Possible involvement of the E-cadherin gene in genetic susceptibility to endometriosis.

BACKGROUND: Endometriotic cells display invasive characteristics, despite their benign histological appearance. Recently, the epithelial-mesenchymal transition, in which epithelial cells acquire mesenchymal and migratory properties, has attracted attention as a mechanism of tumor invasion. We aimed to investigate the association between endometriosis and polymorphisms of the E-cadherin gene, a central player in the epithelial-mesenchymal transition, in Japanese women. METHODS: Twelve single-nucleotide polymorphisms (SNPs) in the E-cadherin gene were identified by real-time polymerase chain reaction using a TaqMan assay in 511 women with endometriosis (the majority in Stages III and IV) and 498 healthy controls. RESULTS: Allele frequency analysis indicated that there was a marginally higher frequency of the rs4783689 C allele in women with endometriosis compared with controls (corrected P = 0.007; odds ratio = 1.37; 95% confidence interval, 1.14-1.64). No significant associations with endometriosis were found for the other 11 SNPs. CONCLUSIONS: Although this study was limited by sample size, the E-cadherin gene polymorphism rs4783689 was marginally associated with endometriosis in the Japanese population, suggesting that E-cadherin might be involved in genetic susceptibility to endometriosis.

Meta-analysis of genome-wide association scans for genetic susceptibility to endometriosis in Japanese population.

To identify susceptibility genes for endometriosis in Japanese women, genome-wide association (GWA) analysis was performed using two case-control cohorts genotyped with the Affymetrix Mapping 500K Array or Genome-Wide Human SNP Array 6.0. In each of the two array cohorts, stringent quality control (QC) filters were applied to newly obtained genotype data, together with previously analyzed data from the Japanese Integrated Database Project. After QC-based filtering of samples and single nucleotide polymorphisms (SNPs) in each cohort, 282 838 SNPs in both genotyping platforms were tested for association with endometriosis using a meta-analysis of the two GWA studies with 696 patients with endometriosis and 825 controls. The meta-analysis revealed that a common susceptibility locus conferring a large effect on the disease risk was unlikely. On the other hand, an excess of SNPs with P-values <10(-4) (36 vs 28 SNPs expected by chance) was observed in the meta-analysis. Of note, four of the top five SNPs with P-values <10(-5) were located in and around IL1A (interleukin 1α), which might be a functional candidate gene for endometriosis. Further studies with larger case-control cohorts will be necessary to elucidate the genetic risk factors.

The vasopressin injection technique for laparoscopic excision of ovarian endometrioma: a technique to reduce the use of coagulation.

STUDY OBJECTIVE: To estimate the efficacy of the vasopressin injection technique for laparoscopic cystectomy of ovarian endometriomas with regard to operative time and coagulation events. DESIGN: Prospective study (Canadian Task Force Classification II-1) SETTING: Osaka Central Hospital in Osaka, Japan PATIENTS: Fifteen women with single lobular similarly-sized ovarian endometrioma. INTERVENTIONS: Women who planned to undergo laparoscopic cystectomy of endometrioma were allocated randomly to 3 groups: (1) ordinary laparoscopic cystectomy without injection, (2) laparoscopic cystectomy with the injection of saline solution, and (3) laparoscopic cystectomy with the vasopressin injection technique. MEASUREMENTS AND MAIN RESULTS: Reviewing the video, we counted the number of pinpoint bipolar coagulations on the normal ovarian cortex that were required from the beginning of stripping until hemostasis had been achieved, as well as the times required to achieve hemostasis. The group with the vasopressin injection technique required significantly fewer coagulation events (p=.041) to achieve hemostasis, as compared with the group receiving an ordinary cystectomy. CONCLUSION: The vasopressin injection technique reduces the use of coagulation, in such a way as to suggest the possibility to protect ovarian reserves.

A case of disseminated peritoneal leiomyomatosis developing after laparoscope-assisted myomectomy.

A 36-year-old nulliparous woman developed multiple extra-uterine fibroids in the pelvic cavity years after laparoscopic myomectomy. Molecular genetic analysis by methylation-specific polymerase chain reaction (MSPCR) of the human X-linked androgen receptor gene and loss of heterozygosity (LOH) analysis at 5 microsatellite loci was performed on the tumors. All tumors showed an identical non-random X-chromosome inactivation pattern by MSPCR and an identical pattern of LOH was found in all the tumors by LOH analysis. This demonstrated that 3 fibroids resected 2 years later and 14 fibroids resected 6 years later were all metastatic tumors originating from the uterine leiomyoma found during the initial surgery, suggesting that morcellation before removal of the leiomyoma nodule during laparoscopic myomectomy may have been associated with the pathogenesis of this case.

[Endoscopic surgery for gynecologic malignancy--less invasive, more radical].

The development of endoscopic equipment and surgical skills make more complicated procedures possible laparoscopically. The application of these techniques to oncologic surgery, which used to be basically the most invasive procedure, has become an important issue when considering patient well-being. For cervical and endometrial cancer we can perform a simple hysterectomy, type II or a type II radical hysterectomy as well as a pelvic and para-aortic lymphadenectomy. For ovarian cancer endoscopic procedures are advantageous for surgical staging, and even debulking surgery is possible in selected cases. The short-term outcome is excellent because post-operative recovery is quick, resulting in no delays in adjuvant therapy and a quick return to normal activity. As for the long-term results, although the number of cases and the observation period are limited, at present the outcome does not differ greatly from the results of conventional laparotomy.

Laparoscopic ureteroneocystostomy.

BACKGROUND: In gynecologic surgery, there is always the possibility that ureteral injuries will occur intraoperatively. Traditionally, ureteral injuries are treated by laparotomy, which increases morbidity. This inspired us to develop a laparoscopic alternative to deal with accidental intraoperative ureteral injuries. CASE: A 49-year-old woman with stage Ia1 cervical cancer found after conization was to undergo a laparoscopic Piver class 2 hysterectomy. Because the ureters could not be effectively mobilized as a result of pelvic fibrosis, the left ureter was accidentally transected. The patient underwent a laparoscopic extravesical ureteroneocystostomy. CONCLUSION: Laparoscopic ureteral reimplantation is technically possible and is a viable alternative to open surgery.