Fallopian Research Articles

STUDY OF THE CONCEPT OF UTERUS IN AYURVEDA WITH APPLIED ASPECTS

The Uterus is the child bearing organ in female, situated in the pelvis between the bladder and rectum. The uterus can be divided into an upper part, consisting of the fundus and the greater part of the body and a lower part consisting of the body, and of the cervix. The upper narrow end is called the internal os and the narrow lower end is called the external os. The cavity of the uterus communicates with that of the vagina through the external os. The study aims to evaluate various terminologies related to the uterus and its parts in Ayurveda. Morphological considerations of various terminologies along with applied aspects with references were studied. The present study is designed to analyze the concept of the uterus from Ayurvedic classics and interpreted. Elucidated terminologies were analyzed from structural anatomy, dimensions, location, and applied aspects. Various terminologies are used to represent the Uterus and its parts which can be correlated as follows- Uterus: Yoni, Phalayoni, Garbhasaya , Garbhakosha, Kukshi, Kshetra. Cervix with External Os: Garbhamarga, Garbhachidra. Fallopian tube /Uterine tubes: Raktavahasrota, Artavahasrotamsi, Artavavahasrotas, Artavavahamarga. Blood Supply: Artavavahasrotamsi, Artavvahinyadhamani.

LAPAROSCOPIC SOLUTION FOR AN UNEXPECTED FINDING IN AN INCARCERATED FEMORAL HERNIA, FIRST CASE PUBLISHED

Abstract Aim Femoral hernias (FH) are relatively uncommon, comprising <2% of all hernias and 2–8% of all inguinal hernias. More common in women and frequently associated with incarceration/strangulation. Different contents in the hernial sac have been described in the literature, but the ileum accompanied by the adnexa (fallopian tube+ovary, FT/O) has never been described before. Material and Method Case and literature review. Results 62-year-old woman with 48 hours of vomiting and non-reducible right inguinal hernia. Normal blood test and obstruction-patternt x-ray. Exploratory laparoscopy was decided, finding FH with an ischemic intestine in the crural orifice and, unexpectedly, herniated FT/O as well. The elements were reduced – they were viable – and repaired using TAPP with tetanized-low-density-PLP mesh. The course was uneventful and asymptomatic. Conclusions The FH appears inferior to the inguinal ligament, between the Gimbernat and the femoral vessels. Its size and ligamentous-anatomy facilitate incarceration. That they contain the adnexa represent <3% and always in pediatric age associated with genital-anomalies. There are <15 published reports of adult FH with incarcerated FT/O. The concomitance of intestine+adnex has not been previously published. Traditional treatment considers the anterior inguinocrural way, but we prefer the laparoscopic-approach to verify intestinal viability and, in this case, discover infrequently herniated organs. Avoids double incisions (Gregoire+laparotomy) in case of resection and accidental reductions without visualizing the hernia content. The posterior approach is an excellent tool that every emergency-surgeon must control, and in this case, it allowed us to describe – and resolve – the first published case of an atypical hernia.

Analysis of sequential chemotherapy efficacy in ovarian epithelial carcinoma, fallopian tube carcinoma and primary peritoneal carcinoma

Objective: To explore the sequential chemotherapy efficacy of different chemotherapeutic regimens in ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma. Methods: A retrospective analysis was conducted on clinical and pathological data of 100 patients with platinum-sensitive ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma treated at Peking University Peopel's Hospital from January 1992 to January 2019. All patients underwent staging surgery or cytoreductive surgery followed by adjuvant chemotherapy. Based on different postoperative adjuvant chemotherapy regimens, patients were divided into the sequential chemotherapy group (70 cases) and the conventional chemotherapy group (30 cases). Clinical and pathological characteristics, chemotherapy efficacy, adverse reactions, and prognosis were compared between the two groups. Results: (1) Clinical and pathological characteristics: the age, tumor types (including ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma), pathological types, International Federation of Gynecology and Obstetrics (FIGO) stage, postoperative residual disease size, presence of neoadjuvant chemotherapy, and total number of chemotherapy cycles were compared between the sequential chemotherapy group and the conventional chemotherapy group. There were no statistically significant differences observed in these characteristics between the two groups (all P>0.05). (2) Chemotherapy efficacy: the median sum of complete response (CR)+partial response (PR) duration in the sequential chemotherapy group was 80.0 months (range: 39 to 369 months), whereas in the conventional chemotherapy group, it was 28.0 months (range: 13 to 52 months). A statistically significant difference was observed between the two groups (Z=-7.82, P<0.001). (3) Chemotherapy adverse reactions: in the sequential chemotherapy group, 55 cases (79%, 55/70) experienced bone marrow suppression and 20 cases (29%, 20/70) had neurological symptoms. In the conventional chemotherapy group, these adverse reactions occurred in 11 cases (37%, 11/30) and 2 cases (7%, 2/30), respectively. Statistically significant differences were observed between the two groups for both bone marrow suppression and neurological symptoms (all P<0.05). For the other chemotherapy adverse reactions compared between the two groups, no statistically significant differences were observed (all P>0.05). (4) Prognosis: during the follow-up period, the recurrence rate in the sequential chemotherapy group was 73% (51/70) and in the conventional chemotherapy group was 100% (30/30). The median sum of recurrence-free interval was 70.5 months (range: 19 to 330 months) in the sequential chemotherapy group and 15.0 months (range: 6 to 40 months) in the conventional chemotherapy group. Statistically significant differences were observed between the two groups for both recurrence rate and median recurrence-free interval (all P<0.01).In the sequential chemotherapy group, the median progression-free survival (PFS) time was 84.0 months (range: 34 to 373 months), and the median overall survival (OS) time was 87.0 months (range: 45 to 377 months). In contrast, in the conventional chemotherapy group, the median PFS time was 30.5 months (range: 14 to 60 months), and the median OS time was 37.5 months (range: 18 to 67 months). Statistically significant differences were observed between the two groups for both PFS and OS (all P<0.001). In the sequential chemotherapy group, the 3-year, 5-year, and 10-year OS rates were 100% (70/70), 93% (65/70), and 21% (15/70), respectively. In contrast, in the conventional chemotherapy group, the OS rates were 50% (15/30) at 3 years, 3% (1/30) at 5 years, and 0 at 10 years, respectively. The two groups were compared respectively, and the differences were statistically significant (all P<0.05). Conclusions: Sequential chemotherapy significantly prolongs PFS and OS in patients with ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma. The efficacy is superior to that of the conventional chemotherapy, with manageable adverse reactions. The use of sequential chemotherapy as first-line treatment for patients with ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma is recommended.

Case Series and Review of Uterine Lipoleiomyomata

Introduction Uterine lipoleiomyomas are benign neoplasms that are not often seen in clinical practice. First described in 1965, these entities were recognized by a composition of intermixed smooth muscle, mature adipocytes, and fibrous tissue [2,4]. The incidence of lipoleiomyoma has always been accepted as 0.03-0.2% by Willen et al. in 1978 [1,4]. However, recent studies propose a higher incidence at 2.9%, such as Akbulut et al. in 2014. Most commonly found in the uterus, these neoplasms can rarely be associated with the cervix, broad ligament, peritoneum, ovary, as well as other extrapelvic locations. These benign tumors present similarly to uterine leiomyomas in peri- and post-menopausal women with obesity, with symptoms of pelvic/abdominal pain, mild abnormal vaginal bleeding, constipation, increased urinary frequency, and possibly a palpable mass. Methods This case series, diagnosed in February and March of 2023, includes the presentation, clinical management, and ultimately pathologic diagnosis of two separate uterine lipoleiomyomas. Results A 51-year-old, G3P2, female presented with six months of severe post-menopausal bleeding, severe left-lower quadrant pelvic pain, and lightheadedness. A transvaginal ultrasound revealed a heterogeneous, thickened endometrium of 3.9 centimeters and a probable left ovarian dermoid cyst. CT showed distension of endometrial cavity due to polyps and/or submucosal masses, as well as a fat-containing mass in the uterine corpus. Hysteroscopy with dilation and curettage was performed with pathology of high-grade malignancy. Differential diagnosis at this time included high-grade stromal sarcoma, undifferentiated carcinoma, adenosarcoma, or malignant mixed Mullerian tumor. Patient underwent MRI due to concern for malignancy, which showed FDG-avid endometrial thickening with no other FDG-avid areas of concern. Histopathologic diagnosis found carcinosarcoma of the uterus, two positive lymph nodes, and an incidental finding of lipoleiomyoma. Further medical management will include chemotherapy and vaginal cuff brachytherapy for uterine carcinosarcoma. A 50-year-old, G5P5, female presented with increasing vaginal spotting and worsening urge incontinence. CT showed increased size of heterogeneous mass in right lateral uterine wall, consistent with previously identified fibroid/leiomyoma. An adjacent fat-containing lesion was identified within the uterine wall. Patient underwent MRI which revealed large uterine mass at fundus with associated fatty component. Due to abnormal rate of growth of fibroid and fat component, there was concern for uterine sarcoma and/or malignant transformation of leiomyoma. Histopathologic diagnosis found lipoleiomyoma with benign atrophic endometrium, paratubal cysts of bilateral fallopian tubes, and follicular cyst of the right ovary. Follow-up in one year was recommended. Conclusion Lipoleiomyomas are uncommon benign entities, occurring most commonly in post-menopausal women, similarly to uterine fibroids. While asymptomatic patients can be managed conservatively, these tumors can cause vaginal bleeding, pain, and urinary or fecal incontinence and can be definitively treated with hysterectomy. While imaging is necessary to initially characterize the lesion and determine malignancy concern, histopathologic diagnosis remains the gold standard for diagnosis. Lipoleiomyomas are associated with other gynecologic malignancies, metabolic disorders, and rarely tumor-to-tumor metastasis. For this reason, careful clinical evaluation and surgical management are required for complete evaluation of the patient.

An Incidental Fallopian Tube Focal Serous Tubal Intraepithelial Lesion (STIL) Discovered on a Postoperative Pathology Report Following Hysterectomy and Salpingectomy: A Case Report

An Incidental Fallopian Tube Focal Serous Tubal Intraepithelial Lesion (STIL) Discovered on a Postoperative Pathology Report Following Hysterectomy and Salpingectomy: A Case Report

Reproductive outcomes of infiltrative endometriosis after surgical treatment with assisted reproductive technologies (a clinical case)

Endometriosis is one of the most urgent problems of modern gynecology and reproductive medicine. About 40 % of women suffering from endometriosis of various localization are infertile. The use of drug therapy has not been proven to increase fertility. Currently, there is no consensus on the impact of surgical treatment on the effectiveness of assisted reproductive technologies.This article presents a clinical case of modern approache to the use of assisted reproductive technologies for endometriosis-associated infertility. The tactics of managing women with endometriosis is determined by its localization, the age of the patient, ovarian reserve, the duration of infertility, the therapy and its effectiveness, the condition of the fallopian tubes, as well as spermogram parameters. The correctly chosen management strategy for this patient made it possible to achieve not only a clinical pregnancy, but also the birth of a healthy child.

Heterotopic pregnancy and the influence of letrozole

Introduction: Heterotopic pregnancy has become increasingly common following increased use of assisted reproductive techniques. We will examine one uncommon instance of a heterotopic pregnancy occurring in the setting of a young woman undergoing letrozole therapy for primary infertility, making it an uncommonly seen case. Case Report: We report a young otherwise healthy female G1P0 at approximately 6 weeks gestation, who was referred from her primary care office to the Emergency Department with progressive abdominal pain that started 12 hours prior and had started to exhibit signs of hemodynamic instability. History was significant for difficulty with conception requiring letrozole treatment. Emergency laparoscopy was performed and confirmed additional ectopic pregnancy in the right fallopian tube with blood originating from the fimbriated end. Evacuation of hemoperitoneum and removal of ectopic pregnancy was completed without complication. She was discharged from the hospital in stable condition. Conclusion: In any woman of reproductive age presenting with lower abdominal pain or abnormal bleeding, there should be a strong suspicion for a pregnancy until confirmed otherwise. These patients may benefit from prompt imaging with pelvic ultrasound to assist in earlier detection of ectopic embryo implantation and, subsequently, earlier intervention. Salpingectomy, ideally via laparoscopic approach, remains the gold standard for diagnosis and treatment of patients with a ruptured ectopic pregnancy in the setting of a heterotopic pregnancy, although surgical intervention is associated with poorer outcomes for the intrauterine pregnancy.

A randomized phase II trial to examine modified vaccinia Ankara-5T4 vaccine in patients with relapsed asymptomatic ovarian cancer (TRIOC)

BackgroundImmunotherapy directed at 5T4 tumor antigen may delay the need for further chemotherapy. An attenuated modified vaccinia Ankara virus containing the gene encoding for 5T4 (MVA-5T4) was studied in asymptomatic...

Isolated Fallopian Tube Torsion in Children With Hydrosalpinx: Is Conservative Management an Option?

Isolated fallopian tube torsion (IFTT) is very rare gynecological emergency in pediatric population. Our objective is to assess treatment options and discuss outcome of a cohort of IFTT with a focus on the association between IFTT and hydrosalpinx (HSX). A retrospective review was conducted. Pediatric patients with IFTT operated in the same center were included. Seventeen girls (aged: 11-16 years) were managed for acute abdominal pain between 2008 and 2018, with intraoperative diagnosis of IFTT. All patients underwent laparoscopic exploration, with laparoscopically fallopian tube detorsion in all patients. Based on the association of IFTT with HSX after fallopian tube detorsion, patients were divided into 2 groups: group 1 (IFTT without HSX; 12 girls) and group 2 (IFTT with HSX; 5 girls). During the same surgery, complementary surgical procedures were done. In group 1: salpingectomies (4), partial salpingectomies (2) and cystectomies (6) were done. In group 2: salpingectomy (1), salpingotomy (1), and cyst ablation (1). The treatment was called conservative when the tube was preserved.Follow-up was uneventful in group 1. In group 2, for all patients with initial fallopian tube preservation, further surgical procedures were necessary (1-4 surgeries/patient), and, finally, another 3 patients required salpingectomy. Conservative treatment with tube preservation of IFTT without HSX appeared to be beneficial compared to those with HSX, with no recurrence of torsion or symptoms during the follow-up. However, the same conservative treatment was not sufficiently effective for IFTT with HSX and required further procedures due to recurrence of torsion. IV.

A case of Mayer-Rokitansky-Kuster- Hauser syndrome type I

Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital disorder characterised by absence of uterus and vagina. Ovaries and fallopian tubes are normal and functional. Its incidence is 1 in 4500-5000 female. Patients present with primary amenorrhea with normal external genitalia and development of secondary sexual characteristics, and 46XX karyotype. It is usually diagnosed by MRI, CT or transabdominal USG, with MRI being the gold standard.

“Sex Cord Stromal Tumor Masquerading as Broad Ligament Fibroid in a Postmenopausal Woman: Lessons Learned from a Case Report”

Background:: Ovarian fibromas are sex cord-stromal tumors accounting for 4% of all ovarian tumors. They are benign, solid ovarian tumors commonly encountered in perimenopausal and postmenopausal women. They are usually asymptomatic or present with vague symptoms like abdominal pain. This makes their pre-operative diagnosis difficult. Case Report:: The present case report briefs the finding of ovarian fibroma in a 59-year-old postmenopausal woman presenting with dull aching lower abdominal pain, misdiagnosed as broad ligament fibroid on ultrasonography and malignant ovarian mass on MRI. She underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intraoperative findings included a right-sided smooth, solid, freely mobile ovarian mass of size 4x5 cm, uterus and left ovary were atrophic, with healthy bilateral fallopian tubes. Her histopathology report revealed ovarian fibroma with minimal nuclear atypia. Conclusion:: Ovarian fibromas are common benign solid ovarian tumors, that are difficult to diagnose pre-operatively, and often confused with uterine or broad ligament fibroids due to their similar clinical and radiological presentations. Hence, the clinician should keep ovarian fibromas as one of the differentials in the diagnosis of solid adnexal masses mimicking broad ligament fibroids.

Unusual spread of cervical adenocarcinoma to the endometrium and left fallopian tube: a case report and literature review

Introduction: The incidence of cervical adenocarcinoma and adenocarcinoma in situ are gradually increasing especially in younger women. However, unusual spread of cervical adenocarcinoma has rarely been reported. Case Presentation: We report a case of a 60-year-old woman who presented with postmenopausal bleeding. She was misdiagnosed to have endometrial adenocarcinoma on the lower uterine segment depending on curettage specimen. After hysterectomy, it was revealed depending on morphological features in histology accompanied with immunohistochemistry that the patient had cervical adenocarcinoma with endometrial and left fallopian tube extension. Discussion: Distinguishing endocervical adenocarcinoma from endometroid adenocarcinoma poses many challenges especially when evaluating endometrial curettage specimens. Histological diagnosis based on morphological features combined with a panel of immunohistochemistry stains is crucial for accurate diagnosis and identifying the primary origin of the tumor. Conclusion: Accurate distinction between cervical adenocarcinoma versus endometrial adenocarcinoma is important because of its significant effects on choosing the appropriate treatment option.

Successful pregnancy with intracytoplasmic sperm injection after bacterial contamination of embryo culture in in vitro fertilization: a case report

BackgroundBacterial infection of embryo culture medium is rare but may be detrimental. The main source of embryo culture contamination is semen. Assisted reproduction centers currently lack consensus regarding the methods for preventing and managing embryo culture infection. In our recent case, a successful pregnancy was achieved with intracytoplasmic sperm injection after failed conventional in vitro fertilization owing to bacterial contamination.Case presentationWe present a case report of two consecutive in vitro fertilization–intracytoplasmic sperm injection cycles with photo and video documentation of the bacterial growth. A 36-year-old Hungarian woman and her 37-year-old Hungarian partner came to our department. They had two normal births followed by 2 years of infertility. The major causes of infertility were a closed fallopian tube and asthenozoospermia. Bacterial infection of the embryo culture medium was observed during in vitro fertilization and all oocytes degenerated. The source was found to be the semen. To prevent contamination, intracytoplasmic sperm injection was used for fertilization in the subsequent cycle. Intracytoplasmic bacterial proliferation was observed in one of the three fertilized eggs, but two good-quality embryos were successfully obtained. The transfer of one embryo resulted in a successful pregnancy and a healthy newborn was delivered.ConclusionIntracytoplasmic sperm injection may be offered to couples who fail conventional in vitro fertilization treatment owing to bacteriospermia, as it seems to prevent infection of the embryo culture. Even if bacterial contamination appears, our case encourages us to continue treatment. Nevertheless, the development of new management guidelines for the prevention and management of bacterial contamination is essential.

Olaparib maintenance therapy for platinum-sensitive relapsed ovarian cancer at a single institution: A retrospective study.

In this study, we aimed to investigate patient characteristics, efficacy, prognostic factors, and safety of olaparib maintenance therapy for platinum-sensitive recurrent ovarian cancer at our institution. Patients responding to platinum-based therapy and starting olaparib maintenance therapy for recurrent epithelial ovarian, fallopian tube, or peritoneal cancer at Kurume University Hospital between January 2018 and November 2021 were enrolled in the study. Their data were extracted retrospectively from medical records. In all, 50 patients were included. The median (range) age of the patients, follow-up time, and duration of olaparib maintenance therapy were 62 (39-87) years, 21.6 (2.2-45.9) months, and 7.2 (2-45.9) months, respectively. Among the 29 patients tested for homologous recombination (HR) status, 22 (75.9%) were positive for HR deficiency (HRD), 12 (54.5%) of whom had BRCA-positive tumors. The median progression-free survival was 8.9 months (95% confidence interval: 6.2-12.6), and the median overall survival was 27.1 months (95% confidence interval: 22.5-40.3). Multivariate analysis of prognostic factors revealed that HRD was an independent prognostic factor for both progression-free survival and overall survival. The most common adverse event was nausea (any grade, n = 30, 60%), resulting in drug interruption (n = 23, 46%), dose reduction (n = 17, 34%), and discontinuation of treatment (n = 1, 2%). Olaparib maintenance therapy for recurrent platinum-sensitive ovarian cancer at our institution was effective, with acceptable adverse events. HRD was the most significant prognostic factor for patients with recurrent platinum-sensitive ovarian cancer.

The categorization of opaque pathologies outside of contrast media in hysterosalpingography which facilitate interpretation: A pictorial review

Hysterosalpingography (HSG) is a practical and reliable imaging method to evaluate the cervical canal, uterine isthmus, uterine cavity, and fallopian tubes. Using HSG, opaque pathologies outside of contrast media can be detected as well as pathologies of uterus and fallopian tubes. We aim to present and categorize some uncommon and interesting abnormal findings that are located outside of the contrast areas in HSG. This is a pictorial review that depicts various types of HSG images that include opaque pathologies outside of the contrast areas. Images have been extracted from valuable archives collected over 50 yr by professor Shahrzad. A plain pelvic film contains soft tissues of the pelvis, bony structures, artifacts, or foreign bodies. Categorization might easily help the radiologist to interpret the HSG cliché. Opaque pathologies outside of contrast area in HSG can be categorized into 2 groups: “Pelvic Tissue Related” and “Foreign Bodies”. Pelvic tissue abnormalities might have a gynecologic or nongynecologic source. Foreign bodies can be located in the pelvis or outside of the body. HSG is a reliable and inexpensive procedure. Familiarity with the pathologies of pelvic tissues and the accurate interpretation of HSG images are important. Key words: Hysterosalpingography, Opaque, Abnormalities, Uterine, Fallopian tubes.

Bilateral adrenal cortical rests: An interesting innocuous intruder in the fallopian tubes.

Ectopic adrenal rests refer to the presence of adrenal tissue outside its normal anatomical location and are usually discovered incidentally on microscopic examination. Literature suggests its occurrence in diverse extrarenal sites, like the genitourinary system and pelvis. Our case describes the rare occurrence of ectopic adrenal rests in the walls of bilateral fallopian tubes of a 43-year-old female patient who presented with a complaint of heavy menstrual bleeding. A total hysterectomy with bilateral salpingo-oophorectomy was performed. Gross examination revealed adenomyosis with multiple fibroids, and the same was confirmed on microscopy. Additionally, the finding of a well-encapsulated lesion on the walls of both tubes made us relook at the fallopian tubes, which showed a small bright yellow area measuring less than 0.3 cm in the walls, which was consistent with ectopic adrenal rests after ruling out the morphological differentials of Walthard cell nests, aggregates of foamy histiocytes, metastatic renal clear cell carcinoma, displaced ovarian luteinized theca cells, heterotopia of ovarian hilus cells. Immunohistochemistry showed positivity for Melan A and CK7 was negative. The present case helps in investigating the lesser-explored aspect of adrenal rest pathology. It also reiterates need for detailed observation of fallopian tubectomy specimens by pathologists during grossing to avoid overlooking of potentially intriguing entities.

ОСОБЕННОСТИ ТАКТИКИ ВЕДЕНИЯ ПРИ НОСИТЕЛЬСТВЕ МУТАЦИЙ В ГЕНАХ BRCA У ЖЕНЩИН

The aim of the study is to study the features of management tactics in the case of BRCA gene mutations in women using the example of a clinical case. Risk-reducing salpingo-oophrectomy is usually offered to women with mutations in BRCA1, BRCA2, or both of them, because, according to research, it improves overall survival and reduces the number of deaths from serous cancer and breast cancer. In this case, a comprehensive examination was carried out in a timely manner in a patient with breast cancer, including a medical and genetic one, which made it possible to identify the presence of a highly oncogenic type of mutation in the BRCA 2 gene. According to large–scale studies, women carrying this type of mutation represent a risk group for developing bilateral breast cancer, as well as ovarian cancer. In addition, carriers of a mutation in the BRCA2 gene are threatened by the occurrence of pancreatic and biliary tract cancers, stomach, fallopian tubes and skin melanoma. Carrying out preventive mastectomy and bilateral ovariectomy in such patients reduces their risk of malignant neoplasms. Therefore, the patient's complex therapy included these stages of surgical treatment. In addition, the detection of such a form of breast cancer associated with mutations in the BRCA genes makes it possible to expand the range of diagnostic search for malignant neoplasms, including in-depth examination of both the patient herself and her closest relatives. Such tactics of management of this group of patients allows them to avoid the occurrence of repeated cases of malignant neoplasms associated with the carriage of mutations in the BRCA genes with timely preventive examination and follow-up.

Cancer incidence, stage shift and survival during the 2020 COVID-19 pandemic: A population-based study in Belgium.

The COVID-19 pandemic was associated with a profound decline in cancer diagnoses in 2020 in Belgium. Disruption in diagnostic and screening services and patient reluctance to visit health facilities led to fewer new cases and concerns that cancers may be diagnosed at more advanced stages and hence have poorer prognosis. Using data from mandatory cancer registration covering all of Belgium, we predicted cancer incidence, stage distribution and 1-year relative survival for 2020 using a Poisson count model over the preceding years, extrapolated to 2020 for 11 common cancer types. We compared these expected values to the observed values in 2020 to specifically quantify the impact of the COVID-19 pandemic, accounting for background trends. A significantly lower incidence was observed for cervical, prostate, head and neck, colorectal, bladder and breast cancer, with limited or no recovery of diagnoses in the second half of 2020 for these cancer types. Changes in stage distribution were observed for cervical, prostate, bladder and ovarian and fallopian tube tumours. Generally, changes in stage distribution mainly represented decline in early-stage than in late-stage tumours. One-year relative survival was lower than predicted for lung cancer and colorectal cancer. Stage shifts are hypothesised to result from alterations in access to diagnosis, potentially due to prioritisation of symptomatic patients, and patient reluctance to contact a physician. Since there were over 5000 fewer cancer diagnoses than expected by the end of 2020, it is critical to monitor incidence, stage distribution and survival for these cancers in the coming years.

Chinese guidelines on the management of endometrial hyperplasia

• Endometrial hyperplasia can be classified as either hyperplasia without atypia or atypical hyperplasia.• Abnormal uterine bleeding is the most common symptom of endometrial hyperplasia. Transvaginal ultrasound is recommended for initial imaging to evaluate endometrial hyperplasia (evidence level 2+), while transrectal ultrasound is recommended for virgo patients (evidence level 3).• Endometrial biopsy should be used to confirm diagnosis in patients where endometrial lesions are suspected. Effective histological approaches to make definite diagnoses include diagnostic curettage (evidence level 2++), hysteroscopic-guided biopsy (evidence level 2+) and endometrial aspiration biopsy (evidence level 2-).• Progesterone is the preferred medication for the treatment of endometrial hyperplasia without atypia. Compared to oral progestins, placement of a levonorgestrel-releasing intrauterine system (LNG-IUS) has been associated with higher regression rates, lower recurrence rates and fewer adverse events which can be the initial treatment method. (Meta evidence level 1-, RCT evidence level 2+). Ultrasound and endometrial biopsies should be performed every 6 months during treatment to evaluate its effect and treatment should continue until no pathological changes are observed in two consecutive endometrial biopsies. Hysterectomy is not the preferred choice of treatment for patients with endometrial hyperplasia without atypia.• Minimally invasive hysterectomy is indicated for patients with endometrial atypical hyperplasia (evidence level 1+), bilateral fallopian tubes should also be removed (evidence level 2+). In cases where surgery cannot be tolerated, fertility is desired or the patient is younger than 45 years old, medical therapy is recommended (evidence level 3). LNG-IUS is the preferred medical therapy method (evidence level 2+). Endometrial pathologic evaluation should be performed every 3 months during conservative treatments, with adjustments made to dosages or approaches based on observed response to medication. Treatment should continue until no pathological changes are detected in two consecutive endometrial biopsies (evidence level 2++). There is no indication of sentinel lymph nodes biopsy and/or lymphadenectomy for hyperplasia with or without atypia.• Total hysterectomy is recommended to treat patients with recurrent endometrial atypical hyperplasia (evidence level 3); however, medical conservative therapy may be considered for patients hoping to become pregnant in the future.• Patients with fully regressed disease who would like to become pregnant should be advised to seek assistance through assisted reproductive technologies (evidence level 3).• Long-term follow-up is suggested for patients after endometrial hyperplasia treatment (evidence level 2+). Patient education is imperative for improving medication adherence, increasing regression rates and lowering recurrence rates (evidence level 3).

Synchronous profiling of mRNA N6-methyladenosine modifications and mRNA expression in high-grade serous ovarian cancer: a pilot study

This study aimed to synchronously determine epitranscriptome-wide RNA N6-methyladenosine (m6A) modifications and mRNA expression profile in high grade serous ovarian cancer (HGSOC). The methylated RNA immunoprecipitation sequencing (MeRIP-seq) was used to comprehensively examine the m6A modification profile and the RNA-sequencing (RNA-seq) was performed to analyze the mRNA expression profile in HGSOC and normal fallopian tube (FT) tissues. Go and KEGG analyses were carried out in the enrichment of those differentially methylated and expressed genes. MeRIP-seq data showed 53,794 m6A methylated peaks related to 19,938 genes in the HGSOC group and 51,818 m6A peaks representing 19,681 genes in the FT group. RNA-seq results revealed 2321 upregulated and 2486 downregulated genes in HGSOC. Conjoint analysis of MeRIP-seq and RNA-seq data identified differentially expressed genes in which 659 were hypermethylated (330 up- and 329 down-regulated) and 897 were hypomethylated (475 up- and 422 down-regulated). Functional enrichment analysis indicated that these differentially modulated genes are involved in pathways related to cancer development. Among methylation regulators, the m6A eraser (FTO) expression was significantly lower, but the m6A readers (IGF2BP2 and IGF2BP3) were higher in HGSOC, which was validated by the subsequent real-time PCR assay. Exploration through public databases further corroborated their possible clinical application of certain methylation regulators and differentially expressed genes. For the first time, our study screens the epitranscriptome-wide m6A modification and expression profiles of their modulated genes and signaling pathways in HGSOC. Our findings provide an alternative direction in exploring the molecular mechanisms of ovarian pathogenesis and potential biomarkers in the diagnosis and predicting the prognosis of the disease.