Concurrent Endometrial Cancer in Women with Atypical Endometrial Hyperplasia: What Is the Predictive Value of Patient Characteristics? †

Background: The rate of concurrent endometrial cancer (EC) in atypical endometrial hyperplasia (AEH) can be as high as 40%. Some patient characteristics showed associations with this occurrence. However, their real predictive power with related validation has yet to be discovered. The present study aimed to assess the performance of various models based on patient characteristics in predicting EC in women with AEH. Methods: This is a retrospective multi-institutional study including women with AEH undergoing definitive surgery. The women were divided according to the final histology (EC vs. no-EC). The available cases were divided into a training and validation set. Using k-fold cross-validation, we built many predictive models, including regressions and artificial neural networks (ANN). Results: A total of 193/629 women (30.7%) showed EC at hysterectomy. A total of 26/193 (13.4%) women showed high-risk EC. Regression and ANN models showed a prediction performance with a mean area under the curve of 0.65 and 0.75 on the validation set, respectively. Among the best prediction models, the most recurrent patient characteristics were age, body mass index, Lynch syndrome, diabetes, and previous breast cancer. None of these independent variables showed associations with high-risk diseases in women with EC. Conclusions: Patient characteristics did not show satisfactory performance in predicting EC in AEH. Risk stratification in AEH based mainly on patient characteristics may be clinically unsuitable

History of clinical transplantation

The emergence of transplantation has seen the development of increasingly potent immunosuppressive agents, progressively better methods of tissue and organ preservation, refinements in histocompatibility matching, and numerous innovations is surgical techniques. Such efforts in combination ultimately made it possible to successfully engraft all of the organs and bone marrow cells in humans. At a more fundamental level, however, the transplantation enterprise hinged on two seminal turning points. The first was the recognition by Billingham, Brent, and Medawar in 1953 that it was possible to induce chimerism-associated neonatal tolerance deliberately. This discovery escalated over the next 15 years to the first successful bone marrow transplantations in humans in 1968. The second turning point was the demonstration during the early 1960s that canine and human organ allografts could self-induce tolerance with the aid of immunosuppression. By the end of 1962, however, it had been incorrectly concluded that turning points one and two involved different immune mechanisms. The error was not corrected until well into the 1990s. In this historical account, the vast literature that sprang up during the intervening 30 years has been summarized. Although admirably documenting empiric progress in clinical transplantation, its failure to explain organ allograft acceptance predestined organ recipients to lifetime immunosuppression and precluded fundamental changes in the treatment policies. After it was discovered in 1992 that long-surviving organ transplant recipient had persistent microchimerism, it was possible to see the mechanistic commonality of organ and bone marrow transplantation. A clarifying central principle of immunology could then be synthesized with which to guide efforts to induce tolerance systematically to human tissues and perhaps ultimately to xenografts

History of clinical transplantation

How transplantation came to be a clinical discipline can be pieced together by perusing two volumes of reminiscences collected by Paul I. Terasaki in 1991-1992 from many of the persons who were directly involved. One volume was devoted to the discovery of the major histocompatibility complex (MHC), with particular reference to the human leukocyte antigens (HLAs) that are widely used today for tissue matching.1 The other focused on milestones in the development of clinical transplantation.2 All the contributions described in both volumes can be traced back in one way or other to the demonstration in the mid-1940s by Peter Brian Medawar that the rejection of allografts is an immunological phenomenon.3,4 © 2008 Springer New York

D-chiro inositol phosphoglycan (IPG-P) as a potential urinary marker to predict preeclampsia

Preeclampsia is a pathological condition that can complicate human pregnancy with a frequency between 2 and 7% of healthy nulliparous women worldwide. Inositol phosphoglycans P type (IPG-P) are phospholipids that exert an insulin mimetic activity and increase during pregnancy in fetal and maternal compartments with a clear higher concentration in pregnancies complicated by preeclampsia. A comprehensive review of the literature was performed to identify the most relevant studies about this topic. Many authors in the last decades investigated IPG-P modifications in different compartments of preeclamptic pregnancies, finding an increased concentration of this phosphoglycans in villous stroma, cord blood, amniotic fluid and in maternal urines even weeks before the clinical onset of the disease. According to these findings, urinary IPG-P can be a reliable test to identify women at risk of preeclampsia weeks before the clinical presentation of the maternal syndrome. This test showed a good sensitivity and specificity and it is based on a low-cost and direct assay that makes this method of great interest especially in low-and middle-income countries. Further longitudinal studies in different ethnic groups are warranted to demonstrate a transverse efficacy of the test

Genital-peritoneal tuberculosis: A case with different diagnostic work up

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Ten-year survival in patients with endometrial adenoacanthoma and endometrial adenocarcinoma with malignant squamous cell differentiation

Objectives: It is acknowledged that squamous differentiation in the endometrial adenocarcinoma does not affect the outcome of type I cancer. However, it has been recently reported that the so-called shadow cell differentiation is likely present in endometrial adenoacanthomas. As the shadow cells differentiation suggests a caspase-independent cell death, based on the previous reports it can be hypothesized that the endometrial adenoacanthoma would have a better prognosis than the endometrial adenocarcinoma with squamous differentiation. Methods: From a database of 829 endometrial cancer, 34 endometrial adenoacanthomas and 18 endometrial adenocarcinomas with malignant squamous differentiation were assessed. The Kaplan-Meier curves were generated and compared for endometrial adenoacanthomas and endometrial adenocarcinomas with malignant squamous differentiation. Results: the 10-year survival in patients with adenocarcinoma with malignant squamous differentiation is significantly lower than the survival in patients with adenoacanthoma. Advanced stage (2009 FIGO II or over) was more likely found in adenocarcinoma with malignant squamous differentiation at the surgery time. Matching groups for the FIGO stage, there were no difference in overall survival. Conclusion: patients with endometrial adenoacanthoma have a better prognosis than patients with endometrial adenocarcinoma with malignant squamous differentiation probably because of the earlier stage diagnosis

Complete work-up for the management of retained products of conception

Retained products of conception represent an uncommon complication after miscarriage, planned termination of pregnancy, term spontaneous vaginal delivery or caesarean section. The aim of this study was to review the diagnostic and therapeutic management of this condition, according to the current literature, in order to assess patients correctly and reduce the number of unnecessary procedures with all their consequences. This updated review of the literature explores the pathophysiology, clinical features, diagnostic investigations, and treatment options for this complex condition. Laboratory tests are normal in most cases and have limited utility. Gray scale and Color Doppler ultrasound are the first line modality for the diagnosis of RPOC, even if ultrasound features alone should not be considered as conclusive, having an overall reported sensitivity of 44-85% and a specificity of 88-94%. Hysteroscopic resection of placental remnants, in absence of electricity use, seems to be the best treatment option with low risks and less complications related to fertility. Diagnosis and correct management of RPOC remain a major clinical challenge, since no clearly defined diagnostic criteria and treatment guidelines still exist. Hysteroscopic resection seems to be a good option, but well-designed randomized controlled trials are needed to define the best treatment modality