FOXP3-positive cell infiltration in the chorionic villi is increased in the placenta accreta and decreased in the placental abruption.

OBJECTIVES: Growing data suggest a role of Treg cells in placentation. The aim of the study was to evaluate Treg cells (FOXP3-positive cells) placental bed infiltration in patients with placenta accrete syndrome (PAS) and patients who experienced placental abruption. MATERIAL AND METHODS: The study group included 13 patients with PAS and the control group consisted of 66 women who had caesarean (CD) delivery of whom, 44 patients with elective caesarean (EC) delivery, and 22 patients with urgent caesarean (UC) delivery due to placental abruption. FOXP3 cell infiltration was assessed by means of immunohistochemistry in placental chorionic villous (CV) and in the decidua (D) and cumulatively in the placental bed (PB). RESULTS: We observed significant difference in the degree of FOXP3-positive cell CV infiltration between studied groups (p = 0.04). FOXP3-positive cells were the most commonly observed in PAS patients, while, they were the least frequently presented in patients after UC. The immunoreactivity for FOXP3-positive cells in CV were as follows: PAS 5 (38%), urgent CS 1 (5%) and elective CS 8 (18%) subjects. We found no difference in the presence of FOXP3-positive cells in the D (p = 0.35) and in the PB (p = 0.23) of analyzed groups. FOXP3-cell infiltration was not related with patient age, BMI, gestational age and neonatal birth weight. CONCLUSIONS: Our study provides further evidence that abnormal invasive placentation is an associated disturbance of the maternal immune response. Accordingly, we have theorized that alteration of the FOXP3-positive Treg cell infiltration into the placental bed allows trophoblast cell invasion.

The impact of splenectomy and diaphragmatic surgery on perioperative morbidity and overall survival of ovarian cancer patients.

OBJECTIVES: The prognosis of ovarian cancer (OC), among other factors, depends on residual disease after primary debulking surgery (PDS) and initial disease advancement. The main aim of our study was to evaluate the survival benefits of splenectomy and diaphragmatic surgery in OC patients, when the procedures result in resection to no macroscopic residual disease or minimal residual disease [tumor nodules below 2.5 mm according to Sugarbaker's completeness of cytoreduction score (CC) = 1]. MATERIAL AND METHODS: The study included 25 OC patients after splenectomy procedures, 28 patients after diaphragmatic surgery and 17 patients who had undergone both splenectomy and diaphragmatic surgery. Patients' overall survival (OS) was compared with residual disease-matched controls (47 patients) who had upper abdomen involvement but no requirement for splenectomy and/or diaphragmatic surgery. RESULTS: Overall survival of patients after splenectomy was not significantly different from OS of patients who did not required splenectomy (36.1 vs 31.6 months; p = 0.85). No differences in OS were observed between patients who did and did not require diaphragmatic surgery (31.3 vs 41.8; p = 0.33). Similarly, we found no differences in OS between patients who underwent both splenectomy and diaphragmatic surgery and those patients who did not require either procedure (20.1 vs 31.6 months; p = 0.45). Splenectomies and diaphragmatic surgeries were associated with prolonged hospitalization and length of surgery, however, no specific morbidity related to the procedures was observed. CONCLUSIONS: In the cases of advanced OC, diaphragm and spleen involvement do not hamper patient prognosis when adequately resected.

An analysis of the significance of the lymph node ratio and extracapsular involvement in the prognosis of endometrial cancer patients.

Introduction: The primary aim of our study was to analyse the impact of the lymph node ratio (LNR) and extracapsular involvement (ECI) on the prognosis of endometrial cancer (EC) patients. Material and methods: We carried out a retrospective analysis of 886 patients surgically treated for EC between 2000 and 2015. In the subgroup of patients with lymph node metastases (LNM), we evaluated the impact of the number and localization of the LNM, LNR, and ECI on patients' overall survival (OS). Results: In the group of patients with LNM, 0.3 was the optimal LNR cut-off for differentiating between short- and long-term survivors [HR = 2.94 (95% CI: 1.49-5.80)]. Patients with a LNR ≥ 0.3 had a significantly shorter OS period (35.0 months, range 0.2-175 months) compared to patients with a LNR < 0.3 [median OS - mOS, was 143, range 15-169 months; (p = 0.003]. We observed significant differences in the mOS of EC patients without LNM compared to patients with LNM, as well as those with both LNM and ECI (p < 0.0001). In the group of patients with LNM, we also found that a poorer prognosis depended on the extension of the primary tumour. Conclusions: Our results suggest that when LNM are found, the long-term outcomes of EC patients are worse in those who have a LNR ≥ 0.3, the presence of ECI, and a more advanced extension of the primary tumour.

Comparison of positron emission tomography with computed tomography examination with histopathological assessment of pelvic lymph nodes in patients with cervical cancer treated surgically.

INTRODUCTION: According to the literature, fluor-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET-CT) is the most effective technique for the examination and detection of metastases in the lymph nodes in patients with cervical cancer. This study aimed to compare the diagnostic value of the preoperative evaluation using 18F-FDG-PET-CT with a histopathological examination of the lymph nodes removed during radical hysterectomy and pelvic lymph node dissection in patients with cervical cancer. MATERIAL AND METHODS: Retrospective analysis covered the medical records of 42 patients with cervical cancer (stage IA-IB according to International Federation of Gynaecology and Obstetrics 2009) treated with radical Piver type III hysterectomy and pelvic lymph node dissection. The preoperative diagnosis was made using a PET/CT examination. Results: The result of the 18F-FDG-PET-CT examination highlighted a suspicion of lymph node metastases in 13 patients (31%). The histopathological examination confirmed this in 12 patients (29%). Metastatic lymph nodes were correctly diagnosed using 18F-FDG-PET-CT in 8 out of the 12 cases confirmed by the histopathological examination. In the patient-based study, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 66.8%, 83.3%, 61.5%, 86.2 % and 78.6%, respectively. CONCLUSIONS: We confirmed the usefulness of PET in the preoperative assessment of cervical cancer advancement, especially in correlation with the new 2018 International Federation of Gynaecology and Obstetrics staging system.

Total Colectomy as a Part of Ultra-Radical Surgery for Ovarian Cancer-Short- and Long-Term Outcomes.

(1) Background: The aim of this study was to assess the outcomes for patients who underwent total colectomy (TC) as a part of surgery for ovarian cancer (OC). (2) Methods: We performed a retrospective analysis of 1636 OC patients. Residual disease (RD) was reported using Sugarbaker's completeness of cytoreduction score. (3) Results: Forty-two patients underwent TC during primary debulking surgery (PDS), and four and ten patients underwent TC during the interval debulking surgery (IDS) and secondary cytoreduction, respectively. The median overall survival (mOS) in OC patients following the PDS was 45.1 months in those with CC-0 (21%) resection, 11.1 months in those with CC-1 (45%) resection and 20.0 months in those with CC-2 (33%) resection (p = 0.28). Severe adverse events were reported in 18 patients (43%). In the IDS group, two patients survived more than 2 years after IDS and one patient died after 28.6 months. In the recurrent OC group, the mOS was 6.9 months. Patient age above 65 years was associated with a shortened overall survival (OS) and the presence of adverse events. (4) Conclusions: TC as a part of ultra-radical surgery for advanced OC results in high rates of optimal debulking. However, survival benefits were observed only in patients with no macroscopic disease.

Molecular Changes on Maternal-Fetal Interface in Placental Abruption-A Systematic Review.

Placental abruption is the separation of the placenta from the lining of the uterus before childbirth. It is an infrequent perinatal complication with serious after-effects and a marked risk of maternal and fetal mortality. Despite the fact that numerous placental abruption risk factors are known, the pathophysiology of this issue is multifactorial and not entirely clear. The aim of this review was to examine the current state of knowledge concerning the molecular changes on the maternal-fetal interface occurring in placental abruption. Only original research articles describing studies published in English until the 15 March 2021 were considered eligible. Reviews, book chapters, case studies, conference papers and opinions were excluded. The systematic literature search of PubMed/MEDLINE and Scopus databases identified 708 articles, 22 of which were analyzed. The available evidence indicates that the disruption of the immunological processes on the maternal-fetal interface plays a crucial role in the pathophysiology of placental abruption. The features of chronic non-infectious inflammation and augmented immunological cytotoxic response were found to be present in placental abruption samples in the reviewed studies. Various molecules participate in this process, with only a few being examined. More advanced research is needed to fully explain this complicated process.

Patient-Specific Variables Determine the Extent of Cellular Senescence Biomarkers in Ovarian Tumors In Vivo.

The mechanisms and clinical significance of the cellular senescence of tumor cells are a matter of ongoing debate. Recently, the triggers and molecular events underlying spontaneous, replicative senescence of primary epithelial ovarian cancer cells were characterized. In this study, we reanalyzed tumors obtained from ovarian cancer patients with respect to the expression of the senescence biomarkers SA-ß-Gal and γ-H2A.X and the proliferative antigen Ki67. The results showed that the tumors displayed strong heterogeneity with respect to the expression of analyzed markers. The expression of SA-ß-Gal and γ-H2A.X in the oldest patients (61-85 y.o.) was significantly higher than in the younger age groups. Conversely, the area of Ki67-positive cancer cells was greater in younger individuals. At the same time, there was a positive correlation between SA-ß-Gal expression and calendar age in FIGO III-IV and malignant ascites-positive patients. The γ-H2A.X positively correlated with age in the whole group, FIGO III-IV, and ascites-positive patients. Ki67 levels correlated negatively with the age of patients among those same groups. Collectively, our study indicated that organismal aging may determine the development of the senescence phenotype in ovarian tumors, particularly in patients with advanced disease and those accumulating malignant ascites.

Radical hysterectomy and its importance in the concept of cervical cancer treatment.

The role and place of a radical hysterectomy in the concept of cervical cancer treatment, despite over one hundred years of its traditional use, still excites controversy. To fully understand the value of the surgical treatment, it is worth analysing and understanding the evolutionary path of the radical hysterectomy and the changes that have occurred in this method over the years. This knowledge will allow for a better understanding as to why the choice of therapy between surgery and radiochemotherapy in the early and locally advanced stages of cervical cancer still raise doubts. Both the introduced changes in the scope of surgery and the use of multi-module treatment - surgery with subsequent radiation therapy did not significantly improve the results of cancer treatment, but significantly increased the prevalence of side effects and therapy complications. As cervical cancer most often affects relatively young women, the number of potential years of life after treatment is high. Over 30% of women in Poland with cervical cancer are in the 45-49 years-old age group. From the perspective of these data, obtaining a high therapeutic index, which is defined as the ratio of the number of healed patients to complications and side effects of treatment significantly reducing the quality of life, is very important in the therapy process. Regardless of the classical radical surgery, which has evolved over many years, a new concept of radical hysterectomy based on tissue morphogenesis, called total mesometrial resection (TMMR) with therapeutic Lymph Node Dissection (tLND) with no adjuvant radiotherapy, has recently been proposed. Based on the ontogenetic research and the study of cancerous tumour development, the concept of TMMR was first introduced by M. Höckel in 2001. In the research conducted by the author, encouraging results of the treatment of stages IB1, IB2, IIA1 and IIA2, and selected cases of stage IIB [according to 2009 International Federation of Gynecology and Obstetrics (FIGO)] cervical cancer were obtained.

Coexistence of a ruptured ectopic pregnancy and cervical cancer: how to avoid a diagnostic error when the same symptoms present two different diagnoses.

An ectopic pregnancy occurs in approximately 0.5-2% of all pregnancies. The number of cases of cervical cancer in women under 30 years of age in Poland is less than 100 cases per year. The case presented herein concerns a rare clinical situation of a 29-year-old woman admitted to the Gynaecological Oncology Department with a diagnosis of cervical cancer. The main symptom resulting in the patient's referral was ascites. The presence of free fluid in the peritoneal cavity in patients diagnosed with a malignant tumour suggests a high degree of progression of the underlying disease, though this could not be confirmed in a clinical study in this case. An interview, examination, and laboratory tests confirmed a coexisting life-threatening ruptured tubal pregnancy. The consequences of not recognising both an ectopic pregnancy and cervical cancer in a patient presenting with nonspecific clinical symptoms could pose a serious threat to health and life.

DHMEQ enhances the cytotoxic effect of cisplatin and carboplatin in ovarian cancer cell lines.

Ovarian cancer (OvCa) is one of the most lethal gynaecological malignancies. It is diagnosed mostly in advanced stages. Due to a lack of appropriate early detection markers and non-ambiguous symptoms, the five-year survival rate is significantly reduced. Despite a primary good response to platinum-based therapy, approximately 70% of patients will develop a chemoresistance phenotype. The activation of the NF-κB signalling pathway plays a crucial role in this process. It is responsible for increasing cell viability, cell cycle progression and induces growth and migration of neoplastic cells. A few independent studies have yet suggested a high correlation between activation of NF-κB and poor outcome in OvCa patients. Thus, developing inhibitors of the NF-κB pathway has become a new target of cancer therapies. One of the promising compounds is DHMEQ (dehydroxymethylepoxyquinomicin). Our preliminary studies indicated that DHMEQ combined with cisplatin (CDDP) or carboplatin (CBP) enhanced apoptosis in the A2780 cell line and caused cell cycle arrest in the G2/M phase in the SKOV3 cell line, but not in the normal cell line MRC-5 pd19. Moreover, the combination of those agents caused decreased motility of cells, especially with the CBP. However, the invasion of cells was not changed significantly. The analysis of drug interactions using CompuSyn software has revealed that observed effect of the doses used in the study was antagonistic, but the DRI guidelines and in vitro observation of biological response indicate that a combination of DHMEQ with CDDP or CBP could be a novel proposal in ovarian cancer treatment.

Expression of small heat shock proteins in exosomes from patients with gynecologic cancers.

Small Heat shock proteins (sHsp) are a group of chaperone proteins. Under conditions of stress, the expression of sHsp is increased. Therefore, they are implicated in the pathogenesis of various autoimmune-mediated disorders and cancer. The purpose of this study was to analyze sHsp expression in exosomes from patients with gynecologic cancers and correlate these results with markers of cytotoxic immune response. The study group included patients with ovarian cancer, endometrial cancer, and patients with endometriosis. The levels of sHsps and cytotoxic markers were analyzed in serum, peritoneal fluid and exosomes using ELISA method. We found the highest levels of sHsp in exosomes from patients with ovarian cancer, but they were also elevated in patients with endometrial cancer and endometriosis. Moreover, we identified the presence of small Hsps in serum and peritoneal fluid in all study groups, but again the highest level was in patients with ovarian cancer. Small Hsps expression levels were positively correlated with markers of cytotoxic immune response.

[Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar]. / Laparoskopowe leczenie ciazy ektopowej w bliznie po cieciu cesarskim.

Pregnancy in a caesarean section scar is the rarest form of an ectopic pregnancy English language literature up to 2007 reports only about 70 cases, including three cases treated laparoscopically. A 25-year-old woman in the sixth week of pregnancy was admitted to our hospital due to profuse vaginal bleeding. During clinical and ultrasound tests, an unruptured ectopic pregnancy of 6 gestational weeks was found in the caesarean section scar. The treatment plan included two phases. Three days after a Methotrexate injection (80mg), the pregnancy was removed laparoscopically Laparoscopy enabled a successful treatment of the unruptured ectopic pregnancy in a previous caesarean scar and made it possible to preserve the reproductive capability of the patient.

[Nerve sparing radical hysterectomy]. / Radykalna histerektomia oszczedzajaca unerwienie wegetatywne.

The aim of the study was to review the literature concerning nerve sparing radical hysterectomy (NSRH). The data about anatomical and physiological background of this operation, its history, technique and perspectives has been presented. In conclusion it has been estimated that the technique is new and its oncological efficiency is not yet fully established; it requires special anatomical knowledge and new instruments.