Curettage Tissue Research Articles

Is it possible to predict the postoperative stage in early-stage endometrial cancer patients based on TCGA classification of preoperative dilatation & curettage tissue? Efforts for personalized surgical approaches

Is it possible to predict the postoperative stage in early-stage endometrial cancer patients based on TCGA classification of preoperative dilatation & curettage tissue? Efforts for personalized surgical approaches

Histopathological evaluation of endometrial curettings in women with abnormal uterine bleeding: A retrospective analysis

Endometrial pathologies have been a predominate problem faced by women globally.Among all the endometrial pathologies, abnormal uterine bleeding is first in the list among the developing countries. To analyse the percentage of endometrial pathology detected in women who were diagnosed from abnormal uterine bleeding in our tertiary health care centre.A retrospective study of 158 women patients who were diagnosed with abnormal uterine bleeding and their endometrial tissue sampling were evaluated for endometrial pathology. The study data were collected from February 2017 till January 2019 based on Inclusion criteria and Exclusion criteria.According to the inclusion criteria, the 152 cases medical data which includes clinical evaluations along with endometrial histopathology evaluation were analysed. According to our analysis, the histopathological examination reports revealed most of the cases were diagnosed with benign endometrial pathology (34.72%) and abnormal endometrial pathology (9.09%). The 9.09% includes 7.44% presented with endometrial hyperplasia and 1.65% presented with endometrial cancer.Histopathological study of endometrial curettage tissue is the approved method for detecting any endometrial pathology. This is an onerous task for pathologists as not to miss any important findings. According to our analysis the commonest incidences of endometrial pathology were normal endometrium 56.19% of cases and benign pathology 34.72% and the less incidences of preneoplastic lesions 7.44% and endometrial carcinoma 1.65%.

Is there an association between Chlamydia trachomatis load and in situ expression of cyclooxygenase/inflammatory cytokines in first trimester aborters

Background: Colonization of Chlamydia trachomatis genital tract infection during pregnancy is associated with adverse obstetric outcomes in women; however, despite clear association between C. trachomatis and spontaneous abortion (SA), study on C. trachomatis load in first trimester abortion remains meagre. The reported occurrence of sporadic/recurrent SA (SSA/RSA) in C. trachomatis-positive women emphasize the need to identify chlamydial load and possible immunomolecular pathway in early SSA/RSA. The study aims to find whether there is association between C. trachomatis load and in situ expression of cyclooxygenase (cox)-2/pro-inflammatory cytokines in C. trachomatis-positive SSA/RSA. Methods and materials: 150 women experiencing SA, viz.: SSA (n = 70) and RSA (n = 80) during first trimester were enrolled from Gynecology Receiving Room (GRR), Department of Obstetrics and Gynecology, Safdarjung hospital, New Delhi (India) after obtaining hospital ethical permission and prior informed written consent from each patient. Endometrial curettage tissue (ECT) was collected for detection of C. trachomatis load and in situ expression of cox-2 and pro-inflammatory cytokines, viz.: IFN-γ/TGF-b1 in each patient by quantitative real time (qRT) PCR. Data was statistically analyzed. Results: C. trachomatis plasmid gene (200 bp) was found in 12.8% and 15% of SSA and RSA respectively; while 1–4/4–12 copies of C. trachomatis were detected in SSA/RSA respectively. Significant upregulation of cox-2/IFN-γ/TGF-b1 gene was found in C. trachomatis-positive RSA versus SSA (‘p’ < 0.0001). After controlling for confounding variables, linear regression analysis showed that C. trachomatis copy load in SSA/RSA was significantly associated with cox-2/IFN-γ/TGF-b1. Significant positive correlation was observed between C. trachomatis copy load and cox-2/IFN-γ/TGF-b1 gene (‘p’ < 0.0001) in SSA/RSA. Conclusion: Findings delineated that C. trachomatis load during early pregnancy is clearly associated with elevated cytokines and cox-2 in SSA/RSA, thereby accelerating endometrial contractions and ultimately resulting in SA. Hence, it is suggested that investigation of C. trachomatis load in SSA/RSA should be undertaken in first trimester of pregnancy for better clinical management of SA.

Puerperal Sepsis Caused by Clostridium Innocuum in a Patient with Placenta Accreta and Literature Review

Puerperal Sepsis Caused by Clostridium Innocuum in a Patient with Placenta Accreta and Literature Review

Acute Miliary Tuberculosis and Pelvic Tuberculosis after In vitro Fertilization

Nearly one-fourth of the world's population is infected with Mycobacterium tuberculosis (MTB). Female genital tuberculosis (TB) is a common cause of infertility in both developing and undeveloped countries. Furthermore, assisted reproduction treatments and pregnancy potentially increase the risk of TB infection and reactivation. In this study, we present the case of a 28-year-old infertile female without a history of TB who developed an acute miliary TB and pelvic TB after in vitro fertilization–embryo transfer (IVF-ET). Elevated serum estrogen levels during controlled ovarian hyperstimulation and T-lymphocyte function inhibition during pregnancy are the risk factors for MTB infection and reactivation. In her 7th week of gestation, the patient developed fever and spontaneously aborted. Her chest computed tomography images revealed classical miliary TB. Uterine curettage tissue and vaginal secretion samples as well as Gene X-pert MTB/rifampicin (RIF) and TB-RNA test results were positive for MTB. Histological examination of the uterine curettage tissue confirmed the diagnosis of endometrial TB. Treatment with isoniazid, RIF, pyrazinamide, amikacin, and levofloxacin was selected based on the patient's diagnosis, complications, and test results. Currently, the patient is undergoing anti-TB treatment, and her condition is stable. It is important to rule out the presence of TB in infertile patients before performing IVF-ET to avoid TB dissemination during pregnancy.

Does tumour necrosis factor alpha-induced cyclooxygenase-2 expression lead to spontaneous abortion in Chlamydia trachomatis-infected women

Cytokines might be involved in spontaneous abortion by triggering inflammatory mediators (Cyclooxygenases (Cox)) leading to spontaneous abortion in Chlamydia trachomatis (Ct)-infected women. Study aimed to quantitate the expression of pro-inflammatory cytokines (TNF-α, IFN-γ, IL-8) and Cox-2 in endometrial curettage tissue (ECT) of Spontaneous Aborters (SA). SA (n = 135) and 120 age-matched controls were enrolled from SJH, New Delhi, India. PCR was performed for detection of Ct MOMP gene (537 bp) in ECT. mRNA expression of pro-inflammatory cytokines and Cox-2 was assessed by real-time qPCR. Data was statistically evaluated. 14.8% SA were diagnosed as Ct-positive. Elevated expression of TNF-α, IFN-γ, IL-8 and Cox-2 was observed in Ct-infected SA. Ct-positive recurrent aborters showed significantly higher cytokine expression. Significant positive correlation was found between expression of Cox-2 and TNF-α in infected SA. Data suggested an increased expression of Th-1 cytokines, particularly TNF-α that induced Cox-2 expression in ECT, leading to spontaneous abortion in Ct-infected pregnant women.

Cytokine-induced expression of nitric oxide synthases in Chlamydia trachomatis-infected spontaneous aborters

Purpose: The aim of study was to evaluate expression of inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) in Chlamydia trachomatis (CT)-infected spontaneous aborters (SA).Materials and methods: Endometrial curettage tissue was collected from 140 SA (sporadic SA- 70; recurrent SA- 70) (Group I) and 140 age-matched controls (Group II) from Department of Obstetrics and Gynecology, Safdarjung Hospital, New Delhi, India. Polymerase chain reaction was performed for diagnosis of CT. The expression of iNOS/ eNOS/ IFN-γ/ TNF-α was assessed by real-time polymerase chain reaction (PCR).Results: 15.7% SA were CT-positive (Group I); none in controls. Sporadic spontaneous aborters (SSA) (n = 8/70), recurrent spontaneous aborters (RSA) (n = 14/70) diagnosed as CT-positive (Group-I). Significant upregulation of iNOS/ eNOS was found in CT-positive SSA/RSA compared with CT-negative SSA/RSA and healthy controls. TNF-α and IFN-γ were expressed in CT-positive SSA/RSA compared with negative SSA/controls. iNOS showed a significant strong positive correlation with TNF-α and IFN-γ in CT-infected SA. eNOS showed a significant positive correlation with TNF-α and no correlation with IFN-γ in CT-infected SA. TNF-α was positively correlated with IFN-γ.Conclusions: Significantly high expression of iNOS/ eNOS and proinflammatory cytokines affected pregnancy in CT-infected RSA, thereby implying that there occurs cytokine-induced expression of nitric oxide synthase (NOS).

Differential expression of circulating Th1/ Th2/ Th17 cytokines in serum of Chlamydia trachomatis-infected women undergoing incomplete spontaneous abortion.

The study aimed to elucidate role of Th1/Th2/Th17 cytokines in the immunopathogenesis of spontaneous abortion in Chlamydia trachomatis (Ct)-positive first-trimester aborters. Endometrial curettage tissue and serum were collected from 145 aborters (spontaneous abortion (SA) group, n=85; recurrent miscarriage (RM) group, n=60) and 120 controls attending Department of Obstetrics & Gynecology at Safdarjung hospital, New Delhi (India). Polymerase chain reaction was used to detect Ct plasmid/MOMP, while commercial cytometric bead array kit was utilized to estimate circulating serum cytokines. 13.7% aborters were Ct-positive, however, none was found to be infected among controls. IFN-γ, TNF-α, IL-2, IL-6 and IL-17A cytokines were significantly increased in SA group/RM group (Ct-infected) versus controls. IL-4 showed no difference between groups, while IL-10 was significantly elevated in controls versus Ct-infected subjects in SA group/RM group. Furthermore, IFN-γ, TNF-α, IL-6, IL-17A cytokines were significantly elevated in Ct-positive RM group versus Chlamydia-infected SA group. However, IL-2, IL-4 and IL-10 cytokines showed no significant difference between Ct-positive SA group versus infected RM group. Positive correlation was found between few cytokines (TNF-α and IFN-γ/IL-17A; IL-17A and IFN-γ/IL-6) in Ct-positive aborters. Our study clearly established the role of Th1/Th2/Th17 cytokines in the pathogenesis of spontaneous abortion in Ct-infected subjects and found that Chlamydia-positive recurrent aborters had a predominant Th1/Th17 bias.

Involvement of matrix metalloproteinases and their inhibitors in endometrial extracellular matrix turnover in Chlamydia trachomatis-infected recurrent spontaneous aborters.

Mechanism underlying Chlamydia trachomatis disease pathology is not completely understood. It was hypothesised that dysregulation of extracellular matrix by matrix metalloproteinases (MMPs) might be involved in sequelae of events leading to abortion in C. trachomatis-infected women. Hence, this study was undertaken to elucidate the expression of MMP-2/MMP-9/TIMP-1/TIMP-3 in infected recurrent spontaneous aborters (RSA) and simultaneously ascertain effect of few cytokines (TNF-α, TGF-β1, TGF-β2)/cyclooxygenase-2 (Cox-2) on MMPs. Endometrial curettage tissue was collected from 135 RSA (group I) and 120 age-matched controls (group II) at Department of Obstetrics and Gynecology, SJH, New Delhi (India). PCR was performed for diagnosis of C. trachomatis MOMP/plasmid gene. Expression of MMP-2/MMP-9/TIMP-1/TIMP-3 mRNA was assessed by quantitative real-time PCR. Data were statistically evaluated. 15.6% (n = 21) RSA (Group-I) were diagnosed as C. trachomatis positive. Significant upregulation of MMP-2/MMP-9 and decreased TIMP-1/TIMP-3 were found in C. trachomatis-positive RSA (group I) versus control women (group II). MMP-2 was found positively correlated with cytokines/Cox-2. Significant positive correlation was observed between MMP-2/MMP-9 and C. trachomatis copy load. Overall data suggested that dysregulated MMPs/TIMPs promoted excessive endometrial matrix degradation which, in turn, affected pregnancy leading to spontaneous abortion in infected women.

Expression of prostaglandin receptors in Chlamydia trachomatis-infected recurrent spontaneous aborters.

A study was undertaken to quantify the expression of prostaglandin (PG) receptors and find the effect of gestational age on expression of PG receptor genes in Chlamydia trachomatis-infected recurrent spontaneous aborters (RSA). Endometrial curettage tissue (ECT) was collected from 130 RSA (Group I) and 100 age-matched controls (Group II) at the Department of Obstetrics and Gynecology, Safdarjung Hospital, New Delhi (India). PCR was performed for diagnosis of C. trachomatis cryptic plasmid; mRNA expression of PG receptor genes was assessed by real-time PCR (q-PCR), while serum progesterone/estrogen levels were determined by respective commercial kits. Data were evaluated statistically. A total of 15.4 % RSA (GroupI) were diagnosed as C. trachomatis-positive (200 bp), whereas controls were uninfected. q-PCR showed significant upregulation (P<0.0001) of PGE2 (EP-1, EP-2, EP-3, EP-4), PGF2α (FP) and PGI2 (IP) receptors in Group I versus Group II. The expression of PG receptors increased significantly with advanced gestational age (P<0.002); however, only contractile receptors, EP-1, EP-3 and FP, were positively correlated with gestational age in Group-I. In infected RSA, mean serum progesterone level was significantly low (P<0.0001) while serum oestrogen was high (P<0.0001). Overall, the data suggest that increased expression of PG receptors, particularly contractile gene receptors (EP-1, EP-3, FP), with advanced gestational age and altered steroid levels could be a possible risk factor for abortion in Chlamydia-infected RSA.

Does aberrant expression of cyclooxygenase-2 and prostaglandin-E2 receptor genes lead to abortion in Chlamydia trachomatis-infected women

Objective: The aim of the study was to characterize the expression of cyclooxygenase-2 (COX-2) and prostaglandin-E2 (PGE2) genes in spontaneously aborted tissues from women infected with Chlamydia trachomatis.Methods: A total of 135 spontaneous aborters (Group I) and 45 induced aborters (controls; Group II) attending Obstetrics and Gynaecology Department at Safdarjung hospital (New Delhi, India), were enrolled. Polymerase chain reaction (PCR) assay was performed to detect C. trachomatis DNA in endometrial curettage tissue (ECT). Differential expression of COX-2 and PGE2 receptors at mRNA level was analysed in ECT using reverse transcription PCR and real-time PCR.Results: In total, 14.8% patients were diagnosed as C. trachomatis-positive in Group I whereas all control patients were C. trachomatis-negative. Qualitative expression of COX-2 (p < 0.05) and PGE2 (p < 0.0001) receptors was found increased in C. trachomatis-positive patients (Group I) in comparison to controls. Quantitative real-time PCR analysis also showed upregulation in transcript levels of both COX-2 (p < 0.002) and PGE2 (p < 0.0001) receptors in infected patients (Group I) versus Group II. COX-2 and PGE2 expression was higher (p < 0.002) in recurrent spontaneous aborters in comparison to sporadic spontaneous aborters.Conclusions: Results suggest that chlamydial infection leads to upregulation of COX-2 in C. trachomatis-positive recurrent spontaneous aborters, which probably mediates increased prostaglandin synthesis.

In situ localization of Chlamydia trachomatis and Chlamydial Heat Shock Protein 60 in Endometrial Curettage Tissue of Recurrent Spontaneous Aborters

In situ localization of Chlamydia trachomatis and Chlamydial Heat Shock Protein 60 in Endometrial Curettage Tissue of Recurrent Spontaneous Aborters

Immunohistohemical evidences of pregnancy in uterine curettage tissue by the use of a double immunocytochemical staining technique using cytokeratin 7 and vimentin antibodies

Usual histopatological diagnosis of intrauterine pregnancy is made by demonstration of chorionic villi, but in the curettage tissue from intrauterine miscarriage they may not be present in all cases. The use of monoclonal antibody against cytokeratin as a sensitive and reliable marker for the morphologic discrimination between invasive trophoblastic (IT) cells and decidual cells has been well established. The aim of this study was to determine the presence of pregnancy in endometrial curettings when chorionic villi are absent from patients suspected of intrauterine pregnancy. Twenty cases of endometrial tissue specimens were investigated for cytokeratin and vimentin expression by a double immunostaining for detection of IT cells. Out of the total number of cases (20) 17 cases expressed cytokeratin 7 positive IT cells, that are an evidence of pregnancy. The obtained results indicated, that double immunohistochemical demonstration of cytokeratin and vimentin is useful for identifying pregnancy in all chorionic villi-negative cases.

Blastomycosis in a South Indian patient after visiting an endemic area in USA

We describe a case of blastomycosis in a diabetic patient from South India who had visited Milwaukee, Wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, India, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as Blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin B, followed by oral itraconazole for a period of 6 months. Blastomycosis cases in India are reviewed and the likely source of infection in this patient is discussed.