ABSTRACT
The fallopian tube fimbrial epithelium, which is exposed to the follicular fluid (FF) contents of ovulation, is regarded as the main origin of ovarian high-grade serous carcinoma. Previously, we found that growth factors in FF, such as IGF2, are responsible for the malignant transformation of fallopian tube epithelium. However, ovulation is a monthly transient event, whereas carcinogenesis requires continuous, long-term exposure. Here, we found the transformation activity of FF sustained for more than 30 days after drainage into the peritoneal fluid (PF). Hepatocyte growth factor (HGF), activated through the ovulation injury-tissue factor-thrombin-HGF activator (HGFA)-HGF cleavage cascade confers a sustained transformation activity to fallopian tube epithelium, high-grade serous carcinoma. Physiologically, the high reserve of the coagulation-HGF cascade sources a sustained level of HGF in PF, then to the blood circulation. This HGF axis promotes the growth of the corpus luteum and repair of tissue injury after ovulation.
Subject(s)
Cell Transformation, Neoplastic/pathology , Corpus Luteum/physiology , Cystadenocarcinoma, Serous/pathology , Fallopian Tube Neoplasms/pathology , Ovarian Neoplasms/pathology , Ovulation , Peptide Hydrolases/metabolism , Adult , Animals , Apoptosis , Cell Proliferation , Cell Transformation, Neoplastic/metabolism , Cells, Cultured , Corpus Luteum/injuries , Cystadenocarcinoma, Serous/metabolism , Fallopian Tube Neoplasms/metabolism , Female , Follicular Fluid/metabolism , Hepatocyte Growth Factor/metabolism , Humans , Insulin-Like Growth Factor II/metabolism , Mice , Mice, Inbred NOD , Mice, SCID , Ovarian Neoplasms/metabolism , Prognosis , Serine Endopeptidases/metabolism , Thrombin/metabolism , Thromboplastin/metabolism , Xenograft Model Antitumor AssaysABSTRACT
OBJECTIVE: To report a case of ovarian heterotopic pregnancy after an IVF cycle. DESIGN: Case report. SETTING: Reproductive medicine unit, Christian Medical College Hospital, Vellore, India. PATIENT(S): A woman with an ovarian heterotopic pregnancy. INTERVENTION(S): Laparoscopic removal of ovarian ectopic pregnancy. MAIN OUTCOME MEASURE(S): Early detection and successful treatment of heterotopic pregnancy. RESULT(S): Successful laparoscopic management of ovarian pregnancy resulting in a single viable ongoing intrauterine pregnancy. CONCLUSION(S): Clinicians need to be aware of such rare and potentially fatal presentations after IVF, because early diagnosis and management in these cases can yield a favorable outcome.
Subject(s)
Fertilization in Vitro , Pregnancy Complications/diagnostic imaging , Pregnancy, Ectopic/diagnostic imaging , Adult , Corpus Luteum/diagnostic imaging , Corpus Luteum/injuries , Diagnosis, Differential , Female , Humans , Laparoscopy , Pregnancy , Pregnancy Complications/surgery , Pregnancy, Ectopic/surgery , Rupture/diagnostic imaging , Treatment Outcome , UltrasonographyABSTRACT
Haemoperitoneum secondary to ruptured corpus luteum is a rare complication for women on anticoagulants and with certain congenital bleeding disorders. A surgical approach is often taken, leading to oophorectomy in many cases. We describe three patients presenting with haemoperitoneum in association with factor VII deficiency, factor X deficiency and sitosterolaemia. In two of the patients, recurrent episodes occurred prior to introduction of the oral contraceptive pill. Conservative management with blood product and factor concentrate support was successful in avoiding surgery in three of the five episodes of bleeding. These cases demonstrate that preservation of ovarian function is possible with a conservative approach and recurrent episodes may be prevented by suppression of ovulation.
Subject(s)
Blood Coagulation Disorders/complications , Contraceptives, Oral, Hormonal/therapeutic use , Hemoperitoneum/prevention & control , Ovulation/drug effects , Adult , Blood Coagulation Disorders/drug therapy , Corpus Luteum/injuries , Factor VII Deficiency/complications , Factor X Deficiency/complications , Female , Hemoperitoneum/drug therapy , Hemoperitoneum/etiology , Humans , Rupture, Spontaneous , Sitosterols/bloodABSTRACT
El presente caso reporta la existencia de un embarazo ectópico de ovario derecho que cumple los criterios de Spiegelberg para su diagnóstico asociado a la presencia de la ruptura del cuerpo lúteo contralateral con hemoperitoneo masivo, motivando una laparotomía exploradora de emergencia. El reporte anátomo patológico diagnosticó gestación en etapa inicial en ovario derecho y ruptura de cuerpo lúteo izquierdo
Subject(s)
Humans , Pregnancy , Adult , Female , Corpus Luteum/injuries , Pregnancy, Ectopic/diagnosis , Hemoperitoneum/diagnosis , PeruABSTRACT
Rupture of the corpus luteum in a young woman can cause massive hemoperitoneum, seen as free fluid in the flanks and pelvis on abdominal films. Radiographic examination alone cannot distinguish hemorrhage due to a ruptured corpus luteum or ectopic pregnancy from pus due to a ruptured appendix or a tubo-ovarian abscess; however, the presence of nonclotting blood on culdocentesis excludes abdominal sepsis. If these symptoms and findings occur during the latter half of the menstrual cycle in a young woman of low parity who has a normal menstrual history and a negative pregnancy test, a ruptured corpus luteum is a more likely diagnosis than ectopic pregnancy.
