A novel epithelial-mesenchymal transition-related lncRNA signature predicts prognosis and immune status in endometrioid endometrial cancer.

The pathogenesis and progression of endometrial cancer (EC) are associated with epithelial-mesenchymal transition (EMT) and long noncoding RNAs (lncRNAs). In the present study, we aimed to identify an EMT-related lncRNA signature and evaluate its prognostic value in EC. We obtained the expression profile of lncRNAs and clinical information of patients with endometrioid EC from The Cancer Genome Atlas database (N = 401). We identified a signature of 5 EMT-related lncRNAs and calculated the risk score of each patient. Next, we validated the independence of the prognostic value of the EMT-related lncRNA signature. Furthermore, we performed Gene Set Enrichment Analysis to identify potential molecular function and Kyoto Encyclopedia of Genes and Genomes pathways related to the EMT-related lncRNA signature. Tumor microenvironment analysis and immune checkpoint blockade (ICB) response prediction were also assessed. Survival analysis revealed that the high-risk group, based on the EMT-related lncRNA signature, had a poorer prognosis than the low-risk group in the training, testing, and entire sets. The predictive value of the EMT-related lncRNA signature was independent of age, The International Federation of Gynecology and Obstetrics stage, tumor grade, and body mass index. Time-dependent receiver operating characteristic curves also demonstrate the prognostic accuracy of this risk model. Gene Set Enrichment Analysis showed that cytokine-cytokine receptor interaction, glycolysis/gluconeogenesis, and IL-17 signaling pathway were significantly enriched. Furthermore, tumor microenvironment analysis indicated a significant negative correlation between the immune score and EMT-related lncRNA signature risks core, while the low-risk group was more likely to respond to ICB therapy than the high-risk group. A reliable EMT-related lncRNA signature of endometrioid EC was identified that could be utilized as an independent prognostic biomarker to predict patient survival outcomes and provide references for the option of ICB therapy.

Pituitrin Injection before Hysteroscopic Curettage for Treating Type I Cesarean Scar Pregnancy in Comparison with Uterine Artery Embolization: A Retrospective Study.

Background: The effectiveness and safety of pituitrin injection coupled with hysteroscopy and suction curettage as treatment for type I cesarean scar pregnancy (CSP) have not been studied enough in the literature, by comparing it to uterine artery embolization (UAE) followed by suction curettage we aim to determine its efficacy. Materials and Methods: Data of 53 patients (the PIT group) with type I CSP treated with pituitrin injection combined with hysteroscopic suction curettage and 137 patients (the UAE group) with type I CSP treated with UAE followed by suction curettage were collected in retrospect. The clinical data were analyzed statistically to compare the efficacy and safety between the two groups. Results: The PIT group had a shorter duration of postoperative vaginal bleeding, postoperative hospitalization, and overall hospitalization length (P < 0.05). The PIT group had lower overall hospitalization costs and a lower rate of adverse events than the UAE group (P < 0.05). There was no significant difference between the two groups in terms of treatment success rate, the average length of operation, blood loss during the procedure, time when serum ß-hCG returned to normal range, and menstrual recovery time after hospital release (P > 0.05). Conclusion: UAE and pituitrin injection followed by hysteroscopic suction curettage are good choices for type I CSP treatment. However, pituitrin injection with hysteroscopic suction curettage outperforms UAE followed by suction curettage. Thus, pituitrin injection may be an option of high priority for type I CSP.

Testosterone elevation in ovarian adult granulosa cell tumor: A case report and review of the literature.

RATIONALE: Adult granulosa cell tumors (AGCT) mainly secret estrogen, but few androgens. It is rarer to have amenorrhea and hyperandrogenemia as clinical features. Here, we report a rare case of right side AGCTs with amenorrhea and hyperandrogenemia in a 19-year-old female. PATIENT CONCERNS: The 19-year-old patient was admitted to our hospital due to amenorrhea for more than 1 year, and discovery of pelvic mass for 4 months. The gynecological ultrasound and computed tomography (CT) cannot define the nature of the mass. Surprisingly, an elevation in testosterone levels was also measured. DIAGNOSIS AND INTERVENTIONS: The present patient underwent laparoscopic right salpingo-oophorectomy and partial omentectomy and biopsy of the peritoneum. OUTCOMES: After the surgery, the testosterone value was down to normal. The patient menstrual cramps on August 13, 2021. Her clitoris is smaller than the front. Up to August 1, 2022, there was no obvious sign of recurrence. LESSONS: Androgen-secreting AGCT is rare. We hope that this case can strengthen gynecologists' early diagnosis and treatment of this disease and improve the prognosis.

Primary mucosa-associated lymphoid tissue lymphoma in fallopian tubes: A case report and literature review.

RATIONALE: Mucosa-associated lymphoid tissue (MALT) lymphoma accounts for 7%-8% of newly diagnosed lymphomas. The stomach is the most common organ of origin (nearly 50% of MALT lymphomas). Only 2% of MALT lymphomas arise from the female genital tract, and most originated from uterus. We described a rare case of MALT lymphoma primarily arising from the fallopian tube. PATIENT CONCERNS: A 26-year-old woman was brought into our gynecological clinic because of a history of irregular menstruation. The transvaginal ultrasonography revealed cystic masses in bilateral adnexa and both of them showed rich vasculature. Laboratory tests showed a high level (455.3 U/mL) of cancer antigen-125 (CA-125). INTERVENTIONS: A laparoscopy was performed. OUTCOMES: Frozen section of the removed specimen revealed acute and chronic inflammation with abundant inflammatory cells infiltrating the mesenchyme. The right fallopian tube was removed. However, the final histological results showed inflammation accompanied by hyperplasia of lymphoid tissue. Immunohistochemistry staining were consistent with MALT lymphoma. The patient received the second surgery to remove the left fallopian tube and also confirmed the same pathology. LESSONS: Gynecologists should be aware of cystic masses which showed rich vasculature and high level of CA-125.

Transplantation of decellularized and lyophilized amniotic membrane inhibits endometrial fibrosis by regulating connective tissue growth factor and tissue inhibitor of matrix metalloproteinase-2.

Intrauterine adhesion (IUA) is a disease characterized by endometrial fibrosis caused by injury to the endometrium. In the present study, decellularized and lyophilized human amniotic membrane (DL-AM) material was transplanted in a rat model to explore the preventive effect against IUA. A total of 24 Sprague Dawley rats were randomly divided into an IUA (n=12) group and an IUA + DL-AM (n=12) group. To establish the model, the endometrium of the left uterus was scraped, while that of the right uterus was used as a control. In the IUA group, scraped uteri were sutured without any other treatment, whereas DL-AM was transplanted onto the scraped uteri in the IUA + DL-AM group. Uteri were resected for histological and immunohistochemical evaluation at 3, 7, 14 and 28 days after surgery. The results confirmed the development of IUA, which was accompanied by an increase in the rate of fibrotic area. Integral optical density (IOD) values of connective tissue growth factor (CTGF) were elevated in the IUA group, while matrix metalloproteinase-2 (MMP-2) decreased relative to the control group (P<0.05). After DL-AM transplantation, the IOD value of CTGF dropped, while MMP-2 increased compared with the IUA group (P<0.05). However, compared with that in the control group, the IOD value of CTGF was still higher, whereas MMP-2 was still lower in the IUA + DL-AM group (P<0.05). Furthermore, no evidence of endometrial regeneration was detected in both the IUA and IUA + DL-AM groups. Overall, these results indicated that in the rat model of IUA, transplantation of DL-AM had the potential to prevent the formation of fibrosis to a certain extent and may thus be an alternative strategy for managing the condition.

Multiple organ benign metastasizing leiomyoma: A case report and literature review.

A case of multiple occurrences of benign metastasizing leiomyoma in the lung, left thigh, left ilium and pelvis in a 43-year-old woman who underwent twice myomectomy in 1999 and 2004 and had hysterectomy in 2009 was reported. She was complained of chest distress as well as the pain of left hip and back of thigh. Computed tomography, X-ray and positron emission tomography-computed tomography (PET-CT) demonstrated multiple nodules in lung, masses of left thigh and pelvis. Biopsy of these nodules indicated benign metastasizing leiomyomas according to pathologic and immunohistochemical results. The patient received gonadotropin-releasing hormone agonist injection and regular follow-up. Up to now, all the symptoms have been alleviated.

Ovarian steroid cell tumor, not otherwise specified, treated with surgery: a case report and review of literature.

Ovarian steroid cell tumors NOS are rare sex cord-stromal tumors. They account for less than 0.1% of ovarian tumors. We present a case of a 17-year-old girl with the complaint of amenorrhea. The serum testosterone level was 11.55 nmol/L (reference value, 0.35-2.6 nmol/L) and the serum value of dehydroepiandrosterone-sulfate (DHEA-S) was 5.9 µmol/L (reference value, 0.49-8.71 µmol/L). A computed tomography (CT) pelvic scan identified a solid, right ovarian tumor and detected no adrenal gland enlargement or additional tumors. We took a surgical excision and a wedge resection of the normal contralateral ovary. The histopathologic examination on microscopy confirmed it was a benign ovarian steroid cell tumor NOS. Four days postoperative, her sex hormones were declined to normal levels and her serum testosterone level was 2.37 nmol/L (reference value, 0.35-2.6 nmol/L) a month after surgery. Her serum testosterone level was in the normal range and there was no evidence of recurrence 6 months after surgery.

[Expression of stromal cell-derived factor-1 in endometriosis by steroid receptor coactivators on steroid hormone].

OBJECTIVES: To study the expression patterns of steroid receptor coactivators (SRC) and steroid-induced stromal cell-derived factor-1 (SDF-1) in endometriosis, and to explore the roles of SRC in the steroid-induced SDF-1 expression endometriosis. METHODS: From May 2010 to October 2012, 16 endometriosis cases at stages III or IV according to the revised American Society for Reproductive Medicine classification undergoing surgery in the First Affiliated Hospital to Nanjing Medical University were enrolled in this study. Their ectopic endometrium were from ovarian endometriomata which were identified pathologically with 9 cases at proliferative phase and 7 cases at secretory phase. The normal endometrium were acquired from the healthy women with normal menstrual cycle (n = 10, proliferative phase = 5, secretory phase = 5). The mRNA levels of SRC and SDF-1α during the menstrual cycle were detected by quantitative real-time polymerase chain reaction. Ectopic endometrium stromal cells were purified and cultured in medium containing 17ß-estradiol (10(-8) mol/L) or 17ß-estradiol (10(-8) mol/L) + progesterone (10(-6) mol/L). At 24, 48, 72 and 96 hours, the supernatants were collected to measure SDF-1α expression by ELISA. Ectopic endometrium stromal cells were transfected respectively with siRNA of SRC-1 and SRC-2 using lipofectamine. Two days after transfection, 17ß-estradiol (10(-8) mol/L) or 17ß-estradiol (10(-8) mol/L) + progesterone (10(-6) mol/L) were added into the media. On the third day after the steroid hormones treatment, the media were collected to quantify SDF-1α expression with ELISA. RESULTS: (1) Cyclical changes: the SRC-1, SRC-2 and SDF-1α showed marked cyclic differences in normal endometrium (P < 0.05). In proliferative phase and secretory phase, the SRC-1, SRC-2 and SDF-1α were 5.6 ± 1.2, 3.8 ± 1.1, 2.7 ± 0.5 and 2.6 ± 1.0, 2.1 ± 1.0, 1.6 ± 0.5, respectively. There was no periodic variation in the expression of SRC-1, SRC-2 and SDF-1α in ectopic endometrium throughout the menstrual cycle. (2) Steroid-induced SDF-1α expression in ectopic endometrium stromal cells: the 17ß-estradiol-induced SDF-1α expression was (1 803 ± 196), (2 272 ± 261) and (2 162 ± 258) ng/L at 48, 72 and 96 hours . At the same time points, the SDF-1α expression induced by 17ß-estradiol and progesterone was (1 307 ± 150), (1 518 ± 301) and (1 550 ± 144) ng/L, respectively. There was significant difference between two groups (P < 0.05 ). (3) The effects of SRC silencing on steroid hormones-induced SDF-1α expression in ectopic endometrium stromal cells: the expression of 17ß-estradiol-induced SDF-1α at 72 hours was significantly decreased from (2 313 ± 357) ng/L to (1 155 ± 244) ng/L after the silencing of SRC-1 (P < 0.05). After the silencing of SRC-2, the 17ß-estradiol-induced SDF-1α at 72 hours was (1 958 ± 324) ng/L. There was no significant difference compared with the before the silencing (P > 0.05). The expression of SDF-1α at 72 hours induced by 17ß-estradiol+progesterone was (1 534 ± 449) ng/L and (2 051 ± 380) ng/L respectively before and after the silencing of SRC-2 and showed the significant difference (P < 0.05). CONCLUSION: During the expression of SDF-1α regulated by steroids in ectopic endometrium cells, SRC-1 is the major coactivator of 17ß-estradiol and SRC-2 is the major coactivator of progesterone.

The role of SRC1 and SRC2 in steroid-induced SDF1 expression in normal and ectopic endometrium.

To compare the expression patterns of steroid receptor coactivators (SRCs) and steroid-induced stromal cell-derived factor 1 (CXCL12 (SDF1)) in normal and ectopic endometrium and to explore the roles of NCOA1 (SRC1) and NCOA2 (SRC2) in the steroid-induced CXCL12 expression in normal and ectopic endometrial stromal cells (ESCs). The NCOA1, NCOA2, NCOA3 (SRC3), and CXCL12 (SDF1)α mRNA levels in normal and ectopic endometrium were analyzed by quantitative real-time PCR. Steroid-induced CXCL12 expression was detected by the ELISA method and the chemotactic activity of conditioned supernatant to monocyte was assessed by the Boyden chamber method before and after the silencing of NCOA1 or NCOA2 with siRNA in normal and ectopic ESCs. The expression of NCOA1 and CXCL12 in ectopic endometrium was significantly greater than that in normal endometrium in the secretory phase. Progesterone (P4) was able to significantly inhibit estradiol (E2)-stimulated CXCL12 expression in normal and ectopic ESCs. The inhibitory rate of P4 in ectopic ESCs at 72 and 96 h was significantly lower than that in normal ESCs. Silencing of NCOA1 but not NCOA2 significantly reduced the E2-induced CXCL12 expression in normal and ectopic ESCs. The ability of P4 to inhibit E2-induced CXCL12 expression and monocyte chemotaxis in normal and ectopic ESCs was significantly attenuated when NCOA2 was silenced. NCOA1 plays a necessary role in E2-induced CXCL12 expression and NCOA2 is required for P4 to inhibit the E2-induced CXCL12 production in normal and ectopic endometrium.

A randomized, controlled study comparing minilaparotomy versus isobaric gasless laparoscopic assisted minilaparotomy myomectomy for removal of large uterine myomas: short-term outcomes.

OBJECTIVE: To compare the operative data and early postoperative outcomes for myomectomy performed by minilaparotomy (MLT) with isobaric laparoscopic assisted minilaparotomy myomectomy (LM) in a series of patients with large uterine myomas (>or=5 cm) randomly assigned to each surgical technique. STUDY DESIGN: 80 patients were randomized blindly using a computer randomization list to MLT (n=40) or LM (n=40). RESULTS: The mean (+/-SD) operating time was significantly shorter after LM than after MLT (75.50+/-25.70 vs 96.00+/-26.20 min; p<0.01). Intraoperative blood loss was less with LM (72.15+/-44.00 vs 96.21+/-38.50 ml; p<0.05), and DeltaHb was less with LM (1.21+/-0.55 vs 1.64+/-0.57; p<0.05). No intraoperative complications occurred, and no case was returned to the theater in either group. No conversion to standard laparotomy was necessary. Hospitalization was shorter after LM than after MLT (4.30+/-1.20 vs 6.90+/-2.70 days; p<0.01). Postoperative ileus was shorter after LM than after MLT (26.20+/-4.20 vs 40.50+/-4.90h; p<0.01). The mean VAS score at 12h for abdominal pain was 5.5+/-0.7 in the LM group and 5.2+/-0.8 in MLT group (p<0.05), whereas it was analogous in the two groups at 24h, and at 48h was 3.4+/-1.1 in the LM group and 4.2+/-1.1 in the MLT group (p<0.05), and no difference between two groups was detected in the overall mean (at 12, 24 and 48h). CONCLUSIONS: Several surgical and immediate postoperative outcomes were significantly better in the LM group than in the MLT group.

A randomized trial of laparoscopic versus laparoscopic-assisted minilaparotomy myomectomy for removal of large uterine myoma: short-term outcomes.

STUDY OBJECTIVE: To compare operative data and early postoperative outcomes for myomectomy performed by isobaric gasless laparoscopic-assisted minilaparotomy (LA-MLT) compared with those by isobaric gasless laparoscopy (LA) in a series of patients with large uterine leiomyomas (> or =5 cm) randomly assigned to each surgical technique. DESIGN: Randomized trial (Canadian Task Force classification I). SETTING: University departments of gynecology in Jiangyin and Nanjing, Jiangsu Province, Republic of China. PATIENTS: Fifty-two patients were randomized blindly by use of a computer randomization list to either LA (n = 26) or LA-MLT (n = 26). MEASUREMENTS AND MAIN RESULTS: The mean operating time was significantly shorter after LA-MLT than after LA (75.50 +/- 25.70 vs 96.00 +/- 26.20 minutes); the 95% confidence interval (95% CI) was 20.5 (6.04-34.96; p =.006). The intraoperative blood loss was less with LA-MLT (71.92 +/- 18.98 vs 96.34 +/- 32.42 mL); the 95% CI was 24.42 (9.63-39.22; p =.002); and the hemoglobin level decrease was less with LA-MLT (1.22 +/- 0.61 vs 1.65 +/- 0.61); the 95% CI was 0.43 (0.09-0.76; p =.014). There was a difference of the visual analog scale score among the 3 time points (0, 12, and 24 hours) with the 2 groups combined (F = 844.15, p <.001); and no difference in the visual analog scale score between the treatment groups, with values at all time points averaged and over time (p >.05). With regard to the early postoperative outcome, no difference between the 2 groups was detected in hospitalization days (1.81 +/- 0.57 vs 2.04 +/- 0.66 days; 95% CI 20.23 [20.57-0.11, p =.183]); and postoperative ileus (23.20 +/- 4.37 vs 22.80 +/- 3.94; 95% CI 0.39 [21.93-2.70, p =.738]). CONCLUSIONS: Several surgical and immediate postoperative outcomes were significantly better in the gasless LA-MLT group than in the LA group.