Endometrioid Disease Research Articles

To the 100th anniversary of professor Viktor Pavlovich Baskakov

The article describes the main milestones in the labor, scientific and pedagogical activities of Professor Viktor Pavlovich Baskakov, born on November 28, 1923. After graduating from the Military Medical Academy and defending his dissertation for the degree of Candidate of Medical Sciences in 1950, he was hired as a teacher in the Department of Obstetrics and Gynecology, in 1958 he was appointed to the position of associate professor, in 1970 he received the title of professor, after which in 1974 he became head of department, where he worked until 1984. Viktor P. Baskakov was the first in the country to begin studying endometrioid disease. Three of his monographs are devoted to this complex pathology: “Endometriosis” (1966), “Clinic and treatment of endometriosis” (1979, 1990) and “Endometrioid disease” (2002). In 1968, based on the published monograph “Endometriosis” by V.P. Baskakov was awarded the academic degree of Doctor of Medical Sciences without defending a dissertation. For many years, Viktor Pavlovich was a member of the presidium of the Leningrad Obstetrics and Gynecology Society, a member of dissertation councils, and the editorial board of the Journal of Obstetrics and Women’s Diseases. He was awarded the Order of the Red Star and medals, including the medal “For Military Merit” and the medal “For Victory over Germany in the Great Patriotic War of 1941–1945.” Professor Viktor Pavlovich Baskakov remained in the memory of his contemporaries as a talented scientist, teacher, and surgeon. It was difficult to find a person more concerned about the problems of others. Students remember him with a smile and great warmth.

Bloody tears: A new option for early diagnosis of endometriosis

Aims/Purpose: To investigate the cytological composition of tears to determine the potential diagnostic criteria of endometriosis.Methods: Tear samples obtained from the lower fornix of the conjunctiva using a glass capillary tube were examined by microscopy in 100 people: 60 healthy women who made up the control group and 40 patients with endometriosis.Results: The proportion of women with endometriosis, in whose tear erythrocytes were determined was significantly higher, 32.5%, compared with the control group ‐ 25.0%. In 69.2% of women with endometriosis, latent haemolacria was detected in the follicular phase of the menstrual cycle, which significantly exceeded the 30.8% of people with erythrocytes in tears detected in the luteal phase. Epitheliocytes were found in tears in 97.5% of patients with endometriosis versus 75.0% of healthy women, at the same time, in 100.0% cases, − in the follicular phase of the menstrual cycle, compared with 74.3% of healthy women in the same phase of the cycle. The proportion of women with epitheliocytes in the tear in the amount of “++” was 56.4%, which was significantly more compared to 20.0% of people from the control group with epitheliocytes in the same amount; at the same time, group accumulations of epitheliocytes were found in 15.0% of patients with endometriosis, which was significantly higher than in healthy women ‐ 8.3%. In 90.0% of cases in the group with endometriosis, glandular cuboidal epithelial cells were found in the tear, morphologically resembling endometrial cells.Conclusions: The revealed features of the cytological composition of tears in patients with endometriosis, which differed from those in the control group, reflected certain links in its etiopathogenesis, so the study of tear parameters can be useful for predicting the prevalence of “endometrioid disease” and developing pathogenetically substantiated treatment.

Aseptic inflammation as the essential link in the pathogenesis of endometrioid disease

The paper was aimed at deter­mination of the quantitative activity of iNOS and Arg1, as well as M1 and M2 phenotype macrophages in women with endometrioid disease to establish their role in the pathogenesis of endometriosis. A prospective study was performed in gynecological units of the medical facilities of Poltava city. 140 women of reproductive age who made up the main group (110 women with endometrioid disease) and the control group (30 women without endometrioid disease) voluntarily participated in the study. All women underwent planned surgical treatment for existing gynecological pathology. Before surgical treatment, women were examined in accordance with the current Orders of the Ministry of Health of Ukraine. The spectrophotometric method was used to determine the enzymatic markers of macrophages (in the endometrium and peritoneal fluid) polarized into M1(iNOS) and M2 (Arg1) phenotypes. The type of macrophages was determined individually in each patient according to the ratios: in iNOS>Arg1, the M1 macrophage type prevailed; in Arg1>iNOS, the M2 macrophage type prevailed. When examining endometrial samplings in women from the main group, the iNOS indicator was by 1.4 times higher compared to women from the control group. The obtained results at the stage of entry into the abdominal cavity showed that mostly women from the main group suffered from the pelvic adhesion, especially stage 3 and stage 4. Among the obtained results, the increased quantitative activity in the peritoneal fluid of both iNOS and Arg1 in women of the main group was significant compared to the control group. When comparing the stages of endometrioid disease to the rates of quantitative activity of macrophage enzyme markers (in peritoneal fluid), it was found that the increase in the stage of the disease (from stage 3 to stage 4) caused an increase in the quantitative activity of Arg1 by 1.9 times and a decrease in the quantitative activity of iNOS by 2.9 times. Therefore, the planning of surgical intervention for women with endometrioid disease should consider a significant percentage of the pelvic adhesive disease, especially at the severe stages. Initiation of the chronic aseptic inflammatory process in endometrioid disease is caused by an increased quantitative activity of iNOS in the endometrium. In the pathogenesis of endometrioid disease, the presence of M2 phenotype macrophages in the peritoneal fluid is important, while the switching of macrophage phenotypes from a pro-inflammatory subpopulation to an anti-inflammatory one is crucial.

Characterization of ovarian cancer survival by histotype and stage: A nationwide study in Norway.

Contemporary population-based data on ovarian cancer survival using current subtype classifications and by surgical status are sparse. We evaluated 1-, 3-, 5- and 7-year relative (and overall) survival, and excess hazards in patients with borderline tumors or invasive epithelial ovarian cancer diagnosed 2012 to 2021 in a nationwide registry-based cohort in Norway. Outcomes were evaluated by histotype, FIGO stage, cytoreduction surgery and residual disease. Overall survival was evaluated for non-epithelial ovarian cancer. Survival of women with borderline ovarian tumors was excellent (≥98.0% 7-year relative survival). Across all evaluated invasive epithelial ovarian cancer histotypes, 7-year relative survival for cases diagnosed with stages I or II disease was ≥78.3% (stage II high-grade serous). Survival for ovarian cancers diagnosed at stage ≥III differed substantially by histotype and time since diagnosis (eg, stage III, 5-year relative survival from 27.7% [carcinosarcomas] to 76.2% [endometrioid]). Overall survival for non-epithelial cases was good (91.8% 5-year overall survival). Women diagnosed with stage III or IV invasive epithelial ovarian cancer and with residual disease following cytoreduction surgery had substantially better survival than women not operated. These findings were robust to restriction to women with high reported functional status scores. Patterns for overall survival were similar to those for relative survival. We observed relatively good survival with early stage at diagnosis even for the high grade serous histotype. Survival for patients diagnosed at stage ≥III invasive epithelial ovarian cancer was poor for all but endometrioid disease. There remains an urgent need for strategies for risk reduction and earlier detection, together with effective targeted treatments.

The prognostic value of the cytological composition of the tear in the diagnosis of endometriosis

Purpose. To investigate the cell composition of the tear in healthy women and endometriosis patients in order to find the potential diagnostic criteria of endometriosis. Material and methods. Tear samples obtained from the lower fornix of the conjunctiva using a glass capillary tube were microscopically examined in 100 females aged 18 to 48: 60 healthy women, who made up the control group, and 40 patients with endometriosis. Results. The share of women with endometriosis who were found to have erythrocytes was 32.5 %, which was significantly higher as compared with the control group, where it was 25.0%. 69.2 % of women with endometriosis showed haemolacria in the follicular phase of the menstrual cycle, which significantly exceeded the percentage of women with erythrocytes in the tear (30.8 %) who had them in the luteal phase. Epitheliocytes were found in the tear of 97.5 % of patients with endometriosis, versus 75.0 % of healthy women. In all 100 % of such patients, these cells were found in the follicular phase of the menstrual cycle, compared with 74.3 % of healthy women who showed these cells in the same phase of the cycle. The share of women with endometriosis showing the ++ quantity of epitheliocytes in the tear was 56.4 %, which was significantly higher than the 20 % of the control group subject with the same level of epitheliocytes. It is to be noted that group accumulations of epitheliocytes were found in 15 % of endometriotic patients, which was significantly higher than in healthy women, of whom only 8.3 % had such accumulations. 90 % of endometriosis group cases revealed glandular cuboidal epithelial cells in the tear, which morphologically resembling endometrial cells. Conclusion. The revealed properties of the cytological composition of the tear of patients with endometriosis reflected particular links in its etiopathogenesis, which suggests that the study of tear parameters can help predict the incidence of the "endometrioid disease" and develop pathogenetically oriented treatment methods.

Endometrioid disease is a modern view of the problem

The article provides a review of specialized literature in order to generalize and systematize data on modern ideas about endometrioid disease in the clinical practice of doctors of various specialties. The social signifi cance of this disease is indicated. The article refl ects the main modern ideas about etiology and pathogenesis of endometriosis. Although there are a number of issues, they are not studied completely. The crucial role of the immune system malfunction in the formation of endometrioid disease is highlighted. The genetic ideas about the development of endometriosis are refl ected. Modern approaches to the treatment of endometriosis and the place of cholecalciferol in modern complex therapy of endometriosis are presented.

ВПЕРВЫЕ ВЫЯВЛЕННЫЙ ЭНДОМЕТРИОЗ У ЖЕНЩИНЫ РЕПРОДУКТИВНОГО ВОЗРАСТА (КЛИНИЧЕСКИЙ СЛУЧАЙ)

To prevent the development, early detection, timely initiation of treatment of endometrioid disease in women of reproductive age, it is necessary to promote a healthy lifestyle, prevent abortions, and conduct medical examinations. The presented material highlights a clinical case of managing a patient who underwent surgical treatment in the gynecological department with a diagnosis of “Retrocervical endometriosis. Stage 4. Cyst of the left ovary. Pain syndrome”. The presented clinical case emphasizes the need to choose surgical treatment at the right time and in full. The treatment tactics we have chosen testifies to the positive effect of the radical removal of all lesions both to reduce pain, relapse risk and to increase pregnancy percentage. In addition, the choice of a drug for postoperative therapy is extremely important, its sufficient duration in terms of preventing endometriosis relapse. The disease is a general medical problem, as it is associated with infertility and chronic pelvic pain that impairs the quality of life of young women. Endometriosis remains one of the main pathological diseases in women of reproductive age. Patients diag-nosed with endometriosis need monitoring and constant therapy even after radical treatments throughout their lives. It is necessary to carry out adequate therapy for endometriosis and find the optimal ratio of surgical and medical treatment individually for each patient.

Endometriosis. Case report

Extragenital endometriosis (EGE) is the rarest variant of endometrioid disease. This is a process in which a benign growth of tissue similar to the endometrium in morphological and functional properties occurs outside the uterine cavity. The manifestation of the disease has an erased course characteristic of other diseases and patients are more likely to end up in non-core departments, which is accompanied by errors in treatment tactics. According to the data of T.V. Dresvyanskaya et al., the frequency of EGE is 68% of the number of all cases of detection of endometrioid disease. The article presents a case of successful surgical treatment of EGE of rare localization.

COMPARATIVE CHARACTERISTICS (CASE - CONTROL) OF WOMEN WITH AND WITHOUT ENDOMETRIOID DISEASE

Endometrioid disease today is ranking one of the leading positions in the structure of gynaecological diseases. The prevalence of this endometrioid disease reaches 10% among the female population and up to 70% among women of child-bearing age. Ambiguity in terms of the aetiology, pathogenesis, and predictors of the disease impedes the accurate and quick diagnosis and proper management of this disease.
 The aim of this study is to analyze and to compare symptomatic and anamnestic data presented by women who have with endometrioid disease and have no it, and to identify and analyze predictors and consequences of endometrioid disease.
 The study examined 80 women of reproductive age. The main group involved 50 women with endometrioid disease; the control group included 30 women without signs of endometrioid disease. All participants underwent clinical examination and were interviewed about symptoms, family history, menstrual function, past gynaecological, reproductive, infectious (infectious diseases, transferred in childhood), somatic diseases. The information about the presence of psychological and physical overstrain in women of both groups was obtained (subjectively from the words of women) and then assessed.
 Contributory factors or predictors in the development and progression of endometrioid disease are as follows: an increased number of occupational hazards (22.6% versus 0%, respectively, p = 0.03) among working women with endometrioid disease; regular psychological overstrain, which can result from endometrioid disease on the one hand, and, contribute to its progression, on the other (70% versus 43.3%; p = 0.03); the presence of the 0 blood type (40% versus 16.7%; p = 0.029), the presence of chronic inflammation of the uterine appendages in the past (60% versus 36.6%; p = 0.04); human papilloma virus in past or present medical history (14% versus 0%; p = 0.04).
 The possible consequences of endometrioid disease include somatic pathology prevailing in 1.3 times. Special attention should be paid to the average number of gastro-intestinal diseases in the women of main and control groups: 1.34 ± 1.3 versus 0.77 ± 1.1, respectively; p = 0.04. The prevalence of diseases of urinary system is as follows: 0.66 ± 0.68 versus 0.33 ± 0.54, respectively; p = 0.04. The menstruations are described as irregular, heaving bleedings often with dark brown discharge before menstruation, pain during menstruation. The study revealed a large percentage of infertility in patients with endometrioid disease (60% versus 33.3%, respectively; p = 0.02), reduced reproductive potential in general (the average number of pregnancies per woman in the control group is 1.9 times higher).
 It should be noted that 14 (28%) women of the main group have relapse of endometrioid disease in the form of repeated cysts after conservative and / or surgical treatment. Thus, endometrioid disease was detected for the first time in 36 (72%) women of the main group.
 The information obtained in the study can be helpful for medical practitioners as it deepens knowledge about possible predictor factors, premorbid background and the consequences of endometrioid disease, and, thus, will serve in customized management of such patients.

Endometriosis and SARS-CoV-2. A case report

Despite the lack of information in the medical literature on endometrioid disease complicated by infectious and inflammatory diseases, past community-acquired pneumonia caused by the new coronavirus infection may cause purulent-septic complications of endometriosis. The effect of the virus on endometrioid cysts was hematogenous in this clinical case. The information presented in this report can help clinicians in conducting differential diagnostics in patients with a history of endometriosis and previous SARS-CoV-2, establishing a diagnosis, as well as determining the tactics of examination and treatment.

The role of the macrophage polarization type in the pathogenesis of endometrioid disease

Endometriosis today occupies one of the leading places in the structure of general gynecological pathology. Theories of the onset and progression of this disease are controversial. One of the most widespread theories is the assumption that endometriosis is a disease of macrophages. The question of which the macrophage phenotype, M1 or M2, is the leading one, however, remains controversial. The aim. To determine the type of macrophage polarization (M1/M2) and the quantitative activity of their marker enzymes (iNos/Arg1) in the endometrium and peritoneal fluid in endometrioid disease. Materials and methods. The total number of reproductive age (30.95±6.49) women enrolled in the study was 80. The main group consisted of 50 women with endometrioid disease. The control group included 30 women without signs of endometrioid disease. Women from the main group (n=24) and the control group (n=27) underwent endometrial sampling using an intrauterine Pipelle catheter in the first phase of the menstrual cycle before a surgery. During laparoscopic or laparotomy approaches, peritoneal fluid was taken (in the main group n=24, in the control group n=28). The type of macrophage polarization (M1 or M2) was determined based on the ratio of marker enzymes (Arg1, iNos) activity in each patient using a spectrophotometric method in the endometrium and peritoneal fluid. The polarization to the M1 phenotype was determined at iNos>Arg1, and at Arg1>iNos– the polarization to the M2 phenotype. Results. As a result of the study, it was revealed that in women with endometrioid disease, pelvic adhesions were much more common, 84.0% versus 46.7% in women without it, and especially 3 and 4 degree of severity (P<0.05). When assessing the type of macrophages in the peritoneal fluid, a significantly greater number of the main group women had the M2 phenotype of macrophage polarization compared to the control group (58.3% versus 28.6%, P=0.03). It was the macrophage polarization to the M2 phenotype that influenced the severity of endometrioid disease, especially the 4 degree of severity. The mean values of the iNOS activity in the main group women, both in the peritoneal fluid and in the endometrium, significantly differed from those in the control group patients (by 1.73 and 1.77 times, respectively). Conclusions. Thus, we can conclude that endometriosis is a disease, the development and progression of which is induced by the M2 phenotype of macrophages. Considering the increase in the mean levels of iNOS activity both in the peritoneal fluid and in the endometrium, it can be concluded that iNOS influences the pathogenesis of endometrioid disease.

Oncologic outcomes of endometrial cancer in patients with low-volume metastasis in the sentinel lymph nodes: An international multi-institutional study

ObjectiveTo assess oncologic outcomes in endometrial cancer patients with low-volume metastasis (LVM) in the sentinel lymph nodes (SLNs). MethodsPatients with endometrial cancer and SLN-LVM (≤2 mm) from December 3, 2009, to December 31, 2018, were retrospectively identified from 22 centers worldwide. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV, adnexal involvement, or unknown adjuvant therapy (ATx) were excluded. ResultsOf 247 patients included, 132 had isolated tumor cell (ITC) and 115 had micrometastasis (MM). Overall 4-year recurrence-free survival (RFS) was 77.6% (95% CI, 70.2%–85.9%); median follow-up for patients without recurrence was 29.6 (interquartile range, 19.2–41.5) months. At multivariate analysis, Non-endometrioid (NE) (HR, 5.00; 95% CI, 2.50–9.99; P < .001), lymphovascular space invasion (LVSI) (HR, 3.26; 95% CI, 1.45–7.31; P = .004), and uterine serosal invasion (USI) (HR, 3.70; 95% CI, 1.44–9.54; P = .007) were independent predictors of recurrence.Among 47 endometrioid ITC patients without ATx, 4-year RFS was 82.6% (95% CI, 70.1%-97.2). Considering 18 ITC patients with endometrioid grade 1 disease, without LVSI, USI, or ATx, only 1 had recurrence (median follow-up, 24.8 months). ConclusionsIn patients with SLN-LVM, NE, LVSI, and USI were independent risk factors for recurrence. Patients with any risk factor had poor prognosis, even when receiving ATx. Patients with ITC and grade 1 endometrioid disease (no LVSI/USI) had favorable prognosis, even without ATx. Further analysis (with more patients and longer follow-up) is needed to assess whether ATx can be withheld in this low-risk subgroup.

PATHOGENETIC ROLE OF MACROPHAGE COLONY-STIMULATING FACTOR (CSF-1) IN PREDICTING ENDOMETRIOID DISEASE

The aim: To assess the CSF – 1 level in peritoneal fluid and menstrual blood of women with endometrioid disease and to investigate its diagnostic and prognostic specificity. Materials and methods: The study included 80 women of child-bearing age (mean age 30.95 ± 6.49 years) with benign gynaecological pathology of the ovaries and / or fallopian tubes. The women included in the study were divided into two groups: study group (n = 50, mean age 31.04 ± 6.3 years), consisting of patients with confirmed endometrioid disease, and control group (n = 30, mean age 30.8 ± 6.8 years), involving individuals without signs of endometriosis (p&gt; 0.05). Results: We have found significantly higher level of CSF-1 content in the peritoneal fluid in the subjects of the study group (2027.05 ± 732.64 pg / ml) compared with those in the control group (1725.62 ± 466.06 pg / ml) (p = 0.029). There is a tendency towards an increase in CSF-1 level in women with endometriosis in its more severe stages and more severe and extended adhesions. The investigation of CSF-1 content in menstrual blood has demonstrated significant increase in its values in the women of the study group (9431.6 ± 2866.22 pg / ml) compared with the values in the control group (6637.12 ± 954.05 pg / ml), (p = 0.00004). Thus, there is a tendency towards the growth in CSF-1 level in peritoneal fluid and menstrual blood in women with endometriosis and concurrent increase in severity of the disease. Conclusions: There has been found significant increase in CSF-1 content in women with endometrioid disease in both peritoneal fluid and menstrual blood (1.2 and 1.4 times, respectively). Thus, macrophage growth factor (CSF-1) can be used as a diagnostic and prognostic criterion in evaluating the progression of endomertioid disease.

ENDOMETRIOSIS AS A GLOBAL MULTI-LEVEL PROBLEM: RETROSPECTIVE CHARACTERISTIC OF PATIENTS.

The article outlines the issue of endometrioid disease, known as a complex gynecological polyetiological pathology. The total coverage of this pathology among women is 10%, with its spread up to 70% among women of reproductive age. The diversity and severity of clinical symptoms worsen not only the physical condition of the woman, but emotional status as well. To date, complicacy in the diagnosis and treatment of the disease gives raise a number of challenges requiring solution. Thus, endometriosis is still remaining a promising area of study, The aim of this study was to characterize the features of the anamnesis and symptoms of women with endometriosis, to determine the diagnostic value of the examination methods, to evaluate the effectiveness of the treatment tactics of women with this pathology. We carried out a retrospective analysis of case histories of 61 women with endometriosis. The diagnosis was 100% histologically confirmed. The average age of the women studied was 30,44 ± 5,6 years. Body mass index was 23,04 ±3,87 kg / m2. 16 women (26.22%) were diagnosed as overweight; 1st degree obesity was found in 2 women (3,27%). The onset of menstruation averaged 13,04 ± 1.07 years. Late onset of menarche was found out in 2 women (3,21%). The duration of menstruation ranged from 4,67 ±1.44 to 5,37 ±1,29 days with 1 reported case of menstrual bleeding for more than 8 days. 55,7% of women reported excessive menstrual blood loss. The interval of the menstrual cycle ranged from 21 to 32 days, was regular and amounted to 27,6±2.31 days. 47,54% of women experienced pain during menstruation. The increasing intensity of the pain syndrome from the moment of diagnosis was noted by 14 women, that made up to 48,27% of cases among 29 women with endometriosis and painful menstruation. There were 22 cases of pregnancy; miscarriages were recorded in 2 women (9,09%). 20 women (32,7%) had infertility, and in all the cases infertility was primary. When assessing the position of the uterus in the pelvis, it was revealed that 7 women (11,47%) had a retrograde uterine location, namely in the retroflexio position. When assessing the somatic history of the women studied, we noted that insult of various organs and systems was revealed in 53 women (86,88%). Top list is occupied by the gastrointestinal diseases, 64,1% of 53 studied cases. In addition to the underlying disease, 24 women (39,34%) had a history of gynaecological pathology. Carbohydrate antigen 125 was determined in 73,77% of cases, but only in 25 of these women this level was higher than 35.0 U / ml. Its value was established only in 55,5% of women. The detection of human epididymal protein 4 was carried out in 17 women (27,86%). Among these women, only in 1 case the level of human epididymal protein 4 exceeded the age normal values and was at the level of 69,59 pmol / L. By ultrasound diagnostic method, endometriosis was established only in 58,3% of cases. One woman was diagnosis to have endometriosis during magnetic resonance imaging. Therapy of endometriosis is divided into conservative and surgical. Before surgical treatment, 31 women (50,81%) were chosen for conservative management tactics, resulted in no effect. During surgical treatment with laparoscopic access, visible endometrioid heterotopies were observed in 50 women (81,96%), and in 18,04% endometriosis was not endoscopically diagnosed, while histologically was confirmed in 100% of cases. It is noteworthy that 46 women (75,4%) had adhesions of the pelvic organs, but only 22 women (47,82%) had had any surgical abdominal interventions before. Thus, endometriosis is a disease, which can not be described from a single unified point of view regarding its etiological factors. Severe clinical symptoms, the inability to use only non-invasive diagnostic methods for diagnosis, and the lack of comprehensive treatment that would provide the absence of relapse after the course of treatment, persistently force researchers and clinicians to deepen their knowledge and continue searching for methods to solve the problems of early diagnosis, treatment and prevention of the disease.

FACTORS OF ENDOMETRIAL RECEPTIVITY DOWN-REGULATION IN GENITAL ENDOMETRIOSIS

Endometriosis, or endometrioid disease, is a chronic estrogen-dependent gynecological disease caused by ectopic localization of endometrial tissue, mainly in the pelvis and ovaries. However, at the present stage of development of reproductive medicine, the classical topographic definition of endometriosis should be expanded with new significant characteristics established using the achievements of cell and molecular biology, which allowed a more detailed study of the pathogenesis of this disease. In addition, the introduction of personalized approaches to the treatment of patients with endometriosis and infertility, more attention should be paid to the search for disease predictors and the formation of risk groups with the observation of patients from puberty to menopause. In this review, we have analyzed the literature data and our own studies with an emphasis on factors and markers of decreased receptivity of eutopic endometrium in women with endometriosis, as well as pain, the manifestations of which can contribute to the exact diagnosis of external genital endometriosis.

Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk: Results from the EPIC cohort.

A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead-based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22-4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60-1) was associated with higher risk of EOC overall (1.36 [1.13-1.64]) and with the serous subtype (1.44 [1.12-1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV-2 was associated with higher risk of endometrioid EOC (2.35 [1.24-4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV-2 might promote the development of endometrioid disease.

Профилактика больших акушерских синдромов у беременных с резистентностью к биодоступному прогестерону

The article presents modern literature data on the role of defective deep placentation in the development of great obstetrical syndromes, bioavailable progesterone and its receptors in the formation of the placenta and the development of pregnancy, mechanisms of development of resistance to bioavailable progesterone, and a scheme of the pathogenesis of progesterone deficiency during pregnancy as one of the main causes of great obstetrical syndromes. Modern data on the development of resistance to bioavailable progesterone in adolescence, in patients with endometrioid disease, polycystic ovary syndrome and idiopathic recurrent pregnancy loss are presented. The therapeutic possibilities of prophylaxis of great obstetrical syndromes with resistance to bioavailable progesterone are described. Research data on the use of highly selective progestogen with increased affinity for progesterone receptors dydrogesterone for the prevention of great obstetrical in pregnant women with resistance to bioavailable progesterone are presented. Key words: great obstetrical syndromes, defective deep placentation, progesterone, progesterone receptors, bioavailable progesterone resistance, adolescence, endometrioid disease, polycystic ovary syndrome, idiopathic recurrent pregnancy loss, prevention, dydrogesterone.

Experience of Surgical Treatment of Adenomyosis and Reproductive Outcomes

Adenomyosis is a benign tumor process of the uterus, one of the forms of endometrioid disease. Surgical treatment of adenomyosis to this day is the subject of discussion by many authors, but the principle of surgical interventions remains the same - excision of the myometrium affected by glandular invasion.

Risk factors for recurrence of endometrial hyperplasia in women of late reproductive and premenopausal age

According to many researchers, hyperplastic endometrial processes are not precancerous diseases. However, recurrent endometrial hyperplastic processes, as well as their combination with genital and extragenital pathologies, significantly increase the risk of malignant transformation of the endometrium. Late reproductive and premenopausal age is associated with an increase in the frequency of endometrial hyperplastic processes, extragenital pathology and operative interventions on the internal genitalia. The limited possibilities of conservative treatment in connection with concomitant diseases and the tendency of an increase in the recurring hyperplastic processes of the uterus make the problem of studying various aspects of hyperplastic endometrial processes in women of this age period extremely urgent.The purpose of research: to identify risk factors for recurrence of endometrial hyperplasia in women of late reproductive and premenopausal age.Materials and methods. We studied the clinical and medical history and long-term results of treatment of 276 women aged 35–54 years with endometrial hyperplastic processes. All patients underwent diagnostic and therapeutic hysteroscopic procedures were carried out. In 88 (31.9%) women for 1.5 years after treatment were observed relapses of the disease. These patients accounted for Рц group, the remaining 188 women included in the group K. Data processing was performed using variation statistics method, Mann-Whitney ranking test, χ2-test and Fisher’s exact test.Results and conclusions. It should be noted the high rate of recurrence of endometrial hyperplastic processes in women of late reproductive and premenopausal age and lack of nosological specificity of recurrent endometrial hyperplastic processes. At the same time, recurrence of endometrial hyperplastic processes significantly increased the risks against the backdrop of giperpolimenorei, endometrioid disease, especially, adenomyosis and ovarian cysts. The greatest chances of recurrence were associated with the presence of patients extragenital diseases: gastrointestinal disorders, iron deficiency anemia, thyroid and breast cancer, vegetative-vascular dystonia. Within the framework of all investigated factors, the chances of recurrence of endometrial hyperplastic processes are most significant increased at the vegetative-vascular dystonia, and the pathology of the lacteal and thyroid gland.

Patterns of care study of brachytherapy in New South Wales: malignancies of the uterine corpus.

PurposeThere are limited data at a population level on adjuvant brachytherapy (BT) practice for uterine corpus malignancies. The aims of the current study were to describe BT practice for this disease in New South Wales (NSW), to assess quality of BT, and to determine if a caseload effect on quality exists.Material and methodsPatient, tumour, and treatment related data were collected from all nine NSW radiation oncology departments that treated patients with BT. Included patients had malignancy of the uterine corpus with treatment including BT. Brachytherapy quality was assessed using published quality benchmarks. Higher gynaecological BT caseload departments were compared with lower caseload departments.ResultsOne hundred sixty-three NSW residents with gynaecological cancer were treated with BT. The four higher gynaecological BT caseload departments treated a median of 25.5 NSW residents (range 22-38), compared to median 10 (range 3-18) in the five lower caseload departments. Seventy-five patients underwent BT for uterine malignancies. Most patients had early stage endometrioid disease and were treated adjuvantly with intravaginal cylinders using high-dose-rate BT. Doses were in accordance with guideline recommendations in 83% of cases, and BT was appropriately indicated in 76% of cases. Higher caseload departments were more likely to treat with guideline doses (96% vs. 53%, p < 0.001) but there was no difference in compliance rate with treatment indications (p = 0.75).ConclusionsBrachytherapy patients, techniques, and numbers/unit for uterine corpus malignancies were similar in NSW compared to the USA but more dispersed than in Western Europe. Doses prescribed may not be optimal in lower gynaecological BT caseload departments – the significance of this represents an area in which more research is needed.