Cystic Glandular Hyperplasia Research Articles

PREVENTION OF HYSTERECTOMY BY AYURVEDIC MANAGEMENT OF ASRUGDARA WITH CYSTIC GLANDULAR HYPERPLASIA: A CASE REPORT

Asrugdara is a condition where there is an occurrence of heavy menstrual bleeding. Excess intake of food, which are excessive Lavana(salty), Amla(sour), Guru(heavy), Katu(hot), Vidahi (producing a burning sensation) and Snigdha (unctuous) etc. leads to this condition. This condition can be correlated with abnormal uterine bleeding (AUB). Abnormal uterine bleeding is defined as any uterine bleeding outside the normal volume, dura-tion, regularity or frequency is considered as abnormal uterine bleeding (AUB). This is a case report of a 41-year-old female patient having complaint of heavy menstrual bleeding with passing of clots for 11 days and ir-regular and early menses for three months. Her ultrasonography report was suggestive of thickened endometrial thickness with chronic cervicitis and a left ovarian simple cyst. She underwent conventional treatment of heavy bleeding, including Dilatation and Curettage (D&C), but was unsuccessful. The histopathology report suggested glandular cystic hyperplasia without atypia. In the allopathic system of medicine, hysterectomy is advised. The patient is diagnosed with Kapha Vataja Asrugadara as per the symptoms. The objective of the present treatment included Ayurvedic management of Asrugadara, ensuring a decrease in the menstrual blood flow and regulariza-tion of the cycle, thereby improving the patient's general condition. The treatment plan included Shamana Chikitsa along with Basti Chikitsa. The treatment outcome was completely relieved of the symptoms with a reg-ular ultrasonography report.

Spontaneous Lesions of Endangered Geriatric Julia Creek Dunnarts (Sminthopsis douglasi, Archer 1979) with Emphasis in Reproductive Pathology.

Julia Creek dunnarts are an endangered species of carnivorous marsupials and the focus of multiple conservation strategies involving significant resources such as captive breeding programs. Despite the relevance for conservation, no study to date has focused on evaluating geriatric diseases in dunnarts. This study describes the pathology findings in a group of one wild and thirty-five captive-born, mostly geriatric Julia Creek dunnarts that failed to produce offspring over multiple breeding periods. A total of 20 females and 16 males were submitted for a postmortem examination, with ages ranging from 9 to 42 and 12 to 42 months for females and males, respectively. Of these, 10 had unremarkable findings. The most common condition in females was cystic glandular hyperplasia (n = 8), typical of hormonal dysregulation profiles in senescence, particularly hyperestrogenism. Rarely, cutaneous disease represented by unidentified dermal round cell infiltrates was observed in females (n = 2). Primary reproductive hormonal dysregulation was also suspected in males diagnosed with testicular degeneration, aspermatogenesis and/or atrophy (n = 3). Cutaneous round cell infiltrates, possibly compatible with epitheliotropic lymphomas, were seen in males (n = 3), and 2/3 affected males also had concurrent testicular degeneration or atrophy, indicating male sex could be a predictor for lymphoid neoplasia in aged dunnarts, especially in individuals with concurrent testosterone-luteinizing hormone dysregulation as it occurs in gonadectomized animals. The role of an underlying viral etiology is also explored. This study is the first to describe major spontaneous diseases in endangered aged Julia Creek dunnarts, providing an important understanding of senescence and geriatric diseases within a conservation context.

ХАРАКТЕРИСТИКА КЛИНИКО-МОРФОЛОГИЧЕСКАЯ ЖЕЛЕЗИСТО-КИСТОЗНОЙ ГИПЕРПЛАЗИИ ЭНДОМЕТРИЯ У КОРОВ

The article presents the material on the study of clinical and morphological indicators of endometrial glandular-cystic hyperplasia in cows. It has been established that the share of endometrial hyperplasia glandulocystica in cows accounts for 11.4% of the total number of chronic uterine diseases. Most often, this pathology is diagnosed in cows 120 or more days after calving with an annual milk production of 6000-7000 kg. Glandular-cystic hyperplasia of the endometrium is most typical of the animals of the Red-Motley and Simmental breeds with loose keeping. Endometrial hyperplasia glandulocystica is characterized by a thickening of the uterine wall up to 6.5±0.28 mm, the presence of a cavity in the uterine horns of 3.4±0.19 mm, follicular cysts in the ovaries with a diameter of 42.5±2.8 mm. Endometrial hyperplasia glandulocystica is characterized by an increase in the height of the cells of the covering epithelium up to the height of prismatic one, growth of the uterine glands with the expansion of their lumens, an increase in height and vacuolization of the glandular epithelium. In case of glandular-cystic hyperplasia, uterine glands account for 28.6%, blood vessels – 12.3%, covering epithelium – 5.7%, which is by 1.88-1.97 times more, compared to clinically healthy animals. The height of the cells of the covering epithelium in case of this pathology is higher by 13.1%, the height of the epithelial cells of the uterine glands – by 23.4%, the thickness of the endometrium – by 1.38 times, which indicates endometrial hypertrophy.

Serous multicystic papillary adenoma of the ovaries and glandular cystic hyperplasia of uterus in a Guinea Pig (Cavia porcellus)

Cystic changes of ovarian tissue are crucial as they cause infertility in laboratory animals. A 4 years old, weighing approximately 500 g adult, intact guinea pig had pruritic progressive alopecia over the flanks at the dorsal area and abdomen symmetrically, bilaterally for a month. Beside, an abdominal enlargement was observed outside on the guinea pig. Large polycystic ovaries were detected behind the kidneys during ultrasonography. Also abdominal radiography revealed the cystic structures at the same region. Ovariohysterectomy was performed on the animal, multiple thin walled, fluctuant fluid-filled, large cysts measured as 3.9x2.5 and 4.5x2.8 cm diameter were detected at the left and right ovary, respectively. The uterine body was observed normal macroscopically. The guinea pig was died after the operation during reanimation because of the hypothermia. The organ pieces were submitted to pathology for histopathological examination after the operation. Histologic examination demonstrated a diagnosis of serous multicystic papillary adenoma of the ovaries and glandular cystic hyperplasia of uterus. In conclusion, this case report describes the necessity of not to ignore the ovarian pathologies with guinea pigs demonstrate symmetric, bilateral alopecia on the skin and indicates the importance of postoperative care in laboratory animals despite a successful anesthethic choice and operation.

Cliniopathological profile in women with abnormal uterine bleeding

Introduction: Abnormal uterine bleeding is a challenging gynecological problem caused by various endometrial pathologies and is a major clinical problem among women in peri and postmenopausal age groups. The problem is common worldwide but causes may vary from one region to another. Aims and Objectives: The main objective was to evaluate pathological spectrum of different endometrial lesions in abnormal uterine bleeding and to correlate with clinical history and diagnosis. Materials and Methods: The study was a prospective study done from August 2017 to July 2019. The specimens received from endometrial biopsy were included in the study. All the specimens were fixed in formalin and processed through paraffin wax embedding method. Sections were cut at 3-5 micrometer thickness and stained by Hematoxylin and Eosin (H&E) stain and were examined under light microscope. Result: A total no. of 247 cases were studied. Out of these, 57 cases were of Proliferative endometrium, 33 cases of Secretory endometrium, 34 cases of simple hyperplasia without atypia, 11 cases of cystic glandular hyperplasia, 17 cases of complex hyperplasia with atypia, 09 cases of menstrual phase endometrium, 07 cases of irregular shedding, 06 cases of endometrial polyp and anovulatory cycle, 04 cases of endometritis, 03 cases each of simple hyperplasia with atypia, progesterone exposed endometrium and inadequate secretory phase, 02 cases each of complex hyperplasia without atypia, atrophic endometrium, products of conception and inadequate proliferative phase and 01 case each of stromal hyperplasia. 45 samples were inadequate. Maximum cases of abnormal uterine bleeding were seen between 31-40 years of age. Interpretation and Conclusion: Abnormal uterine bleeding is one of the commonest condition for which patients seek advice in the gynecological outpatient department. Analysis of histopathology of endometrium in abnormal uterine bleeding helps in management of patients and to know th

ОСОБЛИВОСТІ ЕКСТРАГЕНІТАЛЬНОЇ СОМАТИЧНОЇ ПАТОЛОГІЇ ТА СТРУКТУРНОЇ ТРАНСФОРМАЦІЇ ЕНДОМЕТРІЯ В ЖІНОК РЕПРОДУКТИВНОГО ВІКУ ІЗ ПЕРВИННИМ І ВТОРИННИМ НЕПЛІДДЯМ

Мета дослідження – з’ясувати характерні особливості структурних трансформацій ендометрія за умов коморбідності в жінок репродуктивного віку із первинним та вторинним непліддям.Матеріали та методи. Проведено аналіз медичних карт та патоморфологічного дослідження біопсій ендометрія жінок репродуктивного віку із діагностованим непліддям. Дизайн обстеження включав гінекологічне, загальноклінічні та профільні інструментальні й лабораторні дослідження, результати патоморфологічного дослідження. Вивчали дані анамнезу, репродуктивної функції, гінекологічних захворювань, соматичного статусу.Результати дослідження та їх обговорення. Усі жінки обстежені в умовах стаціонару. У 65,7 % пацієнток діагностовано первинне непліддя і в 34,3 % – вторинне. Патологічні зміни ендометрія, а саме залозиста гіперплазія, стромально поліпозна трансформація, ендометрити, зареєстровані у 55,6 % серед жінок із первинним непліддям та в 71,4 % – у жінок із вторинним непліддям. Частка ж невстановленого причинного фактора суттєво не відрізнялася в обох групах обстежуваних і становила 0,4 % і 0,6 %. Структура патологій функціонального шару матки при вторинному неплідді морфологічно відрізнялася ознаками більш вираженої проліферативної активності залозистих структур при залозистих гіперплазіях, залозистого і стромального компонентів при поліпах ендометрія та вираженістю проявів хронічного запалення, тоді як при первинному неплідді ознаки проліферативної активності ендометрія були менш вираженими, за винятком тих, що розвинулися за умов тиреопатій. Зважаючи на той факт, що, за результатами наших досліджень, у більшості жінок із вторинним непліддям (81,2 % обстежуваних) зустрічалася екстрагенітальна патологія та перевагу мали тиреопатії, вважаємо доцільним подальше поглиблене вивчення особливостей ендометріальної трансформації у жінок із непліддям та їх можливого зв’язку із порушеннями роботи щитоподібної залози.Висновки. Морфофункціональний стан слизової матки слід вважати ендометріальним фактором складової при плануванні вагітності. У структурі коморбідності у пацієнток із вторинною неплідністю переважає відсоток патології щитоподібної залози. У жінок із тиреопатіями переважно діагностуються проліферативна залозисто-стромальна поліпозна трансформація ендометрія, а також від двох до трьох випадків викиднів у різні терміни вагітності. До особливості ремоделювання ендометрія за умов поліморбідності доцільно віднести високу частоту залозисто-кістозної гіперплазії та залозистостромальної трансформації.

Spontaneously Arising Tumours and Tumour-like Lesions of the Cervix and Uterus in 83 Pet Guinea Pigs (Cavia porcellus)

Tumours and tumour-like lesions are rare findings in the genital system of guinea pigs. The aim of the present study was to characterize nodular lesions in the cervix and uterus of guinea pigs submitted for histopathological diagnosis. Samples from 83 pet animals were investigated. Cases included 64 surgically excised masses including complete uteri (n=37), parts from uteri containing masses (n=8), complete masses (n=12) or samples from masses (n=7) and 19 complete necropsy examinations. In 55 of the cases, only solitary changes were observed; in 28 cases two or more lesions were diagnosed. Histopathological diagnoses included polyps in the vagina, cervix or uterus (n=8), hyperplastic lesions of the endocervix (n=10) and seven adenomas and two adenocarcinomas of the endocervix. Endometrial alterations included single small glandular cysts (n=3), nodular glandular-cystic hyperplasia (n=8), adenoma (n=20) and adenocarcinoma (n=3). Four placentas, 10 focal decidualizations and six deciduomas were found. Furthermore, 18 leiomyomas and nine leiomyosarcomas were diagnosed. Uterine malignant mixed Müllerian tumours were observed in seven cases. Overall, benign lesions outnumbered malignant tumours in the female genital tract of pet guinea pigs. Therefore, surgical excision or ovariohysterectomy should be recommended as therapy.

Morphological substantiation of pathogenetic therapyof external genital endometriosis

With the help of morphological study examined endometrioid heterotopias and eutopic endometrium in external genital endometriosis. Histological examination of surgical specimens of endometrial cancer were detected in endometrioid heterotopia, in eutopic endometrium occurred glandular-cystic hyperplasia of the proliferative and secretory type. Have been identified in the heterotopias expressed angiomatosis in patients with III-IV stages of endometriosis. It is proved that inflammatory changes in endometrioid heterotopias more pronounced with stage I-II stages of endometriosis, whereas hyalinosis sclerosis and how the outcomes of the process prevalent in patients with stage III-IV. The difference parameters in ectopic and eutopic endometrium shows marked morphological heterogeneity of both nuclear and cytoplasmic structures. Morphological changes in the heterotopias are intended to justify Dienogest (2 mg) for the treatment of external genital endometriosis.

Relación entre la hiperplasia endometrial y el adenocarcinoma del endometrio

El material histopatológico que se considera en esta ocasión demuestra que la hiperplasia endometrial, como manifestación de un estado estrogénico persistente e incontrarrestado, desempeña un rol importante en la génesis del carcinoma endometria1. Las imágenes histológicas en estas circunstancias pueden corresponder a una hiperplasia glándulo-quística o a una hiperplasia adenomatosa. La hiperplasia endometrial glándulo-quística durante la menacma y el climaterio premenopáusico, reflejo de desequilibrios endocrinos, no tiene mayor importancia en estos períodos, pero cuando se hace presente en la postmenopausia adquiere una significativa influencia en relación con el desarrollo del carcinoma endometrial. La hiperplasia adenomatosa que evoluciona durante el período de madurez sexual reviste mayor importancia que la variedad glándulo-quística, pues si bien traduce al igual que ella la existencia de una disfunción endocrina y como ella constituye también una lesión reversible, su existencia requiere una mayor preocupación aún dentro de este período y en relación directa con la mayor edad de la mujer. Cuando evoluciona en la postmenopausia adquiere mayor significación que la variedad glándulo-quística en la génesis del carcinoma del endometrio. El estudio de 26 casos de coexistencia de hiperplasia y adenocarcinema del endometrio nos permitió establecer en 7 de ellos la concurrencia simultánea de las dos variedades de hiperplasia, glándulo-quística y adenomatosa con adenocarcinoma; en 6 la evolución concomitante de hiperplasia adeno-quística y adenocarcinoma; en otras 6 de hiperplasia adenomatosa y adenocarcinoma y, finalmente, en las 7 restantes se reveló la transformación gradual de una hiperplasia adeno-quística en una hiperplasia adenomatosa y, por dual de una hiperplasia adeno-quística en una hiperplasia adenomatosa y, por último, en un carcinoma, dentro de un plazo variable de 1 a 4 años (Cuadro N°1). Si se analizan las edades de las pacientes que constituyen cada una de estos tres grupos, en el momento en que se estableció el diagnóstico de degeneración maligna, se comprueba que la edad media más baja -48 años- correspondía a la coexistencia de hiperplasia adenomatosa y adenocarcinoma. En cambio, ella era de 52 años para la asociación, hiperplasia glandular quística, hiperplasia adenomatosa y adenocarcinoma y de 58 para la asociación hiperplasia glándulo-quística adenocarcinoma. Sin pretender establecer conclusiones dado su número escaso de observaciones llamamos la atención a que exista una mayor propensión a la degeneración maligna y que ésta se establece más tempranamente, cuando concurre la hiperplasia adenomatosa. Esta afirmación se confirma si establecemos la edad media en los dos grupos de adenocarcinomas en los cuales se hizo presente esta modalidad de hiperplasia en las imágenes histológicas, comprobando que ella es de 50.5 años por 58 en el grupo en que ella no existe. Las comprobaciones anteriores conducen a una conclusión importante en relación con la profilaxia del carcinoma del endometrio en el sentido que la existencia de una hiperplasia endometrial, glándulo-quística o adenomatosa en el período postmenopáusico, haría aconsejable la histerectomia. La radioterapia en general y la curieterapia intrauterina en especial, por constituir el método terapéutico al cual se recurre en las metrorragias disfuncionales del climaterio, sólo podría indicarse cuando existiera una contraindicación quirúrgica absoluta o bien ante la negativa de la paciente para aceptar la intervención. En ambas circunstancias se deberá exigir controles periódicos los que necesariamente deberán comprender exámenes citológicos y nuevos raspados-biópsicos. Las comprobaciones señaladas en la conclusión N° 4 conducirían a aceptar el concepto de carcinoma "in situ" del endometrio, a pesar de algunas autorizadas opiniones en contrario. Se considera que debe mantenérsele vigente para que en la práctica diaria del laboratorio se investiguen las imágenes correspondientes y poder así acumular mayor documentación que permita en el futuro emitir un juicio con mayor fundamento. Convendrá recordar que el Comité de Estocolmo, sin pronunciarse sobre las características propias del carcinoma "in situ" del endometrio ha incluido al igual que en el carcinoma cervical un período 0, definiéndolo así : casos que el patólogo considera que muy probablemente son de naturaleza carcinomatosa aunque no es posible establecer un diagnóstico definitivo en este sentido.

MANEJO DE LOS PRECURSORES DEL CANCER DE ENDOMETRIO EN EL HOSPITAL PRINCIPAL DE APOYO "DANIEL ALCIDE5 CARRION" DURANTE LOS AÑOS 1980 – 1986

Durante los años 1980-1986, se efectuó 2,428 legrados uterinos biópsicos fraccionados en el Servicio de Oncología Ginecológica del HPA-DAC. Se realiza estudio retrospectivo de 146 mujeres portadoras de hemorragia uterina anormal en edad pre y post-menopáusica, procediéndose a descartar neoplasia cervical por clínica, citología e histología, obteniéndose los siguientes resultados: endometrio proliferativo 88 casos (60.27%); hiperplasia glandular quística 24 casos (76.43%); hiperplasia adenomatosa 15 casos (70.28%); hiperplasia adenomatosa atípica 79 casos (13.02%). Se analiza antecedentes epidemiológicos de importancia, exponiendo el manejo realizado en estos pacientes.

New WHO Classification of Endometrial Hyperplasias.

Endometrioid endometrial carcinoma, the most common form of endometrial cancer, usually develops out of a typical sequence of endometrial hyperplasias. The underlying cause of these hyperplasias is a relative predominance of estrogen combined with insufficient progesterone levels. Typical causes include corpus luteum insufficiency/anovulatory cycles (premenopause), polycystic ovary syndrome and obesity with metabolic syndrome (aromatase conversion of ovarian androgens in adipose tissue), inappropriate hormone therapy post menopause (insufficient dosage of gestagens) or an estrogen or androgen-producing tumor 1. Even in patients with Lynch syndrome (formerly known as HNPCC), tumorigenesis of hereditary endometrioid carcinoma usually follows the usual progression with development of the respective hyperplasias 1. Up to now, the correct clinical evaluation of endometrial hyperplasias was made more difficult by the different classification systems still in use: in Germany hyperplasias are sometimes still differentiated according to the classification “glandular-cystic hyperplasia” and “adenomatous hyperplasia grade I to III”. In 1994, the WHO classified endometrial hyperplasias into 4 categories: simple hyperplasia without atypia, complex hyperplasia without atypia, simple atypical hyperplasia, complex atypical hyperplasia 1, 2. While categories 1, 2 and 4 were generally accepted, pathologists continued to debate the existence of group 3-type hyperplasias. Hyperplasias without atypia (categories 1 and 2) are considered benign pathologies which will regress with conservative treatment (oral gestagens, gestagen IUD, elimination of the cause of anovulation/corpus luteum insufficiency) 1. A large percentage (up to 60 %) 3 of atypical endometrial hyperplasias (categories 3 and 4) are found to be coexistent with invasive endometrial carcinoma or develop into invasive endometrial carcinoma within the space of just a few years 1, 2, 4. Hysterectomy (total hysterectomy, not supracervical hysterectomy!) is therefore the treatment of choice for atypical endometrial hyperplasia 4 or – in selected patients, i.e. younger patients wanting to have children – high-dose gestagen therapy with appropriate close histological monitoring 1, 4. The WHO classification of 1994 and even more so the parallel use of the older classification system led to confusion among clinicians. The consequence of this was inadequate diagnosis, with hysterectomies performed for hyperplasias without atypia or gestagens administered in HRT dosages for atypical hyperplasia. Pathologists also experienced difficulties with categorization. This was made even more difficult by the development and parallel use of a further classification system: benign hyperplasia and endometrial intraepithelial neoplasia (EIN) 2. In its latest classification 5 published in 2014, the WHO has clarified the matter: it now only differentiates between 2 categories of endometrial hyperplasia: hyperplasia without atypia atypical hyperplasia/endometrioid intraepithelial neoplasia (Table 1). Table 1 New WHO classification of endometrial hyperplasias 5. This reduction to 2 categories was not only due to the need to do away with the confusing multitude of terms currently in use. Rather, it reflects a new understanding of molecular genetic changes. Hyperplasias without atypia exhibit no relevant genetic changes. They are benign changes and will regress again after the endocrine milieu (physiological gestagen levels) has normalized. In a few cases (1–3 %), progression to invasive disease may occur if the endocrine disorder (long-term estrogen dominance or relative or absolute gestagen deficiency) persists over the long term. Atypical endometrial hyperplasias exhibit many of the mutations typical for invasive endometrioid endometrial cancer 7. In up to 60 % of cases, patients have coexisting invasive cancer or are at extremely high risk of developing invasive cancer (Table 1). The implications for treatment are obvious: hyperplasias without atypia should generally be treated conservatively (normalization of the cycle through weight loss, metformin; oral contraceptives; cyclical gestagens; gestagen IUD). Preventive hysterectomy should only be considered in exceptional cases (e.g., extreme obesity without any prospect of weight loss) 1, 4. The surgery should be done as a total hysterectomy, i.e., it must include removal of the cervix 4. Treatment of atypical hyperplasia/endometrioid intraepithelial neoplasia should generally consist of total (not supracervical) hysterectomy 1, 4. Conservative treatment with high-dose gestagens and close histological monitoring should only be considered in exceptional cases (when the patient wants to have children, satisfactory compliance) 1, 4, 6.

Polycystic Ovarian Syndrome in Perimenopausal Women: A Pilot Study

Background: Polycystic Ovarian Syndrome (PCOS), characterized by hyperandrogenism, chronic anovulation with polycystic ovaries, probably most common endocrine disorder, can occur at any age, with risks for metabolic/ cardiovascular disorders in future. Objective: Present pilot study was done to know incidence of PCOS among perimenopausal women with menstrual abnormalities and associated abnormalities. Material methods: Study was done at a rural institute in women of 35 to 54 years with menstrual disturbances, with or without obesity, with or without hirsutism. PCOS diagnosed as per criteria of PCOS Consensus Workshop Group (2004) and correlation with socio-economic status, lifestyle, family history, Body Mass Index, co-existing disorders was studied. Results: Twelve perimenopausal of 100 studied were diagnosed to have PCOS after clinical, sonographic, biochemical evaluation, two had hyperprolactinemia, 2 hypothyroidism. Of 12 women eight had leiomyoma uteri. They underwent hysterectomy. Endometrial, histopathology revealed cystic glandular hyperplasia without atypia in 3, atypia in one, proliferative endometrium in two. Two had atrophic endometrium. In all ovarian histopathology revealed multiple cystic ovaries with surrounding hyperthecosis typical of PCOS. Of 12 women, 8 had low fasting glucose/insulin ratio, 5 elevated LH/FSH ratio, 4 elevated free testosterone. Of 88 women with no PCOS, 3 had elevated free testosterone, 21 low fasting glucose/insulin ratio, none had deranged LH/FSH ratio. T3, T4 were elevated in two, low TSH in 2. All PCOS had metabolic disorders, 4 diabetes mellitus, 3 hypertension, 2 diabetes and hypertension, 2 hyperlipidemia with diabetes, hypertension, one (8.33%) hypothyroidism and one (8.33%) had hypertension with hypothyroidism. Conclusion: PCOS in perimenopausal is complex. Studies are needed about de novo, PCOS and follow up of young women with PCOS through menopause. [Condensed Abstract: Polycystic Ovarian Syndrome, can occur at any age with metabolic/cardiovascular risk. Present study was to know incidence of PCOS among 100 women of 35 to 54 years with menstrual disturbances, with or without, obesity, hirsutism. Twelve were diagnosed to have PCOS after clinical, sonographic, biochemical, evaluation, 8 had low fasting glucose/insulin ratio, 5 elevated LH/FSH ratio, 4 elevated free testosterone. All had metabolic disorders, 4 diabetes mellitus, 3 hypertension, 2 diabetes hypertension, 2 hyperlipidemia diabetes, hypertension, one hypothyroidism, one hypertension with hypothyroidism. Studies are needed about de novo, PCOS, follow up of young PCOS women through menopause]

Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

IntroductionEndometrial hyperplasia has a high risk for malignant transformation and relapses; existing mini-invasive treatments may lead to irrevocable endometrium destruction. The aims were to analyze receptor systems in endometrial hyperplasia, to evaluate the capabilities of ultrasonography, sonoelastography for diagnosis and treatment control, and to develop treatment algorithm.Materials and methodsWe included 313 women (20–45 years), assessed into the following: group 1 (n = 112) with glandular cystic hyperplasia, group 2 (n = 98) endometrial polyps, and group 3 (n = 103) atypical hyperplasia; and 82 controls who have undergone hysteroscopy before in vitro fertilization in tubal origin infertility were also included. Patients underwent clinical examination, transvaginal ultrasound, immunohistochemical study, and hormonal therapy/hysteroresectoscopy.ResultsIn patients with glandular hyperplasia, we registered increase of endometrium estrogen receptors (75.6% in the epithelium and 30.9% in the stroma; in controls, 43.3% and 29.6%, respectively); in polyps, there was a significant estrogen receptor increase in the stroma (48.2% vs 29.6% in controls), and in atypical hyperplasia, progesterone receptors significantly increased in the stroma. Ki-67 increased (40% to 50%) in the epithelium without changes in the stroma. Ultrasound has a sensitivity of 96% and a specificity of 85% for early detection of endometrial pathology and prediction outcome of intervention, and sonoelastography has a sensitivity of 91% and a specificity of 83% for polyp diagnosis. Personalized treatment was effective in 88.8%, relapse was diagnosed in 11.2% after 6 months, and conservative treatment of atypical hyperplasia was effective in 45%: in 25.8%, ablative hysteroresectoscopy was performed, while in 22.6% with comorbidities, hystero/oophorectomies were performed.ConclusionsThe evaluation of receptor status with ultrasound data in patients with endometrial hyperplasia allows for a clear definition of the treatment policy, avoidance of relapse, treatment optimization, and observation of such patients.

Klinische und endokrinologische Befunde von Hündinnen mit Ovarialzystensyndrom

Aim of this study was to record the clinical findings in bitches with ovarian cyst syndrome (OCS) and to interpret them in connection with the endocrine status in peripheral blood and in cyst liquid. For our investigation 16 bitches of different breeds with an average age of 9.7 years were used. They have been presented to the clinic due to different gynecological symptoms. The leading symptom was in 87.5 % of the cases a chronic vaginal secretion. In addition to a detailed anamnesis a clinical examination was performed including vaginalcytologic, sonographic, hematologic and hormonal findings (progesterone P4, 17β estradiol E2). As basic diagnoses could be made: Cycle aberrations (n = 8), pyometra endometritis complex (n = 4), vaginal tumor (n = 4). In addition 3 patients were presented with alopecia. All patients were ovariohysterectomized without prior conservative treatment and the ovaries histologically examined and classified. Based on sonographic findings before and macroscopic evaluation the ovaries after surgery, the OCS could be divided into an oligocystic and polycystic syndrome. There were predominating (94 %) follicle theca cysts. The formation of cysts on the ovary was in the vast majority (66.7 %) combined with corpora lutea. The endometrium showed mainly (50 %) a glandular cystic hyperplasia (CHE) and the hematologic examination revealed in 31.2 % of the patients a combination of advanced erythropenia and thrombocytopenia. Generally there was no direct relationship between increased P4 and E2 values in the pooled cyst fluid and in the peripheral blood when the oestrous phase was considered. Based on present data the diagnosis of OCS of the bitch by means of peripheral P4 and E2 values is not possible.

Uterine artery embolisation for symptomatic fibroids: the University of Malaya Medical Centre experience.

Background:Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic fibroids has been performed in several centres in the United States, Western Europe and Asia with promising results. This study reports the authors' experience with UAE at the University Malaya Medical Centre.Method:Fifty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via patient-controlled analgesic pump. The patients were followed up at an interval of 6/12 clinically and with MRI.Results:Transcatheter UAE was performed on all 50 patients with no major complications. 49 patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery due to previous myomectomy. The mean hospital stay was 3.5 days (range, 2 to 7). At a mean follow-up of 24/52, all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on MRI. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) after 6 months and subsequent endometrial sampling revealed cystic glandular hyperplasia for which total abdominal hysterectomy was performed. Two other patients had no change in symptoms and after hysterectomy, the pathology revealed concurrent adenomyosis. Another 2 patients with cervical fibroids were treated with hysterectomy as there was no gross reduction in the size of fibroid following UAE. Overall, 90% of the patients had dramatic improvement of anaemia and symptoms at 1 year follow-up.Conclusion:Out of the 50 patients, 17 patients had total disappearance of their fibroids and 28 patients had more than 50% reduction in the size of fibroids after 1 year. 5 patients ended up with total abdominal hysterectomy. These results suggest that UAE is an appealing alternative to hysterectomy or myomectomy for many women with symptomatic fibroids.

Development of cystic glandular hyperplasia of the endometrium in Mullerian inhibitory substance type II receptor–pituitary tumor transforming gene transgenic mice

The pituitary tumor transforming gene (PTTG)/securin is an oncogene that is involved in cell cycle regulation and sister chromatid separation. PTTG is highly expressed in various tumors including ovarian tumors, suggesting that PTTG may play a role in ovarian tumorigenesis. Overexpression of PTTG resulted in induction of cellular transformation in vitro and tumor formation in nude mice. To ascertain PTTG function in ovarian tumorigenesis, we generated a transgenic mouse model of PTTG by cloning PTTG cDNA downstream of Mullerian inhibitory substance type II receptor gene promoter (MISIIR) in order to target the ovarian surface epithelium. By screening of transgenic animals, we identified five founders (four males and one female). Using the four male founders, we developed four transgenic lines. PTTG expression was increased in ovarian surface epithelium, ovarian granulosa cells, as well as in the pituitary gland. Transgenic females did not develop any visible ovarian tumors at 8-10 months of age; however, there was an overall increase in the corpus luteum mass in transgenic ovary, suggesting increased luteinization. These changes were associated with an increase in serum LH and testosterone levels. In addition, there was a generalized hypertrophy of the myometrium of MISIIR-PTTG transgenic uteri with cystic glandular and hyperplasia of the endometrium. Based on these results, we conclude that the overexpression of PTTG may be required to initiate precancerous conditions but is not sufficient to induce ovarian tumorigenesis and may require another partner to initiate cellular transformation.

Some Clinico and Histopathological Changes in Female Goats Experimentally Exposed to Dioxin

Female Baladi goats were used for investigating the toxicological effects of dioxin. Each animal in the treated group was given an oral dose of 4 mL of stock standard solution of dioxin (labelled and native congeners) diluted in 5 mL distilled water (1/3 of LD50) for three times with 2 days interval and slaughtered 16 days post treatment. Blood and tissue samples were taken and subjected for haemogram, biochemical and pathological studies as well as for determination of dioxin residues. Results revealed that exposure of female goats to dioxin induced anemia, leucocytopenia, neutropenia and eosinophilia with non significant increases in activities of serum ALT and AST as compared with untreated group. Meanwhile, activity of ALP and BUN concentration were significantly increased. Histopathological examination showed degenerative and necrotic changes associated with inflammatory reaction in liver and kidney, in addition to cystic glandular hyperplasia and adenomyosis in uterus. In ovarian tissue, marked decrease ofpreantral follicles together with cystic atretic follicle were noticed. The average percentage residues ofpg WHO-TEQ values for dioxins (PCDDs and PCDFs) in liver, kidney, mammary gland, uterus and milk after oral dose were 0.013, 0.0012, 0.0012, 0.009 and 0.0012%, respectively. It was concluded that oral exposure to dioxin in female goats induced adverse effects on liver and kidney. Dioxins had estrogenic like effect as indicated by uterine and ovarian histopathological changes.

Subcutaneous Implantation of Pure Crystalline Estradiol Pellets for Conception Control

Objectives: Assessment of the contraceptive effectiveness of pure estradiol pellets implanted annually under the skin, thus avoiding the ‘first passage phenomenon’ through the liver, using a modification of Emperaire and Greenblatt’s method. Study Design: 228 women wishing birth control for 1 year or more were included. 5 pellets of estradiol (25 mg each) were implanted initially. At each subsequent annual treatment, 4 pellets were implanted. Withdrawal bleeding was induced monthly with oral norethindrone acetate 5 mg taken for 7 days. Our experience encompassed 8,136 cycles, or 678 women years. The study obtained approval of the local Ethical Committee. Results: Annual continuation rates were 51 per 100 women in the second year, 65 in the third, 72 in the fourth and 84 ± 10.1 annually over the next 6 years. Through 12 years of our study, 2 accidental pregnancies occurred. The annual net cumulative pregnancy rates were 0.44 and 0.48 per 100 women at 1 and 2 years, and reduced to 0.29 at the end of 10 years. Return of fecundity after discontinuing treatment was 53% after 12 months, 81% after 24 months and 89% after 36 months. The mean estradiol levels were 1,413 ± 161 pmol/l one week following the pellet installation. The mean serum estradiol level of the 43 women who were assayed arbitrarily or a year following last insertion was 1,207 pmol/l (range 462–2,904 pmol/l); 22% had serum estradiol levels <1,000 pmol/l and 6.3% (3 women) had levels >1,750 pmol/l. A total of 28 endometrial biopsies were obtained –19 were proliferative, 6 showed slight simple hyperplasia, and three, benign cystic glandular hyperplasia. Conclusion: Subcutaneous implantation of pure estradiol pellets offers excellent birth control, has minimal untoward effects, is simple to insert and can serve as a possible alternative for conception control. It could be considered for 3 indications: for women who have completed family planning; for women in older age group (above 35 years) who are approaching the climacteric; and for women at any age, who need prolonged periods of contraception.

Disorders in Cytokine Gene Expression in Endometrial Hyperplasia and Effect of Hormone Therapy

We studied local expression of insulin-like growth factor 1, insulin-like growth factor receptor, epithelial growth factor, transforming growth factor beta2, PCNA, TNF-alpha, type I TNF receptor, Fas, FasL, IFN-gamma, IL-1beta, IL-4, IL-6, IL-8, IL-10, and IL-12 genes in intact and hyperplastic endometrium. Endometrial hyperplasia was associated with reduced production of TNF-alpha (p<0.05), PCNA (p<0.05), and epithelial growth factor mRNA and enhanced production of Fas mRNA (p<0.01). The expression of TNF-R1, IL-1beta, and IL-12 genes decreased only in glandular cystic hyperplasia (p<0.05 for all genes), expression of insulin-like growth factor 1 gene decreased only in adenomatous hyperplasia (p<0.05). Dufaston therapy of glandular cystic hyperplasia and zoladex therapy of adenomatous hyperplasia normalized expression of Fas receptor, PCNA, and insulin-like growth factor 1 genes, while the expression of IFN-gamma and IL-6 genes, which was normal in hyperplasia, decreased (p<0.05). Zoladex therapy decreased the production of transforming growth factor beta2 (p<0.05) and IL-1beta (p<0.01) mRNA, dufaston therapy decreased production of TNF-alpha (p<0.05) and IL-4 mRNA (p<0.05). Hence, both apoptosis and proliferative activity were suppressed in endometrial hyperplasia, and hormone therapy created prerequisites for transition of the endometrium into the normal proliferation stage.

Expression of the inhibin-alpha subunit in normal, hyperplastic and malignant endometrial tissue: an immunohistochemical analysis

Objective. Determination of the frequency and tissue distribution of inhibin-alpha (INH-α) in normal, hyperplastic and malignant endometrium. Materials and methods. Endometrial tissue was obtained from normal, hyperplastic (glandular-cystic hyperplasia), adenomatous hyperplasia (AH grade I to III) and endometroid adenocarcinoma and immunohistochemically characterized with INH-α antibody. Results. INH-α was expressed in normal, hyperplastic and malignant endometrium. Highest expression was observed during secretory phase and glandular-cystic hyperplasia compared to all groups. A continuous decline was noted from AH grade I to III with a significance between AH I and II. Discussion. A menstrual cycle associated expression of INH-α in glandular endometrial epithelium was observed. Since AH grade II and III can be considered as a precursor of endometrial cancer, INH-α could be a marker of cell transformation and an endometrial tumor-suppressor agent.