Cíl: Kazuistika gynekologicky polymorbidní pacientky s diagnózou vaskularizované léze myometria, shrnutí současných vědeckých poznatků o výskytu, diagnostice a léčbě tohoto fenoménu. Kazuistika: Třicetiosmiletá pacientka dlouhodobě léčena pro sekundární sterilitu s anamnézou laparotomické cytoredukční operace adenomyózy, s následným rozvojem a léčbou pooperačních nitroděložních srůstů. Nyní sledována pro diagnózu vaskularizované léze myometria po spontánním abortu. Vzhledem k symptomatickému protrahovanému průběhu bez tendence ke spontánní úpravě stavu a riziku rozvoje akutní hemoragie pacientka nejprve indikována k selektivní embolizaci uterinních tepen a následnému definitivnímu řešení cestou operační hysteroskopie. Závěr: Vzhledem k nízké incidenci a tendenci ke spontánní úpravě, ale také k potenciálně velmi vážným až letálním komplikacím zůstává včasné rozpoznání a správný management vysoce vaskularizovaných lézí myometria lékařskou výzvou.
Objective: Case report of a gynecologically polymorbid patient with enhanced myometrial vascularity, and review of current scientific literature on incidence, diagnostic method, and management of this phenomenon. Case report: A 38-year-old patient that has been treated long-term for secondary sterility with a medical history of laparotomic cytoreduction surgery for adenomyosis and subsequent development and treatment of postoperative intrauterine adhesions. Currently presenting with enhanced myometrial vascularity after spontaneous abortion. For symptomatic prolonged course of the observation period without tendency for spontaneous regression and risk of acute hemorrhage, she was initially indicated for selective embolization of uterine arteries and consecutive definitive treatment via hysteroscopic resection. Conclusion: Due to low incidence and tendency for spontaneous resorption, early recognition, and correct management of enhanced myometrial vascularity, it still represents a medical challenge.
- Klíčová slova
- vysoce vaskularizovaná léze myometria, placentární rezidua, embolizace uterinních tepen,
- MeSH
- adenomyóza * MeSH
- adheze tkání MeSH
- dospělí MeSH
- hysteroskopie MeSH
- lidé MeSH
- myometrium MeSH
- nemoci dělohy * chirurgie MeSH
- těhotenství MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- submukózní myom,
- MeSH
- diagnostické zobrazování metody MeSH
- hysteroskopie metody MeSH
- leiomyom diagnóza etiologie patologie terapie MeSH
- lidé MeSH
- myom * chirurgie diagnóza etiologie klasifikace terapie MeSH
- myometrium diagnostické zobrazování patologie MeSH
- nádory dělohy diagnóza etiologie klasifikace patologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Cíl studie: Kazuistika pacientky s intramyometrální graviditou s anamnézou hysteroskopické transcervikální resekce reziduí po císařském řezu. Kazuistika: Žena, 35 let, byla vyšetřena 6 měsíců po císařském řezu pro silné bolesti břicha. Anamnesticky u ní byla provedena transcervikální resekce reziduí 6 týdnů po císařském řezu. Bolest lokalizovala převážně do levého hypogastria. Ultrazvukové vyšetření 2D a 3D ukázalo vitální intramyometrální graviditu v 7. týdnu. Vzhledem k stupňujícím se bolestem a stanovené diagnóze byla pacientka referována k laparoskopické okluzi uterinních arterií a fertilitu zachovávající operaci s adekvátní rekonstrukcí stěny dělohy. Závěr: Laparoskopie je vhodným operačním přístupem k řešení intramyometrální gravidity. I když se intramurální gravidita řadí mezi vzácné varianty ektopické gravidity, je důležité na tuto diagnózu myslet, jelikož může vést až k život ohrožujícímu krvácení.
Objective: The aim of this study is to report a case of intramyometrial gravidity after hysteroscopic resection of retained products of conception. Case report: We report the case of a 35-year old woman who presented at 7 weeks gestation with abdominal pain in the right iliac fossa, having had caesaren section 6 months ago. She underwent hysteroscopic resection of retained products of conception 6 weeks after casesarean section. The woman was submitted to two-and three-dimensional transvaginal ultrasound. Sonography revealed intramural ectopic pregnancy. Subsequently, we decided to perform a laparoscopic artery occlusion and removal of pregnancy with adequate multiple layer closure of the myometrial defect. Conclusion: Conservative laparoscopic surgery can be used successfully in patients with intramyometrial pregnancy. Even though the intramural pregnancy is a very rare type of ectopic pregnancy, it should be kept in mind by gynecologists because it can become a life-threatening condition. Early diagnosis helps to preserve future fertility.
- Klíčová slova
- intramyometrální gravidita, rezidua po porodu,
- MeSH
- dospělí MeSH
- hysteroskopie metody MeSH
- laparoskopie MeSH
- lidé MeSH
- mimoděložní těhotenství * chirurgie diagnostické zobrazování MeSH
- myometrium MeSH
- těhotenství MeSH
- ultrasonografie metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Type 2 uterine fibroids are challenging to resect surgically as ≥ 50% volume of myoma lies within the myometrium. A hysteroscopic approach for ablating fibroids is minimally-invasive, but places a considerable burden on the operator to accurately place the ablation applicator within the target. We investigated the sensitivity of transcervical microwave ablation outcome with respect to position of the ablation applicator within 1 - 3 cm type 2 fibroids.Methods:A finite element computer model was developed to simulate 5.8 GHz microwave ablation of fibroids and validated with experiments inex vivotissue. The ablation outcome was evaluated with respect to applicator insertion angles (30°, 45°, 60°) , depth and offset from the fibroid center (±2 mm for 3 cm fibroid and ±1 mm for 1 cm fibroid) with 35 W and 15 W applied power for 3 cm and 1 cm fibroids, respectively. Power deposition was stopped when thermal dose of 40 cumulative equivalent minutes at 43 °C (CEM43) was accrued in adjacent myometrium.Results:Within the range of all evaluated insertion angles, depths and offsets, the ablation coverage was less sensitive to variation in angle as compared to depth and offset, and ranged from 34.9 - 83.6% for 3 cm fibroid in 140 - 400 s and 34.1 - 67.9% for 1 cm fibroid in 30 - 50 s of heating duration. Maximum achievable ablation coverage in both fibroid cases reach ∼ 90% if thermal dose is allowed to exceed 40 CEM43 in myometrium.Conclusion:The study demonstrates the technical feasibility of transcervical microwave ablation for fibroid treatment and the relationship between applicator position within the fibroid and fraction of fibroid that can be ablated while limiting thermal dose in adjacent myometrium.
- MeSH
- leiomyom * chirurgie MeSH
- lidé MeSH
- mikrovlny * MeSH
- myometrium MeSH
- radiofrekvenční ablace MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer. METHODS/MATERIALS: We included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases. RESULTS: The MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion (≥ 50%) (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011). CONCLUSIONS: Tumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.
- MeSH
- histiocyty patologie MeSH
- hysterektomie MeSH
- invazivní růst nádoru MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenektomie MeSH
- lymfatické uzliny diagnostické zobrazování patologie chirurgie MeSH
- myometrium diagnostické zobrazování patologie chirurgie MeSH
- nádory endometria diagnostické zobrazování patologie chirurgie MeSH
- následné studie MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři MeSH
- ultrasonografie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
Uterine leiomyosarcomas (uLMS) are rare, aggressive malignancies for which limited treatment options are available. To gain novel molecular insights into uLMS and identify potential novel therapeutic targets, we characterized 84 uLMS samples for genome-wide somatic copy number alterations, mutations, gene fusions and gene expression and performed a data integration analysis. We found that alterations affecting TP53, RB1, PTEN, MED12, YWHAE and VIPR2 were present in the majority of uLMS. Pathway analyses additionally revealed that the PI3K/AKT/mTOR, estrogen-mediated S-phase entry and DNA damage response signaling pathways, for which inhibitors have already been developed and approved, frequently harbored genetic changes. Furthermore, a significant proportion of uLMS was characterized by amplifications and overexpression of known oncogenes (CCNE1, TDO2), as well as deletions and reduced expression of tumor suppressor genes (PTEN, PRDM16). Overall, it emerged that the most frequently affected gene in our uLMS samples was VIPR2 (96%). Interestingly, VIPR2 deletion also correlated with unfavorable survival in uLMS patients (multivariate analysis; HR = 4.5, CI = 1.4-14.3, p = 1.2E-02), while VIPR2 protein expression was reduced in uLMS vs. normal myometrium. Moreover, stimulation of VIPR2 with its natural agonist VIP decreased SK-UT-1 uLMS cell proliferation in a dose-dependent manner. These data suggest that VIPR2, which is a negative regulator of smooth muscle cell proliferation, might be a novel tumor suppressor gene in uLMS. Our work further highlights the importance of integrative molecular analyses, through which we were able to uncover the genes and pathways most frequently affected by somatic alterations in uLMS.
- MeSH
- dospělí MeSH
- genomika metody MeSH
- Kaplanův-Meierův odhad MeSH
- karcinogeneze genetika MeSH
- leiomyosarkom genetika mortalita patologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- myometrium patologie MeSH
- nádory dělohy genetika mortalita patologie terapie MeSH
- onkogeny genetika MeSH
- proliferace buněk genetika MeSH
- receptory vazoaktivního intestinálního peptidu typu II genetika MeSH
- regulace genové exprese u nádorů genetika MeSH
- sekvenční analýza RNA metody MeSH
- sekvenování celého genomu metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- signální transdukce genetika MeSH
- tumor supresorové geny MeSH
- vysoce účinné nukleotidové sekvenování metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy. METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ). RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually. CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.
- MeSH
- dospělí MeSH
- invazivní růst nádoru MeSH
- kontrastní látky MeSH
- lidé středního věku MeSH
- lidé MeSH
- myometrium diagnostické zobrazování patologie MeSH
- nádory endometria diagnostické zobrazování patologie chirurgie MeSH
- odchylka pozorovatele MeSH
- reprodukovatelnost výsledků MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- staging nádorů metody MeSH
- ultrasonografie metody MeSH
- zobrazování trojrozměrné * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
OBJECTIVE: To investigate differences and similarities in the clinical approach of young clinicians managing women with endometrial cancer (EC) conservatively. METHODS: A web-based survey was carried out. A platform of the European Network of Young Gynaecological Oncologists (ENYGO) database was used. A 38-item multiple-choice questionnaire was used to evaluate current practice in fertility-sparing management of EC. The survey covered investigations, treatment options, follow-up and management of recurrence and future family planning. Descriptive statistics were used. RESULTS: Overall, 116 out of 650 (17.84%) ENYGO members responded to the survey. In 92 (79.3%) centres, the caseload of early stage EC treated conservatively was less than 10 per year. One hundred and seven responders (93.8%) believe that treatment with progestins could be offered in grade 1 EC without myometrial invasion, but a minority would recommend it even for grade 2 tumours with no myometrial invasion or grade 1 with superficial invasion. The diagnostic tool for establishing grade of tumour was hysteroscopy with dilatation and curettage in 64 (55%) centres. Medroxyprogesterone acetate represents the most commonly prescribed progestogen (55, 47.4%). In 78 (67.2%) centres, a repeat endometrial biopsy was offered after 3 months of treatment commencement. Recurrences are treated mostly with hysterectomy (81, 69.9%) with only a small number of responders recommending to repeat progestin treatment. Lynch syndrome is a contraindication for conservative management in half of the responders (57, 49.1%). Most clinicians agree that patients should be referred promptly for assisted reproductive techniques once complete response has been achieved (68, 58.6%). CONCLUSIONS: Our study shows that conservative management is increasingly offered to women affected by early stage EC wishing to preserve their fertility. Further studies and joint registries are required to evaluate safety and effectiveness of this approach in this probably growing number of patients.
- MeSH
- antitumorózní látky hormonální terapeutické užití MeSH
- asistovaná reprodukce MeSH
- dilatace a kyretáž MeSH
- dospělí MeSH
- endometrium patologie MeSH
- hysteroskopie MeSH
- konzervativní terapie metody MeSH
- lidé MeSH
- lokální recidiva nádoru patologie terapie MeSH
- medroxyprogesteronacetát terapeutické užití MeSH
- myometrium patologie MeSH
- nádory endometria farmakoterapie patologie MeSH
- progestiny terapeutické užití MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- výsledek terapie MeSH
- zachování plodnosti MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
The aim of this study was to assess the diagnostic accuracy of subjective ultrasound evaluation of myometrial invasion of endometrial cancer and to compare its accuracy to objective methods. All consecutive patients with histologically proven endometrial cancer, who underwent ultrasound evaluation followed by surgical staging between January 2009 and December 2011, were prospectively enrolled. Myometrial invasion was evaluated by subjective assessment using ultrasound (<50% or ≥50%) and calculated as deepest invasion/normal myometrium ratio (Gordon's ratio) and as tumor/uterine anteroposterior diameter ratio (Karlsson's ratio). Histological assessment from hysterectomy was considered the gold standard. Altogether 210 patients were prospectively included. Subjective assessment and two objective ratios were found to be statistically significant predictors of the myometrial invasion (AUC = 0.65, p value < 0.001). Subjective assessment was confirmed as the most reliable method to assess myometrial invasion (79.3% sensitivity, 73.2% specificity, and 75.7% overall accuracy). Deepest invasion/normal myometrium (Gordon's) ratio (cut-off 0.5) reached 69.6% sensitivity, 65.9% specificity, and 67.3% overall accuracy. Tumor/uterine anteroposterior diameter (Karlsson's) ratio with the same cut-off reached 56.3% sensitivity, 76.4% specificity, and 68.1% overall accuracy. The subjective ultrasound evaluation of myometrial invasion performed better than objective methods in nearly all measures but showed statistically significantly better outcomes only in case of sensitivity.
- MeSH
- invazivní růst nádoru diagnóza diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- myometrium diagnostické zobrazování patologie chirurgie MeSH
- nádory endometria diagnóza diagnostické zobrazování patologie chirurgie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ultrasonografie * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl studie: Analýza úspěšnosti ultrazvukového stagingu časných stadií karcinomu endometria v závislosti na gradingu (histologickém typu), vyhodnocení přesnosti vyšetření s přibývajícími zkušenostmi sonografistů a komparace subjektivního versus objektivního hodnocení hluboké invaze do myometria v souboru pacientek, které byly referované do Onkogynekologického centra Gynekologicko-porodnického oddělení v Českých Budějovicích. Typ studie: Retrospektivní studie. Název a sídlo pracoviště: Gynekologicko-porodnické oddělení, Nemocnice České Budějovice a.s. Metodika a soubor: V tomto článku retrospektivně hodnotíme soubor 136 pacientek s časným stadiem karcinomu endometria, které podstoupily diagnostiku a léčbu na našem pracovišti v období let 2012–2016 a u kterých bylo možno porovnat různé modality hodnocení hluboké invaze tumoru do myometria pomocí ultrazvukového vyšetření. Výsledky: Při srovnání jednotlivých použitých metod hodnocení hluboké myometriální invaze pomocí ultrazvukového vyšetření u pacientek s časným stadiem karcinomu endometria je patrné, že nejvyšší míry přesnosti dosahuje subjektivní hodnocení expertem, kdy po prvním roce hodnocení senzitivita dosahovala 80 %, specificita 79 %, u postižení stromatu hrdla 70 % a 99 %. V případě rozdělení do podskupin podle gradingu je patrný se zvyšujícím se gradingem nárůst senzitivity z 64 % na 100 %, při poklesu specificity ze 75 % na 56 %. Při vyhodnocování způsobů objektivního hodnocení při zvolených cut off nejvyšší senzitivitu, 81 %, vykazovalo měření vzdálenosti tumor/seróza (specificita 67 %). Naopak nejlepších hodnot specificity 90 % dosahovalo hodnocení poměru AP (anterioposteriorní) rozměr tumoru/AP rozměr dělohy (senzitivita 54 %). Závěr: Všeobecně je v onkologické léčbě kladen důraz na co nejpřesnější staging nádorových onemocnění. V rámci onkogynekologie se čím dál tím více prosazuje v tomto ohledu ultrazvukové vyšetření. Náš soubor prokázal význam ultrazvuku v diagnostice a stagingu karcinomu endometria a míru jeho přesnosti u časných stadií v závislosti na zkušenostech sonografisty, které po roce již dosahují celosvětově prezentovaných výsledků, ať pomocí ultrazvukového vyšetření, MRI či při využití frozen section.
Objective: The aim of the presented study was to evaluate the accuracy of ultrasound staging of early stage endometrial cancer depending on grading, evaluation of ultrasound examination accuracy growing overtime with gained experience of examiners and comparison of subjective versus objective modalities of deep myometrial invasion assessment in the file of patients who were referred in The Oncogyneacologic Center, Department of Gyneacology and Obstetrics in České Budějovice. Design: Retrospective study. Settings: Department of Gyneacology and Obstetrics, Hospital České Budějovice a.s. Methods and the file: In this arcticle we retrospectively evaluate the file of 136 patients with early stage endometrial cancer. The patients underwent diagnostic and therapeutic procedures during the years 2012-2016 in our department. All these patients were able to be compared in different aproaches to deep myometrial invasion assessment using ultrasound examination. Results: Comparing the used methods of deep myometrial invasion assessment with ultrasound examination of early stage endometrial cancer patients the examiner's subjective evaluation seems to be the best approach. After the first year of doing these assessments sensitivity performed 80%, specificity 79% and infiltration of cervix sensitivity 70% and specificity 99%. In case the patients were divided into groups according to the grading, low grade assessed worst sensitivity 64% (high grade l00%), but the best specificity 75% (high grade 56%). The evaluation of objective approaches of ultrasound assement with used cut offs performed the best sensitivity 81% tumour free minimal margin (specificity 67%). On the contrary the best specificity 90% performed the ratio AP (anteroposterior) diameter tumour/AP diameter uterine (senzitivity 54%). Conclusion: Generally in oncological therapy the most important things to put stress on the very accurate staging of oncological disease. In oncogyneacology ultrasound becomes more and more required examination. In our file we proved the significance of ultrasound examination in diagnostics and staging of endometrial cancer and we also proved that the accuracy level in early stage depends on the examiner´s experience. After one year practice our results reach the level of the results presented globally, no matter which of the methods – ultrasound MRI or frozen section – was used.
- MeSH
- endometrium anatomie a histologie MeSH
- incidence MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- myometrium diagnostické zobrazování MeSH
- nádory endometria * diagnostické zobrazování diagnóza MeSH
- retrospektivní studie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika MeSH