Uterine Lesions Research Articles

Abstract 5771: Performance of uterine cervix liquid based cytology, in patients with ASCUS by conventional pap smear

Abstract Background: The diagnosis of uterine cervix premalignant lesions is ​​the goal of cervical cancer prevention programs; Conventional Pap smear (CPS) with its limitations remains the screening method used in these programs in many Latin-American countries. In Colombia, after the implementation of CPS as a primary screening test, a less than expected decrease in mortality from cervical cancer has been observed. Actions aimed to improving cytological diagnosis could reduce the number of patients followed and treated unnecessarily. The demonstration of high specificity for liquid-based cytology (LBC) to adequately categorize cases with ASCUS in CPS, will serve as support for public health authorities, in their decisions about the best method to the screening programs. Design: Were included all patients with ASCUS results in CPS, referred to a Cervical Pathology Unit in Cartagena, Colombia. Material for LBC was obtained and LBCs were interpreted by two pathologists, blind to previous CPS or colposcopy diagnosis. Colposcopy were classified as negative/normal and positive/abnormal, colposcopic abnormalities were biopsied. Histological analyzes were performed by two pathologists blind to CBL outcome. Pathology diagnosis used were: CIN1/HPV infection: low-grade squamous intraepithelial lesion (LSIL), CIN2/CIN3: high-grade squamous intraepithelial lesion (HSIL). Diagnostic gold standards used to calculate LBC performance were: normal/negative for SIL: if colposcopy did not reveal lesion or colposcopy was abnormal but biopsy revealed no lesion; abnormal/positive: biopsy diagnosis ≥CIN2. Sensitivity, specificity, positive (PPV), negative predictive values (NPV), ​​ and Kappa concordance and correlation test were performed. Results: A total of 114 cases taken from patients with ASCUS in CPS were included, 77 of them corresponded to patients ≥30 years old. LBC sensitivity and specificity to detect HSIL/≥CIN2 were 76.5% and 66.0% respectively; PPV and NPV were 28.3% and 94.1%, when the cut-off point was a cytological result of HSIL. The concordance with the histological study was k = 0.2492 (p= 0.01). LBC is possible to reduce doubtful results and colposcopy remissions. Using LBC there were fewer results of ASCUS which is the most common cytological abnormality in screening populations that imposes heavy burden for follow-up. Concordance in HSIL cases with histological study was 100%, but in general the accuracy measured by the kappa statistic is low. Conclusions: These results support the evidence that LBC is no more sensitive than CPS for detection of HSIL/≥CIN2. The sensitivity and predictive values for HSIL/≥CIN2 were not significantly different between CPS and LBC, but, taking into account the benefits of unsatisfactory minors, and material availability for molecular biomarkers and HPV detection in the same sample, it could be used in cervical cancer program management guidelines. Citation Format: Ines Benedetti, Yoled Vizcaino, Lia Barrios. Performance of uterine cervix liquid based cytology, in patients with ASCUS by conventional pap smear [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5771.

ASSESSMENT OF SUSPICIOUS OVARIAN MASSES BY COMPARATIVE STUDY OF USG AND CT TECHNIQUES

Undoubtedly, most ovarian lesions, endometrial pathology and uterine lesions are best detected with ultrasound. Computed tomography (CT) imaging offers better diagnostic capabilities for large pelvic masses, tubo- ovarian abscesses, postoperative and postpartum complications. In some cases, Computed Tomography (CT) is employed to achieve optimal differential Diagnosis to determine the clinical pathway to follow. Hence based on above findings the present study was planned for Assessment of Suspicious Ovarian Masses by Comparative Study of USG and CT Techniques.
 The present study was planned in Department of Radio- Diagnosis, Katihar Medical College, Katihar (Al-Karim University), Bihar, India. In the present study 50 females were enrolled having Suspicious Ovarian Masses. Computed tomography (CT) and USG characteristics of different lesions were noted and recorded. The histopathological diagnosis was followed up and recorded. The results of this study were analysed and compared with other available studies in literature.
 The data generated from the present study concludes that Ultrasonography is usually the first imaging modality in evaluation of female patients suspected to have pelvic pathology. Computed tomography is superior diagnostic imaging modality than USG prior to treatment which improved detection and characterization of tumour due to better diagnostic accuracy and consequently reduction of invasive procedure which lead to significant reduction of mortality and morbidity from tumour.
 Keywords: Ovarian Masses, Comparative Study, USG, CT Techniques, etc.

The Uterine Plexiform Lesions Revisited.

Uterine lesions with plexiform morphology are uncommon lesions with debated histogenesis. Despite being an incidental and usually benign finding (plexiform tumorlet), some cases can pose diagnostic problems. Their paucity in the recent literature adds to these difficulties and often causes ambiguities. The objective of this study is to systematically review published cases to highlight the historical aspects of their recognition, reappraising their morphology, histogenesis, and differential diagnosis. English literature is reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and 32 reports are analyzed. Most cases are reported in the fourth to sixth decades. In most cases (66.7%), plexiform lesions are incidental findings while 33.3% of cases have been the chief pathology. Size varies from 0.5 to 195 mm. Plexiform foci were solitary in 78.2% cases and multiple in 21.8%. In 67.8% of cases, the lesions are reported as myometrial, while 32.2% are arising from endometrial stroma. Immunohistochemistry shows smooth muscle and no sex cord marker expression. They are usually benign lesions, but worrisome features include plexiform morphology in disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, and diffuse uterine leiomyomatosis. Plexiform lesions represent a diverse pathology varying from epithelioid leiomyomas to epithelioid smooth muscle metaplasia of endometrial type of stroma.

Abstract A20: Persistent high-risk HPV infection in the development of uterine cervical cancer

Abstract The early detection and treatment of preneoplastic uterine cervical lesions is certainly a major challenge for developing countries. Preneoplastic lesions result from human papilloma virus (HPV) infection in cells located in the transformation zone of the cervical epithelial tissue, causing low-grade or high-grade lesions. HPV infections are transient and most of the time cleared within a couple of years following exposure. However, 10–20% of infections persist latently, leading to disease progression and, ultimately, various forms of invasive cancer. The transformation of preneoplastic lesions in invasive cancer cells is provoked at least partly by HPV, especially through gene and protein expression modulation. This modulation involves tissue oxygenation, oncogene activation, loss of tumor suppressor genes and aberrant molecular signaling pathways (such as Insulin-like growth factor-1 receptor (IGF-1R). In recent studies, it was reported that IGF1R is overexpressed by effect of E6 AA-a and E-G350 HPV-16 variants. The aim of the present study was to prospectively and retrospectively report the detection of HPV-16 variants and IGF1R expression in patients with cervical cancer and assess the relationship with development of uterine cervical cancer. Sixty consecutive patients with invasive cervical cancer were assessed for HPV-16. A total of 35 patients (58.3%) were infected with HPV-16, with a mean age of 51 years (range: 30–76 years). Thirty patients (85.7%) were diagnosed with European HPV-16 variant and five patients (14.3%) were diagnosed with non-European HPV-16 variants. European HPV-16 variants (E-HPV-16) were mainly E-G350 (n = 14; 41.1%) and E-T350 (n = 12; 35.2%) subclasses. Of these 35 patients, 15 received exclusive radiotherapy and four radiochemotherapy, and the remaining 16 did not complete the treatment (NCT). Of the patients who presented an incomplete response, overexpression of IGF1R was detected in all. Of patients NCT, we retrospectively studied one case in IIIB stage FIGO. Samples of preneoplastic lesions and invasive cervical cancer were analyzed to confirm histopathologic diagnosis and detect the presence of HPV variants and overexpression of IGF-1R. Of the results found in this case, in which the patient was diagnosed in 1986 with a high-grade squamous intraepithelial cervical lesion, HPV-16 E-G350 and HPV-33 coinfection as low expression of IGF1R were detected and for the invasive cancer diagnosed in 2002, the presence of HPV-16 AA-c and overexpression of IGF1R was detected. The detection of high-risk HPV in samples of preneoplastic lesions and invasive cancer in a 60-year-old patient at the time of diagnosis showed that HPV33 infection was eliminated. Results such as these suggest that persistent infection with HPV-16 variants, overexpression of IGF1R, such as viral load and age, could be necessary factors for disease progression, and thus contribute to the identification of patients with a high risk of viral persistence and development of cervical neoplasia. Note: This abstract was not presented at the conference. Citation Format: Pablo Moreno Acosta, Diana Mayorga, Nicolas Magné. Persistent high-risk HPV infection in the development of uterine cervical cancer [abstract]. In: Proceedings of the AACR Special Conference on the Microbiome, Viruses, and Cancer; 2020 Feb 21-24; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2020;80(8 Suppl):Abstract nr A20.

Role of Uterine Artery Embolization in Management of Uterine Lesions with Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding is one of the most frequent gynecological and obstetrics problems. Till the recent decades, myomectomy and hysterectomy were the only treatment options available to control uterine bleeding regardless the morbidity and mortality. Over the past decade, uterine artery embolization (UAE) has become a popular alternative treatment. Our study aim is to evaluate the efficacy of UAE for the treatment of uterine bleeding of different etiologies as Fibroids & uterine arterio-venous malformation (AVM). Material & Methods: Thirty patients were enrolled in the study: 28 patients with fibroids & 2 patients with AVM, all underwent UAE by PVA for fibroid & Hystroacryl with lipidol & coils for AVM. Bleeding as an end point was Followed up for 6 months. Results: Cessation of bleeding with no recurrence through the 6 months of follow up. UAE significantly decreased the bleeding towels from 4.4 to 2 towels after 6 months. As well, the menstrual duration was reduced from 7.6 to 4.4 days (p < 0.05*). Hemoglobin level was boosted from 10.7 to 11.4 gm/dl after 6 months (p=0.001*). As well, the fibroid size was significantly reduced from 314.7 to 70.4 cm3 after 6 months (p < 0.05*). The AVM cases have completely recovered & one of them got pregnant with delivery of normal fetus with no reported complication. The majority of our patients showed high level of satisfaction with the obtained outcomes. Conclusion: UAE, either unilateral or bilateral, is a safe and effective technique for management of abnormal uterine bleeding of fibroids & AVM origin. A high clinical success rate and fibroid volume with the mean menstrual duration& amount reduction can be achieved.

UTERINE FIBROIDS IMPACT ON FERTILITY AND PREGNANCY OUTCOME

The clinical confirmation of the relationship between uterine leiomyoma and female infertility is of interest to scholars. The aim of our research was to study obstetric history and the level of sex hormones in women of reproductive age with leiomyoma. Materials and methods. The main group consisted of 90 women of reproductive age with uterine leiomyoma, the control group - 45 healthy women. Gynaecological and obstetric history, hormone content in peripheral blood and pelvic vessels (estradiol, progesterone) were analysed. Statistical processing of clinical material was performed using Microsoft Excel, Statistica 7.0, and Statistica 8.0 for Windows. Results. The frequency of infertility in the surveyed women with LM was 18.9 %. One in three patients in the main group (33.3 %) did not give birth, which was statistically different from the healthy women group. In this case, 25.6 % of women in the main group did not use any methods of contraception. It was found that 51.11 % of patients with LM had threatened miscarriage in their history, 37.5 % – complicated delivery. Pathological changes in the concentrations of estradiol and progesterone in the preferential blood and blood vessels of women with fibroids have been identified. We have found that the content of sex hormones in the local bloodstream has a reliable relationship with the location of the myomatous node. Conclusion. The obtained results may indicate that leiomyoma contributes to the reduction of fertility. This is evidenced by the fact that women with LM are more likely to have the risk of miscarriage, complicated delivery and delivery by caesarean section, including complicated one. The findings have made a significant contribution to the further development of effective strategies for the prevention and treatment of infertility in women with fibrotic uterine lesions.

Diagnostic Accuracy of 3D-transvaginal Ultrasound Compared to Hysteroscopy in Detecting Uterine Abnormalities Before ICSI

Abstract Introduction Various forms of female infertility were associated with congenital uterine anomalies and acquired uterine disease. In fact, the myometrium can only be indirectly imaged by X-ray hysterosalpingography but is directly seen on Ultrasonography. More recently, further advances in ultrasonography have led to three-dimensional multiplanar or volume imaging (three-dimensional ultrasonography [3DUS]) in which sonographic images are obtained from a volume of ultrasonographic data (rather than from a slice of data) the application of 3DUS to gynecologic imaging has suggested a role for transvaginal 3DUS in the assessment of uterine anomalies and endometrial lesions. Aim To evaluate the diagnostic accuracy and sensitivity of Hysteroscopy vs TV3D in the evaluation of the uterine abnormalities in infertile women before ICSI. Methodology This is a study including 60 patients were selected from the outpatient gynecological clinic, private center at Sohag government (Ibn Sina Center) in collaboration with (Ain Shams University Hospital in IVF unit) from12/2017 -8/2018. All cases files are computerized and saved in Ibn Sina Center. Results The overall result of accuracy of different modalities was 98.3% for 3D sonography and the accuracy of different modalities in detection of endometrial polyp was 93.3% for 3D sonography and 100% for hysteroscopy. The accuracy of different modalities in detection of septate uterus was 100% for 3D sonography and hysteroscopy. The accuracy of different modalities in detection of intrauterine adhesions was 100% for 100% for 3D and hysteroscopy. Conclusion Hysteroscopy is the gold standard diagnostic & therapeutic tool for uterine anomalies (bicornuate, septate, arcuate, polyp), However 3D ultrasonography is diagnostic tool only but superior to hysteroscopy in certain lesions e.g. (subserous and intramural fibroid). Recommendation we recommend 3D to become soon as the diagnostic procedure of choice in assessment of suspected uterine lesions. Furthermore, we recommend that 3D US, if available, to be performed routinely for all cases of uterine cavity anomalies and prior to corrective uterine surgery.

Uterine precursor lesions in patients with incidental nodal lymphangioleiomyomatosis: A report of 4 cases

Uterine sections from 6 patients with incidental nodal lymphangioleiomyomatosis (LAM) were examined for LAM lesions by screening these sections with cathepsin K immunohistochemistry (IHC) stains. The hysterectomy specimens were all concurrent with the lymph node dissections in which the nodal LAM was discovered. In 4 of 6 patients microscopic lesions of pre-LAM were identified and confirmed by IHC staining for HMB-45 and beta-catenin. All lesions were grossly inapparent and also inapparent by routine hematoxylin and eosin stains. Three variants of pre-LAM lesions were identified. None of the pre-LAM lesions had an associated lymphatic proliferation. It is proposed that these pre-LAM lesions gave rise to the incidental nodal LAM lesions. Furthermore, it is suggested that the absence of an associated lymphatic proliferation associated with these lesions may be a factor in the attenuated potential for spread and the only rare association of these nodal lesions with pulmonary LAM.

Pathological and bacteriological studies on reproductive tract abnormalities of she-camels (Camelus dromedarius), emphasizing on zoonotic importance.

Objective:Infertility caused by reproductive pathologies plays a significant role in animal breeding and could result in massive economic losses to livestock owners. Hence, this study was designed to allocate various pathological lesions in the female reproductive tract of she-camels (Camelus dromedarius) slaughtered in Egypt and isolate the causative agents associated with those pathologies.Materials and Methods:A total of 500 genitalia of adult nonpregnant she-camels aged between 6 and 15 years old were collected from three slaughterhouses at the Giza Governorate, Egypt, from August 2017 to August 2019. The uterus, cervix, and vagina were examined pathologically and microbiologically.Results:The uteri of 152 cases (30.4%), cervices of 24 cases (4.8%), and vaginae of 20 cases (4.2%) showed pathological abnormalities. The uterine inflammatory lesions were detected in 119 cases (23.8%), and the non-inflammatory lesions were detected in 58 cases (11.6%). Pathological changes of the cervix comprised 4.8%, whereas vaginal abnormalities represented 4%. The total microbial recovery rate was 28.4%, and the isolated organisms included Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas aeruginosa, in addition to Candida albicans. Trials to isolate Brucella and Salmonella species were negative; however, virological examination revealed the isolation of bovine herpesvirus type-1 in two cases.Conclusion:Inflammatory lesions were the most prevailing pathological lesions observed along the genital tract of she-camels, and E. coli was the most prevalent isolate. The microbiological burden from the genital discharge could be of zoonotic importance to the examiner and could be a contaminant to the environment and, consequently, human. In addition, attention should be paid toward the possibility of infected she-camels to transmit such infections to farm animals in contact.

Atypical Mesonephric Hyperplasia of the Uterus Harbors Pathogenic Mutation of Kirsten Rat Sarcoma 2 Viral Oncogene Homolog (KRAS) and Gain of Chromosome 1q.

Mesonephric carcinoma (MNC) is a rare but notable entity of the female genital tract. While many researchers have acknowledged and studied MNC, much remains unknown on the characteristics of mesonephric remnant (MNR) or hyperplasia (MNH). There has not been any study examining the molecular features of MNR and MNH so far. The aim of this study was to investigate the clinicopathological and molecular characteristics of ten uterine mesonephric lesions, including two MNRs without atypia, four MNHs without atypia, and three MNHs with atypia. We reviewed the electronic medical records and all available slides of ten cases from multiple institutions. Targeted sequencing and array comparative genomic hybridization were performed. Three atypical MNHs displayed nuclear enlargement, mild-to-moderate nuclear pleomorphism, and nuclear membrane irregularity, and harbored pathogenic Kirsten rat sarcoma 2 viral oncogene homolograt sarcoma 2 viral oncogene homolog (KRAS) mutation. Two of those that co-existed with MNC harbored the same sequence alterations as each of their adjacent MNC. One of the three atypical MNHs harbored chromosome 1q gain. Atypical MNH is a potential premalignant lesion in which KRAS mutation and chromosome 1q gain play an important role in the early stage of mesonephric carcinogenesis.

Hysterolaparoscopy (pan-endoscopy) in the management of female infertility in Nigeria: A report of 230 cases

Background: Hysterolaparoscopy has emerged as a better evaluation tool than laparoscopy and dye test in cases of infertility because of the ability to evaluate intra uterine lesions. Objective: To examine the role of Hysterolaparoscopy in the management of infertile women who were seen in 2 Fertility/ Gynaecological Endoscopy units in Nigeria. Methods: A cross sectional descriptive survey of the first 230 infertile women who were managed in the fertility and Gynaecological endoscopy units of Nnamdi Azikiwe University Teaching Hospital Nnewi Anambra State, Nigeria and Holy Rosary Specialist Hospital & Maternity, Onitsha, Nigeria. Data were analyzed with STATA software, version 12.0 SE (Stata Corporation, TX, USA). Result: The mean age of the women was 35.6+/- 5.9 years and the mean duration of infertility was 4.6+/- 2.7 years. More than half (53.9%. n=43) of the women had secondary infertility. Ninety -eight (42.61%) of the women had done a pelvic surgery in the past and pelvic ultrasound study was abnormal in 95(41.3%) of them. Abnormal hysteroscopy was found in 152 (66.1%) of the women and comprised mainly of intrauterine adhesions (41.%; n=95), endometrial polyps (20.%; n= 46), submucous fibroids (16.1%; n=37) and mullerian duct abnormalities (14.8%; n=34). Other findings were lost IUCD (6.1%'n=14), retained fetal bone (2.6%; n=6) and incarcerated omentum (2.2%; n=5). Abnormal laparoscopy findings were seen in 171 (74.4%) of the women. The main abnormal laparoscopy findings were tubal pathologies (161, n=70.0%), pelvic adhesions (39.6%, n=91), polycystic ovaries (33.0%; n=76), and endometriosis (8.8%, n=19). Tubal pathologies comprised mainly tubal occlusions (56.5%, n=130), hydrosalpinx (41.7%, n= 96) and plastered tubes (25.7%, n=59). Bilateral tubal occlusion was seen in 46 (20.0%). Conclusion: Hysterolaparoscopy is an effective tool for evaluating tuboperitoneal and intrauterine lesions among infertile women. There is a need to develop the capacity for this investigative modality.

Role of Hormones in Common Benign Uterine Lesions: Endometrial Polyps, Leiomyomas, and Adenomyosis.

Leiomyoma, adenomyosis, and endometrial polyps are benign uterine disorders which seem to develop in the context of hormonal imbalances, due to steroid hormones, estrogen and progesterone, in association with various factors ranging from genetic factors to modifiable lifestyle factors. A growing body of evidence suggests that those hormones and their receptors are key modulators in the genesis and the growth of those pathologic entities. Further studies are required to understand their involvement in the pathogenesis of those lesions and their link to other factors such as extracellular matrix components, growth factors, chemokines, cytokines, and tissue repair mechanisms.

Treatment outcomes of uterine lesion resection versus hysterectomy for cesarean scar pregnancy

Treatment outcomes of uterine lesion resection versus hysterectomy for cesarean scar pregnancy

Role of diffusion-weighted magnetic resonance imaging in the characterization of uterine neoplasms

Context Uterine malignant neoplasms are considered a frequent major cause of mortality. Aims To detect the role of diffusion-weighted images in assessing uterine neoplasms. Settings and design Department of Radiology, Assiut Faculty of Medicine, Egypt. Department of Obstetrics and Gynecology, Assiut Faculty of Medicine, Egypt. Patients and methods Our study included 20 patients with uterine neoplasms. All patients were examined by pelvic advanced MRI techniques with diffusion MRI. Statistical analysis Categorical data were reported in frequencies and percentages. Quantitative data were reported as mean (SD) and evaluated for statistically significant differences between both groups utilizing independent Student's t test. Results The apparent diffusion coefficient value in benign uterine lesions is equal to 1.088 ± 0.146 and for the malignant lesions it is equal to 0.658 ± 0.178 with a P value of 0.000 which is highly significant. A cutoff apparent diffusion coefficient value of 0.85 × 10-3 mm2/s for malignant lesions resulted in 91.7% sensitivity, 100% specificity, 100% positive predictive value, 88.7% negative predictive value, and 91.67% accuracy. Conclusions Diffusion-weighted image has a great role in differentiating malignant and benign uterine neoplasms.

VALIDITY OF DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING AND APPARENT DIFFUSION COEFFICIENT MAP IN DIFFERENTIATING BENIGN FROM MALIGNANT UTERINE ENDOMETRIAL PATHOLOGIES

Endometrial pathologies represent a diagnostic challenge for radiologist and gynecologist due to dynamic changes of the endometrium, wide variability in imaging appearance and overlap between benign and malignant causes of endometrial abnormalities. Although tissue analysis via dilatation and curettage, endometrial biopsy or hysteroscopy is the backbone in the diagnosis, these tests are invasive, not without complications and may be difficult to perform in certain circumstances, hence the need for noninvasive imaging methods to aid in the diagnosis and triaging the patient for subsequent invasive procedures as well as contribution in treatment planning. This study aimed to evaluate the role of diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value measurement in differentiating benign from malignant uterine endometrial lesions. The study included 47 patients with endometrial lesions divided into two groups according to the result of histopathological analysis; the malignant group consisting from 18 cases and the benign group consisting from 29 cases, the latter was further subdivided into: polyp, hyperplasia and other benign entities. Pelvic magnetic resonance imaging with DWI performed for each patient with visual evaluation of signal intensity on diffusion and ADC value measurement. Subsequently mean ADC values for each group were calculated and compared, and validity measures for the optimal cut-off values for differentiating benign from malignant lesions were determined. The mean±standard deviation for ADC value (x10-3mm2/sec) for malignant group was 0.71±0.12, and for benign group was 1.52±0.42, with a significant difference between the two groups (P value <0.01), there was no significant difference in ADC value between the subdivision of benign group. At ADC cut-off value of 0.976x10-3mm2/sec, the sensitivity, specificity, positive predictive value and negative predictive value and accuracy of DWI in detecting endometrial carcinoma were 100%, 89.6%, 85.71%, 100% and 93.62% respectively. In conclusion, DWI with ADC value measurement is a valuable non-invasive diagnostic test, aiding in the differentiation of benign from malignant uterine endometrial cavity lesions. Key words: diffusion weighted imaging, apparent diffusion coefficient map, benign endometrial lesions, malignant endometrial lesions.

Correlation between Uterine Cervical Lesion and HPV in Busan Region

2013년 1월부터 2016년 3월 사이 인제대학교 해운대백병원에 내원한 환자를 대상으로 HPV genotype 분석 후 세포학적 검사 결과, 조직학적 검사 결과와 비교하였다. 총 검사대상 2,130건 중 58.9%인 1,254건은 HPV 양성으로, 41.1%인 876건은 HPV 음성으로 분석되었다. HPV 양성검체 중 단순감염은 58.4%인 732건, 복합감염은 41.6%인522건이었다. 감염비율은 HPV 16, 68, 56의 순으로 각각7.1%인 152건, 4.6%인 97건, 3.8%인 80건으로 나타났다. HR HPV 감염은 40대, 30대, 50대 순으로 높은 감염률을 보였고, LR HPV 감염은 40대, 50대, 30대 순으로 높은 감염률을 보였다. 조직병리학적 분석 결과 CIN 2 이상으로 나온HPV 16, 68, 56 건수는 329건 중 155건으로 47.1% (155/329)로 분석되었다. 부산지역 여성의 HPV subtype 감염은 주로 16, 68, 56, 58, 51과 관련이 있었으나, 이중68, 56, 51형은 현재 시판 중인 GardasilⓇ 9가 백신으로도 예방할 수 없는 유전자형이었다. 이 연구를 통해 부산 지역의 HPV 예방 접종을 위한 프로그램에 대한 중요한 기준 데이터를 제공할 수 있을 것으로 사료된다.

Correlation between endometrial thickness and perinatal outcome for pregnancies achieved through assisted reproduction technology.

Objective To explore the relationship between endometrial thickness and perinatal outcome in assisted reproductive techniques (ART). Methods A retrospective cohort study was conducted in 1139 infertile women who underwent ART treatment from January 2011 to July 2014. Four groups were divided by endometrial thickness on the human chorionic gonadotropin (HCG) trigger day in fresh embryo transfer cycles or on the progesterone administration day in frozen embryo transfer cycles, as group A (<8 mm), group B (8-10 mm), group C (10-14 mm) and group D (≥14 mm). Two other groups were delineated according to whether uterine lesions were present. The incidence of premature rupture of membranes (PROM), postpartum hemorrhage (PPH) and other common perinatal complications were observed subsequently. Results It was found that the highest incidence of PROM and PPH was in group A (P < 0.05). The incidence of PROM in group B was higher than in groups C and D (P < 0.05). The occurrence of mothers entering the intensive care unit (ICU) was significantly higher in group A than in group B (P < 0.05). However, no significant differences were found in other adverse outcomes. There was no difference in the incidence of adverse perinatal outcome when the endometrial thickness of pre-implantation was not attenuated by uterine lesions. Conclusion The incidence of PROM and PPH increased significantly when the thickness of the endometrium was less than 10 mm before implantation. Correspondingly, the number of mothers treated in the ICU was also higher under these circumstances. To reduce such perinatal placenta-related complications, we should maximize the thickness of the endometrium before transplantation of embryos.

Application of deep learning to the classification of uterine cervical squamous epithelial lesion from colposcopy images combined with HPV types.

The aim of the present study was to explore the feasibility of using deep learning, such as artificial intelligence (AI), to classify cervical squamous epithelial lesions (SILs) from colposcopy images combined with human papilloma virus (HPV) types. Among 330 patients who underwent colposcopy and biopsy performed by gynecological oncologists, a total of 253 patients with confirmed HPV typing tests were enrolled in the present study. Of these patients, 210 were diagnosed with high-grade SIL (HSIL) and 43 were diagnosed with low-grade SIL (LSIL). An original AI classifier with a convolutional neural network catenating with an HPV tensor was developed and trained. The accuracy of the AI classifier and gynecological oncologists was 0.941 and 0.843, respectively. The AI classifier performed better compared with the oncologists, although not significantly. The sensitivity, specificity, positive predictive value, negative predictive value, Youden's J index and the area under the receiver-operating characteristic curve ± standard error for AI colposcopy combined with HPV types and pathological results were 0.956 (43/45), 0.833 (5/6), 0.977 (43/44), 0.714 (5/7), 0.789 and 0.963±0.026, respectively. Although further study is required, the clinical use of AI for the classification of HSIL/LSIL by both colposcopy and HPV type may be feasible.

Sonic Hedgehog, a Novel Endogenous Damage Signal, Activates Multiple Beneficial Functions of Human Endometrial Stem Cells.

Local endometrial stem cells play an important role in regulating endometrial thickness, which is an essential factor for successful embryo implantation and pregnancy outcomes. Importantly, defects in endometrial stem cell function can be responsible for thin endometrium and subsequent recurrent pregnancy losses. Therefore, many researchers have directed their efforts toward finding a novel stimulatory factor that can enhance the regenerative capacity of endometrial stem cells. Sonic hedgehog (SHH) is a morphogen that plays a key role in regulating pattern formation throughout embryonic limb development. In addition to this canonical function, we identified for the first time that SHH is actively secreted as a stem cell-activating factor in response to tissue injury and subsequently stimulates tissue regeneration by promoting various beneficial functions of endometrial stem cells. Our results also showed that SHH exerts stimulatory effects on endometrial stem cells via the FAK/ERK1/2 and/or phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathways. More importantly, we also observed that endometrial stem cells stimulated with SHH showed markedly enhanced differentiation and migratory capacities and subsequent invivo therapeutic effects in an endometrial ablation animal model.

The usefulness of diffusion-weighted MRI in the differentiation between focal uterine endometrial soft tissue lesions

BackgroundSeveral endometrial conditions may be challenging for radiologists due to the overlap of imaging features and variable endometrial pathologies. MRI with DWI is the most commonly used imaging technique for the diagnosis and characterization of endometrial focal lesions.ResultsThe 50 studied lesions were classified according to their histopathological results into the benign group (28 lesions, 56%) and the malignant group (22 lesions, 44%). Conventional MRI could correctly diagnose 39 of the 50 lesions (22/28 benign and 17/22 malignant lesions), achieving a sensitivity of 77.27%, specificity of 78.56%, accuracy of 78%, predictive positive value (PPV) of 73.91%, and negative positive value (NPV) of 81.48%. By combining DWI and apparent diffusion coefficient (ADC) value mapping at a high b value (b = 1000) in MRI, we could correctly diagnose 47 of the 50 lesions (26/28 benign and 21/22 malignant lesions), with increased sensitivity (95.45%), specificity (92.86%), accuracy (94%), PPV (91.3%), and NPV (96%).ConclusionCombining DWI with ADC mapping at a high b value in pelvic MRI examination is valuable in differentiating endometrial focal lesions with increased diagnostic sensitivity, specificity, and accuracy.Aim of the workThis study aimed to evaluate the role of DWI in the diagnosis and differential diagnosis of benign and malignant focal endometrial masses.