Accuracy of ultrasound signs on two-dimensional transvaginal ultrasound in prediction of adenomyosis: prospective multicenter study.

OBJECTIVE: Two-dimensional (2D) transvaginal ultrasound (TVS) is an accessible and cost-effective diagnostic tool for the detection of adenomyosis. Different ultrasound features related to adenomyosis have been described, but the predictive value of each ultrasound sign and their combinations requires further investigation. We aimed to analyze the accuracy of 2D-TVS and describe possible combinations of ultrasound signs with a high predictive value in the diagnosis of adenomyosis. METHODS: This was a prospective multicenter study of patients scheduled for laparoscopic hysterectomy who had been examined using standardized 2D-TVS at nine expert centers specializing in the diagnosis and treatment of endometriosis. 2D-TVS examination included nine typical adenomyosis ultrasound features, comprising heterogeneous myometrium, myometrial linear striations, myometrial cysts, subendometrial microcysts, asymmetrical myometrial thickening, uterine enlargement, the 'question mark sign', thickening of the junctional zone and hyperechoic myometrial spots, in order to predict or exclude the presence of adenomyosis. Ultrasound examination results were compared with histology after hysterectomy. The diagnostic reliability of the nine ultrasound signs and their combinations, and the influence of concurrent fibroids on the accuracy of the results, were analyzed. RESULTS: A total of 202 patients were enrolled into the study. Histopathological examination revealed adenomyosis in 130 patients (64.4%). The accuracy of prediction of adenomyosis by 2D-TVS examination using all signs was 63.4% (positive predictive value, 71.5%; negative predictive value, 48.6%; sensitivity, 71.5%; specificity, 48.6%). Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy (55.7-62.1%) as individual ultrasound signs for the prediction of adenomyosis. The combination of the most accurate ultrasound signs (subendometrial microcysts, myometrial cysts and heterogeneous myometrium) improved the specificity of prediction (86.1%) when compared with that of these three single markers (35.2-81.7%). Uterine enlargement and asymmetry showed both low sensitivity (60.8% and 52.3%, respectively) and specificity (41.7% and 49.3%, respectively) as individual sonographic signs. CONCLUSIONS: Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy for the detection of adenomyosis in this study, while uterine enlargement and asymmetry led to high false-positive and false-negative results. A combination of ultrasound features including the most accurate signs increases specificity. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Peritoneal enterobiasis causing endometriosis-like symptoms.

PURPOSE: Enterobiasis is the most common parasitic disease of the temperate zones and infects the human intestinal tract. In rare cases extraintestinal infections with Enterobius vermicularis may occur and can affect the female genital tract and peritoneal cavity. In most cases the infection is asymptomatic, but there are also cases described in which peritoneal enterobiasis can cause abdominal pain. METHODS: A case report and review of the pertinent literature. RESULTS: A 32-year-old patient was admitted with cyclical lower abdominal pain. With suspected endometriosis a diagnostic autofluorescence laparoscopy (DAFE) was performed. At surgery extensive peritoneal deposits were seen. Macroscopically these deposits were not typical for endometriosis. The histological examination showed granuloma caused by E. vermicularis eggs. The patient was treated with mebendazole. After completion of treatment the patient was asymptomatic. At the second-look laparoscopy no more peritoneal changes were detected. CONCLUSION: Enterobius vermicularis may cause symptoms similar to endometriosis. In cases with reasonable suspicion it should therefore be considered in the differential diagnosis.

Leiomyosarcoma of the vulva.

Malignant tumors of the vulva soft tissue are uncommon. About 1-3% are sarcomas. They can be mistaken as benign lesions, leading to misdiagnosis and mistreatment. A case of a 71-year-old woman with a leiomyosarcoma of the vulva is presented. The surgical excision of the lesion is described and there were no additional malignancies or lesions found. There was no need for adjuvant therapy.

Correlation of prostaglandin metabolizing enzymes and serum PGE2 levels with vitamin D receptor and serum 25(OH)2D3 levels in breast and ovarian cancer.

BACKGROUND: Vitamin D and its active form calcitriol have multiple effects in cancer cells, such as anti-proliferative effects, induction of apoptosis and cell cycle arrest. There is a link between vitamin D metabolism and inflammatory processes, which should be considered in cancer therapy. An association between these two types of metabolism is also observed in breast and ovarian cancer. These inflammatory processes are based on an increase of cyclooxygenase-2 (COX-2) activity. The current study aimed to evaluate the expression of prostaglandin-metabolising enzymes COX-2 and 15-hydroxyprostaglandin-dehydrogenase (15-PGDH) along with the vitamin D receptor (VDR) in benign and malignant breast and ovarian tissues. PATIENTS AND METHODS: VDR, COX-2, 15-PGDH and prostanoid receptor E2/E4 expression were measured in tissues by western blot analysis. Additionally, plasma 25(OH)(2)D(3) and PGE(2) levels were measured in healthy patients and cancer patients. RESULTS: We detected an elevated COX-2 and inversely a lowered VDR expression in cancer patients compared to healthy women. Breast cancer patients diagnosed during wintertime had a significantly lower serum level of 25(OH)(2)D(3); PGE(2) serum levels were higher in both types of cancer. CONCLUSION: These results support the idea of a link between prostaglandin and vitamin D metabolism in regards to their influences on breast and ovarian cancer.

Retromesenteric para-aortic lymphadenectomy in gynecologic malignancy.

UNLABELLED: In gynecologic oncology lymphadenectomy is of prognostic and therapeutic importance because recurrence-free time and survival depend on the metastatic involvement of lymph nodes. Lymphadenectomies are not performed to such an extent as they are indicated. This might be due to a laborious or problematic preparation. The authors therefore report their experience in a seldom taught preparation of the left para-aortic compartment in the form of a learning curve. MATERIALS AND METHODS: To access the left para-aortic area, the descending colon is lifted to open the retroperitoneum along the line of Toldt. The mesentery of the descending colon was separated from the kidney along the fascia of Gerota by blunt preparation. Time was measured from the incision of the peritoneum until the renal vein was clearly visible. RESULTS: The authors collected the data from the first 25 preparations. Mean duration for the left para-aortic preparation was 7.8 minutes compared to 5.9 minutes for the right side. Duration of preparation of the left area dropped from 11.0 minutes within the first patients (#1 to #5) to 3.8 minutes in the last patients (#20 to #25). No complications were observed in the study group linked to the retromesenteric approach described. CONCLUSION: Retromesenteric para-aortic lymphadenectomy is quick to learn. The authors needed 20 preparations to observe a significant drop in the time needed for preparation. Retromesenteric para-aortic lymphadenectomy offers an excellent overview that lightens lymphadenectomy and therefore reduces the risks for patients.

Compliance to adjuvant therapy in breast cancer patients.

During recent years a continuous reduction of mortality from breast cancer has taken place in the Western countries. We wanted to verify whether the actual therapy for our own cases deviates from our recommendations, although the surgeon, radiotherapist and gynaecological oncologist are on the same premises. We sent out questionnaires to all newly diagnosed breast cancer patients in the last seven years regarding their adjuvant therapy. Comparing these answers to our own recommendation showed a very good compliance regarding chemotherapy and radiation therapy. Adjuvant endocrine therapy showed a very poor compliance with an adherence of 77%. Overall we can conclude that endocrine therapy causes many side-effects that seem to burden the patients. In combination with the duration of the therapy this causes a severe reduction in compliance and length of the therapy.

Immunhistochemical analysis for expression of calpain 1, calpain 2 and calpastatin in ovarian cancer.

Calpains, also called calcium activated neutral proteases (CANP), are expressed ubiquitously. They are intracellular, non-lysosomal cytoplasmic cysteine endopeptidases. Calcium is required for their activation. Their endogenous specific inhibitor is calpastatin, which is expressed ubiquitously and coexists within cells besides calpain. When calcium is present, calpastatin and calpain attach to each other inhibiting the protease. The calpain system plays an important role in many processes including apoptosis, necrosis, ischemia formation and exocytosis. So far, many reports exist on studies about the influence of calpains in different tumors (skin, breast, renal cell and prostate cancers). The role of calpains in pathogenesis or further tumor progression has always been proved in related studies, but their exact function could not be demonstrated. So far, no studies on calpains being involved in the pathogenesis of ovarian cancer have been published. In our study we focused on the expression of the enzymes calpain 1, calpain 2 and their inhibitor calpastatin in normal and malign ovarian tissue. Therefore, we performed immunohistochemical stainings of paraffin slices and evaluated staining intensity (SI), percentage of positive cells (PP) and immunoreactive score (IRS). We evaluated the correlation between enzyme expression in malign and benign ovarian tissues. In malignant ovarian tissue, we found decreased expression, staining intensity and immunoreactive score of calpastatin. With higher grading of the ovarian carcinoma, staining intensity and immunoreactive score of calpain 1 decreased. Staining intensity of calpain 2 in ovarian carcinoma decreased with increasing lymph node status. We clearly demonstrated differences between enzyme expressions in malign and benign tissue. This study could not find any specific function of calpains. Only few studies in the literature have been found that deal with calpain evaluation of ovarian cancer. Additional studies including more patients are required to elucidate the functional role and impact of calpain in tumors in detail.

Management of recurrence from a retroperitoneal xanthogranuloma: case report.

Xanthogranulomas from the retroperitoneal space are rare. To our knowledge only a few cases have been reported in the literature in the retroperitoneal space. In this report, the authors present the case of a 24-year-old woman with a recurrence of this rare tumor. Two years after resection, the mass showed rapid local recurrence. Attention should be paid to the possibility of the transformation into a fibroxanthosarcoma, which could have an aggressive clinical course.

Vitamin D-1alpha-hydroxylase and vitamin D-24-hydroxylase in benign and malign breast tissue.

BACKGROUND: It is known that 1,25(OH)2D3 can be metabolized to 1,24(OH)2D3 in breast tissue. This tissue-specific expression of 24-OHase may act as a pivotal link between vitamin D status (25(OH)D3 level) and the anticancer effects of 1,25(OH)2D3. Different expressions of the enzymes of vitamin D metabolism are found in breast cancer cells and tissues, and alternative splicing may play a role in biological functions and may cause tissue-specific variations. We describe the expression of vitamin D-1alpha-hydroxylase and vitamin D-24-hydroxylase in benign and malign breast tissues. We estimated that alternative splicing of the enzymes would lead to a catalytically dysfunctional product and may lead to a lower reduction of the target protein. MATERIAL AND METHODS: Expression of 1alpha-OHase and 24-OHase RNA and protein was assessed using a real-time polymerase chain reaction (RT-PCR) and on protein level by Western blot in benign and malign breast tissue samples. RESULTS: In breast cancer tissue the expression of 1alpha-OHase and 24-OHase were reduced significantly compared to benign breast tissue. CONCLUSION: The results described above do not support results of previous studies. Alternative splicing of 1alpha-OHase and 24-OHase may regulate the levels of active enzyme but is more likely due to different cell types in samples with the result of testing a variety of tissue samples not purified benign and malign breast cancer cells. The significance of smaller variants in cells has not been clarified either, but it is known that they are not able to use 25(OH)D3 as a substrate to generate 1,25(OH),D3.

Vitamin D-24-hydroxylase in benign and malignant breast tissue and cell lines.

Tissue-specific expression of 25-hydroxyvitamin D-1alpha-hydroxylase (1alpha-OHase) and vitamin D-hydroxylase (24-OHase) may act as the pivotal link between 25-hydroxyvitamin D3 (25(OH)D3) serum levels and the anticancer effects of 1,25-dihydoxyvitamin D3 (1,25(OH)2D3) and alternative splicing of the enzymes may regulate their biological function. The expression of 24-OHase in cells and breast tissue was investigated and its splice variants were detected. The expression of 24-OHase RNA and protein was assessed by RT-PCR followed by Western blot. The expression of 24-OHase was reduced by about 57% in MCF-7 breast cancer cells, compared to MCF-10F benign breast cells. In the Western blot, a signal at 56 kDa was found and further bands were detected at 42 and 44 kDa. In the breast cancer tissue, the expression of 24-OHase was reduced by about 58% compared to benign tissue. However, in the Western blot, only one signal was found in the benign tissue at 56 kDa, while in malignant tissue, a further band was detected at 40 kDa. Alternative splicing of 24-OHase may lead to a catalytically dysfunctional enzyme and may lead to less reduction of the target protein.

Tartrate-resistant acid phosphatase (TRAP) as a serum marker for bone resorption in breast cancer patients with bone metastases.

BACKGROUND: A novel immunoassay specific for the osteoclast-produced tartrate-resistant acid phosphatase TRAP isoform 5b was developed some years ago. By means of this assay, the usefulness of serum TRAP in monitoring the response to palliative treatment with clodronate in breast cancer patients with bone metastases was studied. Serum TRAP was examined for correlation with the activity of bone osteoclasts in these patients. MATERIALS AND METHODS: Seventeen patients took part in this study taking 1600 mg clodronate daily as a tablet for five months. Eleven of these patients were evaluated. RESULTS: TRAP activity correlated well with the grade of bone metastases and with the number of locations in the body. During the therapy with clodronate, TRAP activity in serum decreased. CONCLUSIONS: We conclude that the measurement of TRAP is useful in monitoring treatment with bisphosphonate clodronate in patients with bone metastatic breast cancer.