MiRNAs and their interplay with PI3K/AKT/mTOR pathway in ovarian cancer cells: a potential role in platinum resistance.

Ovarian cancer is a leading cause of death among gynecologic malignancies. This disappointing prognosis is closely related to intrinsic or acquired resistance to conventional platinum-based chemotherapy, which can affect a third of patients. As such, investigating relevant molecular targets is crucial in the fight against this disease. So far, many mutations involved in ovarian cancer pathogenesis have been identified. Among them, a few pathways were implicated. One such pathway is the P13K/AKT/mTOR with abnormalities found in many cases. This pathway is considered to have an instrumental role in proliferation, migration, invasion and, more recently, in chemotherapy resistance. Many miRNAs have been found to influence P13K/AKT/mTOR pathway with different potential role in tumor genesis and ovarian cancer behaviour. In particular, their biological function was recently investigated as regards chemoresistance, therefore, leading to the identification of potential specific indirect biomarker of platinum sensitivity in ovarian cancer.

Beyond circulating microRNA biomarkers: Urinary microRNAs in ovarian and breast cancer.

Breast cancer is the most common malignancy in women worldwide, and ovarian cancer is the most lethal gynecological malignancy. Women carrying a BRCA1/2 mutation have a very high lifetime risk of developing breast and ovarian cancer. The only effective risk-reducing strategy in BRCA-mutated women is a prophylactic surgery with bilateral mastectomy and bilateral salpingo-oophorectomy. However, many women are reluctant to undergo these prophylactic surgeries due to a consequent mutilated body perception, unfulfilled family planning, and precocious menopause. In these patients, an effective screening strategy is available only for breast cancer, but it only consists in close radiological exams with a significant burden for the health system and a significant distress to the patients. No biomarkers have been shown to effectively detect breast and ovarian cancer at an early stage. MicroRNAs (miRNAs) are key regulatory molecules operating in a post-transcriptional regulation of gene expression. Aberrant expression of miRNAs has been documented in several pathological conditions, including solid tumors, suggesting their involvement in tumorigenesis. miRNAs can be detected in blood and urine and could be used as biomarkers in solid tumors. Encouraging results are emerging in gynecological malignancy as well, and suggest a different pattern of expression of miRNAs in biological fluids of breast and ovarian cancer patients as compared to healthy control. Aim of this study is to highlight the role of the urinary miRNAs which are specifically associated with cancer and to investigate their role in early diagnosis and in determining the prognosis in breast and ovarian cancer.

Retroperitoneal tumors in the pelvis: a diagnostic challenge in gynecology.

Retroperitoneal tumors can pose a diagnostic and therapeutic challenge to gynecologists because of their rarity, late presentation, and complex anatomical location in the retroperitoneum. This article reviews the diagnosis and management of retroperitoneal tumors in the pelvis, and highlights the potential pitfalls that may be faced by gynecologists.

Period prevalence and risk factors for postoperative short-term wound complications in vulvar cancer: a cross-sectional study.

INTRODUCTION: Although clinicians recognize that postoperative wound management in patients with vulvar cancer (VC) is challenging, the prevalence and risk factors for different types of short-term wound complications (WCs) remain unclear. The aims of this study were: (1) to determine the period prevalence of postoperative short-term WCs and (2) to identify risk factors associated with short-term WCs in patients with VC. METHOD: In a cross-sectional study in a Swiss University Hospital, a sample of 108 patients with VC treated surgically (and free of WCs at the time of admission) was included. Data were collected retrospectively from 2007 to 1997 from medical records using an investigator-developed data collection instrument to assess risk factors preoperatively and perioperatively and WCs that occurred within the first 30 postoperative hospital days. The period prevalence of WCs was calculated, and logistic regression was used to identify risk factors for WCs. RESULTS: The median age was 69 years (interquartile range [IQR], 21 years). The period prevalence of WCs was 45.4% (49/108), showing at least 1 of 8 assessed WCs per patient within the median hospital duration of 11 days (IQR, 12 days). The period prevalence for each type of WC was 31.5% for dehiscence, 12% for hematoma, 6.5% for necrosis, 5.6% for infections, 4.6% for seroma, 1.9% for lymph cysts, 1.9% for malignant wounds, and 0% for disturbed tissue formation. Two significant predictors of WCs were identified out of 14 risk factors examined (P < 0.05). The odds ratio (OR) for WC increased with the extent of surgical therapy, ie, from excision to hemivulvectomy and to radical vulvectomy, by a factor of 2.6 (OR, 2.6; 95% confidence interval [CI], 1.34-5.14), and, in the case of inguinofemoral lymphadenectomy, by a factor of 3 (OR, 3.0; 95% CI, 1.03-8.76). CONCLUSION: The high prevalence of short-term WCs (45.4%) indicates a need for systematic wound assessment and early risk management--especially after hemivulvectomy, radical vulvectomy, and inguinal lymphadenectomy.

Iatrogenic orifice transluminal endoscopic surgery (IOTES): managing uterine perforations at operative hysteroscopy.

OBJECTIVE: To prove safety and feasibility of an intra-abdominal endoscopic evaluation via an iatrogenic uterine perforation that occurred during operative hysteroscopy. DESIGN: Clinical case report. SETTING: University Hospital. PATIENT(S): A multimorbid woman with postmenopausal bleeding with iatrogenic uterine perforation during hysteroscopic resection of an endometrial polyp. INTERVENTION(S): Intra-abdominal endoscopic evaluation via the iatrogenic uterine perforation site with use of a standard diagnostic hysteroscope. MAIN OUTCOME MEASURE(S): Visibility, technical feasibility, clinical course, and hematologic follow-up of the patient. RESULT(S): A sufficient assessment of the intra-abdominal cavity and the uterine defect was possible with use of a small-diameter diagnostic hysteroscope during the workup of an iatrogenic uterine perforation. No additional intervention-related side effects occurred. CONCLUSION(S): This technique was safe and feasible to gain operative access to the abdominal cavity, allowing a complete diagnostic intra-abdominal inspection for lesions of the adjacent organs. IOTES bears the potential to become a time-saving low-risk alternative to diagnostic standard laparoscopy.

The net which made her wet: two unusual cases of stress incontinence.

This report describes two cases of urinary stress incontinence secondary to mesh repair of large abdominal hernias. Both patients had never experienced urinary incontinence before their hernia repair. In both cases, polypropylene nets were inserted to stabilise the abdominal wall. Immediately after the intervention, both patients became stress incontinent. Probably pressure transmission to the pelvic floor was increased due to stabilisation of the abdominal wall, which worked as a "windpipe" before surgery. After the insertion of suburethral tapes the incontinence resolved.