Glandular Dilatation Research Articles

Hyperechogenicity of the pyloroduodenal junction in small dogs: Population prevalence in 175 dogs and histological correlation in 14 specimens.

At the pyloroduodenal junction (PDJ), an increase in wall echogenicity is frequently observed. A prospective study was performed to assess the PDJ sonographically in 175 adults and small dogs (>1 year old, <11.4kg (25lb)) over 12 months to evaluate the prevalence of this finding. Additionally, changes in echogenicity were correlated with histology in 14 postmortem specimens. A scoring system of echogenicity change centered on the mucosa and submucosa of the PDJ was implemented; 0: no change, 1: mild, 2: moderate to marked. Other included parameters were age, sex, breed, gastric distention, gastric contents, and reported vomiting at the time of presentation. Hyperechogenicity of the PDJ was highly prevalent (scores 1 and 2: 85.7%). No statistical association between hyperechogenicity of the PDJ and age, sex, gastric distention, gastric contents, or vomiting was identified. Hyperechogenicity of the PDJ is thought to represent an anatomical transition zone, and based on histology, hyperechogenicity of the PDJ may represent a variation in distribution and amount of fibrous connective tissue, glandular number, and glandular dilation within the submucosa and mucosa.

Distribution of degenerative changes in the equine endometrium as observed in a single versus two biopsies

Equine endometrial degeneration is diagnosed by microscopy of an endometrial biopsy but it is uncertain if findings in a single biopsy represent the state of the entire endometrium. Previous studies have compared samples from multiple sites but conclusions are inconsistent. Further clarification is therefore needed. In this study, presence and characteristics of endometrial degeneration were compared in two full thickness specimens from the ventral base of both uterine horns, obtained post mortem from cyclic mares (n = 82). Hematoxylin and eosin-stained sections were blinded evaluated for periglandular fibrosis, glandular nests, dilated glands, glandular dilation, excessive lymphatic vessels, and lymphatic lacunae. Each section was also assigned to a modified Kenney and Doig categorization. Statistical analysis included multiple logistic regression models for fraction of mares with disagreement in the modified Kenney and Doig category and fraction of mares with disagreement for each parameter, multiple generalized linear regression models for fraction of parameters with disagreement, and equivalence tests for agreement of a cumulative score of degenerative parameters. Possible effect of age, mare type and estrous cycle stage were included in the analyses. For the Kenney and Doig categorization, 49% of the mares had good agreement, 46% had moderate agreement and 5% had poor agreement between the two biopsies. Disagreement in the Kenney and Doig categorization between the two biopsies increased with age (OR = 1.1, P = 0.009). Disagreement within each parameter ranged from 10% of mares (glandular nests), to 31% (periglandular fibroblasts) and 37% (lymphatic lacunae). Disagreement for changes in endometrial glands increased with age (OR = 1.15–1.16, P < 0.040). Several mares (33%) had disagreement in at least two parameters, and the number of parameters with disagreement increased with age (HR = 1.04, P = 0.010). When tested for equivalence, the cumulative scores for paired endometrial samples did not differ for mares younger than 18 years (P = 0.011). In conclusion, the degenerative changes were not uniformly distributed, revealed by a disagreement between paired endometrial samples for individual parameters and for the Kenney and Doig categorization, which increased with age. This suggests that conclusions based on a single biopsy, particularly in mares over 17 years of age, should be interpreted with caution, and evaluation of two biopsies should be considered.

Long exposure to a mixture of endocrine disruptors prediposes the ventral prostate of rats to preneoplastic lesions.

Endocrine disruptors (ED) are compounds dispersed in the environment that modify hormone biosynthesis, affecting hormone-dependent organs such as the prostate. Studies have only focused on evaluating the effects of ED alone or in small groups and short intervals and have not adequately portrayed human exposure. Therefore, we characterized the prostate histoarchitecture of rats exposed to an ED mixture (ED Mix) mimicking human exposure. Pregnant females of the Sprague-Dawley strain were randomly distributed into two experimental groups: Control group (vehicle: corn oil, by gavage) and ED Mix group: received 32.11mg/kg/day of the ED mixture diluted in corn oil (2ml/kg), by gavage, from gestational day 7 (DG7) to post-natal day 21 (DPN21). After weaning at DPN22, the male pups continued to receive the complete DE mixture until they were 220days old when they were euthanized. The ED Mix decreased the epithelial compartment, increased the fractal dimension, and decreased glandular dilation. In addition, low-grade prostatic intraepithelial neoplasia was observed in addition to regions of epithelial atrophy in the group exposed to the ED Mix. Exposure to the mixture decreased both types I and III collagen area in the stroma. We concluded that the ED Mix was able to cause alterations in the prostatic histoarchitecture and induce the appearance of preneoplastic lesions.

Conditioned medium of mesenchymal stem cells: application in mares with endometrial fibrosis

The use of stem cells to promote tissue regeneration has increased in recent years mainly due to their role in growth, remodeling, and repair processes, increasing the number of progenitor cells in the affected tissue. Conditioned medium, a by-product containing metabolites, growth factors, and extracellular matrix proteins is secreted by cultured stem cells. This conditioned medium has been used as a cell-free therapy in regenerative medicine. The objective of the present study was to evaluate the effect of mesenchymal stem cell conditioned medium on endometrial fibrosis in mares through histopathological evaluation. The selected mares had an average age of 18.61 ± 5.68 years and a history of no foaling in the last two breeding seasons. They were grouped according to the degree of uterine fibrosis described by Kenney in 1978: Grade II (n=4), Grade III (n=2). All mares underwent evaluation of vulvar conformation, complete gynecological examination, and ultrasonographic evaluation of the reproductive tract, as well as uterine cytological, bacteriological, and histopathological examinations. The conditioned medium was made from the culture of stem cells derived from the adipose tissue of the lumbarregion of a young horse. During diestrus, using an artificial insemination pipette, 20 mL of conditioned medium was infused into the uterus of each mare, divided into 10 mL per uterine horn. After applying the medium to a horn, 5 mL of sterile 0.9% NaCl solution was administered to ensure that the conditioned medium was infused. Twenty-one days after treatment with the conditioned medium, the six mares were submitted to a new collection of uterine biopsies for histopathological evaluation. In this second evaluation, the same changes characteristic of endometrosis were observed in the histopathology, such as nests with glandular dilation and the presence of areas of fibrosis. These findings suggest that, although no improvement was observed in the histopathological characteristics of endometrial biopsies, the use of the conditioned medium of stem cells did not induce an inflammatory reaction following its intrauterine use, suggesting its safety for further studies in equine medicine. In conclusion, the application of 20 mL of conditioned medium from stem cells in the uterine lumen of six mares with endometrosis grades II and III did not induce endometrial regeneration in the evaluated period.

Are degenerative changes in a single endometrial biopsy representative for the endometrial state?

Equine endometrial fibrosis is diagnosed by microscopy of an endometrial biopsy. It is however uncertain how representative a single biopsy is for the state of the entire endometrium. While previous studies have compared samples from multiple sites, further clarification is needed on specific degenerative changes that may vary in severity between sites. Histopathology was compared, with an emphasis on degenerative changes, in two full thickness specimens from the ventral base of the left and right uterine horns, collected post slaughter from cyclic mares (n=82). Hematoxylin and eosin-stained sections were blinded evaluated by the same evaluator for layers of periglandular fibroblasts (mild[0-3], moderate[4-10], severe[>10]), glandular nests per view (mild[0-2], moderate[3-4], severe[>4]), dilated glands per view (mild[0-3], moderate[4-6], severe[>6]), degree of glandular dilation (mild, moderate, severe), excessive lymphatic vessels (absent, present), and lymphatic lacunae (absent, present). In addition, each section was scored according to a modified Kenney and Doig classification. Statistical analysis included a multiple logistic regression model for fraction of mares with disagreement in Kenney and Doig category, a multiple generalized linear regression model for fraction of parameters with disagreement, a multiple logistic regression model for fraction of mares with disagreement within each parameter, and equivalence tests for agreement of a cumulative score ofdegenerative parameters. Possible effect of age, breed and estrous cycle stage on disagreement between paired uterine horns were included in the analysis. In 49% of mares, specimens from paired uterine horns were assigned the same Kenney and Doig category, and in 46% of mares, the specimens were assigned either of two adjacent categories. In 5% of mares, the specimens varied with two categories. Disagreement in Kenney and Doig category between paired uterine horns increased with each year of age (OR=1.1, p=0.012). Analysis of degenerative parameters showed a disagreement in at least two parameters in 39% of mares, and the number of parameters with disagreement increased with age (HR=1.04, p=0.005). Disagreement within each parameter ranged from 10% of mares (glandular nests), to 31% (periglandular fibroblasts) and 38% (excessive lymphatic vessels). Disagreement increased with age for parameters involving glands (OR=1.14-1.16, p<0.04). When tested for equivalence, the cumulative scores for paired uterine horns did not differ for mares younger than 20 years (p<0.001). In conclusion, although cumulative scores of degenerative changes were equal for paired samples in mares under 20 years of age, the changes were not uniformly distributed. This suggests that conclusions based on a single biopsy, particularly in mares over 20 years of age, should be interpreted with caution, and evaluation of two biopsies is recommended.

ULTRASONOGRAPHIC ASPECTS OF THE CERVIX IN CHRONIC CERVICITIS

The aim of this study was to evaluate the structural changes of the cervix using the ultrasound examination. The studied group consisted of women aged between 21 and 75 years. 30,43% of the structural changes were represented by glandular dilatation. Other aspects observed were microcalfications (9,75%), and one endocervical polyp. All these changes are characteristic of chronic inflammation called cervicitis. The distribution of cases by age group showed that 41,46% belonged to the 41-50 age group and 36,58% to the 31-40 age group. The fewest cases (9,76%) were in the 21-30 age group. Regarding the medical history 80,49% of the patients had births or abortion in the past.

Clinicopathological characteristics of anti-PD-1 associated gastroenteritis

Objective: To investigate the clinicopathological features of anti-PD-1 related gastroenteritis, understand and recognize the disease, and avoid misdiagnoses. Methods: Three cases of anti-PD-1 related gastroenteritis diagnosed and treated at the Zhongshan Hospital Affiliated to Fudan University, Shanghai, China from 2020 to 2021 were collected. The clinical and pathological features were analyzed and the patients were followed up by telephone. Results: The three patients were all male and aged 63, 39 and 73 years, respectively. They had previously developed gastrointestinal symptoms as a result of immunotherapy for a malignant tumor. Endoscopically, 2 patients presented with pancolitis, and 1 patient presented with a large antral ulcer involving the pyloric canal in the stomach. Histologically, there were marked atrophy and thinning of the epithelium, diffuse infiltration of numerous neutrophils in the lamina propria, formation of micro-abscesses in the crypt/glandular lumen, structural changes (branching and distortion) of the glands, and significant glandular dilatation. In addition, chronic inflammatory features (e.g., lymphoplasmacytosis) were focally seen in 2 cases. Cytomegalovirus immunohistochemical stains were negative in all 3 cases. Based on the history and morphology, all 3 cases were diagnosed as anti-PD-1 related gastroenteritis. According to the above diagnosis, the treatment for all 3 patients was to stop anti-PD-1 therapy and use corticosteroids. Clinical follow-up was conducted. The gastrointestinal symptoms of all 3 patients improved significantly and diarrhea symptoms were relieved after stopping immunotherapy. Conclusions: Anti-PD-1 related gastroenteritis is not rare, but pathologists may lack sufficient understanding of it. Combined with clinical history and pathologic characteristics of the lesion, pathologists should consider this disease to avoid the misdiagnoses and missed diagnoses.

The Heteromorphic Receptacle–Juvenile Polyp

Juvenile polyp is a common paediatric intestinal polyp constituted of prominent, cystic glandular dilatation circumscribed by an inflamed stroma.

Significance of EZH2 and BMI-1 Protein Expression in Carcinogenesis of Colon Serrated Adenoma

Objective: To observe the significance of EZH2 and BMI-1 protein expression in the carcinogenesis process of colon serrated adenoma (SSA/P). Methods: Hematoxylin-eosin (HE) staining was used to observe the morphological characteristics of normal tissues, hyperplastic polyp (HP), SSA/P and colon cancer. Immunohistochemical staining was used to detect the expression of EZH2 and BMI-1 protein. The relative expression of EZH2 and BMI-1 was detected by qRT-PCR. Results: Compared with normal tissues, HP and colon cancer tissues, SSA/P showed serrated glandular hyperplasia, glandular dilatation, and deep nuclear staining, which had certain atypia. The positive expression rates of EZH2 and BMI-1 protein were 53.3% and 56%, which were close to those of colon cancer (66.7% and 76.6%) and higher than those of normal group and HP (16% and 8%, P &lt; 0.05). The relative expression of EZH2 and BMI-1 in SSA/P tissue was significantly higher than that in normal group and HP, but lower than that in carcinogenesis group (P&lt;0.05). Conclusion: EZH2 and BMI-1 play an important role in the carcinogenesis of colon serrated adenoma, and can be used as the primary screening index before carcinogenesis.

The gynecological examination in Pantaneiro mares.

Gynecological examination is essential to assess the reproductive tract of mares and can provide important information about the uterine environment. It includes physical, vaginal, and rectal examination, ultrasound, cytology, culture, and endometrial biopsy. The present study aimed to perform gynecological examination and fertility to assess the fertility prognosis of Pantaneiro mares that have not been reproductively active and to determine their reproductive ability. Eight mares underwent ultrasound and gynecological examination and artificial insemination. Ultrasound revealed changes only in one mare. Histopathological findings were mild, such as periglandular and perivascular inflammatory cell infiltrates, fibrotic areas, glandular dilation, glandular island formation, and edema due to the phase of the estrous cycle. One animal was classified in category I and the others in category IIA. Cytological changes were found in only one mare. Endometrial culture from five mares resulted in isolation of Pseudomonas sp., Bacillus sp., Escherichia coli and Candida sp. Only four mares resulted pregnant through artificial insemination, using the same stallion with fresh semen, which has been proving fertility. Thus, mares with better uterine conditions will not always become pregnant and those with mild changes will not always be barren.

P095 The Very Interesting Small Bowel Lesions of Cronkhite-Canada Syndrome

BACKGROUND: Cronkhite-Canada syndrome (CCS) is a non-hereditary disease characterized by the presence of gastrointestinal polyposis and skin symptoms such as hair loss, nail plate atrophy, and skin pigmentation. Approximately 50% of cases of CCS also have small bowel lesions. However, there have been few image reports of the small intestine lesions. METHODS: We examined the findings of small intestine capsule endoscopy (CE) in 3 cases of CCS in our hospital. RESULTS: Case 1 was of a 64-year-old male whose chief complaint was diarrhea, abnormal taste, and weight loss. He had diarrhea for 2 months and aware of finger pigmentation and nail atrophy. Esophagogastroduodenoscopy (EGD) revealed a collection of reddish polyps that expanded in the stomach and duodenum, and colonoscopy (CS) revealed glossy reddish bumps in the colon. CE showed diffuse reddish, edematous mucosa and villi enlargement in the entire small bowel. From these characteristic endoscopic and skin findings, he was diagnosed with CCS and was started on prednisolone (PSL) treatment. The treatment response was good, and there was no relapse. Case 2 was of a 65-year old female whose chief complaint was skin pigmentation. She had been aware of pigmentation on her back, palms, and upper arms, and loss of fingernails for the last 6 years with repeated disappearances and exacerbations. Furthermore, erosive gastritis and gastric hyperplastic polyps had been detected 4 years ago, and she was followed-up for these symptoms. Gradually, she became aware of nausea and loose stools, which prompted her to visit our hospital. EGD and CS revealed multiple reddish polyps predominantly in the gastric antrum, villous atrophy and reddish polyps in the terminal ileum, and scattered reddish polyps in the entire colon. Mucosal biopsies revealed glandular dilation, mucosal edema, and inflammatory cell infiltration. CE showed diffuse mulberry ridges and villi atrophy throughout the small bowel. She was diagnosed with CCS based on characteristic clinical and endoscopic findings, and was started on steroid treatment. There was no relapse. Case 3 was of a 75-year old male whose chief complaint was diarrhea and hair loss. EGD and CS revealed multiple polyps in the stomach, duodenum, and colon. CE showed reddish edematous mucosa and villi mixed with atrophy and swelling in the small bowel. Of note were that these findings were found in the jejunum. He was diagnosed with CCS and started on PSL and immunomodulator. Four years later, the characteristic findings disappeared in the CE. CONCLUSION(S): All patients had lesions in the entire small bowel, but there they were not associated with clinical findings or steroid response. The mucosa of the small intestine were more likely to have various findings as the period from onset to diagnosis became longer.

Metabolic and histopathological effects of sleeve gastrectomy and gastric plication: an experimental rodent model

IntroductionObesity has recently become a major health problem, and researchers have been directed to work toward the development of surgical techniques, with new mediators playing an important role in nutrition. Gastric plication (GP) and sleeve gastrectomy (SG) have become popular recently. These are widely used techniques in bariatric surgery.ObjectivesIn this study, we aimed to compare the efficiency of SG and GP techniques on rats.MethodsWistar-Hannover rats (n=18) were divided into three equal groups, namely SG, GP, and control. Blood samples were taken before the operation and on the 30th day after the operation. The weights of all rats were recorded both on first day and the 30th day after the operation. Serum gastrin, ghrelin, and leptin levels were also measured on the same days. For histopathological examination, gastrectomy was performed after the animals were sacrificed.ResultsAverage weight loss was 10% for the SG group and 6.5% for the GP group. One month after the operations, the decrease in the ghrelin and leptin levels of GP and SG groups was significant compared with the levels of the control group. Gastrin levels of the SG group increased significantly compared with those of the control group. Histopathological examination revealed that there was significant decrease in the ghrelin and leptin levels of the GP and SG groups compared with those of the control group. Foveolar hyperplasia (FH), cystic glandular dilatation, and fibrosis were significantly higher in the GP and SG groups compared with the control group.ConclusionAlthough GP is not as effective as SG in terms of weight loss, it provides the same effectiveness in decreasing ghrelin and leptin levels. Histopathological findings revealed that FH, fibrosis, and the cystic glandular dilatation development rates were similar.

Endometriosis - An Overview

Endometriosis - An Overview

Mifepristone for uterine fibroids.

Uterine fibroids are the most common benign uterine tumours present in women of reproductive age. Mifepristone (RU-486) competitively binds and inhibits progesterone receptors. Studies have suggested that fibroid growth depends on the sexual steroids. Mifepristone has been shown to decrease fibroid size. This review summarises the effects of mifepristone treatment on fibroids and the associated adverse effects as described in randomised controlled trials. To determine the efficacy and safety of mifepristone for the management of uterine fibroids in pre-menopausal women. We searched the specialised register of the Cochrane Menstrual Disorders and Subfertility (Cochrane Menstrual Disorders and subfertility Review Group), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE, EMBASE, PsycINFO, and CINAHL (to November 2011). We handsearched a number of journals, and searched reference lists, databases of ongoing trials and the Internet. There were no language restrictions. Only truly randomised controlled trials of mifepristone versus other forms of medical therapy or placebo in pre-menopausal women with confirmed uterine fibroids were included. Four authors independently extracted data and assessed trial quality. Data were analysed using the Peto odds ratios (OR) for dichotomous data and the weighted mean differences for continuous data, with 95% confidence intervals (CI). Meta-analyses were performed using the fixed-effect model. Three studies involving 112 participants were included. Comparison interventions included different dosages of mifepristone, placebo and vitamin B tablets. There is evidence that treatment with mifepristone relieves heavy menstrual bleeding compared with placebo (Peto OR 17.84; 95% CI 6.72 to 47.38; 2 RCTs, 77 women, I(2) = 0%). Three studies (Bagaria 2009; Engman 2009; Fiscella 2006) were included in the meta-analysis of this comparison. There was no evidence of an effect of mifepristone on the fibroid volume (standardised mean difference (SMD) -0.02; 95% CI -0.38 to 0.41; 99 women).Two studies (Bagaria 2009; Fiscella 2006) were included in the meta-analysis of this comparison. There was no evidence of an effect of mifepristone on uterine volume (mean difference (MD) -77.24; 95% CI -240.62 to 86.14; 72 women). The pooled data suggest an increased adverse event (abnormal endometrial histology) in the mifepristone group compared to placebo (OR 31.65; 95% CI 4.83 to 207.35; 2 RCTs; 54 women; I(2) = 0%). Only one study (Bagaria 2009) reported endometrial hyperplasia at the end of the therapy (12/19 women in the mifepristone group versus 0/16 in the placebo group; OR 55.0; 95% CI 2.86 to 105.67). Engman 2009 found a significantly higher rate of cystic glandular dilatation in women in the mifepristone group (5/8 women biopsied) compared with the placebo group (1/11 women biopsied) (OR 16.67; 95% CI 1.36 to 204.03).One study (Fiscella 2006) suggested significant improvements (P < 0.001) for specific quality of life outcomes. Mifepristone reduced heavy menstrual bleeding and improved fibroid-specific quality of life. However, it was not found to reduce fibroid volume. Further well-designed, adequately powered RCTs are needed before a recommendation can be made on the use of mifepristone for the treatment of uterine fibroids.

Toxicology and toxicokinetics of oral pantoprazole in neonatal and juvenile dogs

Pantoprazole is an irreversible inhibitor of H(+) /K(+) adenosine triphosphatase proton pump. This study encompassed the period of postnatal stomach development to determine whether immature animals are uniquely sensitive to progression of PPI-induced enterochromaffin-like cell hyperplasia. Pantoprazole was administered to beagle dogs at 3, 10, or 30 mg/kg/day (10/sex/group) from PND 1 for 13 weeks, subsets of animals had a 13-week recovery period. Clinical signs, body weights, growth, clinical chemistry, and neurobehavioral endpoints were assessed. Selected organs were weighed and histologically examined. There were no effects on body weights, growth, landmarks of physical and reproductive development, or sensory and neurobehavioral function. Cholesterol and triglyceride levels were increased at 10 and 30 mg/kg/day, but resolved during the recovery period. Stomach weight was increased at all doses, but after recovery the differences in stomach weights resolved for females although male stomach weights remained slightly increased. Pantoprazole-related microscopic findings in the stomach consisted of increased mucosal height, glandular necrosis, and glandular dilation at all doses; and ECL cell hyperplasia, parietal cell vacuolation, and atrophy of chief cells are noted at 10 and/or 30 mg/kg/day. There was a partial recovery of these microscopic changes indicated by a decreased incidence and/or severity of increased mucosal height, glandular necrosis, ECL cell hyperplasia, and chief cell atrophy, and complete resolution of other microscopic observations. Pantoprazole administered to beagles from PND 1 for 13 weeks resulted in findings similar to those in adult dogs and juvenile dogs, which showed no increase in severity or progression of ECL hyperplasia.

Clinical utility of progesterone receptor modulators and their effect on the endometrium

In view of the spate of recent publications related to mifepristone and some second generation progesterone receptor modulators (PRMs), this appears to be an opportune time to view the clinical status of these compounds. Randomized double-blind placebo-controlled trials have been conducted with mifepristone, CDB-4124 (Proellex), CDB-2914 (VA 2914, Ulipristal) and asoprisnil (J867). All these PRMs are effective in the treatment of uterine fibroids where they are associated with a reduction in pain, bleeding and improvement in quality of life and decrease in fibroid size. CDB-4124 is also efficacious in endometriosis. Long-term treatment with PRMs may be associated with endometrial thickening on ultrasound and there have been reports of endometrial hyperplasia. Several reassuring recent publications have done much to explain the mechanism underlying these endometrial changes. The most common histological finding is cystic glandular dilatation often associated with both admixed estrogen (mitotic) and progestin (secretory) epithelial effects. This histology has not been previously encountered in clinical practice and should not be confused with endometrial hyperplasia. The endometrial thickness is related to this cystic glandular dilatation. At this stage of development, PRMs cannot be administered for longer than 3 or 4 months. Even over this time, there is improvement of symptoms associated with fibroids and endometriosis. Clinicians and pathologists need to be aware that the endometrial thickening and histological appearance do not represent endometrial hyperplasia.

Open-label study of ultra low-dose mifepristone for the treatment of uterine leiomyomata

Objective To assess the effect of ultra low-dose mifepristone on uterine size, pain, bleeding and quality of life among women with symptomatic leiomyomata. Study design Open-label cohort study of 2.5 mg mifepristone orally among adult women with at least moderately severe symptoms related to leiomyomata and total uterine volume of greater than 160 cm 3, or at least one myoma of greater than 2.5 cm diameter. Assessments of leiomyomata and uterine size (ultrasound), pain (McGill Pain Questionnaire), bleeding (daily log duration), quality of life (Uterine Fibroid Symptom and Quality of Life) and health status (SF-36) were conducted at baseline, three months and six months. Endometrial sampling was done at baseline and six months. Results Seventeen (74%) participants completed the entire six-month trial. Each of the measures showed significant improvement at six months compared to baseline ( p < 0.001). Uterine volume decreased by 11% and anemia, bleeding, pain, health status and fibroid-related quality of life improved during the course of the trial. Endometrial sampling showed cystic glandular dilatation, but no evidence of endometrial hyperplasia or cellular atypia. Conclusion Treatment of women with symptomatic leiomyomata with ultra low-dose mifepristone for six months is associated with modest reduction in uterine size, appreciable improvements in symptoms and quality of life and no evidence of endometrial hyperplasia.

Posterior Urethral Diverticulum on Transrectal Sonography

Received December 8, 2008, from the Department of Radiology, Derriford Hospital, Plymouth, England. Revision requested December 29, 2008. Revised manuscript accepted for publication January 13, 2009. Address correspondence to Nanda Venkatanarasimha, MBBS, MRCP, FRCR, Department of Radiology, Derriford Hospital, Derriford Road, Plymouth PL6 8DH, England. E-mail: nandashettykv@yahoo.com Abbreviations MRI, magnetic resonance imaging 45-year-old male patient underwent transrectal sonography to assess a 3-month history of perineal pain, dysuria, painful ejaculation, and postvoid dribble. The pain was worse after alcohol and on sitting. The patient had no relevant medical or surgical history. Urinalysis and blood test results for inflammatory markers were negative. Transrectal sonography showed a multiseptated cystic mass at the apex of the prostate (Figure 1). Color Doppler imaging showed no internal flow (Figure 2). A paraurethral diverticulum, congenital mullerian duct abnormalities, a prostatic retention cyst, and a chronic prostatic abscess were considered in the differential diagnosis. Follow-up transrectal sonography (Figure 3) performed 4 months later showed a slight increase in size and a cystic component to the right of the prostatic urethra. Magnetic resonance imaging (MRI) of the prostate (Figures 4 and 5) performed for further evaluation showed a multiseptated cystic mass anterior to the prostatic apex and encasing the posterior urethra. Appearances on MRI were consistent with a paraurethral diverticulum, the other differential diagnoses being considered less likely. Cystoscopy and urethrography (Figure 6) confirmed a urethral diverticulum with a large neck arising from the left posterolateral wall of the urethra at the level of the verumontanum. Histologic assessment showed nonspecific inflammatory changes and no evidence of neoplasia. A posterior urethral diverticulum is usually acquired1 and is rare in men. The classic clinical triad of urethral diverticula, although infrequently observed, includes dysuria, postvoid dribbling, and dyspareunia.2 The causes of urethral diverticula include congenital origins, recurrent infections, and instrumentation or surgery; when acquired, they are thought to result from inflammation and trauma of the periurethral glands and ducts, leading to local glandular dilatation and subsequent rupture into the urethra.3 Because our patient had no evi-

The equine endometrosis: New insights into the pathogenesis

This paper describes the histomorphological and immunohistochemical characterisation of phenotypic variations of endometrosis as well as potential etiological factors which may influence disease progression. In total, 779 endometrial biopsies were examined. These biopsies were taken in the breeding and non-breeding season ( n = 509), on defined days during the estrous cycle ( n = 70) and before and after experimentally induced bacterial endometritis ( n = 200). In addition to conventional histopathology, selected biopsies were investigated using alcianblue staining as well as immunohistochemical methods for the detection of steroid hormone receptors, Ki-67-antigen, vimentin, desmin, fibronectin, smooth-muscle-α-actin and laminin. The equine endometrosis can be divided into a destructive and a non-destructive form. Based on the morphology of the stromal cells involved, an active or inactive state can be distinguished in fibrotic foci. In all types of endometrosis, fibrotic stromal cells show a distinctly reduced expression of steroid hormone receptors in comparison to the intact stroma, indicating their dedifferentiation. However, the steroid hormone receptor expression of involved glandular epithelia seems to depend on the activity of the fibrosis. These results suggest an independency of all fibrotic foci from the hormonal control mechanism of the uterus. The characteristical features of destructive endometrosis are a large number of smooth-muscle-α-actin containing myofibroblasts, a pronounced epithelial vimentin expression, excessive extracellular matrix accumulation and a progressive alteration of the basal lamina. Furthermore, the frequently seen cystic glandular dilatation and mechanical destruction of the uterine glands may occur due to the contractibility of the myofibroblasts involved. As shown in this study, a simultaneous endometritis can cause a temporary activation of fibrotic stromal cells. However, cyclic and seasonal endocrine changes seem to have no effects on progression of the disease. It can be concluded that the various types of endometrosis represent different stages in the fibrotic process, possibly leading to the destruction of the glands and subsequently resulting in the development of a stromal fibrosis.

Chronic Active Gastritis in X-linked Lymphoproliferative Disease

Gastric lesions in primary constitutive immune deficiencies include multifocal atrophic gastritis, erosive pangastritis, and a pattern of gastric lesions reminiscent of graft-versus-host disease. We describe the genetic anomalies in 2 monozygotic twins with an X-linked lymphoproliferative disease (XLP; MIM 308240), a rare familial setting of high susceptibility to Epstein-Barr virus (EBV). Since early childhood, both twin brothers exhibited a severe chronic active atrophic pangastritis. A germline screening of the SH2D1A (MIM 300490) and BIRC4 (MIM 300079) genes was performed, and also a high-resolution whole-genome SNP profiling (Infinium Sentrix Human-1 Genotyping BeadChip, Illumina). A 3 Megabase deletion in the Xq25 region, encompassing the SH2D1A gene, was defined by SNP array genotyping. Histologic analysis of yearly or twice yearly gastric biopsies in both children showed a Helicobacter pylori-negative, Epstein-Barr virus-negative chronic active atrophic pangastritis, with superficial ulcer formation, foveolar hyperplasia, glandular dilatation and ultimately pseudopyloric and intestinal metaplasia. No such chronic active inflammatory gastric lesions have been reported to date in XLP. The similarities between XLP and common variable immunodeficiency (MIM 240500) underscore the need for early recognition and close monitoring of these gastric lesions, with special regard to their neoplastic potential. No infectious cause was determined. We favor a dysimmune mechanism in the development of this chronic atrophic gastritis, presenting a striking similarity to the recently described atrophic autoimmune pangastritis.