There is no significant correlation of adenomyosis with benign, premalignant and malignant gynecological pathologies. Retrospective study on 647 specimens

Objectives: The aim of this study is to identify the prevalence of benign, premalignant and malignant gynecological pathologies in women with adenomyosis who underwent gynecological surgery. Material and methods: The medical records collected between 1985 and 2020 were retrospectively reviewed. The pathology reports were studied from 647 cases where adenomyosis was presented. The estimated prevalence of benign, premalignant and malignant gynecological disorders in the general population was further evaluated. Results: The mean age of women with adenomyosis was 54.1 ± 10.4 years old. Out of 647 patients, in 18.5% of the specimens we detected isolated adenomyosis and in 81.5% of cases a coexistence of one or more gynecological diseases, while in 84 out of 647 patients (13%) there was coexistence of adenomyosis with more than one gynecological condition (benign or malignancy). Among all cases, uterine leiomyomas were observed in 61.3% of patients, followed by endometrial polyps (11.9%), endometriosis (11.6%), endometrial hyperplasia (7.1%), endometrial cancer (3.6%), ovarian (1.4%) and cervical cancer (0.8%) (p < 0.001).Additionally, we found that women with a simultaneous co-existence of adenomyosis, leiomyomas and endometrial polyps or hyperplasia were younger (p < 0.01) in comparison to cases with malignancy. Conclusions: Adenomyosis presents a common benign but often progressing myometrial condition that it is underestimated in clinical practice. Even though some studies suggest a potential association with several gynecological pathologies, we did not confirm a significant difference of adenomyosis prevalence between benign, premalignant and malignant gynecological conditions compared with the general population. Further investigation is required to confirm our results

The prognostic value of the p53 and Bcl-2 protein expression in endometrial cancer

In the present study were estimated the immunohistochemically expression of p53 and Bcl-2 proteins, and the positive expression of estrogen (ER) and progesterone (PR) receptors. The former results were correlated with the clinico-pathologic features of the endometrial cancer, and the prognostic value was estimated as well. Seventy seven patients with endometrial cancer of median age (±SD) 62.5±10 years (range 35-80 yrs), all surgical treated in 4th Department of Obstetrics and Gynecology of Aristotle University of Thessaloniki (AUTH), were analysed. The relative follow up of the patients was done in the same department and the median time was 60 months (range 9-120 months). Formalin fixed and paraffin embedded tumor blocks selected and were analyzed from the Department of Pathology of AUTH. According our methodology were estimated the overexpression of p53 protein the expression of Bcl-2 protein and the positive ER and PR. The former markers were correlated with clinico-pathologic features of endometrial cancer (tumor grade, histopathology subtype, myometrial infiltration, lymph nodes metastasis, etc.), while the prognostic impact was estimated as well. Seventy-nine % of the patients were of stage I, while the endometrioid was the most common subtype (96%). Ninety % of the tumors were of grade 1 and 2, and in 69% of the cases the myometrial infiltration was ≤1/2. Thirty-five % of the patients were classified as low risk for nodal metastasis and extra-uterine disease. The median follow up of the patients was 60 months (range 9-120 months). The SPSS program was used for the statistical analysis of the study (SPSS Inc., Chicago, IL, USA). In 23.4% of the patients there was overexpression of p53 protein. Positive association was noted between p53 and advanced stages, special histopathology subtypes, patients >60 years and older, and patients with positive nodes in cases which staging lymphadenectomy was performed (P60 ετών, καθώς και σε ασθενείς µε θετικούς λεµφαδένες (P<0.05). Το 39% των ασθενών εµφάνισε κυτταροπλασµατική έκφραση της πρωτεΐνης Βcl-2, ενώ θετική σχέση υπήρξε µεταξύ Βcl-2 πρωτεΐνης και ασθενών ≤60 ετών και όγκων καλής διαφοροποίησης. Μετά από ανάλυση της σχέσης µεταξύ των πρωτεϊνικών δεικτών της µελέτης και των ορµονικών υποδοχέων, υπήρξε θετική σχέση µεταξύ της Βcl-2 πρωτείνης και των προγεστερονικών υποδοχέων. Θετική επίσης σχέση υπήρξε µεταξύ της επιβίωσης ελεύθερης νόσου (DFS) και αρχόµενων σταδίων, όγκων καλής διαφοροποίησης, επιπολής διήθησης του µυοµητρίου και ασθενών ελεύθερων εξαρτηµατικής και λεµφαδενικής νόσου (P < 0.05), ενώ η ίδια παρατήρηση δεν έγινε σε ό,τι αφορά τους ανοσοϊστοχηµικούς δείκτες της µελέτης. Μετά από ανάλυση πολλαπλών µεταβλητών όπου συµπεριλήφθηκαν κλασικοί κλινικοπαθολογικοί παράγοντες του καρκίνου του ενδοµήτριου και οι ανοσοϊστοχηµικοί δείκτες της µελέτης (Βcl-2, p53, ER, PR), µόνο το στάδιο της νόσου διατήρησε τη σηµαντικότητα του ως ανεξάρτητος προγνωστικός παράγοντας σε ό,τι αφορά την επιβίωση ελεύθερης νόσου. Σύµφωνα µε τα αποτελέσµατα της παρούσας µελέτης, υπήρξε θετική σχέση της πρωτεΐνης p53 και των δυσµενών κλινικοπαθολογικών παραγόντων (προχωρηµένο στάδιο νόσου, ειδικοί ιστοπαθολογικοί τύποι, λεµφαδενικές µεταστάσεις, προχωρηµένη ηλικία ασθενών), ενώ θετική σχέση υπήρξε µεταξύ πρωτεΐνης Βcl-2 και ασθενών µικρότερης ηλικίας, όγκων καλής διαφοροποίησης και προγεστερονικών υποδοχέων. Το στάδιο της νόσου έχει αποτελέσει τον µόνο ανεξάρτητο προγνωστικό παράγοντα µετά από ανάλυση πολλαπλών µεταβλητών, όπου συµπεριλήφθηκαν οι κλασικοί κλινικοπαθολογικοί παράγοντες και οι ανοσοϊστοχηµικοί δείκτες της µελέτης

Myomectomy during pregnancy: A systematic review

Objective: Uterine fibroids affect 2–10 % of pregnant women. Although usually asymptomatic, they may be associated with pregnancy complications. Myomectomy is preferably avoided antenatally, however, it has been reported in symptomatic cases that did not respond to conservative management. The aim of this study was to summarize the published literature and present the reported outcomes and associated risks of this procedure. Study Design: A systematic research of the literature was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library, including case reports and case series. An effort was made to numerically analyse all parameters included in the case reports. Results: Overall, 54 relevant articles were identified, including 97 patients. The median gestational age at diagnosis was 13 (range 6–26) weeks, while the median age at myomectomy was 16 (range 6–26) weeks. Abdominal pain, not responding to medical treatment was the most common indication for surgery. The median number of fibroids removed per patient was one (range 1–5). Most of them were subserous pedunculated or subserous and fundal. Laparotomy (78.4 %) was the principal surgical approach, however, laparoscopic and vaginal operations were also reported. The median duration of surgery was 53 (range 20–150) min. The histopathology revealed necrosis and degeneration as the main findings of removed fibroids. The pregnancy outcome was favourable in most of the cases, with few complications reported. Conclusion: Based on the limited published data, myomectomy during pregnancy appears as a safe procedure in cases of symptomatic uterine fibroids not responding to conservative management and therefore it may be considered, following appropriate counselling regarding the associated risks. © 2020 Elsevier B.V

Outcome of laparoscopic sacrocolpopexy with anterior and posterior mesh

Aim: The assessment of the postoperative outcome following laparoscopic sacrocolpopexy using anterior and posterior mesh

The role of gene polymorphisms in endometriosis

Endometriosis is a benign gynecologic disorder, affecting up to 10% of women, characterized by the presence of functional endometrial tissue at ectopic positions generally within the peritoneum. It is a heritable condition influenced by multiple genetic and environmental factors, with an overall heritability estimated at approximately 50%. In this study, we investigated whether single nucleotide polymorphisms (SNPs) rs7521902, rs10859871 and rs11031006, mapping to WNT4, VEZT and FSHB genetic loci, respectively, are associated with risk for endometriosis in a Greek population. This study included 166 women with histologically confirmed endometriosis diagnosed through surgery and 150 normal controls. Genotyping of the rs7521902, rs10859871 and rs11031006 SNPs was performed with Taqman primer/probe sets. A significant association was detected with the AC genotype of rs7521902 (WNT4) in patients with stage III and IV disease only. Evidence for association with endometriosis was also found for the AC genotype of the rs10859871 of VEZT. Notably, a significant difference in the distribution of the AG genotype and the minor allele A of FSHB rs11031006 SNP was found between the endometriosis patients and controls. We found a genetic association between rs11031006 (FSHB) SNP and endometriosis. WNT4 and VEZT genes constitute the most consistently associated genes with endometriosis. In the present study, an association of rs7521902 (WNT4) and rs10859871 (VEZT) was confirmed in women with endometriosis at the genotypic but not the allelic level