Uterine Endocervix Research Articles

The Sequence of Prostaglandin-Endoperoxide Synthase 2 Gene in Women with Cervicitis

Cervicitis is a clinical syndrome characterized by inflammation of primarily the columnar epithelium of the uterine endocervix. It can be acute or chronic. Prostaglandin endo peroxide synthase2 (Cyclooxygenase-2) is a key enzyme in prostaglandin synthesis, which is coded by the PTGS2 gene, and recognized as the master switch that activates the inflammatory response; its induction leads to the biosynthesis of prostaglandins. The current study aims to determine the CA125, CA 19.9, and, CA 15.3 markers level and their relationship with the COX-2 gene. Venous blood samples were obtained from 100 women with cervicitis whose ages ranged from 18 to 60 years, and 100 healthy women as a control group. Detection of CA19-9, CA- 125 and CA 15-3 markers was performed by using Cobas E411 analyzer while the CRP test was detected by using Afias CRP instrument. The conventional PCR was used for gene detection and DNA sequencing. The mean± SD of Ca125, CA15.3 and CRP showed a highly significant differences between patient (30.33±1.09), (22.82±1.07), (88.06±5.88) respectively and the healthy control (19.40±0.68), (18.34±0.77), (6.73±0.12) respectively-value >0.001. The mutation in PTGS2 gene with highly CA125 marker 100(100%) and CRP levels 20(80%), while in CA15.3 marker 3(15%) and CA19.9 marker 1(5%). The mutation occurrence in analysis of rs20417 NSP of PTGS2 gene with wild CC GG and the variation C>G G>C.

Invasive hydatidiform mole in the cervix.

A patient aged 43-years, multiparous consulted for uterine bleeding of average abundance. The examination revealed a burgeoning lesion of the cervix, which came from the uterine endocervix, measuring two centimeters. The uterus was increased in size measuring 88 mm long and 67 mm in anteroposterior diameter. There were no adnexal mass. Pelvic ultrasound showed a heterogeneous snowflake mass measuring 29 mm in anteroposterior diameter. Beta-h-CG (human chorionic gonadotrophin) quantitative plasma were highly increased to 854212 IU / ml. Histological study of aspirate objectified a complete hydatidiform mole. The staging featuring a thoraco-abdominopelvic CT scan, chest radiography, ultrasound abdomen and pelvis was normal. Pathological examination of the hysterectomy piece objectified an invasive mole to cervical and uterine location. A methotrexate-based agent chemotherapy was introduced. The evolution was marked by the gradual decline of the mass until it disappearance within four months. Plasma beta-h-CG had regressed and were normalized after two months of treatment. The outcome was favorable. With a follow-up of 24 months, no recurrence was noted.

EP24.13: Cervical ectopic pregnancy: case series of 6 cases

A “cervical pregnancy” is an ectopic pregnancy that has implanted in the uterine endocervix. It typically aborts within first trimester, however, if it is implanted closer to the uterine cavity-so called cervicoisthmic pregnancy, it may continue longer. Placental removal in a cervical pregnancy may result in major hemorrhage. It can be confused with miscarriage as abortion in progress with sac passing through the cervix. Hence it is important to diagnose it correctly. We discuss the diagnostic features on ultrasound, importance of Colour Doppler in correct diagnosis and role of USG in follow up and treatment options in these cases. We analysed the ultrasound findings of cervical ectopic pregnancy in 6 cases. The study was performed on Phillips HD 11 XE & IU 22 ultrasound machine using C 5-2 convex & C 8-4 V transvaginal transducer. The size of gestational sac, trophoblastic reaction and vascularity, presence of embryo, its cardiac activity if present was documented. The gestational age at diagnosis was 6-9 weeks. All 6 cases showed empty endometrial cavity, closed internal os, three cases showed presence of only gestational sac (without fetal pole) with trophoblastic vascularity, three showed presence of embryo within sac; two with cardiac activity and one without cardiac activity. Five patients underwent curetting. One live ectopic was treated with methotrexate first and curetting was done later. Another live ectopic was treated with KCl injection for fetal reduction and then curetting was done. One was treated with methotrexate, patient started bleeding on 3rd day and aborted completely. A cervical ectopic pregnancy is a very rare form of extrauterine pregnancy. Its correct diagnosis helps in timely intervention. Surgical evacuation of the pregnancy alone is not recommended because the cervix is unable to contract and prolonged bleeding may follow. Hence expectant management with methotrexate is recommended in non-emergency cases. USG as imaging modality not only helps in diagnosis but also in follow up if it's treated on methotrexate.

EP24.24: Cervical ectopic pregnancy: a case report

A cervical pregnancy is an ectopic pregnancy that has implanted in the uterine endocervix. Cervical ectopic pregnancy (CEP) is extremely rare with an incidence of 1:1,000 to 1: 16,000 pregnancies. The etiology of ECP is unknown but risk factors include: Cervical dilatation, cervical curettage, c-section and pregnancies resulting from assisted reproductive technology, occurring in 0.1 % of in vitro fertilisation. The patient was a 35 y.o. gravida: 2, para:1 with a previous c-section who comes to our unit with a B-hCG test: 4.540 IU/L at 6.1 weeks of pregnancy and pelvic pain. A transvaginal ultrasound was performed. After 48 hours B-hCG test was 9.120 IU/L and patient presented with vaginal spotting, another transvaginal ultrasound was performed. A single dose of methotrexate was given to the patient. After 3 days patient begins reported bleeding and was prepared for dilatation of cervix along with removal of embryonic tissue and sac, her private physician reports no complication. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Advanced endocervical adenocarcinoma metastatic to the ovary presenting as primary ovarian cancer

Dear Editor,Cervical squamous cell carcinoma (SCC) and adenocarcinomamay involve the ovary. Although it is not difficult to diagnose inmost cases, on very rare occasions the presentation may showsymptoms related to an ovarian mass, with the cervical cancerbeing undetected, especially endocervical adenocarcinoma [1,2].This is important because the challenge of diagnosing primaryendocervical adenocarcinoma occurs especially in women whoshow no symptoms, and have a grossly normal cervix and anegative Pap smear [3]. The spread of cervical malignancy (bothSCC and adenocarcinoma) is often through lymphatic drainage ordirect invasion [4]; except some reports show that endocervicaladenocarcinoma carries a higher risk of ovarian metastases thanSCC of the cervix [5]. There is an apparent difference in the treat-ment strategy for advanced cervical cancers and ovarian cancers[6,7]. Therefore, making an accurate diagnosis before planningtherapy is of paramount importance. The following is a case reportof advanced cervical adenocarcinoma metastatic to the ovarymimicking primary ovarian cancer.A 54-year-old menopausal woman (G3P3) visited the emer-gency room due to acute sudden onset of abdominal pain afterseveral weeks of abdominal fullness. Her past medical history wasunremarkable. She did not have any Pap smears since the birth ofherlastchild(28yearspreviously).Physicalexaminationrevealedaprotuberant and tense abdomen, but the cervix was essentiallynormal. Transvaginal ultrasound revealed a 15 cm complex cysticmass lesion located at the right adnexal area accompanied withmassive ascites, but the uterus and the left ovary seemed to benormal.Computedtomographyidentifiedandconfirmed theabovefinding (Fig. 1). Serum tumor markers, including CA 125, CA 199,and CEA were 286.0 U/mL, 209.0 U/mL, and 226.0 ng/mL, respec-tively. Other investigations, including hematological andbiochemical tests, a chest X-ray, and upper and lower gastrointes-tinal (GI) tract evaluations were within normal limits.Under the diagnosis of ovarian malignancy, the patient under-went a laparotomy. During surgery, a right ovarian cystic complexmass with a mucinous component (Fig. 2) accompanied withmassive ascites (7000 mL) and peritoneal carcinomatosis wasfound. The immediate frozen pathology report favored a diagnosisof adenocarcinoma-mucinous type. Therefore, the patient under-went an optimal debulking surgery, including total hysterectomy(Fig. 3), bilateral salpingo-oophorectomy, infracolic omentectomyand retroperitoneal lymph node sampling, and multiple biopsies.However, the final pathologic report was primary uterine endo-cervical adenocarcinoma.Pathologic features included hyperchromatic dysplasia of themucinous glandular cells of the uterine endocervix; the mucinoustumor occupied the whole layer of the endocervix and extended tothe lower segment of the uterine body. Other sections of the rightovary, appendix, omentum, abdominal wall, and mesentery allshowed tumor metastases with floating mucinous tumor cellswithin an extensive mucin pool.The patient was treated with adjuvant systemic chemotherapy(8 cycles of topotecan [Hycamtin Injection, GlaxoSmithKline, San

Primary Mucinous Cystadenocarcinoma of the Breast: Cytologic Finding and Expression of MUC5 Are Different from Mucinous Carcinoma

Mucinous cystadenocarcinoma (MCA) in the breast is a rare neoplasm. There have been 13 cases of primary breast MCA reported. The MCA presents as a large, partially cystic mass in postmenopausal woman with a good prognosis. The microscopic findings resemble those of ovarian, pancreatic, or appendiceal MCA. The aspiration findings showed mucin-containing cell clusters in the background of mucin and necrotic material. The cell clusters had intracytoplasmic mucin displacing atypical nuclei to the periphery. Histologically, the tumor revealed an abundant mucin pool with small floating clusters of mucin-containing tumor cells. There were also small cysts lined by a single layer of tall columnar mucinous cells, resembling those of the uterine endocervix. The cancer cells were positive for mucin (MUC) 5 and negative for MUC2 and MUC6. This mucin profile is different from ordinary mucinous carcinoma and may be a unique characteristic of breast MCA.

Cytoarchitecture modifications of the human uterine endocervical mucosa in long-term three-dimensional organotypic culture

We assayed the effects of phenol red ( pr), estrogen (Es), and progesterone (Pg) in three-dimensional organotypic cultures of human uterine endocervix. Small intact fragments deposited on sponges submerged in DMEM with 10% fetal bovine serum were cultured in three different conditions: with pr (DMEM pr+), without pr (DMEM pr−), and without pr but with the addition of physiological concentrations of Es and Pg [DMEM pr−(Es+Pg)]. Cell viability and cellular responses were assayed after 4, 10, and 21 days using immunohistochemistry for the expression and distribution of the following markers: mucins and mucopolysaccharides (PAS staining), pan-cytokeratins (AE1/AE3), CK19, p63, Ki-67, vimentin, estrogen receptor- α (ER- α), and progesterone receptor (PR). The fragments cultivated in DMEM pr+ showed a cuboidal, poorly differentiated epithelial phenotype and signs of stroma degeneration. In DMEM pr−, both tissue architecture and cellular heterogeneity were much better preserved: epithelial cells showed a more columnar shape, and stroma was very well conserved, maintaining cell density. The addition of Es and Pg further improved the histology and physiology of the fragments: in DMEM pr−(Es+Pg), epithelial cells retained a columnar shape, secreted mucins, and formed areas of squamous hyperplasia.

Concurrent Occurrence of Adenocarcinoma and Neuroendocrine Type Small Cell Carcinoma in the Uterine Endocervix

Concurrent occurrence of neoplasms, adenocarcinoma and small cell carcinoma, have been rarely reported to occur in several areas of ´the body, including gastrointestinal tract, breast, prostate, lung, skin, and kidney. Also concurrent occurrence of adenocarcinoma and small cell carcinoma in the uterine endocervix is extremely rare. We report a case of concurrent occurrence of primary neruoendocrine type small cell carcinoma and infiltrating adenocarcinoma in the uterine endocervix with multiple pelvic lymph node metastases.

Endocervical Cancer Is Associated with an Increase in the Ligands and Receptors for Transforming Growth Factor-β and a Contrasting Decrease in p27Kip1

Objective. The aim of this study was to investigate the relationship between the expression of the TGF-β ligands and TGF-β receptors to the expression of p27Kip1, a TGF-β-regulated gene, in endocervical cancer.Methods. To examine the expression of TGF-β and p27Kip1 in malignant transformation of the uterine endocervix, a panel of 23 formalin-fixed and paraffin-embedded human cervical specimens, including 8 with benign endocervical glands, 8 with cervical adenocarcinoma in situ, and 7 with cervical adenocarcinomas, was used. Tissues were immunostained with polyclonal antibodies that react specifically with TGF-β1, TGF-β2, TGF-β3, TGF-β RI, TGF-β RII, and p27Kip1.Results. Immunostaining for TGF-β1, TGF-β2, TGF-β3, TGF-β RI, TGF-β RII, and p27Kip1 was detected in normal endocervix, with the TGF-βs showing weak cytoplasmic staining, while p27Kip1 showed strong nuclear staining. Expression of TGF-β increased significantly upon neoplastic transformation with the TGF-β ligands and receptors showing strong cytoplasmic staining in adenocarcinoma in situ compared to normal endocervix. Interestingly, expression of TGF-β was lower in adenocarcinoma than in adenocarcinoma in situ, but still significantly higher than in normal endocervix. TGF-β2 and TGF-β3 showed higher levels of immunostaining than TGF-β1 in adenocarcinomas. In contrast, p27Kip1 protein expression decreased with progressive malignancy, with lower p27Kip1 protein levels detected in adenocarcinoma than in adenocarcinoma in situ, while normal endocervix showed the highest level of p27Kip1 protein expression.Conclusion. Elevated expression of the TGF-β ligands and receptors is found in both cervical adenocarcinoma in situ and adenocarcinoma compared to normal endocervix. In contrast, a progressive decrease in p27Kip1 occurs upon neoplastic transformation of the normal endocervix to cervical adenocarcinoma. These results suggest that neoplastic transformation of the endocervix may be related to dysregulation of TGF-β and p27Kip1 seen as an elevation of TGF-β and a reduction of p27Kip1 expression that may lead to loss of cell cycle control.

Uterine adenomyoma of endocervical type

A uterine adenomyoma of endocervical type was presented histopathologically in a 44-year-old woman. She had a mural tumor of the uterine endocervix, which showed a well-circumscribed margin and multiple cysts filled with mucin. Histologically, the tumor was composed of a proliferation of endocervical glands and smooth muscle. The glandular epithelial components were cystic and occasionally papillary, but neither component showed cytological atypia. A differential diagnosis of the uterine endocervical tumor should include adenomyoma of endocervical type.

A monoclonal antibody CF703 raised against human fetal lung recognizes a novel onco-fetal mucin

To obtain murine monoclonal antibodies (MAb), mice were immunized with the extract of a human fetal lung from the first trimester of gestation as initial immunogen followed by booster immunization with a human lung cancer cell line. MAb CF703 which reacted to the booster material was screened and selected. In adults, expression of the antigen defined by MAb CF703, CF703 antigen, was shown immunohistochemically in 78% of gastric carcinomas (14/18), 59% of ovarian adenocarcinomas (10/17), 50% of pancreatic carcinomas (5/10), 17% of lung carcinomas (4/24), 50% of uterine cervical adenocarcinomas (2/4), 20% of endometrial adenocarcinomas (1/5) and 10% of renal cell carcinomas (1/10). Other malignant tumors failed to demonstrate the reactivity. MAb CF703 was weakly reactive with only three adult normal tissues including surface lining of gastric mucosa, Brunner's glandular epithelia of the duodenum and columnar epithelia in the uterine endocervix. In fetal tissues, 5 of 23 tissues including squamous epithelia in lower portion of the;esophagus, surface epithelia of gastric mucosae and goblet cells in the small and large intestine were reactive. The CF703 antigen had a molecular weight over 500 kDa and its epitope was carbohydrate in nature by reason of the resistance to proteinase digestion and sensitivity to periodate oxidation, neuraminidase and alkaline-borohydrite. MAb CF703 recognizes probably a unique epitope in oncodevelopmental mucin glycoprotein. Additionally, this immunization method has the advantage of rapid acquirement of MAbs with restricted, narrow cancer spectrum and is a worthy strategy for generating the new MAbs.

A case of polypoid adenomyoma of the uterine body associated with adenofibroma of the uterine endocervix

A case of polypoid adenomyoma of the uterine body associated with adenofibroma of the uterine endocervix

Mucin gene expression in the human endocervix

In the human uterine endocervix, five out of the six human mucin genes investigated (MUC 2, MUC 3, MUC 4, MUC 5AC, MUC 5B and MUC 6) are expressed, whereas in some other mucosae the hybridization pattern demonstrates the expression of only two or three of these genes. The most intense labelling by in-situ hybridization is obtained significantly with MUC 4, predominantly during the luteal phase. The expression of the MUC 4 gene appears to be influenced by the oestro-progesterone ratio. During the ovulatory cycle, there are only a few differences concerning the variations of expression of all other MUC genes.

Analysis of Clonality by Amplification of Short Tandem Repeats

The clonal composition of cancers of the female reproductive tract was evaluated by analysis of patterns of X-chromosome inactivation. Using DNA extracted from frozen tissues or paraffin-embedded archival specimens as template, polymerase chain reaction (PCR) was performed to generate amplified DNA fragments of exon 1 of the X-linked androgen receptor gene, which contains a highly polymorphic trinucleotide repeat. Predigestion of tumor DNA with methylation-sensitive restriction endonuclease Hha I or Hpa II permitted selective PCR amplification from the methylated (uncleaved) allele. Of a total of 54 tumors analyzed, 50 cases showed heterozygosity (93%) and were therefore informative for clonal analysis. Monoclonal composition of the tumors was suggested in a total of 49 of 50 cases, including 12 adenocarcinomas of the uterine endometrium, 13 squamous cell carcinomas of the uterine cervix, 6 adenocarcinomas of the uterine endocervix, and 18 epithelial tumors of the ovary. However, polyclonal composition was observed in one mucinous carcinoma of the ovary, in which we previously showed that both GGT-->GAT and GGT-->GTT mutations are present in > 20% of total K-ras copies in the tissue. Our studies demonstrate the utility of PCR amplification of highly polymorphic repetitive sequences for analysis of patterns of X-chromosome inactivation. This approach is practical for the analysis of clonal cell composition in a high proportion of both formalin-fixed and frozen archival tissues.

Paramesonephric mucinous cysts of the vulva

Three new cases of mucinous cysts of the vulva are reported. Characteristically, they are located in the superior portion of the labium minus of multiparous women. They are subject to trauma by virtue of their location and often produce discomfort and postcoital pain. The epithelial lining is distinctive. A simple layer of tall columnar cells has basally placed nuclei and cytoplasm containing abundant mucin. Papillary infoldings of the wall, focal subcolumnar reserve cell hyperplasia and squamous prosoplasia, and epithelial cilia are often present. The marked resemblance to the mucosa of the uterine endocervix suggests that these cysts are of paramesonephric (Müllerian) origin. The possible factors related to histogenesis include the effects of progestational hormones on developmentally displaced epithelium. These cysts are uncommon but should be distinguished from mesonephric duct cysts and other cystic lesions of the vulva.