Controversies in the Management of Endometrial Carcinoma: An Update

Endometrial carcinoma is the commonest type of female genital tract malignancy in the developed countries. Endometrial carcinoma is usually confined to the uterus at the time of diagnosis and as such usually carries an excellent prognosis with high curability. Our understanding and management of endometrial cancer have continuously developed. Current controversies focus on screening and early detection, the extent of nodal surgery, and the changing roles of radiation therapy and chemotherapy and will be discussed in this paper

Adenomyosis: Three-dimensional sonographic findings of the junctional zone and correlation with histology

To correlate with histopathological features the adenomyosis-induced morphological alterations of the outer myometrium and the inner myometrium ('junctional zone', JZ) detectable on two- (2D) and three-dimensional (3D) transvaginal ultrasound imaging (TVS), and to evaluate their diagnostic accuracy for adenomyosis

Is adenomyosis the neglected phenotype of an endomyometrial dysfunction syndrome?

Since the dissociation between adenomyoma and endometriosis in the 1920s and the laparoscopic progress in the diagnosis and surgery of endometriosis, the literature has been greatly focused on the disease endometriosis. The study of adenomyosis, on the other hand, has been neglected as the diagnosis remained based on hysterectomy specimens. However, since the introduction of magnetic resonance and sonographic imaging techniques in the 1980s, the myometrial junctional zone has been identified as a third uterine zone and interest in adenomyosis was renewed. This has also been the start for the interest in the role of the myometrial junctional zone dysfunction and adenomyosis in reproductive and obstetrical disorders

The Pathogenesis of Uterine Adenomyosis

The exact aetiology and pathogenesis of uterine adenomyosis are not clear. Increased endometrial invasiveness has been proposed in the literature, but without conclusive evidence. This thesis was undertaken to examine the pathogenesis of adenomyosis and the differences between affected and unaffected uteri, testing two possibilities with adenomyosis: (i) that the myometrium is permissive to invasion by a normal basal endometrium, or (ii) that the basal endometrium has a higher invasive potential and penetrates a normal myometrium. To examine the early phases of development of adenomyosis, a mouse model was used, where adenomyosis was induced by dosing female pups with tamoxifen. The same experiment was used on C57/BL6J strain to examine strain differences in response to tamoxifen and predisposition to adenomyosis. Adenomyosis in the human uterus was characterised, examining the immunohistochemical, light and electron microscopy structure, and RNA microarrays of affected and unaffected uteri. The invasive properties of the stroma and its interaction with the underlying myometrium were further studied in a co-culture model. Adenomyosis was successfully induced in the CD1 mice, with abnormal development and disruption of the inner circular myometrium. However, the C57/BL6J did not develop adenomyosis inspite of the presence of inner myometrial abnormalities comparable to the CD1 mice. Affected human uteri showed distinct myometrial features such as reduced myometrial cellular density and enlarged nuclei with hypertrophy and hyperplasia seen on light microscopy. Electron microscopy revealed ultrastructural features (e.g. reduced caveolae and increased myelin bodies, intermediate filaments and dense bands) in adenomyotic uteri. A large number of dysregulated genes were detected between affected and unaffected uteri, with Wnt5a being a key downregulated gene. Steroid reception expression was equally altered in cases of adenomyosis (e.g. reduced progesterone receptors and increased estrogen receptor beta). Increased vimentin immunostaining was equally observed in the inner myometrium of diseased uteri. An increased adenomyotic stromal invasiveness and increased myometrial permissiveness was observed in the co-culture model. The thesis demonstrates that the endometrial – myometrial interface behaves differently in uteri with adenomyosis, concluding that adenomyosis is a uterine disease characterized by both increased endometrial invasiveness and myometrial defects that play a facilitative role for this invasion. Both the myometrium and endometrial stroma of diseased uteri show a unique phenotype, gene expression and protein expression profiles

The pathogenesis of uterine adenomyosis

The exact aetiology and pathogenesis of uterine adenomyosis are not clear. Increased endometrial invasiveness has been proposed in the literature, but without conclusive evidence. This thesis was undertaken to examine the pathogenesis of adenomyosis and the differences between affected and unaffected uteri, testing two possibilities with adenomyosis: (i) that the myometrium is permissive to invasion by a normal basal endometrium, or (ii) that the basal endometrium has a higher invasive potential and penetrates a normal myometrium. To examine the early phases of development of adenomyosis, a mouse model was used, where adenomyosis was induced by dosing female pups with tamoxifen. The same experiment was used on C57/BL6J strain to examine strain differences in response to tamoxifen and predisposition to adenomyosis. Adenomyosis in the human uterus was characterised, examining the immunohistochemical, light and electron microscopy structure, and RNA microarrays of affected and unaffected uteri. The invasive properties of the stroma and its interaction with the underlying myometrium were further studied in a co-culture model. Adenomyosis was successfully induced in the CD1 mice, with abnormal development and disruption of the inner circular myometrium. However, the C57/BL6J did not develop adenomyosis inspite of the presence of inner myometrial abnormalities comparable to the CD1 mice. Affected human uteri showed distinct myometrial features such as reduced myometrial cellular density and enlarged nuclei with hypertrophy and hyperplasia seen on light microscopy. Electron microscopy revealed ultrastructural features (e.g. reduced caveolae and increased myelin bodies, intermediate filaments and dense bands) in adenomyotic uteri. A large number of dysregulated genes were detected between affected and unaffected uteri, with Wnt5a being a key downregulated gene. Steroid reception expression was equally altered in cases of adenomyosis (e.g. reduced progesterone receptors and increased estrogen receptor beta). Increased vimentin immunostaining was equally observed in the inner myometrium of diseased uteri. An increased adenomyotic stromal invasiveness and increased myometrial permissiveness was observed in the co-culture model. The thesis demonstrates that the endometrial – myometrial interface behaves differently in uteri with adenomyosis, concluding that adenomyosis is a uterine disease characterized by both increased endometrial invasiveness and myometrial defects that play a facilitative role for this invasion. Both the myometrium and endometrial stroma of diseased uteri show a unique phenotype, gene expression and protein expression profiles.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Bio-inspired green manufacturing of plasmonic silver nanoparticles/Degussa using Banana Waste Peduncles: Photocatalytic, antimicrobial, and cytotoxicity evaluation

International audiencePlasmonic silver nanoparticle, AgNPs (~14.1 nm) having an absorption peak at 421 nm was fabricated via a biogenic, rapid, and costless technique using Banana Waste Peduncles (BWP) as new disposals instead of plant extracts. According to HPLC analysis, BWP included gallic acid, catechin, chlorogenic acid, caffeic acid, etc. Degussa (P25) has been in-situ added in one-step to AgNPs using the microwave synthesis to produce nanocomposite sensitive to solar-light irradiation. Transmission electron microscope (TEM) images showed incorporation of P25 over plasmonic AgNPs grown by spherical shape. Based on the photocatalytic process, methylene blue (MB) was fully degraded, and 16 min was sufficient for chromium (IV) reduction. AgNPs/Degussa nanocomposite is photochemical stable even after eight cycles. Besides, the antimicrobial activity indicated the capability of the nanocomposite, as an efficient antimicrobial agent for killing and prevent the diffusion of the nominated microbes; Staphylococcus aureus, Escherichia coli, Candida albicans, and Aspergillus niger due to the synergistic effect of AgNPs. The cell viability showed up to 94.85% reliable cell migration, particularly at higher concentrations. The significant improvement of photoactivity and stability of the as-synthesized photocatalysts might be relevant for their reusability in practical applications

The use of the V-Care laparoscopic uterine manipulator to facilitate total abdominal hysterectomy: a novel approach and case-series

Hysterectomy remains mostly performed via the abdominal route in the United Kingdom, despite advances in minimal access techniques and increased training in laparoscopic hysterectomy. The use of uterine manipulators remains a key component of the laparoscopic approach. During abdominal surgery, access to the pelvis can be challenging on occasion, and there may be a higher incidence of intraoperative complications. We describe the use of a laparoscopic uterine manipulator during total abdominal hysterectomy as a novel approach to facilitate the procedure by improving surgical exposure, reducing dissection, while safeguarding vital structures and maintaining vaginal length.Impact Statement What is already known on the subject? Hysterectomy remains mostly performed via the abdominal route in the United Kingdom, despite advances in minimal access techniques and increased training in laparoscopic hysterectomy. The use of uterine manipulators remains a key component of the laparoscopic approach. What do the results of this study add? We describe the use of a laparoscopic uterine manipulator during total abdominal hysterectomy as a novel approach to facilitate the procedure by improving surgical exposure, reducing dissection, while safeguarding vital structures and maintaining vaginal length. What are the implications of these findings for clinical practice and/or future research? The proposed technique is safe, easily reproducible and could be widely adopted. This approach may be considered as an option in morbidly obese women or those women with anticipated complex pelvic pathology