Accuratezza di nuovi marker ecografici nella diagnosi di adenomiosi

Objective: to evaluate the diagnostic accuracies of well-known sonographic markers of adenomyosis and of two innovative ones, the question mark sign and the transvaginal ultrasound uterine tenderness. Methods: 78 patients scheduled for hysterectomy for uterine benign diseases underwent preoperative transvaginal ultrasonography to evaluate the criteria of sonographic diagnosis of adenomyosis as reported by consensus statement MUSA. Adenomyosis was diagnosed in presence of two or more of the following parameters: asymmetry of the uterine walls, hyperechoic striae, anechoic myometrial cysts, hyperechogenic islands, echogenic subendometrial lines and buds, interruption/irregularities of the junctional zone and translesional vascular flow. In addition the question mark sign and the transvaginal ultrasound uterine tenderness were evaluated, the first being the longitudinal section of the uterus with a morphology similar to a question mark and the other being the dynamic ultrasound evaluation of uterine tenderness by the pressure of the transvaginal probe. Sonographic features were compared with histological examination. Results: the prevalence of adenomyosis in the sample is 33.3%. Sensitivity, specificity, positive and negative predictive values and accuracy of transvaginal ultrasound in the diagnosis of adenomyosis are 83%, 96%, 91%, 89% and 92%. Asymmetry, hyperechoic striae and interruption of the junctional zone were the most accurate markers for the diagnosis of adenomyosis. Myometrial heterogeneity was the most frequently encountered feature (100%), but showed a low specificity (7%). The question mark sign and the transvaginal ultrasound uterine tenderness showed sensitivity, specificity, positive and negative predictive values and accuracy of 41%, 96%, 83%, 77%, and 69% and 69%, 65%, 66%, 81% and 67% respectively. Conclusions: the sonographic markers proposed by consensus statement MUSA were confirmed accurate in the diagnosis of adenomyosis in our sample. The question mark sign and the transvaginal ultrasound uterine tenderness showed good diagnostic capacities and may be a useful complement in the sonographic diagnosis of adenomyosis.Obiettivo: valutare le capacità diagnostiche dei marker ecografici già noti di adenomiosi e di due innovativi, ovvero il question mark sign e la transvaginal ultrasound uterine tenderness. Metodi: 78 pazienti candidate ad isterectomia per patologia uterina benigna sono state sottoposte ad ecografia transvaginale preoperatoria per la valutazione dei criteri di diagnosi ecografica di adenomiosi riportati dal consensus statement MUSA. L’adenomiosi è stata diagnosticata in presenza di due o più fra i seguenti parametri: asimmetria delle pareti uterine, strie iperecogene, lacune anecogene, isole iperecogene, irregolarità sub-endometriali, interruzione o irregolarità della zona giunzionale, vascolarizzazione trans-lesionale. In aggiunta, sono stati valutati due marker ecografici innovativi: il question mark sign e la transvaginal ultrasound uterine tenderness, ovvero la sezione longitudinale dell’utero con morfologia a punto interrogativo e la valutazione ecografica dinamica della dolorabilità dell’utero alla pressione mirata della sonda vaginale. Le caratteristiche ecografiche sono state confrontate con l’esame istologico. Risultati: La prevalenza di adenomiosi nel campione è risultata pari a 33.3%. Sensibilità, specificità, valore predittivo positivo e negativo e accuratezza dell’ecografia transvaginale nella diagnosi di adenomiosi sono risultate rispettivamente 83%, 96%, 91%, 89% e 92%. Asimmetria, strie iperecogene ed interruzione della zona giunzionale sono risultati i marker più accurati per la diagnosi di adenomiosi. La caratteristica più frequentemente riscontrata (100%) è stata l’eterogeneità miometriale, ma ha mostrato scarsa specificità (7%). Il question mark sign e la transvaginal ultrasound uterine tenderness hanno presentato sensibilità, specificità, valore predittivo positivo e negativo e accuratezza pari rispettivamente a 41%, 96%, 83%, 77%, e 69% e 69%, 65%, 66%, 81%, e 67%. Conclusioni: I marker ecografici proposti dal consensus statement MUSA si confermano accurati nella diagnosi di adenomiosi. Il question mark sign e e la transvaginal ultrasound uterine tenderness hanno dimostrato buone capacità diagnostiche e potrebbero rivelarsi un utile complemento nella diagnosi ecografica di adenomiosi

Malignant peritoneal mesothelioma in a woman with bilateral ovarian serous borderline tumour: Potential interactions between the two diseases

We report a case of a 59-year-old woman with peritoneal malignant mesothelioma and no previous exposure to asbestos with a diagnosis of bilateral ovarian serous borderline tumour with peritoneal implants one year before. We discuss the histopathological and immunohistochemical findings to explain possible and potential interactions between the two diseases. To our knowledge, the association of both serous borderline ovarian tumour and malignant peritoneal mesothelioma has never been described before in the same woman and in such a tight temporal connection. This finding raises numerous issues about the origin of the two tumours and further biomolecular studies are needed to fully understand the carcinogenetic process. From a clinical point of view, this case report can be useful to gynaecologists because it leads to recommend a careful examination of the peritoneal cavity during a surgical resection of borderline serous tumour. Moreover, it may suggest performing a close follow-up associated with a careful surveillance of the patient, especially in the case of micropapillary pattern, to oncologists. A complete clinical approach could help to detect sooner possible relapses or other metachronous malignancies

Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study

<p>Abstract</p> <p>Background</p> <p>Deep infiltrating endometriosis (DIE) can affect importantly patients' quality of life (QOL). The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment.</p> <p>Methods</p> <p>It is a prospective cohort study. In a tertiary care university hospital, between April 2008 and December 2009, 100 patients underwent laparoscopic management of DIE and completed preoperatively and 6-months postoperatively a QOL questionnaire, the short form 36 (SF-36).</p> <p>Quality of life was measured through the SF-36 scores. Intra-operative details of disease site, number of lesions, type of intervention, period of hospital stay and peri-operative complications were noted.</p> <p>Results</p> <p>Six months postoperatively all the women had a significant improvement in every scale of the SF-36 (p < 0,0005). Among patients with intestinal DIE, significant differences in postoperative scores of SF-36 were not detected between patients submitted to nodule shaving and segmental resection (p > 0.05). There was no significant difference in the SF-36 scores at 6 months from surgery between patients who received postoperative medical treatment and patients who did not (p > 0.05).</p> <p>Conclusions</p> <p>Laparoscopic excision of DIE lesions significantly improves general health and psycho-emotional status at six months from surgery without differences between patients submitted to intestinal segmental resection or intestinal nodule shaving.</p

Long-Term Outcome After Adoptive Immunotherapy With Natural Killer Cells: Alloreactive NK Cell Dose Still Matters

Recently, many reports were published supporting the clinical use of adoptivelytransferred natural killer (NK) cells as a therapeutic tool against cancer, including acutemyeloid leukemia (AML). Our group demonstrated promising clinical response usingadoptive immunotherapy with donor-derived alloreactive KIR-ligand-mismatched NK cellsin AML patients. Moreover, the antileukemic effect was correlated with the dose of infusedalloreactive NK cells (“functional NK cell dose”). Herein, we update the results of ourprevious study on a cohort of adult AML patients (median age at enrollment 64) infirstmorphological complete remission (CR), not eligible for allogeneic stem celltransplantation. After an extended median follow-up of 55.5 months, 8/16 evaluablepatients (50%) are still off-therapy and alive disease-free. Overall survival (OS) and disease-free survival (DFS) are related with the dose of infused alloreactive NK cells (≥2×105/kg

The baseline comorbidity burden affects survival in elderly patients with acute myeloid leukemia receiving hypomethylating agents: Results from a multicentric clinical study

Background: In older patients with acute myeloid leukemia (AML), the definition of fitness, prognosis, and risk of death represents an open question. Methods: In the present study, we tested the impact on survival of disease- and patient-related parameters in a large cohort of elderly AML patients homogeneously assigned to treatment with hypomethylating agents (HMAs). Results: In 131 patients with a median age of 76 years, we confirmed that early response (&lt;0.001) and biology-based risk classification (p&nbsp;=&nbsp;0.003) can select patients with better-predicted survival. However, a full disease-oriented model had limitations in stratifying our patients, prompting us to investigate the impact of baseline comorbidities on overall survival basing on a comorbidity score. The albumin level (p&nbsp;=&nbsp;0.001) and the presence of lung disease (p&nbsp;=&nbsp;0.013) had a single-variable impact on prognosis. The baseline comorbidity burden was a powerful predictor of patients' frailty, correlating with increased incidence of adverse events, especially infections, and predicted overall survival (p &lt; 0.001). Conclusion: The comorbidity burden may contribute to impact prognosis in addition to disease biology. While the therapeutic armamentarium of elderly AML is improving, a comprehensive approach that combines AML biology with tailored interventions to patients' frailty is likely to fully exploit the anti-leukemia potential of novel drugs

Use of B-flow ultrasound facilitates visualization of contrast media during hysterosalpingo-contrast sonography (HyCoSy).

To assess if B-flow ultrasound (BF) improves visualization of flow of contrast medium in the Fallopian tubes during hystero-salpingo-contrast sonography (HyCoSy) compared to gray scale (GS) ultrasound

<i>TP53</i> Mutant Acute Myeloid Leukemia: The Immune and Metabolic Perspective

TP53 mutated/deleted acute myeloid leukemia (AML) stands out as one of the poorest prognosis forms of acute leukemia with a median overall survival not reaching one year in most cases, even in selected cases when allogenic stem-cell transplantation is performed. This aggressive behavior relies on intrinsic chemoresistance of blast cells and on high rates of relapse. New insights into the biology of the disease have shown strong linkage between TP53 mutant AML, altered metabolic features and immunoregulation uncovering new scenarios and leading to possibilities beyond current treatment approaches. Furthermore, new targeted therapies acting on misfolded/dysfunctional p53 protein are under current investigation with the aim to improve outcomes. In this review, we sought to offer an insight into TP53 mutant AML current biology and treatment approaches, with a special focus on leukemia-associated immune and metabolic changes

TP53 Mutant Acute Myeloid Leukemia: The Immune and Metabolic Perspective

TP53 mutated/deleted acute myeloid leukemia (AML) stands out as one of the poorest prognosis forms of acute leukemia with a median overall survival not reaching one year in most cases, even in selected cases when allogenic stem-cell transplantation is performed. This aggressive behavior relies on intrinsic chemoresistance of blast cells and on high rates of relapse. New insights into the biology of the disease have shown strong linkage between TP53 mutant AML, altered metabolic features and immunoregulation uncovering new scenarios and leading to possibilities beyond current treatment approaches. Furthermore, new targeted therapies acting on misfolded/dysfunctional p53 protein are under current investigation with the aim to improve outcomes. In this review, we sought to offer an insight into TP53 mutant AML current biology and treatment approaches, with a special focus on leukemia-associated immune and metabolic changes

Endometriosis in Adolescence: Practical Rules for an Earlier Diagnosis.

Dysmenorrhea, cyclic pelvic pain, and acyclic pelvic pain are common in adolescent girls, and at least 10% of these girls are at risk for subsequent development of endometriosis. In this article we highlight practical tips for the management of dysmenorrhea and chronic pelvic pain and how to diagnose endometriosis as early as possible and detect patients at risk for developing the disease in the future. We suggest five practical rules for managing adolescents with dysmenorrhea and chronic pelvic pain: (1) Never underestimate the pain; (2) Always consider endometriosis as a possible cause of severe cyclic pain; (3) Obtain a detailed and accurate history before performing clinical evaluation and pelvic sonography; (4) Treat the pain with hormonal therapies (combined oral contraceptives or progestogen-only pill) and analgesics (acetaminophen and nonsteroidal anti-inflammatory drugs); and (5) Plan frequent follow-up visits to re-evaluate the patient