Endometriotic lesions mimicking advanced ovarian cancer - A case report and a review of the literature.

BACKGROUND: Approximately 2-5% of women affected by endometriosis are postmenopausal. The disease may simulate various malignancies. A case of endometriosis in a postmenopausal woman, spreading similarly to ovarian cancer, is reported. A broad review of existing literature on postmenopausal endometriosis, endometriosis involving the urinary tract, and the links between endometriosis and cancer are also presented. CASE DESCRIPTION: A 51-year-old woman was diagnosed with a pelvic mass. She complained of pain in the lower abdomen that began three weeks prior, and had no history of dysmenorrhea, acyclic pelvic pain, or infertility. CT scan revealed a solid and cystic tumor in the region of the right adnexa, infiltrating the surrounding tissues, with possible infiltration of the urinary bladder, as well as soft-tissue lesions of the small intestinal mesentery. Bilateral hydronephrosis and distension of the ureters were also present. A malignant neoplasm of the ovary or the corpus uteri was suspected. Total abdominal hysterectomy and appendectomy were performed. A superficial infiltration of the urinary bladder was also excised. The pathology report revealed endometriotic foci in the tumor and in the bladder infiltration, as well as an endometriotic cyst in the right ovary. Two years postoperatively the patient is disease-free and in good condition. CONCLUSIONS: Clinicians should remain conscious of the possibility of endometriosis mimicking advanced ovarian cancer and infiltrating the peritoneum and internal organs of the abdominal cavity, including the urinary tract. Imaging techniques, including CT and MRI, are not always effective in establishing the correct diagnosis preoperatively.

Complications following Tension-Free Vaginal Tapes: Accurate Diagnosis and Complications Management.

The sling procedures are the gold standard for SUI treatment. They are highly effective but not free from complications. The most common adverse effect for the surgery with the implant insertion is: overactive bladder occurring de novo after the surgery, voiding dysfunctions, urine retention, and unsatisfactory treatment outcome. The most important question that arises after 20 years of sling procedures is how to manage the complications and what can be offered to complicated patients. The above review summarises the ultrasound findings in complicated cases and shows the scheme of management of the clinical problems concerning the tape location in suburethral region.

Genetic polymorphism of KIR2DL4 in the Polish population.

The KIR2DL4 gene is characterized by alleles with either 9 or 10 consecutive adenines in exon 7, which encodes the transmembrane domain. The 9A variant produces either a protein with a truncated cytoplasmic tail or one lacking the transmembrane region. This causes a lack of KIR2DL4 expression. In contrast, 10A alleles encode receptors that may be expressed at the cell surface. We tested 438 healthy individuals for polymorphism of the KIR2DL4 gene. KIR2DL4 9A/10A alleles were distinguished by the high resolution melting (HRM) method, and restriction fragment length polymorphism (RFLP) was used for genotyping of three other single nucleotide polymorphisms (SNPs) spanning the near vicinity of the poly-adenine fragment. We found a weak difference between males and females in 9769 C/A genotypes and alleles. In addition, we observed complete linkage disequilibrium (LD) between 9A insertion/deletion in the 9620 position and the 9571T/C position of the gene (r(2) = 1) both in females and males and almost complete LD with the 9797G/A position (r(2) = 0.963 for females and r(2) = 0.892 for males). Most importantly, we detected, in a group of fertile women, a high frequency (30.2%) of homozygosity for the defective 9A variant, which suggests that KIR2DL4 as a functional cell surface receptor is not absolutely necessary for reproduction. On the other hand, lower representation of 10A/10A homozygotes and high frequency of 10A/9A heterozygotes indicates a need for both cell membrane-anchored and soluble KIR2DL4 molecules. Finally, cost-reducing RFLP instead of HRM is proposed for typing 9A and 10A variants.

Frequencies of killer immunoglobulin-like receptor genotypes influence susceptibility to spontaneous abortion.

Natural killer (NK) cells are the most abundant lymphocyte population in the decidua. These cells express killer immunoglobulin-like receptors (KIRs), which upon recognition of HLA class I molecules on trophoblasts may either stimulate NK cells (activating KIRs) or inhibit them (inhibitory KIRs) to produce soluble factors necessary for the maintenance of pregnancy. KIR genes exhibit extensive haplotype polymorphism; individuals differ in both the number and kind (activating vs. inhibitory) of KIR genes. This polymorphism affects NK cell reactivity and susceptibility to diseases, including gynecological disorders. Therefore we KIR-genotyped 149 spontaneously aborting women and 117 control multiparae (at least 2 healthy-born children). Several genotypes (i.e. combinations of various KIR genes) were differently distributed among the patients and control subjects. Differences were observed in the numbers and the ratios of activating to inhibitory KIRs between patients and healthy women: (i) genotypes containing 6 activating KIR genes were less frequent and those containing 6 inhibitory KIR genes were more frequent in patients than in control subjects, and (ii) an excess of inhibitory KIRs (activating-to-inhibitory KIR gene ratios of 0.33 to 0.83) was associated with miscarriage, whereas ratios close to equilibrium (0.86-1.25) seemed to be protective. In addition, the results suggest for the first time that sporadic and recurrent spontaneous abortions as well as miscarriage in the presence or absence of autoantibodies may have different KIR genotypic backgrounds.

Angiogenic activity and IL-8 concentrations in peritoneal fluid and sera in endometriosis.

OBJECTIVES: During menstruation endometrial fragments are transported into the peritoneal cavity where they form endometriotic lesions. Angiogenesis is proposed as one of the mechanisms in endometriosis pathogenesis. The aim of the study was to determine the angiogenic activity and interleukin 8 concentrations in peritoneal fluid and sera in endometriosis. METHODS: Angiogenesis was determined in cutaneous assay in Balb/c mice; IL-8 concentrations were measured by ELISA test in sera and peritoneal fluid of 32 control and 56 endometriosis patients. Wilcoxon and Mann-Whitney tests and Spearman rank correlations were used in statistical analysis. RESULTS: Peritoneal fluid and sera from the examined group had higher angiogenic activity and interleukin 8 concentrations. There was correlation found between AFS and neovascularization induced by sera and PF of patients with peritoneal lesions. CONCLUSIONS: Angiogenesis plays an important role in pathogenesis of endometriosis. Although IL-8 takes part in neovascularization, there are other factors modulating angiogenesis in endometriosis.

Efficacy and tolerability of low-dose transdermal estrogen (Oesclim) in the treatment of menopausal symptoms.

OBJECTIVE: To establish the proportion of symptomatic postmenopausal women who can be satisfactorily maintained on a low HRT dose of 25 microg/day 17-beta-estradiol (Oesclim 25 transdermal patches), after 8 weeks of treatment. STUDY DESIGN AND PATIENTS: This was a multicenter open label non-comparative trial. Treatment was initiated with 25 microg/day dosage, which could be increased to 50pg/day if required after 8 weeks, according to clinical evaluation. Sequential treatment with an oral progestogen was also given for > or = 12 days/month in all non-hysterectomized women. The primary criterion for evaluation of efficacy was the proportion of patients who remained on Oesclim 25 after 8 weeks of treatment in comparison to patients requiring Oesclim 50. RESULTS: Sixty-two patients were included in the study and 60 were treated. 88.3% of treated patients [CI: 78.7-94.9] fulfilled the primary criterion, remaining with the Oesclim 25 dosage after 8 weeks of treatment. All clinical menopausal symptoms showed a decrease from baseline to the end of the study. The mean daily number of vasomotor symptoms decreased from 8.2 (+/- 5.6) at baseline, for the entire treated population, to 1.0 (+/- 2.2) and 1.0 (+/- 1.2) at the end of the study in patients remaining with Oesclim 25 and in those requiring Oesclim 50, respectively. At the interim visit, patients in the Oesclim 50 group had a higher number of symptoms than those maintained on Oesclim 25. The global efficacy of the treatment was evaluated as very effective/effective by 93% of all patients and very good/good by investigators for 91% of their patients. Overall 91% of all patients evaluated the global tolerability as very well/well, while investigators rated it very good/good for 97% of their patients. The vast majority of all patients (93%) were very satisfied/satisfied with the trial treatment, and 90% of them were willing to continue the study drug. CONCLUSION: Oesclim low dose (25microg) hormonal transdermal therapy was efficient in management of climacteric symptoms in this 16-week study. The good acceptance of the treatment was associated with its high efficiency and tolerability.

[The results of GnRH analog treatment of endometriosis]. / Wyniki leczenia endometriozy analogami GnRH.

Our study consisted of 146 patients with endometriosis diagnosed during laparoscopy. The age of those women varied from 19 to 43. Pathological changes were classified according to Revised American Fertility Society scale. Numeric scale was also used to evaluate clinical symptoms characteristic to this disease. During the initial laparoscopy biopsies were taken, endometrial implants were coagulated, pelvic adhesions deliberated and endometriomas were enucleated or their wall cut out and coagulated. When endometriosis was histopathologically confirmed the hormonal treatment was undertaken during a period of time from 3 to 6 months depending on the severity of the disease. The patients were treated with 3.6 mg gosereline and 3.75 mg triptorelin monthly or with 400 mcg of naphareline daily. The hormonal therapy was monitored by the concentration of estradiol in blood serum. After full cycle of GnRH analogues treatment laparoscopy was repeated. The mean of The Symptom Severity Scores decreased from 7.1 to 2.1 after the treatment which is a 70% decrease. In the group of women with pain complains 96% of patients noticed improvement, in the group suffering from infertility there were 26.3% of patients who got pregnant. GnRH analogues were good tolerated by patients during the treatment.

[VEGF concentration in peritoneal fluid of patients with endometriosis]. / Stezenie VEGF (czynnik wzrostu sródblonka naczyniowego) w plynie otrzewnowym kobiet z endometrioza.

The theory of Sampson that endometrial cells and fragments desquamated during the menstrual period are transported through fallopian tubes into the peritoneal cavity where they implant, proliferate and develop into endometriotic lesions is generally accepted. There is increasing evidence that immunological mechanisms play a role in the pathogenesis and pathophysiology of endometriosis. Excessive endometrial angiogenesis is proposed as an important mechanism in the pathogenesis of endometriosis. Evidence is reviewed for the hypothesis that the endometrium of women with endometriosis has an increased capacity to proliferate, implant and grow in the peritoneal cavity. From the known angiogenic factors, vascular endothelial growth factor (VEGF) has emerged as a pivotally important regulator of normal angiogenesis and pathological neovascularization. In present study we evaluated the concentrations of VEGF in peritoneal fluid of patients with endometriosis and showed no correlation between AFS score and VEGF concentration in peritoneal and in ovarian endometriosis. Above results do not confirm former observations indicating the role of VEGF in endometriosis pathogenesis.

[Bacterial and fungal vaginal infections--immunologic and clinical aspects]. / Bakteryjne i grzybicze stany zapalne pochwy--aspekt immunologiczny i kliniczny.

Bacterial and fungal vaginal infections seem to be one of the most important problem in clinical gynaecology, because of their very often incidence and recurrence. One of the most important factor that implicates those epidemiological facts is local immunological response. Present paper summarises immunological mechanisms involved in antimicrobial response, and current knowledge on diagnosis and treatment of bacterial and fungal vaginal infections.

[Serum VEGF (vascular endothelial growth factor) concentration in patients with endometriosis]. / Stezenie VEGF (czynnik wzrostu sródblonka naczyniowego) w surowicy kobiet z endometrioza.

The theory of Sampson that endometrial cells and fragments desquamated during the menstrual period are transported through fallopian tubes into the peritoneal cavity where they implant, proliferate and develop into endometriotic lesions is generally accepted. Accumulating data suggest that deficient immunity against retrograde endometrium during menstruation may be involved in the pathophysiology of endometriosis. Recent studies in women with endometriosis demonstrated functional changes in several immunologic components in the peritoneal fluid as well as in sera of those patients. Among others it was shown that a wild pattern of cytokines take part in events occurring during endometrial cells implantation, proliferation and forming of endometriotic lesions. One of them VEGF seems to play a very important role in neovascularisation and implantation of ectopic endometrial lesions. In present study we evaluated the concentrations of VEGF in serum of patients with endometriosis and showed negative correlation between AFS score and VEGF concentration in peritoneal endometriosis. Above results do not confirm former observations indicating the role of VEGF in endometriosis pathogenesis.

[The efficacy of low estrogen transdermal therapy in climacteric symptoms management]. / Skutecznosc niskodawkowej terapii przezskórnej w usuwaniu objawów klimakterycznych.

The aim of the study was to evaluate the efficacy and tolerability of low doses estrogen transdermal system treatment in management of climacteric symptoms. On the basis of performed researches it seems to be reasonable to start hormonal replacement therapy with the very low dosage of estrogen to achieve sufficient results and avoid side effects.

Adenosine receptor antagonism causes inhibition of angiogenic activity of human ovarian cancer cells.

Angiogenesis, new blood vessels development, is an important process involved in ovarian cancer growth and metastasis. Adenosine is a known mediator of angiogenesis in hypoxic tissues. Theobromine, adenosine receptor antagonist, exerts antiangiogenic properties in many types of tumors in Balb/c mice cutaneous angiogenesis assay. The aim of the present study was to evaluate the mechanism of its action. We showed that theobromine inhibits angiogenic activity of ovarian cancer cells as well as CD45 positive lymphocytes isolated from peritoneal ascitic fluid of ovarian cancer patients. Using synthetic adenosine receptor antagonists: 8-phenyl-theophylline and 8-cyclopentyl-1,3 dipropylxantine we established that antiangiogenic properties of theobromine are dependent on its interaction with A2 adenosine receptor. Our observations were confirmed in full suspensions of ascitic cells as well as in isolated cancer cells and CD45 lymphocytes. We postulate that A2 receptor antagonism may diminish angiogenesis induced by hypoxia in different cancer tissues and may find a place in future cancer therapy.

[Malfunction of some immunologic functions in patients with obstructive sleep apnea]. / Zaburzenia niektórych funkcji ukladu odpornosciowego u chorych na obturacyjny bezdech senny (OBS).

Hypoxia and sleep disorders may result in an impairment of immune system in patients with obstructive sleep apnea (OSA). Therefore we studied mitogenic stimulation of peripheral blood lymphocytes by PHA (1 microgram/ml) by measurement of 3H-thymidine incorporation, metabolic activity of neutrophils measured by chemiluminescence (CL), immunoglobulins (IgG, IgA and IgM) concentration in serum (radial immunodiffusion) and TNF-alpha concentration in serum (ELISA), and E-rosette tests (with theophylline) in 57 obese patients with severe OSA. In OSA patients severe impairment of f-MLP-induced granulocyte chemiluminescent activity was observed.

GRANULOCYTE CHEMILUMINESCENCE ACTIVITY, ANTIBODY PRODUCTION AND PERCENTAGE OF CD4(+)AND CD8(+)LYMPHOCYTES IN PERIPHERAL BLOOD OF OFFSPRING OF SALBUTAMOL-TREATED PREGNANT C3H MICE.

Preterm delivery is one of the most important problems in obstetric care. One of commonly used treatment of such high risk cases is salbutamol-beta(2)adrenoceptor agonist. The aim of present study was to determine if such treatment causes any changes in neonatal immune system and therefore should be considered in newborn care. The experiments were performed in 4-5- and 6-7-week-old female and male offspring of salbutamol treated C3H inbred mice. In the present study chemiluminescent activity of peripheral blood granulocytes, percentage of CD4(+)and CD8(+)lymphocytes and antibody production were evaluated. A lower number of peripheral blood granulocytes in 6-7-week-old offspring of salbutamol treated mothers was observed, while in the case of younger mice's lymphocytes count in both groups, the differences were not signtificant as compared to control group. In 4-5-week-old mice a lower percentage of CD4(+), CD3(+)and CD8(+)was evaluated, while in older offspring the percentage of CD4(+)and CD3(+)was higher in the case of the progeny of salbutamol treated mothers. As far as chemiluminescent activity was concerned no differences were found in any of experimental groups. We showed higher IgM production both in male and female offspring of the experimental group and no changes in IgG levels in mice sera. Alterations observed in progeny of salbutamol treated mice might have influence on their further immune system development and function. 2000 Academic Press@p$hr Copyright 2000 Academic Press.

THYMUS AND LYMPH NODE CELL CD4(+)AND CD8(+)MARKER EXPRESSION AND THEIR ANGIOGENIC ACTIVITY OF OFFSPRING OF SALBUTAMOL-TREATED PREGNANT C3H MICE.

Salbutamol, beta(2)-adrenoceptor agonist is a first choice drug in preterm delivery treatment. The aim of the present study was to determine whether salbutamol can cause any alterations in neonatal immune systems and therefore should be considered in newborn care. The experiments were performed on 4-5- and 6-7-week-old female and male offspring of salbutamol-treated C3H inbred mice. Thymus and lymph node weight, cellularity and lymphatic organs, lymphocytes phenotypes and their angiogenic activity were evaluated. We observed lower thymus weight in 6-7-week-old progeny of salbutamol-treated mothers and in the same time lower thymus cell number in both age groups. Lower lymph node weight was developed in older progeny while cellularity was diminished both in 4-5- and 6-7-week-old offspring of salbutamol-treated mothers. We have not detected any changes in percentage of CD4, CD8, CD3 and CD4CD8 positive lymphocytes in progeny of salbutamol-treated mothers. As far as lymph node lymphocytes phenotype is considered we showed in both age groups lowering of CD4 and CD3 positive cells in experimental groups. In the LIA test (lymphocyte-induced angiogenesis) we showed lower lymph node cell angiogenic activity of salbutamol-treated mothers' progeny in both age groups. In the case of thymus lymphocytes we have not observed any alterations in their angiogenic activity. The differences in histological examination of thymus and lymph nodes were not detected in experimental and control groups. 2000 Academic Press@p$hr Copyright 2000 Academic Press.

Role of cytokines in pathogenesis of endometriosis.

Sampson's theory stating that endometrial cells and fragments desquamate during the menstrual period are transported through Fallopian tubes into the peritoneal cavity where they implant, proliferate and develop into endometriotic lesions is generally accepted [1]. Accumulating data suggest that deficient immunity against retrograde endometrium during menstruation may be involved in the pathophysiology of endometriosis. Recent studies in women with endometriosis have demonstrated functional changes in several immunologic components in the peritoneal fluid as well as in sera of those patients. It was shown, for instance, that a wide pattern of cytokines are involved during endometrial cells implantation, proliferation and forming of endometriotic lesions. Those factors play a critical role in decreased immunologic surveillance, recognition and destruction of ectopic endometrial cells and possible facilitation of the implantation of ectopic endometrial tissues. The present review summarises the current knowledge on the role of different cytokines in the pathophysiology of endometriosis.

Granulocyte chemiluminescence activity, antibody production and percentage of CD4(+) and CD8(+) lymphocytes in peripheral blood of offspring of salbutamol-treated pregnant C3H mice.

Preterm delivery is one of the most important problems in obstetric care. One of commonly used treatment of such high risk cases is salbutamol-beta(2) adrenoceptor agonist. The aim of present study was to determine if such treatment causes any changes in neonatal immune system and therefore should be considered in newborn care. The experiments were performed in 4-5- and 6-7-week-old female and male offspring of salbutamol treated C3H inbred mice. In the present study chemiluminescent activity of peripheral blood granulocytes, percentage of CD4(+) and CD8(+) lymphocytes and antibody production were evaluated. A lower number of peripheral blood granulocytes in 6-7-week-old offspring of salbutamol treated mothers was observed, while in the case of younger mice's lymphocytes count in both groups, the differences were not significant as compared to control group. In 4-5-week-old mice a lower percentage of CD4(+), CD3(+) and CD8(+) was evaluated, while in older offspring the percentage of CD4(+) and CD3(+) was higher in the case of the progeny of salbutamol treated mothers. As far as chemiluminescent activity was concerned no differences were found in any of experimental groups. We showed higher IgM production both in male and female offspring of the experimental group and no changes in IgG levels in mice sera. Alterations observed in progeny of salbutamol treated mice might have influence on their further immune system development and function.

Thymus and lymph node cell CD4(+) and CD8(+) marker expression and their angiogenic activity of offspring of salbutamol-treated pregnant C3H mice.

Salbutamol, beta(2)-adrenoceptor agonist is a first choice drug in preterm delivery treatment. The aim of the present study was to determine whether salbutamol can cause any alterations in neonatal immune systems and therefore should be considered in newborn care. The experiments were performed on 4-5- and 6-7-week-old female and male offspring of salbutamol-treated C3H inbred mice. Thymus and lymph node weight, cellularity and lymphatic organs, lymphocytes phenotypes and their angiogenic activity were evaluated. We observed lower thymus weight in 6-7-week-old progeny of salbutamol-treated mothers and in the same time lower thymus cell number in both age groups. Lower lymph node weight was developed in older progeny while cellularity was diminished both in 4-5- and 6-7-week-old offspring of salbutamol-treated mothers. We have not detected any changes in percentage of CD4, CD8, CD3 and CD4CD8 positive lymphocytes in progeny of salbutamol-treated mothers. As far as lymph node lymphocytes phenotype is considered we showed in both age groups lowering of CD4 and CD3 positive cells in experimental groups. In the LIA test (lymphocyte-induced angiogenesis) we showed lower lymph node cell angiogenic activity of salbutamol-treated mothers' progeny in both age groups. In the case of thymus lymphocytes we have not observed any alterations in their angiogenic activity. The differences in histological examination of thymus and lymph nodes were not detected in experimental and control groups.

The effect of salbutamol treatment on the cellular immunity of the offspring of pregnant mice: spleen cell activity.

Preterm delivery is one of the greatest problems in obstetric care. One of the most commonly used treatments for high risk cases is salbutamol, a beta-2-adrenoceptor agonist. The aim of the present study was to determine if such treatment causes any changes in the neonatal immune system which should therefore be a concern in the care of the newborn. The experiments were performed on 4 to 5 or 6 to 7-week old female and male offspring of salbutamol-treated C3H/W inbred mice. In the first part of the study, the number of spleen cells, phenotypes and activity (phytohemagglutinin-induced proliferation, ability to induce local graft versus host reaction) were determined. We observed lowering of cell number and lowered proportions of cluster of differentiation (CD)3, CD4 and CD8 positive lymphocytes in spleens of progeny of salbutamol-treated mice. However, CD4+ to CD8+ ration was higher in the progeny of salbutamol-treated mothers than in the corresponding controls. In addition, reactivity to phytohemagglutinin and ability to induce local graft vs. host reaction were higher (popliteal lymph node test) or undisturbed (lymphocyte-induced angiogenesis test) in this group of mice.