Presence Of Endometrial Cells Research Articles

[Understanding endometriosis].

Endometriosis is a chronic disease defined by the presence of endometrial cells outside the uterus. Research is ongoing to better understand its etiologies, the anatomopathological forms it takes and the associated symptoms, which often have pain in common.

Similarities in Pathogenetic Mechanisms Underlying the Bidirectional Relationship between Endometriosis and Pelvic Inflammatory Disease

Endometriosis is a common inflammatory disease characterized by the presence of endometrial cells outside of the uterine cavity. Endometriosis affects 10% of women of reproductive age and significantly reduces their quality of life as a result of chronic pelvic pain and infertility. Biologic mechanisms, including persistent inflammation, immune dysfunction, and epigenetic modifications, have been proposed as the pathogenesis of endometriosis. In addition, endometriosis can potentially be associated with an increased risk of pelvic inflammatory disease (PID). Changes in the vaginal microbiota associated with bacterial vaginosis (BV) result in PID or a severe form of abscess formation, tubo-ovarian abscess (TOA). This review aims to summarize the pathophysiology of endometriosis and PID and to discuss whether endometriosis may predispose to PID and vice versa. Papers published between 2000 and 2022 in the PubMed and Google Scholar databases were included. Available evidence supports that women with endometriosis are at increased risk of comorbid PID and vice versa, supporting that endometriosis and PID are likely to coexist. There is a bidirectional relationship between endometriosis and PID that shares a similar pathophysiology, which includes the distorted anatomy favorable to bacteria proliferation, hemorrhage from endometriotic lesions, alterations to the reproductive tract microbiome, and impaired immune response modulated by aberrant epigenetic processes. However, whether endometriosis predisposes to PID or vice versa has not been identified. This review summarizes our current understanding of the pathogenesis of endometriosis and PID and discusses the similarities between them.

Influence of dioxines on endometriosis development – study review

Introduction: Dioxins and dioxin-like polychlorinated biphenyls are considered to be among the most toxic to humans due to their persistence, resistance to degradation and chemical properties. Endometriosis is characterized by the presence of endometrial cells outside the uterine cavity showing secretory activity. It is one of the most common causes of pelvic pain and decreased fertility; is formed as a result of the action of hormonal and immune mechanisms. The exact etiology is unknown and multifactorial; risk factors for endometriosis include both family conditions and various environmental factors, including exposure to chemicals. The aim of the study:  Evaluation of the impact of dioxins on endometriosis development. Materials and methods: A research was performed using Pubmed, Google Scholar and ResearchGate; we made review and meta-analysis of the most relevant studies. Results: Dioxins can contribute to cancer development, which is well documented, as well as several conditions, such as sexual dysfunctions, oxidative stress and inflammation. Doxins have similar structure to steroid hormones, so their main target are male and female gonads, thyroid gland and other organs in which steroid hormones are produced. Conclusions: Endometriosis is a multifactorial disease, whereas dioxins are strong poisons that have an adverse effect on live organisms. Many epidemiological studies suggest that dioxins may significantly contribute to the development of endometriosis.

Molecular Mechanisms Underlying the Association between Endometriosis and Ectopic Pregnancy.

Endometriosis is a common inflammatory disease characterized by the presence of endometrial cells outside the uterine cavity. It is estimated that it affects 10% of women of reproductive age. Its pathogenesis covers a wide range of abnormalities, including adhesion, proliferation, and cell signaling disturbances. It is associated with a significant deterioration in quality of life as a result of chronic pelvic pain and may also lead to infertility. One of the most serious complications of endometriosis is an ectopic pregnancy (EP). Currently, the exact mechanism explaining this phenomenon is unknown; therefore, there are no effective methods of prevention. It is assumed that the pathogenesis of EP is influenced by abnormalities in the contraction of the fallopian tube muscles, the mobility of the cilia, and in the fallopian microenvironment. Endometriosis can disrupt function on all three levels and thus contribute to the implantation of the embryo beyond the physiological site. This review takes into account aspects of the molecular mechanisms involved in the pathophysiology of endometriosis and EP, with particular emphasis on the similarities between them.

Clinical Significance of Endometrial Cells in Pap Smear of Women Aged 40 Years and Older.

To investigate the histopathological follow-up results in women diagnosed with endometrial cells in the Papanicolaou (Pap) test. Between January 2013 to December 2018, women with endometrial cells on the Pap test were searched from the hospital electronic database. The patients with endometrial cells on the Pap test who underwent further histopathological evaluation and who were followed-up for at least 1 year were enrolled in the study, while those who had a Pap test result other than endometrial cells, were lost during follow-up, or had missing data were excluded. Out of 91,142 Pap smears, 121 (0.1%) cytologically had endometrial cells, and of those 65 cases were eligible for final analysis. The mean age of patients with premalignant/malignant lesions (57.7 ± 2.9) was higher than those with benign lesions (50.1 ± 0.7), with 77% of them in the postmenopausal period. Gynecologic premalignant/malignant lesions were detected in 9 (17.7%) patients including 2 (3.1%) endometrial hyperplasias and 7 (10.8%) endometrial cancers. The menopausal status (p=0.010) and being 50 years and older (p=0.002) were significantly associated with pre-neoplastic or neoplastic changes in patients with endometrial cells. The presence of endometrial cells in Pap tests may be a harbinger of endometrial pathologies, especially at the age of 50 years and over. The menopausal status is another possible determinant in detecting endometrial carcinoma. Further investigation may be suggested in women aged ≥50 years and postmenopausal in the event of endometrial cell detection.

Abdominal wall endometriosis: A monocentric continuous series and review of the literature

Introduction: Endometriosis is characterized by the presence of endometrial cells anywhere outside the uterine cavity. Endometriosis has been encountered on surgical scars especially resulting from a cesarean section recently. Our aim was to investigate the patients with abdominal wall endometriosis in our clinics where all the patients having this disease are managed via surgical resection. We also compared them with the patients presented in the literature. Methods: A study was conducted on the patients with histopathological diagnosis of abdominal wall endometriosis as a case series. All the subjects were analyzed through a comprehensive medical assessment including documentation of the detailed history and physical and gynecological examination based on the patients’ medical records. Results: A total of 53 patients diagnosed with abdominal wall endometriosis were included in this study. The mean age and the mean body mass index of the patients were 32.6 ± 6.5 years and 25.2 ± 3.5 kg/m2, respectively. A total of 49 patients had at least one operation history, mainly cesarean section. The most common sites for abdominal wall endometriosis were skin and the region containing the rectus abdominis muscle and rectus sheath, 56.6% and 18.9% respectively. The main symptom was the pain getting worse during menstruation and the presence of a mass in all patients. The main diagnostic tools in all patients were detailed history and physical examination, ultrasonography, and then histopathological confirmation after surgical excision. Conclusion: Abdominal wall endometriosis is a common diagnosis mainly due to increased cesarean section rate. Clinical suspicion has the most important place in correct diagnosis and management of abdominal wall endometriosis.

Vibrational characterization of granulosa cells from patients affected by unilateral ovarian endometriosis: New insights from infrared and Raman microspectroscopy

Endometriosis is a chronic gynaecological disease characterised by the presence of endometrial cells in extra-uterine regions. One of the main factors impacting on the fertility of women affected by endometriosis is the poor oocyte quality. Granulosa Cells (GCs) regulate oocyte development and maintain the appropriate microenvironment for the acquisition of its competence; hence, the dysregulation of these functions in GCs can lead to severe cellular damages also in oocytes. In this study, luteinized GCs samples were separately collected from both ovaries of women affected by Unilateral Ovarian Endometriosis and analysed by infrared and Raman microspectroscopy. The spectral data were compared with those of GCs from women with diagnosis of tubal, idiopathic or male infertility (taken as control group). The coupling of these two spectroscopic techniques sheds new light on the alteration induced by this pathology on GCs metabolism and biochemical composition. In fact, the study revealed similar biochemical modifications in GCs from both ovaries of women affected by unilateral ovarian endometriosis, such as the alteration of the protein pattern, the induction of oxidative stress mechanisms, and the deregulation of lipid and carbohydrate metabolisms. These evidences suggest that unilateral endometriosis impairs the overall ovarian functions, causing alterations not only in the ovary with endometriotic lesions but also in the contralateral "healthy" one.

The Presence of Endometrial Cells in Peritoneal Fluid of Women With and Without Endometriosis

To reinforce Sampson's theory of retrograde menstruation in the pathogenesis of endometriosis, proof should be provided that during menstruation endometrial cells are present in peritoneal fluid (PF). We hypothesize that the prevalence of PF samples containing endometrial cells is higher in patients with endometriosis than in controls without endometriosis during menstruation. We selected from our biobank PF samples of 17 reproductive-age women with (n = 9) or without (n = 8) endometriosis who had received a diagnostic laparoscopy for investigation of pain/infertility. Peritoneal fluid had been collected during laparoscopy in the menstrual phase of the cycle, centrifuged, and the resulting pellet was stored at -80°C. About 5-(j,m sections of frozen PF pellets were stained using the Dako Envision Flex system with primary antibodies against epithelial cell adhesion molecule (Ep-CAM; endometrial epithelial cells), CD 10 (endometrial stromal cells), prekeratin (epithelial/mesothelial cells), vimentin (endometrial/mesothelial/immune cells), calretinin (mesothelial cells), and CD68 (macrophages). The PF cells positive for Ep-CAM were detected in 5 of 9 patients with endometriosis and 6 of 8 controls (P =.62). CD10 stained positively in 6 of the 9 patients with endometriosis and 3 of the 8 controls (P =.35). Calretinin and prekeratin staining showed the presence of mesothelial cells in all pellets. Vimentin stained approximately 100% of the PF cells. CD68+ macrophages represented >50% of cells in all pellets. The prevalence of PF samples containing endometrial epithelial and stromal cells was not higher in patients with endometriosis than in controls without endometriosis during menstruation. Our findings question the relevance of endometrial cells in PF for the pathogenesis of endometriosis and support the importance of other mechanisms such as immune dysfunction and/or endometrial stem cells.

Tasa acumulada de nacido vivo en pacientes con endometriosis

IntroductionEndometriosis is a disease characterised by the presence of endometrial cells outside the uterine cavity, leading to negative effects on the fertility of the woman. However, the mechanism whereby this occurs remains unclear. ObjectiveA retrospective observational case-control study was conducted to compare the results of IVF/ICSI in women with endometriosis and male factor infertile couples, with the aim of finding evidence on the impact of endometriosis on the IVF/ICSI outcomes. Material and methodsA study was carried out from 2009 to 2014, in which a total of 821 first cycles were performed on 156 patients with endometriosis, and 665 patients in whom the cause of infertility was due to pathology in their partner (male factor), and were considered as the control group. Ovarian stimulation parameters and IVF/ICSI outcomes were studied. ResultsEndometriosis patients required higher doses of FSH stimulation, subsequently yielding fewer oocytes and mature oocytes, although fertilisation rates were higher in these patients than in those with male factor. All cryopreservation parameters analysed were higher in male factor. No statistically significant results were obtained in other parameters analysed, such as the implantation rate, although the pregnancy and live birth rates analysed, especially the accumulated rate (fresh transfers +cryotransfers) were higher in all cases in the male factor, but without significance. DiscussionThis study suggests that endometriosis affects the success of IVF/ICSI by reducing the ovarian response to controlled stimulation, but neither oocyte quality nor endometrial receptivity are affected. It may be necessary to determine the factors that cause the decrease in ovarian follicle reserve, such as previous surgery, extent of disease, or previous drug treatments.

Significance of endometrial cells in cervical cytology

This study evaluated the clinical significance of endometrial cells in Papanicolaou test (Pap test). A retrospective study was performed from the cytological database of Seoul National University Hospital. The results of Pap tests of women aged 40 years or older between January 1998 and December 2007 were sorted. Medical records were reviewed to identify the presence of endometrial cells from cytology, and cytologic and histologic follow-ups were performed to determine the clinical significance of the lesions. Among 75,673 Pap cases, 832 cases presenting normal endometrial cells (nEMCs) were included in this study. Their follow-up data are as follows: 800 with nEMCs, 5 with atypical EMCs (aEMCs), and 27 with endometrial cancer cells (EMCCs) on cytologic and histologic follow-ups. Significant endometrial or cervical diseases were found in 0.5%, 40%, and 100% of the cases on the following-up the pathologic examination of the women with nEMCs, aEMCs, and EMCCs, respectively. Unlike aEMCs and EMCCs, nEMCs on Pap tests did not increase the risk of developing endometrial hyperplasia or endometrial cancer in women aged 40 years or older. There is no clinical benefit to perform routine endometrial work-up in women with nEMCs, as recommended in the 2001 Bethesda System. However, symptomatic women with nEMCs on Pap test should perform endometrial work-up regardless of menopausal status.

Abnormal Endometrial Cells on Pap Smear in Endometrial Cancer

Background The presence of endometrial cells during Pap test smear performance in postmenopausal patient may denote further investigation to confirm the presence of uterine pathology.

Normal-Appearing Endometrial Cells in Pap Tests of Women Aged Forty Years or Older and Cytohistological Correlates

Objective: The Bethesda System 2001 for reporting cervical cytology recommends reporting benign-appearing, exfoliated endometrial cells in women aged 40 years or older. The objective of this study was to determine the significance of normal endometrial cells in conventional Papanicolaou (Pap) tests of women aged 40 years and older and to correlate this finding with histological follow-up. Study Design: Over a period of 5 years, all Pap tests showing endometrial cells in women aged ≥40 years were identified. Histological follow-up and outcome were evaluated. Results: Out of 17,275 Pap tests, 199 (1.15%) showed benign endometrial cells. Forty-seven of these 199 patients had subsequent tissue sampling by surgical procedures including endometrial curettage (n = 31), lower genital tract biopsy (n = 30) and hysterectomy (n = 2). Overall, out of 47 cases, 3 (6.4%) had significant endometrial pathology including 2 simple hyperplasias without atypia and 1 complex hyperplasia with atypia. Conclusion: The incidence of clinically significant endometrial lesions associated with the presence of endometrial cells in Pap tests of women aged 40 years and older was very low. Considering this finding, women aged between 40 and 50 years with benign endometrial cells in a Pap test should undertake endometrial sampling only when additional clinical indicators are recognized.

English

BACKGROUND: An association has been reported with presence of endometrial cells on cervical smears and clinically significant uterine lesions. Hence for early detection of endometrial pathology, the 2001 Bethesda system has suggested the mandatory reporting of presence of any atypical endometrial cells regardless of age and menstrual status and out of phase normal looking endometrial cells in women aged 40 years or more. OBJECTIVES: To assess the association between atypical glandular cells of endometrial origin in cervical cytology and histopathological findings in abnormal uterine bleeding cases. SETTINGS AND DESIGN: The study was conducted at JSS hospital, Mysore in the department of pathology. This was a descriptive type of study. The sample was collected from patients attending the gynecology OPD with the complaints of abnormal uterine bleeding in JSS hospital. MATERIALS AND METHODS: Smears for cervical cytology are collected using either pap smear or manual liquid based smear from 82 patients in the age group of 20-75 years with complaints of abnormal bleeding history. The results of cervical cytology were compared and confirmed with the endometrial pathology. RESULTS: Out of 82 abnormal uterine bleeding cases 14 showed atypical endometrial cells. On follow up of these cases, the results indicated an association between atypical endometrial cells in cervical cytology with endometrial carcinoma in 8 cases (60%), 1 case with complex hyperplasia with atypia (10%). CONCLUSION: Presence of atypical endometrial cells in all women with abnormal uterine bleeding has considerable clinical implications & further

The Mystery of Atypical Glandular Cells in Cervical Cytology: Histopathologic and Clinical Correlation

Introduction: The current standard practice to help identify endometrial carcinoma (EC) on Papanicolaou (Pap) test is to document “endometrial cells in women 40 years of age” (E40). Since a significant fraction of women in this category are still menstruating, the presence of endometrial cells correlates with menstrual history and is likely not pathologic. Routine biopsy following E40 may lead to unnecessary procedures and costs. Therefore, setting a different age threshold in combination with other findings may help to guide management. Materials and Methods: A retrospective chart review was performed on consecutive EC biopsies (2007-2013) and E40 Paps (2012-2013). Clinicopathologic data included age, biopsy (reason, diagnosis, FIGO grade, time since Pap), Pap diagnosis, HPV status, and resection (diagnosis, depth of invasion, stage, and metastasis). Results: One hundred EC cases had 62 prior Pap diagnoses: negative for intraepithelial lesion (27/62), atypical glandular cells of undetermined significance (14/62), adenocarcinoma (10/62), and E40 (1/62; 51 years). 370 E40 cases had 68 biopsies (18%) and 2 hysterectomies (0.5%). E40 prompted biopsy in 26/68 (38%). 2/68 (3%) biopsied women had EC (50 and 60 years, both post-menopausal). 1/68 had complex hyperplasia with atypia (52 years; abnormal uterine bleeding [AUB]), and 3/68 had complex hyperplasia without atypia (ages 52, 40, and 58; AUB). Conclusions: Analysis of women with EC revealed 2% with E40 on prior pap testing. Analysis of E40 cases showed the majority correlated with menstrual history or did not prompt biopsy. Only 18% were biopsied, with EC in 3%. In asymptomatic women <50 years, E40 correlated with benign, non-hyperplastic endometrium. However, postmenopausal women with E40 had a risk of EC. These findings suggest that E40 diagnoses on Pap tests in asymptomatic pre-menopausal women may not warrant further work-up. Perhaps endometrial cells should only be reported in post-menopausal women or women 50 years of age.

CRISPLD2 is a target of progesterone receptor and its expression is decreased in women with endometriosis.

Endometriosis, defined as the presence of endometrial cells outside of the uterine cavity, is a major cause of infertility and pelvic pain, afflicting more than 10% of reproductive age women. Endometriosis is a chronic inflammatory disease and lipopolysaccharide promotes the proliferation and invasion of endometriotic stromal cells. Cysteine-rich secretory protein LCCL domain-containing 2 (CRISPLD2) has high affinity for lipopolysaccharide and plays a critical role in defense against endotoxin shock. However, the function of CRISPLD2 has not been studied in endometriosis and uterine biology. Herein, we examined the expression of CRISPLD2 in endometrium from patients with and without endometriosis using immunohistochemistry. The expression of CRISPLD2 was higher in the secretory phase in human menstrual cycle compared to proliferative phase. The expression of CRISPLD2 was significantly decreased in the endometrium of women with endometriosis in the early secretory phase compared to women without endometriosis. The increase of CRISPLD2 expression at the early secretory and dysregulation of its expression in endometriosis suggest progesterone (P4) regulation of CRISPLD2. To investigate whether CRISPLD2 is regulated by P4, we examined the expression of the CRISPLD2 in the uteri of wild-type and progesterone receptor knock out (PRKO) mice. The expression of CRISPLD2 was significantly increased after P4 treatment in the wild-type mice. However, CRISPLD2 expression was significantly decreased in the (PRKO) mice treated with P4. During early pregnancy, the expression of CRISPLD2 was increased in decidua of implantation and post-implantation stages. CRISPLD2 levels were also increased in cultured human endometrial stromal cells during in vitro decidualization. These results suggest that the CRISPLD2 is a target of the progesterone receptor and may play an important role in pathogenesis of endometriosis.

Are Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios Associated with Endometrial Precancerous and Cancerous Lesions in Patients with Abnormal Uterine Bleeding?

An easy, reproducible and simple marker is needed to estimate phase of endometrial pathologic lesions such as hyperplasia and endometrial cancer and distinguish from pathologically normal results. We here aimed to clarify associations among neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), endometrial hyperplasia and cancer in patients with abnormal uterine bleeding. Patients (n=161) who were admitted with abnormal uterine bleeding and the presence of endometrial cells on cervical cytology or thick endometrium were investigated. The study constituted of three groups according to pathologic diagnosis. Group 1 included endometrial precancerous lesions like hyperplasia (n=63), group 2 included endometrial cancerous lesions (n=38) and group 3 was a pathologically normal group (n=60). Blood samples were obtained just before the curettage procedure and the NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count; similarly, PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. The white blood cell count was significantly higher in patients with cancer than in those with hyperplasia (p=0.005). The platelet count and neutrophil to lymphocyte ratio were significantly higher in patients with cancer than in control patients, but there was significantly no difference between patients with hyperplasia and other groups (p=0.001 and p=0.025 respectively). PLR was significantly lower in control subjects than in other groups (p<0.001), but there was no significant difference between patients with hyperplasia and those with cancer. PLR was significantly lower in control subjects than in other groups. Thus both hyperplasia and cancer may be differentiated from pathologically normal patients by using PLR. White blood cell count was significantly higher in patients with cancer than in those with hyperplasia and pathologically normal patients. Therefore white blood cell count may be used for discriminate hyperplasia to cancer. By using multiple inflammation parameters, discrimination may be possible among endometrial cancer, endometrial precancerous lesions and pathologically normal patients.

Evaluation of Endometrial Precancerous Lesions in Postmenopausal Obese Women - A High Risk Group?

To evaluate precancerous lesions such as hyperplasia and endometrial polyps in obese postmenopausal women. Women who were referred with abnormal uterine bleeding in postmenopausal period or the presence of endometrial cells on cervical cytology in our department were investigated. Anthropometric measurements such as height, weight, body mass index, waist/hip ratio and endometrial thickness were compared between a precancerous lesion (hyperplasia and endometrial polyp) group and a pathologically normal group. We detected statistically significant thickening of endometrium in patients with precancerous lesions. Moreover patients with precancerous lesions had higher body mass index than the pathologically normal group. We found elevated precancerous lesion rates in overweight and obese women in the postmenopausal period, of interest given that the prevalence of obesity is increasing in most parts of the world. Although screening for endometrial cancer is not recommended for the general population, in high-risk populations like obese postmenopausal women, it may be very important.

MAPK signaling pathway and endometriosis: what is the link?

Endometriosis is defined as the presence of endometrial tissue outside the uterus, predominantly on the ovary and pelvic peritoneum [1]. It occurs in approximately 10 % of women of reproductive age and, although it is a benign disease, it causes infertility and pelvic pain, compromising the quality of life [1]. Out of various theories put forward to explain the origin of endometriosis, retrograde menstrual reflux has gained the widest acceptance [1, 2]. Endometriosis has been reported to be characterized by the presence of endometrial cells with capacity to avoid apoptosis beyond the uterine cavity [1, 2]. Apoptosis plays an important role in maintaining tissue homeostasis by striking a balance between proliferation and cell death [1]. Endometriotic cells have been described to show the peculiar biological characteristics of resistance to apoptosis with the inability to transmit apoptotic signal and the ability to avoid cell death [1, 2]. Recently, endometriosis has been correlated with aberrant endometrial expression of telomerase and survivin implying modifications in cell fate [1, 2]. Telomerase is a specialized transcriptase that can prevent telomere shortening [2, 3]. Telomeres are noncoding tandemly repeated DNA sequences that are vital for maintaining chromosomal integrity and cell stability [2]. The critical shortening of telomeres is linked to cell division and their senescence and death [2, 3]. Consequently, telomerase activation allows cells to overcome apoptosis acquiring immortal capacity [2, 3]. Survivin is the smallest member of the inhibitor of apoptosis protein family that acts by suppressing primarily caspases [1, 4]. It is prominently expressed in embryonic and fetal tissues and over-expressed in virtually all tumor types [1]. It is transcriptionally silent in most differentiated adult tissues, but it is expressed in ovary and in the proliferative phase of the cycling human endometrium, suggesting a physiological role in normal endometrial function [1, 4]. Survivin has been shown to be closely linked to escape from apoptosis of endometriotic cells and their viability with a critical role in the pathogenesis and progression of endometriosis together with telomerase [1–4]. It has been found that both the survivin and telomerase are up-regulated by epidermal growth factor (EGF) through MAPK (mitogen activated protein kinase) signaling pathway activation [3, 4]. MAPK has been reported to play an important role in many cellular reactions such as apoptosis, proliferation and inflammation [5]. Many studies have demonstrated that MAPK is involved directly in regulating the pathogenesis of endometriosis [5]. MAPK pathways seem to play a pivotal role as intracellular and extracellular signal transducers in endometriotic cells [6, 7]. It has been reported that enhanced proliferation and survival of eutopic endometrial cells from patients with endometriosis compared with healthy women have correlated with abnormal activation of MAPK signaling pathways [7]. In addition, accumulating evidences, show that MAPK pathways regulate pain hypersensitivity in different injury conditions implying their possible involvement in endometriosisrelated pelvic pain [8]. With respect to the above, we suggest that inhibition of MAPK signaling pathway downregulating both telomerase and survivin expression, may be candidate as a new therapeutic target for endometriosis. Moreover, understanding the possible regulatory role of MAPK in apoptosis and, ultimately, in the signal R. Mormile (&) Division of Pediatrics and Neonatology, Moscati Hospital, Via A. Gramsci, 3, 81031 Aversa, Italy e-mail: raffaellamormile@alice.it; raffaellamormile@libero.it

Apoptosis and endometriosis

Apoptosis is a distinctive form of programmed cell death resulting in the efficient elimination of cells without eliciting an inflammatory response. Endometriosis is characterized by the presence of endometrial cells with capacity to avoid apoptosis outside the uterus. Apoptosis plays a fundamental role for the pathogenesis of endometriosis. Eutopic endometrium from women with endometriosis has increased expression of anti-apoptotic factor and decreased expression of pro-apoptotic factors compared with endometrium from healthy women. These differences could contribute to the survival of regurgitating endometrial cells into the peritoneal cavity and development of endometriosis. Increased apoptosis of Fas-bearing immune cells in the peritoneal cavity may leads to their decreased scavenger activity that eventually results in prolonged survival of ectopic endometrial cells in women with endometriosis. This study is a current review of the literatures focused on the physiological role of apoptosis in normal endometrium and alterations in regulation of apoptosis in eutopic and ectopic endometrium from women with endometriosis. The role of apoptosis in the treatment of endometriosis is also reviewed.

Rapid prescreen of cervical liquid‐based cytology preparations: Results of a study in an academic medical center

A rapid prescreening or rapid rescreening method for quality assurance in cervical cytology has been used in Europe and in Canada but has not been accepted in the United States. The rapid prescreen method was tested in a cytology laboratory that serves an academic medical center with a high-risk population for cervical cancer. For a period of 3 months, a tray of 20 sequentially numbered Surepath™ liquid-based preparations, randomly selected from the cervical cytology daily workload, were each prescreened in a random fashion for 1 minute. Experienced cytotechnologists performed the rapid prescreen. Results were recorded as negative, further review needed, or epithelial cell abnormality, category specified. The 20 cervical cytology preparations were then replaced in their same position in the daily workload for routine screening performed by another cytotechnologist. Final interpretation was by a cytopathologist as requested or required by Clinical Laboratory Improvement Amendments of 1988. The rapid prescreen data was tabulated and compared with data for a similar time period using the laboratory's normal quality assurance program. Seven hundred and twelve cases underwent rapid prescreen. Six hundred and forty-two were interpreted as negative. Twenty-six cases were interpreted as low-grade squamous intraepithelial lesion (LGSIL) or higher. Forty-four cases were classified as needing further review. For the 642 negative cases by rapid prescreening, routine screening reported 537 as negative and 105 as either abnormal or needed cytopathologist review. The error rate for the rapid prescreen is 50 of 712 (7.0%); for LGSIL and above 19 of 712 (2.6%). Of the 105 abnormal cases or those submitted for cytopathologist review, 31 were interpreted as atypical squamous cells of undermined significance (ASCUS), 41 cases as reactive/repair, 17 as LGSIL, 4 as unsatisfactory, 1 as atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion (ASC-H), 8 as the presence of endometrial cells in a women aged >40, 1 as malignant melanoma, and 2 as within normal limits with the presence of Actinomyces. The laboratory's routine quality assurance program selects cases, 10% of initially interpreted negative cases plus any gynecologic cytology on patients with a prior abnormal cervical cytology, or history of cervical epithelial cell abnormality. This quality assurance program averages 29% of cases, 4,045 of a total of 13,767, in 2008. Thirty-seven (0.9%) cases were detected in this rescreen (ASCUS, 16 cases; LGSIL, 13 cases; 1 high-grade squamous intraepithelial lesion; 4 ASC-H; and 3 atypical glandular cells of undetermined significance). Eliminating ASCUS cases, eight significant cases were detected, with an error rate of 0.2%. In this cytology laboratory, the rapid prescreen did not prove as reliable as routine quality assurance program for cervical cytology cases.