The role of gut dysbiosis in endometriosis' diagnosis and treatment approaches - case report.

BACKGROUND: Endometriosis (EM) is a chronic multifactorial disease characterized by the presence of endometrial tissue outside the uterus. The clear etiopathogenesis of EM is unclear. Increasing evidence was gathered about the crucial involvement of gut microbiota in early stages of the disease, and in its progression. CASE PRESENTATION: We report the case of a 33-year-old Caucasian woman diagnosed with EM, that presented with painful pelvic (dysmenorrhea, dyspareunia) and gastrointestinal (GI) symptomatology. The patient underwent an intestinal microbiota analysis before the surgical treatment was performed. DISCUSSIONS: The GI microbiome culture identified high levels of non-pathogen bacteria Escherichia coli, Bifidobacterium, hemolytic E. coli and potential pathogens: Hafnia alvei and Enterobacter cloacae. The mycology culture performed identified the presence of potential pathogens: Candida albicans and C. glabrata. Microscopic examination and polymerase chain reaction (PCR) analysis showed Giardia lamblia in moderate amounts. These findings were compared with the information available in the literature of specialty and they imply that the patient' intestinal microbiome is heavily disrupted. CONCLUSIONS: There are changes in the microbiota of EM patients in comparison to those not suffering from this disease. The findings addressed in this article characterize the intricate bilateral connection between the microbiota and EM. The goal of future studies ought to be to establish how the microbiome and EM are interconnected by implementing breakthrough diagnostic and treatment strategies.

Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam - literature review and authors' experience.

The aim of this paper was to correlate the circumstances that could lead to an abnormal invasion of placenta with the updated requirements to perform screening by ultrasound for all pregnant women prone to develop this pathology. To screen in the middle trimester of gestation for placenta accreta spectrum (PAS) disorders sets up an in-time referral opportunity for pregnant women prenatally detected with this pathology to a medical center with elevated level of expertise in the management of PAS disorders, able to act permanently by a multidisciplinary team (MDT) and to have access at medical resources including blood bank available. The literature review reveals especially useful data for clinical practice as regards novel explanations related to the etiology and physiopathology of PAS disorders, the composition of the MDT and the relevance of an indispensable pathologist physician at the time of Cesarean hysterectomy involved in the selection of best samples with the purpose of avoiding the possibility of losing undiagnosed cases with litigation implications. Conclusions show that the prenatal diagnosis of PAS disorders is possible so decreasing the risk of mortality and morbidity of pregnant women. Screening in the second trimester of pregnancy for PAS disorders becomes mandatory as the number of births by Cesarean section is expected to rise past three-fold until 2030. The professional expertise of the pathologist physician could be enriched by immunohistochemical staining in all suspected cases of placental invasion in myometrium wall.

Review of the biotechnologies and tests used for precancerous cervical lesions diagnosis.

This paper draws on the author's extensive experience in the clinical research focused on the implementation of the new biotechnologies able to identify precancerous cervical lesions and is intended to be a systematic approach to new achievements. The goal of this review is to provide updated information concerning the significance of each biotechnology used in clinical medicine to screen women for cervical cancer or to allow a pertinent discrimination between spontaneous remission lesions and progressive lesions. The data is arranged according to the most widely used biotechnologies and the worldwide recommendations of specialized guidelines.

Epithelioid trophoblastic tumor: a case report and literature review.

Epithelioid trophoblastic tumor (ETT) is a very rare case of malignant trophoblastic tumor, which can occur particularly during the fertile age of women with a long history of abortion and delivery. ETT originates from the intermediate trophoblastic cells of chorion laeve. The main features of this tumor include lack of vessels within the tumor, nuclear hyperchromasia and pleomorphism and a large zone of necrosis and hyalinization. The clinical features of ETT are specific to each case and often consist of vaginal bleeding or amenorrhea in the absence of other complains. The beta-human chorionic gonadotropin (ß-hCG) serum level cannot be an absolute criterion useful in defining diagnosis. The right diagnosis can only be established by a histopathological examination of the tissue picked-up via intrauterine curettage. This paper describes the case of a 35-year-old woman who required gynecological investigation for amenorrhea. The diagnosis established by biopsic curettage and the clinical evolution have influenced the physician's decision to perform hysterectomy. The only method to differentiate between the microscopic diagnosis of ETT and choriocarcinoma was the immunohistochemical staining of trophoblastic cells for cytokeratin AE1÷AE3, p63, Ki67. Despite the diagnosis of malignity, this tumor does not usually require a recommendation for chemotherapy and does not seem to have a bad prognostic. However, these data do not rule out that clinical behavior is sometimes difficult to predict. We analyzed the clinical and histology criteria in line with the data published in literature.

Perineal reconstruction with biologic graft vulvoplasty for verrucous carcinoma treated by repeated vulvar excisions: a case report.

Vulvar neoplasia represents 5% of malignancies in female genital tract and 0.6% of all cancers in women. Although it is known to be a rare type of cancer, which occurs especially in elderly women, its incidence is increasing in young females because of its association with the human papillomavirus (HPV). In this paper, we report the case of a 46-year-old woman, gravidity 4, parity 3, with a medical history of multiple vulvar excisions for recurrent ulcerative vulvar lesions during a period of 11 years. The first lesion appeared in 2003, it was excised and the histopathological result showed squamous cell carcinoma with undifferentiated areas and chronic ulcerative inflammation. The patient underwent radiation therapy remaining at the end of it a small-ulcerated lesion at the superior vulvar commissure, which was biopsied in 2004 showing chronic ulcerative inflammation with reparatory areas of squamous immature benign metaplasia In April 2014, a dermatological consult described vulvar scleroatrophic lichen confirmed by a biopsy. In November 2014, the patient presented to our clinic when a vicious vulvar scar was detected, with a transformed tegument with aspect of atrophic lichen. A perineal reconstruction including anal sphincter plasty was performed. Due to the important remaining skin defect, a Surgisis graft vulvoplasty was performed. The histopathological result of the excised suspect areas was vulvar intraepithelial high-grade neoplasia (VIN III). A retrospective histopathological review of the case established that is more accurate to consider that the vulvar lesions were, all along, a very well differentiated squamous cell carcinoma (verrucous carcinoma), which lacks cytopathic effect of HPV infection, has a low p53 expression but a high Ki67. Case evolution was favorable with the acceptance and integration of the biologic grafts at two months after surgery and normal healing.

The assessment of immunohistochemical profile of endometriosis implants, a practical method to appreciate the aggressiveness and recurrence risk of endometriosis.

UNLABELLED: Endometriosis represents a chronic female genital tract disease characterized by implants outside the endometrial cavity, leading to alteration of pelvic anatomy and having as result chronic pelvic pain and infertility. AIM: From the molecular perspective, the aim of studying endometriosis is identifying a cause and a consequence, that lead to the appearance and perpetual arising of new implants. The description of the immunohistochemical (IHC) profile of ectopic endometrium could represent a new element in the pathogenesis of endometriosis and also a practical method to appreciate the aggressiveness and possibility of recurrence of the disease. The study consisting of histopathological and immunohistochemical (IHC) analysis of the tissues excised included 14 patients, operated from June to December 2014, to which was confirmed the presumptive diagnosis of endometriosis, based on anamnesis, clinical examination and ultrasound appearance. We identified the expression of estrogen and progesterone receptors, whose presence in the ectopic endometrium guides the medical hormone postoperative treatment. We also identified the expression of a cellular proliferation marker - Ki-67, and inhibition marker of cellular apoptosis - Bcl-2, in order to characterize the aggressiveness of endometriosis implantations and a stromal marker CD10. Although there are plenty of medical and surgical therapeutic methods available, the treatment of endometriosis must be individualized for every patient taking into consideration the IHC analysis. Consolidation of surgical treatment by prescription of a medical long-term treatment is indispensable, because endometriosis is a chronic relapsing disease.

Immunofluorescence expression of Ki-67, p53 and cyclin inhibitors (p16ink4a, p21 and p27) in low-grade cervical lesions versus high-grade cervical lesions. Research study on cell cultures.

OBJECTIVE: The aim of this research was to assess the immunofluorescence expression (IFE) of cell cycle regulators p16ink4a, p21, p27, in association with proliferation and prognosis factors Ki-67, p53 respectively, in cell cultures, obtained from different types of cervical intra-epithelial lesions. The final purpose was to distinguish a best marker able to identify with high accuracy the high-grade squamous intra-epithelial lesion. MATERIALS AND METHODS: The study was carried out on 68 epithelial cell cultures. Three senior specialists have analyzed 500 cells/case individually. The statistic analysis for correlation between used markers has been performed. RESULTS: The study batch revealed a very low expression of investigated parameters (<1%) in negative cases for malignancy and intraepithelial lesion (NMIL), a progressive exponential expression in low-grade squamous intraepithelial lesion (LSIL), and a very high expression in high-grade squamous intra-epithelial lesion (HSIL) and invasive squamous cervical carcinoma (ISCC). Ki-67 and p53 were overexpressed in nuclei both in LSIL and HSIL. A slightly direct correlation between p21 and Ki-67 (r=0.35, p<0.001) was observed in HSIL. Statistically significant correlations were noticed between some markers: p16ink4a and p27 (r=0.4, p=0.03), p16ink4a and Ki-67 (r=-0.4, p=0.002). CONCLUSIONS: The most reliable parameters for assessing HSIL and ISCC proved to be Ki-67 and p16ink4a. Both were with percentages and intensity of IFE around 100% and higher immunoexpression within the nucleus of cell cultures. Our study reveals that p27 cyclin inhibitor was not reliable in differentiating between LSIL and HSIL.

The triage of low-grade cytological abnormalities by the immunocytological expression of cyclin-dependent kinase inhibitor p16INK4a versus Human Papillomavirus test: a real possibility to predict cervical intraepithelial neoplasia CIN2 or CIN2+.

OBJECTIVE: Assessing the hypothesis that p16(INK4a) immunocytochemistry (ICC) has better relevance than Human Papillomavirus (HPV) testing at detecting high-grade cervical intraepithelial neoplasia (HGCIN) upon histopathological diagnosis in women with abnormal cytologies such atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL). MATERIALS AND METHODS: A retrospective study of 63 selected cases (22 with ASC-US and 41 with LSIL) was performed at "St. Pantelimon" Clinical Hospital, Bucharest, Romania, using p16(INK4a) ICC and Linear Array HPV Genotyping Test. All cases have been followed-up by colposcopy and biopsies. The sensitivity and specificity of p16(INK4a) and HPV were analyzed by chi-squared test. RESULTS: LSIL cytologies were more likely to be p16(INK4a) positive than those with ASC-US: OR=3.1, 95% CI (1.06-9.11). The processed data show that in women with LSIL the sensitivity of p16(INK4a) is 37.5% higher than that of high-risk(hr)-HPV (p=0.0050), whereas in ASC-US it is 44.5% higher (p=0.0577). In ASC-US, p16(INK4a) has a higher specificity (84.62%) than hr-HPV (53.85%); for LSIL cytologies, this difference is less steep: 58.82% for p16(INK4a) as compared to 47.06% for HPV. CONCLUSIONS: The p16(INK4a) is significantly more sensitive than hr-HPV in both low-grade abnormal cytologies and has higher specificity than HPV testing to detect HGCIN, mainly in women with ASC-US cytologies. Only women with ASC-US and LSIL cytologies who test positive for p16(INK4a) should be directed to colposcopy and/or biopsy. p16(INK4a) is a suitable immunocytochemical marker which increases the accuracy of diagnosis at women with low-grade cytologic abnormality.