Do Th17 cells play an important role in the pathogenesis and prognosis of ovarian cancer?

Ovarian cancer is the sixth most common cancer in women worldwide and remains the leading cause of death due to gynecologic tumors. Bad prognosis is caused by advanced-stage high-grade disease. To reduce mortality and improve outcomes in this type of cancer, researchers attempt to introduce new therapies based on genetic engineering or immunotherapy. Th17 lymphocytes belong to the helper T cell population. These cells arise from immature CD4 + lymphocytes in the presence of IL-6 and TGF-β. Produce IL-17A, IL-17F, IL-21, IL-22, IL-26, IL-6, TNF-α. Interleukin-17 and Th17 cells play an active role in inflammation and autoimmune diseases. The existence of these cells was confirmed in different types of cancer. However, the exact role of IL-17 in tumor immunopathogenesis remains undefined. It has been reported that expression of interleukin-17 in tumor cells suppresses tumor progression through enhanced antitumor immunity or promotes tumor progression through an increase in inflammatory angiogenesis

Atypical Endometrial Hyperplasia Arising in a Cesarean Section Scar: A Mechanism of Malignant Transformation

The incidence of scar endometriosis in Cesarean sections varies between 0.03 and 0.4%. However, the recently increased rate of Cesarean sections worldwide may be causing an increase in occurrence of scar endometriosis. This report presents anatomopathological evidence of an early-stage malignant transformation in endometriotic tissue from a post-Cesarean scar and briefly reviews possible underlying mechanisms. A 40-year-old woman with a body mass index of 42.7 was referred to the gynecological department with recurrent pain and presence of a palpable mass in her Cesarean section scar. She had undergone this procedure 7 years earlier and began experiencing discomfort and pain at the incision site 6 months postoperatively. Surgical treatment was instituted with complete removal of the lesion. Anatomopathological examination revealed endometriotic tissue intertwined with atypical endometrial hyperplasia and fibrosis. At 2 years’ follow-up, she was asymptomatic, both clinically and based on ultrasound examination. Endometriotic foci inoculated within an abdominal scar may undergo malignant transformation. Long-lasting abdominal scar endometriosis, in morbidly obese women, requires special attention from the physician

Stężenie wybranych czynników angiogennych w płynie otrzewnowym i surowicy krwi pacjentek z endometriozą

Introduction: Endometriosis is a sex hormone-dependent and successively progressing gynecological disease, characterized by the presence of endometrial tissue outside the uterus. The etiology of endometriosis is known to be multifactorial, and its growth depends on immunological, hormonal, genetic and environmental factors. Angiogenesis plays a key role in implantation and growth of endometriotic lesions, as well as in adhesion formation. Physiologically angiogenesis is responsible for neoangiogenesis and recruitment of new capillaries from the already existing capillaries. It is well-documented that altered angiogenesis provokes improper follicular maturation, infertility, recurrent miscarriages, ovarian hyperstimulation syndrome, and carcinogenesis. Factors stimulating angionesis include angiogenin, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). Objectives: The aim of the study was to analyze angiogenic factor concentration (angiogenin, VEGF, FGF) in blood serum and peritoneal fluid in patients with diagnosed endometriosis and idiopathic infertility. Material and methods: A total of 39 patients were recruited for the study, including 19 patients (study group) diagnosed with endometriosis during the laparoscopic procedure and 20 patients (control group) with idiopathic infertility and no morphologic changes within the pelvis revealed during the laparoscopic procedure. All patients underwent laparoscopy during the follicular phase of the menstrual cycle. Vein blood sample was obtained before the procedure and during laparoscopy the entire peritoneal fluid was aspirated for further measurement of VEGF, FGF and angiogenin concentrations. Results: Angiogenin concentration in peritoneal fluid was statistically higher in patient with idiopathic infertility in comparison to endometriosis (p0.05). There were no significant differences between serum and peritoneal fluid in case of VEGF, FGF and angiogenin in any of the groups. Conclusions: Angiogenic factors concentration (VEGF, FGF, agiogenin) in the peritoneal fluid and blood serum during the follicular phase of the menstrual cycle is not a diagnostic criterion for endometriosis.Wstęp: Endometrioza jest hormonozależną, przewlekłą i postępującą chorobą charakteryzującą się występowaniem funkcjonującej tkanki endometrialnej poza jamą macicy. Etiologia endometriozy jest wieloczynnikowa, a rozwój jej zależy od czynników immunologicznych, hormonalnych, genetycznych i środowiskowych. Jednym z kluczowych procesów odpowiedzialnych za implantację i wzrost zmian endometriotycznych oraz tworzenie zrostów jest angiogeneza. Fizjologicznie proces ten odpowiada za powstawanie nowych naczyń oraz przebudowę już istniejących. Udowodniono związek pomiędzy występowaniem zaburzeń procesu angiogenezy a brakiem owulacji, niepłodnością, nawracającymi poronieniami, zespołem hiperstymulacji jajników oraz nowotworzeniem. Do czynników pobudzających angiogenezę możemy zaliczyć między innymi angiogeninę, naczyniowy czynnik wzrostu śródbłonka (VEGF) oraz czynnik wzrostu fibroblastów (FGF). Cel pracy: Celem pracy była ocena stężenia czynników angiogennych (angiogenina, VEGF, FGF) w surowicy krwi żylnej oraz płynie otrzewnowym pacjentek z endometriozą i niepłodnością idiopatyczną. Materiały i metody: Do badania włączono 39 pacjentek. Grupę badaną stanowiło 19 pacjentek, u których w trakcie laparoskopii zdiagnozowano endometriozę, natomiast do grupy kontrolnej włączono 20 pacjentek z niepłodnością o niewyjaśnionej etiologii, u których w trakcie laparoskopii nie stwierdzono zmian morfologicznych w obrębie narządów miednicy mniejszej. Pacjentki zostały poddane laparoskopii w fazie folikularnej cyklu miesiączkowego. Przed zabiegiem od wszystkich pacjentek pobrano krew z żyły łokciowej, a podczas operacji, bezpośrednio po wprowadzeniu trokarów aspirowano całą widoczną objętość płynu otrzewnowego w celu oznaczenia stężenia VEGF, FGF i angiogeniny. Wyniki: W grupie pacjentek z niewyjaśnioną niepłodnością stwierdzono istotnie statystycznie (p0,05). Stężenie VEGF i FGF w surowicy krwi oraz w płynie otrzewnowym było podobne u pacjentek z endometriozą i z niepłodnością idiopatyczną. (p>0,05). Nie wykazano istotnych różnic między surowicą a płynem otrzewnowym dotyczących stężeń VEGF, FGF i angiogeniny w każdej z grup. Wniosek: Stężenie czynników angiogennych (VEGF, FGF, angiogenina) w płynie otrzewnowym i w surowicy krwi kobiet w folikularnej fazie cyklu nie jest markerem odzwierciedlającym występowanie endometriozy

Expression of tumor necrosis factor-α (TNF-α) on peritoneal fluid mononuclear cells in women with endometriosis

Objectives: Tumor necrosis factor-α (TNF-α) plays a key role in the processes underlying the development of pelvic endometriosis. TNF-α acts on target cells via two receptors: TNFR1(p55) and TNFR2(p75). Depending on cell type and its activation state, ligand binding to TNF-α may induce activation and proliferation of the cells or promote apoptosis. The aim of our study has been to evaluate the expression of TNFR1 and TNFR2 on peritoneal fluid macrophages and T lymphocytes derived from women with endometriosis. Material and methods: The study group consisted of 22 patients with endometriosis (stage I and II rAFS). 14 patients with benign, non-inflammatory ovarian tumors composed the reference group. Mononuclear cells have been isolated from peritoneal fluid, obtained during laparoscopy. The expression of TNFR1 and TNFR2 proteins has been evaluated by means of flow cytometry, using monoclonal antibodies against CD120a, CD120b, CD3 and CD14. Results: The percentage of peritoneal fluid macrophages revealing the expression of TNFR1 and TNFR2 proteins has been higher in patients with endometriosis, in comparison with control group (22.6+/-5.3% vs. 6.8+/-1,8%; p=0.03 and 29.3+/-2.3% vs. 8.8+/-1.8%; p=0.01, respectively). The percentage of T lymphocytes with the expression of TNFR1 and TNFR2 has been similar in endometriosis and control group. Conclusion: Higher percentage of peritoneal fluid macrophages expressing TNFR1 and TNFR2 proteins in endometriosis suggests dependence of these cells on TNF-α stimulation. Changes in TNF receptors distribution on PF macrophages, but not lymphocyte, may play its role in the pathogenesis of endometriosis

Thrombocytopenia in pregnant women

Thrombocytopenia is one of the two most common hematological problems in pregnant women. It is defined as the platelet (PLT) count below 150 × 103/μL. Gestational incidental thrombocytopenia (GIT) represents about 75% of thrombocytopenia cases in pregnancy and it is believed that GIT is secondary to accelerated platelet destruction and increased plasma volume associated with pregnancy. The pregnancy complications such as preeclampsia and its most severe form — HELLP syndrome account for 20% cases of thrombocytopenia in pregnancy and primary immune thrombocytopenic purpura (ITP) — for 3–4 percent. During ITP, maternal antiplatelet antibodies can pass through the placenta and bind to fetal thrombocytes leading to the development of fetal thrombocytopenia which occurs in about 50% cases. Even if the maternal platelet count stabilizes, the estimated fetal and neonatal risk of thrombocytopenia in ITP is approximately 30%. Other types of thrombocytopenia in pregnant women constitute 1–2% of cases (disseminated intravascular coagulation, autoimmunological diseases, congenital, infection and drug-related, concomitant with blood neoplastic diseases). Although thrombocytopenia in pregnant women usually has a mild course, in case of a significant decrease in PLT count may lead to dangerous bleeding, especially when the platelet count falls below 20 × 103/μL.Since it is important to identify the cause of thrombocytopenia and to determine the risk for both the mother and the child, this paper presents the influence of maternal thrombocytopenia on the pregnancy course as well as its etiology and diagnostics. The treatment principles are discussed

Progress on macrophage's proinflammatory products as markers of acute endometriosis

To provide the review of the macrophage activity products as pathophysiological markers of endometriosis by literature survey (PubMed, Cochrane). Immunoreactive cells and several of their synthesis products concentrations are elevated in the serum and peritoneal fluid in patients with endometriosis. The enhanced reactive proteins contributed to local inflammation and aggregation of endometriotic lesions. Immune response and immune surveillance of tissue play an important role in pathogenesis of endometriosis. Activated macrophages in peritoneal environment secrete immunoreactive cytokines which are responsible for inflammatory cascade of reactions. The immunoreactive cytokines should be a target not only as a disease marker but also as a part of therapeutic protocol

The State of Health and the Quality of Life in Women Suffering from Endometriosis

Quality of life is related to good health, family relations, feeling of self-esteem, and ability to cope with difficult situations. Endometriosis is a chronic condition which affects different areas of life. The lack of satisfaction in everyday life is mainly due to constant pain. The process of adjusting to a life with illness is associated with negative emotions. The aim of the article is to review the current state of knowledge concerning the impact of social and medical factors on a population of women affected by endometriosis. Women with endometriosis have an impaired quality of life compared to the general female population. Psychological consequences of endometriosis include: depression, anxiety, powerlessness, guilt, self-directed violence, and deterioration of interpersonal relations. It may contribute to lower productivity at work and less satisfying intimate life. A multi-disciplinary, evidence-based care is needed. The disease can take away the ability to be physically active, obtain an education, work continuously, and interact with friends. Social support and cognitive-behavioral therapy are extremely important for healing