian tumours the sonomorphological index demonstrated in following histopathological types: mucinouse cystadenoma and adult teratoma. Particular histopathological diagnosis is the tubo-ovarian abscess--all analyzed cases had a false positive result in the test.

CONCLUSIONS

In all histopathological types of malignant and benign tumours mentioned above, the use of the sonomorphological index require caution. To increase accuracy of preoperative diagnosis based on ultrasonographical examination, additional Doppler examination and also biochemical markers concentration should be considered.