Exposure to polycyclic aromatic hydrocarbons and its relationship with increased expression of human epididymal secretory protein 4.

INTRODUCTION: Ovarian cancer is the most lethal gynecologic malignancy, and its early detection is important for prognosis. Human epididymal secretory protein 4 (HE4) elevation has been studied as a crucial biomarker for this type of cancer. There are currently many organic pollutants in the environ-ment, including polycyclic aromatic hydrocarbons (PAHs). OBJECTIVES: The purpose of our study was to determine relationships between PAH exposure, HE4 levels, and the risk for ovarian cancer. PATIENTS AND METHODS: We included a total of 799 participants over the age of 20 years from the United States National Health and Nutrition Examination Survey datasets (2001-2002) with complete data on urinary PAH metabolites and HE4 levels for multivariable analysis. A multivariable linear regression model was used to investigate the associations between PAH metabolites and HE4 in ovarian cancer. RESULTS: Multivariable linear regression analysis showed that except for 2­hydroxyphenanthrene, PAH metabolites correlated positively with ln(HE4) after adjustment for relevant covariates (all P <0.05). Higher quartiles of urinary concentrations of PAH metabolites tended to be associated with higher HE4 levels, with statistical significance in per­quartile analysis. A dose­dependent relationship between PAH metabolites and HE4 was found (all P trends <0.05). CONCLUSIONS: Exposure to PAHs was found to be associated with elevated HE4 levels and a higher risk for ovarian cancer, which was confirmed by epidemiological evidence. This finding should alert gynecologists and public health experts to pay more attention to the potential role of PAH metabolites in the tumorigenesis of ovarian cancer.

Herlyn-Werner-Wünderlich syndrome: An unusual case with presentation of menorrhagia.

OBJECTIVE: Herlyn-Werner-Wünderlich (HWW) syndrome is a rare condition in which patients present with a palpable pelvic mass and pain caused by an obstructed hemivagina. Here we present a case of HWW syndrome characterized by prolonged menstrual bleeding. CASE REPORT: A 19-year-old nonsexually active unmarried women experienced irregular menstrual cycles and menorrhagia. The duration of menstrual bleeding was 10-14 days. She also suffered from mild dysmenorrhea since menarche at the age of 13. Transabdominal sonography revealed a double uterus and a heterogeneous myoma-mimicking mass over the left cervical region. The left kidney was absent. Magnetic resonance imaging revealed a double uterus, a double vagina with an unperforated left hemivagina, and ipsilateral renal agenesis. The patient underwent cervicovaginal orifice reconstruction surgery. CONCLUSION: Left hematocolpos compression, a partially obstructed right vaginal channel, and an orifice with local venous drainage abnormalities resulted in prolonged menstrual bleeding. In HWW syndrome, the occurrence of a pelvic mass and pain is common; however, prolonged menstrual bleeding is rare.