Is cystic ovarian endometriosis an asymmetric disease? Vercellini, Paolo; Aimi, Giorgio; Giorgi, Olga ...
BJOG : an international journal of obstetrics and gynaecology,
September 1998, Letnik:
105, Številka:
9
Journal Article
Recenzirano
Objective
To investigate whether asymmetry exists in the left‐ and right‐handed distribution of ovarian cystic lesions in a large series of women with endometriosis.
Design
Retrospective evaluation ...of a case series.
Setting
Tertiary care and referral academic centre for the study and treatment of endometriosis.
Population
A total of 1054 consecutive women undergoing first‐line surgical treatment for endometriosis in an eight‐year period.
Methods
Data were collected on indication for the intervention, age at surgery, parity and disease stage as well as side and size of ovarian endometriomas.
Main outcome measure
Frequency of left‐ and right‐sided ovarian endometriomas.
Results
Histologically confirmed endometriotic ovarian cysts were present in 561 women, which were on the left side in 255 instances, on the right in 148, and bilateral in 158. In the patients with unilateral endometriomas, the observed proportion of left cysts (255/403, 63%; 95% confidence interval, 58% to 68%) was significantly different from the expected proportion of 50% (χ21, 28.41, P < 0.001). Including also the bilateral endometriotic cysts gave a total of 413/719 (57%) left‐sided and 306/719 right‐sided endometriomas. The magnitude of these proportions did not vary appreciably during the eight years considered. The difference in proportion of left‐ and right‐sided endometriotic cysts was virtually similar in subgroups of women with different indications for surgery. Cyst side was not related to age, parity or cyst diameter.
Conclusions
The finding of a lateral asymmetry in the occurrence of ovarian endometriotic cysts is compatible with the anatomical differences of the left and right hemipelvis and supports the menstrual reflux theory.
Endometriosis and ovarian cancer Vercellini, P; Parazzini, F; Bolis, G ...
American journal of obstetrics and gynecology,
07/1993, Letnik:
169, Številka:
1
Journal Article
Recenzirano
In 556 patients undergoing surgery for ovarian cancers the frequency of endometriosis ranged from 3.6% to 5.6% in serous, mucinous, and miscellaneous neoplasms versus 26.3%, 21.1%, and 22.2%, ...respectively, in endometrioid, clear cell, and mixed subtypes; the differences were statistically significant (chi 2 heterogeneity 50.0, p < 0.001) and consistent in strata of age, parity, menopausal status, and disease stage.
To investigate the left‐ and right‐sided distribution of ovarian malignant surface epithelial tumours, data were collected on 209 women undergoing first‐line surgery for Stage I and II disease. ...Considering the unilateral cancers, the observed proportion of left‐sided lesions was 35/54 (65%) in the endometrioid, 20/45 (44%) in the serous, 19/35 (54%) in the clear cell, 13/29 (45%) in the mucinous, 2/8 (25%) in the mixed, and 2/5 (40%) in the undifferentiated histological type group. The proportion of left‐sided unilateral endometrioid cancers was significantly different from the expected 50% (χ21, 4.74, P= 0.03) and very similar to that previously observed for benign endometriotic cysts, constituting further evidence in favour of a possible development of endometrioid cancers from the latter lesions.
We describe a case of primary alveolar soft part sarcoma presenting as a vaginal mass in a 27 year old woman and also review the literature on this type of tumor arising in the lower female genital ...tract. Histologically, most of the tumor exhibited poorly developed alveolar architecture, but anaplasia was absent. Although the mass was well circumscribed, a few tumor cells were seen focally within the peritumoral tissue. Treatment consisted of wide local excision followed by external radiation therapy. The patient is alive without evidence of disease 17 years after operation.
A case of focal severe atypical hyperplasia-carcinoma in situ discovered during voluntary abortion is described. The patient did not undergo hysterectomy; after abortion, menses were regular and the ...endometrium was histologically normal at a control. Ten cases of endometrial epithelial neoplasia in pregnancy (9 cases) or in puerperium (1 case) found in the literature were reviewed. Although in some of them stromal invasion, which actually is the main prognostic indicator of endometrial neoplasia, was absent or not documented, all lesions were designated as adenocarcinoma. There is evidence that young women with a noninvasive neoplasm and desiring children or preservation of the uterus may be treated conservatively even if the lesion is detected in pregnancy or puerperium.
In this article, we describe eight cases of sclerosing stromal tumors (SST) of the ovary and review the literature. We could not demonstrate unequivocal hormonal activity in any of the cases, ...although suggestive evidence for it has been reported in the literature in the form of clinical, histologic, electron microscopic and immunohistochemical findings.
We evaluated the reliability of transvaginal ultrasonography in the differential diagnosis of adenomyoma versus leiomyoma.
Preoperative transvaginal ultrasonographic results were compared with ...postoperative pathologic findings in 405 women who underwent surgery for symptomatic uterine nodularity.
For adenomyoma diagnosis, transvaginal ultrasonography demonstrated a sensitivity of 87%, a specificity of 98%, a positive predictive value of 74.1%, and a negative predictive value of 98.6%, compared with a sensitivity of 96.1%, a specificity of 83.3%, a positive predictive value of 98.4%, and negative predictive value of 35.7% for leiomyoma diagnosis.
Transvaginal ultrasonography is an effective, noninvasive, and relatively inexpensive procedure for the preoperative differential diagnosis of adenomyoma versus leiomyoma.
Problem: Regeneration and tolerance factor (RTF) has been recently suggested to contribute to the control of fetal‐ablating immunity at the maternal–fetal interface through the induction of T helper ...2 (Th2)‐dominated response. The protein consists of a membrane‐associated domain and an extracellular portion which is proteolitically cleaved to yield a soluble peptide. In humans, it has been shown to be expressed by invading cytotrophoblasts and decidual lymphoid cells, to be increased on peripheral blood B lymphocytes during a normal gestation and on circulating natural killer cells during unsuccessful pregnancies. However, the expression of RTF in other cell types and, specifically, in non‐hematopoietic maternal cells of the human uterus has not been characterized in detail. Thus, we have specifically studied the expression and modulation of the cytokine in human endometrium obtained in different phases of the cycle and in early pregnancy.
Methods: The 20 kDa extracellular domain of RTF has been localized by immunohistochemical method and Western blot analysis. Levels of RTF messenger RNA (mRNA) in basal and stimulated conditions have been evaluated by semiquantitative reverse transcription‐polymerase chain reaction.
Results: The extracellular domain of RTF could be detected in both the glandular epithelium and stroma with diffuse distribution in both cycling endometrium and first trimester decidua. Both cycling and pregnant endometrium expressed the gene for RTF but mRNA levels resulted significantly increased in secretory phase‐endometrial stromal cells when compared to proliferative phase samples. Inflammatory cytokines, interleukin‐1β and tumour necrosis factor α were able to directly increase endometrial RTF mRNA expression.
Conclusion: These results indicate that RTF is constitutively expressed at endometrial and decidual level and its up‐regulation during the secretory phase of the cycle may be relevant in mediating some immune‐related aspects of uterine physiology.
