Endometrioza i mięsakorak – hipotetyczny związek czy udowodniona wspólna ścieżka patogenetyczna? Opis przypadku mięsakoraka jelita grubego wychodzącego z ogniska endometriozy

We present the first case of a patient with a synchronic occurrence of three neoplasms: non-small cell lung cancer, serous cancer of the ovary, and carcinosarcoma of the colon. Moreover, the possible origin of the carcinosarcoma is an endometriotic focus, which is an extremely rare occurrence, especially in women with no history of endometriotic treatment. Immunohistochemical staining of the carcinosarcoma was positive for CD10, estrogen receptors and desmin – typical markers for endometriotic foci. The growth of endometriosis depends on estrogen, which is produced at reduced levels after menopause. However, in some cases endometriosis could be diagnosed de novo in postmenopausal women. On the basis of the reported patient we discuss possible correlations between endometriosis and carcinosarcoma, as well as treatment methods of carcinosarcoma.Prezentujemy pierwszy na świecie przypadek pacjentki, u której rozpoznano synchroniczne występowanie trzech nowotworów: niedrobnokomórkowego raka płuc, raka surowiczego jajnika oraz mięsakoraka jelita grubego. Co więcej, najbardziej prawdopodobnym punktem wyjścia mięsakoraka jelita grubego jest ognisko endometriozy. Niesłychanie rzadko opisuje się karcynogenezę związaną z endometriozą u pacjentek, które wcześniej nie leczyły się z powodu endometriozy. Badanie immunohistochemiczne mięsakoraka ujawniło ekspresję CD10, desminy oraz receptorów dla estrogenów – typowych markerów endometriozy. Aktualnie uznaje się, że endometrioza – mająca podłoże estrogenne, może być diagnozowana de novo nawet po menopauzie. Na podstawie przedstawionego opisu przypadku przedyskutowaliśmy możliwy związek endometriozy i mięsakoraka oraz dostępne opcje terapeutyczne mięsakoraków

IUMPA–2: release of medroxyprogesterone acetate from the intrauterine system in the treatment of endometrial hyperplasia relative to the patient's body mass index (BMI)

CelPo pierwsze: opracowanie systemu w postaci wkładki domacicznej zawierającej octan medroksyprogesteronu do leczenia rozrostów endometrium. Po drugie: sprawdzenie dystrybucji leku zastosowanego w postaci wkładki wewnątrzmaicznej w zależności od masy ciała.Materiał i metodaBadaniem objęto 20 kobiet po menopauzie z rozpoznanym histologicznie rozrostem prostym endometrium poddanych leczeniu przy użyciu IUMPA-2 przy zastosowaniu technik endoskopowych (hysteroskopowa biopsja celowana endometrium), histologicznych (ocena bioptatów) i ultradźwiękowych (pomiary objętości systemu terapetycznego oraz endometrium).WynikiWraz ze wzrostem BMI u wszystkich pacjentek wzrastała szybkość uwalniania leku z nośnika rzutując na rzeczywisty czas leczenia, który wynosił odpowiednio od 35 do 14 dni.Wnioski1) Masa ciała chorej wpływa na szybkość uwalniania octanu medroksyprogesteronu z IUMPA-2. 2) W przypadkach chorych o wysokiej masie ciała należy rozważyć 2-krotne, sekwencyjne założenie IUMPA-2.AimFirst, to develop a system of an intrauterine diaphragm with medroxyprogesterone acetate in the treatment of endometrial hyperplasia. Second, to check the distribution of this drug depending on the patient's BMI.Materials and methodsThe study comprised a group of 20 postmenopausal patients with histologically diagnosed simple hyperplasia treated with IUMPA-2 using endoscopic techniques (hysteroscopic targeted endometrial biopsy), histological methods (bioptate assessment) and ultrasound techniques (treatment volume and endometrial measurements).ResultsIn all patients investigated the rate of medroxyprogesterone acetate release increased with BMI, which had an effect on the treatment time ranging between 35 and 14 days, respectively.Conclusions1) The BMI affects the rate of medroxyprogesterone acetate release from IUMPA-2. 2) In patients with a high BMI double (sequentially) application of a diaphragm should be considered

Burch colposuspension – analysis of complications on our own material

Objectives: Literature describing complications after colposuspension and analyses of the learning curve is scarce. Knowledge concerning this topic may lower the frequency of complications, improve the effectiveness of the procedure and increase patients’ satisfaction. Design: The purpose of the study was to evaluate types and frequency of complications which occur during modified Burch colposuspension and shortly after the procedure (to the moment of admission home), aiming at the optimization of the operative technique. Materials and methods: Indications for colposuspension were: genuine stress incontinence II and III degree and paravaginal defect medium to large degree (type II stress incontinence according to Blaivais). We have analyzed first 400 procedures, performed by 3 gynecologists. A complex analysis of the course of the operation and postoperative period (till patient’s withdrawal from hospital) has been performed. Colposuspension has been conducted according to professor’s Petri’s tips. Results: The most common complications during the first procedures were: bleeding into Retzius space, transient haematuria and residual of urine after miction. Their incidence diminished with the increasing of number of procedures. The presence of highly experienced team during the operation lowered the risk of complications. Conclusions: Percentage of complications during and after modified Burch colposuspension is low and it decreases with the number of procedures

The efficacy of SUI treatment with Burch colposuspension evaluated with use of ITT analysis

Objectives: Search for methods of assessment of effects of SUI treatment, which goal is to minimize risk of bias, are inconclusive and remain the subject of investigation. Design: The aim of the study was to analyze the influence of application of different methods of efficacy measurement of SUI treatment with use of Burch colposuspension on final conclusions concerning the treatment effects. Material and methods: Prospective investigation was carried out among 50 women with SUI symptoms II or III degree, scheduled for Burch colposuspension. The analysis of obtained results was carried out with use of ITT and modified ITT. To compare, therapy effects were explored with the use of principles which have been, until quite recently, most often used in urogynecology. Results: Differences in percentage of cured, based on results of several urogynecologic examinations according to method of analysis (previously used method, ITT, modified ITT), have oscillated between 3% to 20%. Conclusions: 1. While selecting diagnostic methods to analyze SUI treatment effectiveness, potential problems with obtaining complete data after the treatment should be taken into account. 2. In order to minimize statistic bias, the usage of few methods of analysis of obtained results is highly recommended

The influence of SUI operative treatment with use of IVS tape on quality of life

Objectives: Real influence of urinary incontinence symptoms and adopted modes of treatment on patient’s quality of life is not known. Design: Assessment of influence of operative SUI treatment with the use of IVS tape on patient’s quality of life. Material and methods: Prospective study was conducted among 57 patients with SUI symptoms II and III degree (type III according to Blavais), who were classified to apply IVS tape. Diagnostic investigations were completed by questionnaires: IIQ-7 and UDI-6, which were filled by patients. In analysis there were included results obtained before the operation and 6 months after procedure. Results: We recognized women as cured: based on physicians anamnesis – 80,7% of patients, according to UDI-6 – 71,93%. Half year after operation relevant improvement of quality of life, evaluated by IIQ-7 questionnaire, showed 89,47%. Improvement of quality of life correlated with lack of SUI symptoms in anamnesis (r=0,631;

The effects of operative SUI treatment established using Burch colposuspension and IVS tape and evaluated through various urogynecologic tests

Objectives: Numerous diagnostic instruments have been used in modern urogynecology; alas, sufficient comparative analysis between most of them has not been carried out in world literature. Design: The aim of the study was to compare the results of selected urogynecology tests, used to analyze the effectiveness of SUI treatment, using Burch colposuspension and IVS tape. Material: The study was conducted among 76 patients selected for operative treatment of SUI II and III degree, using of Burch colposuspension (I group, n=47) and IVS tape, Tyco (II group, n=29). Methods: The following investigations: urogynecologic anamnesis and examination with cough test, miction diary, pad test, urodynamic exam and UDI-6 questionnaire, have been used to evaluate SUI symptoms before and half a year after the operation. Results: The percentage of the cured, depending on the adopted urogynecology investigation, oscillated in group I between 56,8% to 91,5%, and 56,5% to 86,2% in group II. The best results were obtained in anamnesis and cough test. Conclusions: 1. The analyzed methods of urogynecology tests correlate with anamnesis as far as SUI symptoms after operative treatment are concerned. 2. There are relevant differences between several tests, in case of the estimation of SUI cure rate after colposuspension, as well as when using IVS tape.

Ocena ekspresji cykliny E w rozrostach i raku błony śluzowej trzonu macicy u kobiet po menopauzie

Objectives: The aim of present study was to determine expression of cyclin E in endometrial hyperplasia without atypia, atypical endometrial hyperplasia and endometrial cancers in comparison with expression of cyclin E in atrophic endometrium of postmenopausal women. We have also estimated relationship between cyclin E expression and prognostic factors for endometrial cancer such as: histological type, cancer stage and histological grade. Material and methods: 154 women were enrolled into study. Women were divided into 4 groups. The first group consist of 38 women with endometrial hyperplasia without atypia, the second group consist of 18 women with atypical endometrial hyperplasia. The third group comprise 62 women with endometrial cancer and the forth 36 women with atrophic endometrium. Cyclin E expression was estimated in formalin-fixed, paraffin-embedded tissues obtained from enrolled women with the use of immunohistochemical techniques. We estimated labelling index (LI) – the number of cells that stained for cyclin E in relation to all cells at the certain field of view. Results: Medians of labelling indices of cyclin E in atrophic endometrium, endometrial hyperplasia with atypia, atypical endometrial hyperplasia end endometrial cancer were 13,7%, 34,7%, 62%, 72,2% respectively. These differences were statistically significant. In our study we haven’t found relationship between cyclin E expression and histological type of tumour (p=0,186), cancer stage (p=0,186) and histological grade (p=0,539). Conclusions: In the carcinogenesis of endometrial tumours in postmenopausal women there is a progressive disorder in mechanisms regulating cell cycle. It seems impossible to use cyclin E as prognostic factor for endometrial cancer.Cel pracy: Celem pracy była ocena ekspresji cykliny E w rozrostach endometrium bez atypii komórkowej, w rozrostach endometrium z atypią komórkową oraz w rakach endometrium, w porównaniu do ekspresji cykliny E w endometrium atroficznym u kobiet po menopauzie. Dodatkowo oceniliśmy zależność między ekspresją cykliny E a czynnikami prognostycznymi w raku endometrium takimi jak: typ histologiczny nowotworu, stopień klinicznego zaawansowania wg FIGO oraz stopień zróżnicowania histologicznego. Materiał i metody: Do badania zakwalifikowano 154 kobiety podzielone na 4 grupy. Do pierwszej grupy włączono 38 kobiet z rozrostem endometrium bez atypii, do drugiej 18 kobiet z rozrostem endometrium z atypią, do trzeciej 62 kobiety z rakiem endometrium, a do czwartej 36 kobiet z endometrium atroficznym. Ekspresję cykliny E oceniono w utrwalonych w formalinie, zatopionych w parafinie preparatach endometrium uzyskanych od badanych kobiet przy użyciu metod immunohistochemicznych. Oceniono indeks komórkowy (LI - labelling index) – liczbę komórek wykazujących ekspresję cykliny E w stosunku do wszystkich komórek w danym polu widzenia Wyniki: Mediany indeksów komórkowych cykliny E w endometrium atroficznym, rozroście endometrium bez atypii, rozroście endometrium z atypią oraz raku endometrium wynosiły odpowiednio 13,7%, 34,7%, 62%, 72,2%. Różnice te były istotne statystycznie. W pracy nie wykazaliśmy zależności między nasileniem ekspresji cykliny E, a typem histologicznym nowotworu (p=0,186), stopniem klinicznego zaawansowania wg FIGO (p=0,186) oraz stopniem zróżnicowania histologicznego guza (p=0,539). Wnioski: W procesie rozwoju nowotworu błony śluzowej trzonu macicy u kobiet po menopauzie dochodzi do stopniowego zaburzenia mechanizmów regulujących cykl komórkowy. Ocena ekspresji cykliny E nie może być wykorzystana jako czynnik prognostyczny w raku endometrium

Znaczenie ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych dla rokowania u chorych z gruczolakorakiem endometrialnym endometrium

Objectives: To assess the prognostic significance of Ki-67 expression in the tissue microarray method (TMA) for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC). Material and methods: The study examined 159 consecutive patients aged 37-86 (62.82±9.95) with EEC stages I-III according to FIGO, treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards they were subsequently treated and examined at the Regional Cancer Center, Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery, and constructed into the TMA recipient blocks. Using TMA method, the relationship between Ki-67 expression, DFS and OS was examined. DFS was defined as a period from primary surgery until relapse. OS was defined as a period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE; KE/1673/12). Results: The follow-up time varied between 3 - 60 months (51.42±15.87). In 31 patients (19.50%) the relapse of was diagnosed 1–59 months (24.97±16.08) after commencement of the treatment. During follow-up 32 patients (20.12%) died. DFS and OS were 80.50% and 79.88%, respectively. The lack of Ki-67 expression was found in 37 cases (23.27%) while in 122 patients (76.73%) the expression was present (p20% was present in 76 cases, 26 cases and 20 cases, respectively. Positive correlation between the expression of Ki-67 and staging was present (r=0.353; pCel pracy: Celem pracy była ocena znaczenia rokowniczego obecności i wielkości ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych (TMA) dla przeżycia wolnego od choroby (DFS) oraz przeżycia ogólnego (OS) chorych z gruczolakorakiem endometrialnym endometrium (GEE). Materiał i metody: Grupę badaną stanowiło 159 chorych. Wykorzystując metodę TMA, oceniono zależność między obecnością i wielkością ekspresji Ki-67 a DFS i OS. Wyniki: Okres obserwacji wynosił 3-60 miesięcy (51,42±15,87). DFS i OS wynosiły odpowiednio 80,50% i 79,88%. Brak ekspresji Ki-67 stwierdzono w 37 przypadkach (23,27%), a obecność ekspresji Ki-67 u 122 chorych (76,73%;

Ocena niezrównoważenia genomu w przypadkach rozrostu oraz raka endometrium

Objective: The main goal of our study was to identify the earliest and specific genetic changes which could be associated with an increased risk of neoplastic transformation in a group of patients with endometrial hyperplasia. Another goal was to characterize genetic changes associated with advanced forms of cancer. Material and methods: The study involved forty-four (44) female patients, including five (5) patients with no histopathologically confirmed hyperplastic features, twenty-six (26) patients with histopathologically confirmed endometrial hyperplasia, and thirteen (13) patients with diagnosed carcinoma of the endometrium. The study was conducted using a custom-made 4x180K microarray of BlueGnome. Results: Copy number variations (CNV) were found in the cases without endometrial hyperplasia. Such changes occur with varying frequency in the genome of healthy female population. Significant genome imbalance was identified in the twenty-six (26) (100%) patients with diagnosed hyperplasia and in eleven (11) subjects (84.6%) with diagnosed endometrial cancer. Other, not yet reported, changes localized in characteristic regions of the genome were also found.Cel pracy: Celem podjętych badań było zidentyfikowanie w grupie pacjentek z rozrostem endometrium najwcześniejszych i specyficznych zmian genetycznych, które można identyfikować z podwyższonym ryzykiem transformacji nowotworowej, a także charakterystyka zmian genetycznych związanych z rozwiniętą formą nowotworu. ateriał i metody: Badaniami objęto 44 pacjentki: w 5 przypadkach histopatologicznie nie potwierdzono cech rozrostu, w 26 przypadkach potwierdzono histopatologicznie rozrost endometrium, u 13 pacjentek zdiagnozowano raka błony śluzowej trzonu macicy. Wyniki: Badania przeprowadzono przy użyciu mikromacierzy typu custom-made 4x180K firmy BlueGnome. W przypadkach bez rozrostu zdiagnozowaliśmy zmiany o charakterze CNV’s (Copy Number Variation), które z różną częstością występują w genomie populacji osób zdrowych. Istotne niezrównoważenie genomu zostało wykryte u 26 (100 %) pacjentek z rozpoznanymi rozrostami oraz u 11 (84, 6%) pacjentek z rozpoznanym rakiem endometrium. Wykryliśmy również dotąd nieopisywane zmiany zlokalizowane w charakterystycznych regionach genomu. Wnioski: Technika aCGH jest efektywnym narzędziem do analizy aberracji chromosomowych. Badanie niestabilności chromosomowej, czyli określenie rodzaju i zakresu zmian w chromosomach, jest badaniem pozwalającym ustalić regiony krytyczne, a co za tym idzie zidentyfikować geny lub grupy genów ważne dla powstawania i rozwoju raka endometrium. W oparciu o przeprowadzone badania zaproponowaliśmy hipotetyczny model sekwencji zmian genetycznych towarzyszących wielostopniowemu procesowi transformacji nowotworowej endometrium