scholarly journals «VULNERABLE» ENDOMETRIUM: A MODERN VIEW ON THE PATHOGENESIS AND PATHOGENETIC THERAPY OF ENDOMETRIAL HYPERPLASTIC PROCESSES

2021 ◽  
pp. 54-60
Author(s):  
M.R. Orazov ◽  
V.Е. Radzinskiy ◽  
M.B. Khamoshina ◽  
I.A. Mullina ◽  
Yu.S. Artemenko
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Young Patients ◽  
Reproductive Function ◽  
Developed Countries ◽  
Modern Medicine ◽  
Reproductive Age ◽  
Management Algorithm ◽  
Randomized Controlled Studies ◽  
Pathogenetic Therapy

Relevance: Endometrium is a unique human tissue with a strong regenerative potential which is implemented after desquamation during each menstrual cycle. At that, regeneration in the endometrium is not accompanied by scarring. Endometrial hyperplasia as a variant of defect transformation is a widespread disease which remains an urgent problem of modern medicine. In recent years, endometrial hyperplasia is becoming more common among patients of reproductive age. This problem is even more significant due to the spread of endometrial cancer in developed countries, and endometrial hyperplasia being its precursor. Purpose: The article describes modern views on the pathogenesis and pathogenetic therapy of endometrial hyperplastic processes. Materials and Methods: Sources available in the Pubmed, Embase, Cochrane databases were analyzed and international reviews of randomized controlled studies in that area were selected for the last few years using the keywords «endometrial hyperplasia,» «atypical hyperplasia,» «endometrial cancer,» «progestins,» and «hysterectomy.» Results: The article discusses the modern ideas about etiopathogenesis and the tactics of management of patients, according to the data of foreign literature. Conclusion: Early diagnostics and timely treatment of endometrial hyperplasiaare an important preventive factor due to the high risk of malignancy. The patient management algorithm depends on many factors: the type of hyperplastic conditions, the patient’s age, unrealized reproductive function, and etc. Progestin therapy is more preferable for young patients wishing to preserve reproductive function. If cellular atypia is present, panhysterectomy is the first line of treatment for women who have realized their reproductive function and have endometrial hyperplasia with atypia.

scholarly journals INFLUENCE OF CYTOKINES PRODUCTION, NITROGEN OXIDE METABOLITES AND LIPIDS EXCHANGE ON THE FORMATION OF EXTERNAL GENITAL ENDOMETRIOSIS STAGES IN PATIENTS OF REPRODUCTIVE AGE

2020 ◽  
Vol 17 (35) ◽  
pp. 813-824
Author(s):  
Natalya Victorovna ERMOLOVA ◽  
Yuriy Alekseevich PETROV ◽  
Marina Arkadevna LEVKOVICH ◽  
Ludmila Valerievna KOLESNIKOVA ◽  
Nina Aleksandrovna DRUKKER
Keyword(s):  
Nitric Oxide ◽  
Growth Factor ◽  
Transforming Growth Factor ◽  
Young Patients ◽  
Reproductive Function ◽  
Transforming Growth Factor Β1 ◽  
Biologically Active ◽  
Reproductive Age ◽  
Nitric Oxide Metabolites ◽  
Factor Α

The relevance of the study is due to the prevalence and increase in the incidence of endometriosis, especially in young patients, its influence on reproductive function, and the lack of reliable non-invasive diagnosis of the disease and its stages. There are no unified views on the etiology and multifactorial pathogenesis of this disease. This article is aimed at revealing the mechanisms of the formation of endometriosis stages basing on the study of the effect of cytokines production, nitric oxide metabolites and lipid metabolism. The main approach to study this problem is both to investigate systemic (blood serum) and local (peritoneal fluid) levels, their comparison. This allows comprehensive consideration of the pathogenesis of the disease and determination of the value of the mentioned biologically active factors depending on the stages of the disease. The article presents new data on the content of high- and low-density lipoproteins, cholesterol, transforming growth factor β1 and tumor necrosis factor α, the content of nitric oxide metabolites and their clinical interpretation is given according to the stages of the disease. The materials of the article are of practical value for researchers of endometriosis and practicing obstetrician-gynecologists.. Keywords: external genital endometriosis, lipoproteins, nitric oxide, transforming growth factor.

COMPARATIVE STUDY OF ENDOMETRIAL CYTOLOGY AND ENDOMETRIAL BIOPSY IN PERI MENOPAUSAL WOMEN

2021 ◽  
pp. 42-43
Author(s):  
Vasudha Rani ◽  
Punam Kumari ◽  
Asha Jha
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Endometrial Hyperplasia ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Focal Lesion ◽  
Diagnostic Strategy ◽  
Rule Out

Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anaesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, ofce vacuum aspiration (Pipette) and the use of ofce hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of nding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-à-vis each other. Histological assessment is the nal word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Carcinoma. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. Asingle-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the ofce hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.

scholarly journals The Perspectives of Fertility Preservation in Women with Endometrial Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 602
Author(s):  
Jure Knez ◽  
Leyla Al Mahdawi ◽  
Iztok Takač ◽  
Monika Sobočan
Keyword(s):  
Endometrial Cancer ◽  
Fertility Preservation ◽  
Gynecological Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Developed Countries ◽  
Reproductive Age ◽  
Younger Women ◽  
Future Fertility ◽  
Fertility Sparing

Endometrial cancer is the most common gynecological cancer in developed countries. The disease is diagnosed with increasing frequency in younger women, commonly also in their reproductive age. The standard treatment of endometrial cancer is surgical in the form of hysterectomy and bilateral salpingo-oophorectomy, and this precludes future fertility in younger women. The current challenge is to identify the group of women with endometrial cancer and low-risk features that would benefit from more conservative treatment options. More focus in management needs to be aimed towards the preservation of quality of life, without jeopardizing oncological outcomes. In this review, we analyze the current approaches to identification of women for conservative management and evaluate the success of different medical options for treatment and surgical techniques that are fertility sparing. We also elaborate on the future perspectives, focusing on the incorporation of molecular characterization of endometrial cancer to fertility preservation algorithms. Future studies should focus specifically on identifying reliable clinical and molecular predictive markers in this group of young women. With improved knowledge and better risk assessment, the precision medicine is the path towards improved understanding of the disease and possibly widening the group of women that could benefit from treatment methods preserving their fertility.

scholarly journals Fertility-Sparing Methods in Adolescents Affected by Endometrial Cancer: A Comprehensive Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1020
Author(s):  
Krzysztof Gałczyński ◽  
Piotr Olcha ◽  
Katarzyna Romanek-Piva ◽  
Maciej Jóźwik ◽  
Andrzej Semczuk
Keyword(s):  
Endometrial Cancer ◽  
World Literature ◽  
Young Patients ◽  
Developed Countries ◽  
Type I ◽  
Genetic Syndromes ◽  
Patient Death ◽  
Future Fertility ◽  
Fertility Sparing

Although in developed countries endometrial cancer (EC) is the most common gynecological malignancy, its occurrence in adolescents is exceedingly rare. The increasing rate of obesity in children and adolescents is held responsible for the increasing prevalence of EC in younger cohorts of patients. The diagnosis of this malignancy can have devastating consequences for future fertility because standard treatment protocols for EC include hysterectomy. Here, we present the first detailed review of the world literature on EC in subjects aged 21 years or younger (n = 19). The mean age at diagnosis was 16.7 ± 0.6 years. One patient (5.3%) had a Type II (high-risk) disease. No communication retrieved from the search reported on patient death; however, two (10.5%) patients were lost to follow-up. There was also a high proportion (five subjects, or 26.3%) of cases with genetic background (Cowden syndrome and Turner syndrome), therefore genetic screening or a direct genetic study should be considered in very young patients with EC. The current fertility-sparing options, limited to Type I (low-risk) disease, are presented and discussed. Such information, obtained from studies on older women, translates well to adolescent girls and very young women. Careful anatomopathological monitoring at follow-up is essential for the safety of a conservative approach. Improved survival in very young EC patients makes the preservation of fertility a central survivorship issue, therefore both patients and caregivers should undergo counseling regarding available options. Moreover, our study suggests that genetic syndromes other than Lynch syndrome may be associated with EC more frequently than previously thought.

scholarly journals Fertility-Sparing Treatment of Patients with Endometrial Cancer: A Review of the Literature

2021 ◽  
Vol 10 (20) ◽  
pp. 4784
Author(s):  
Umberto Leone Roberti Maggiore ◽  
Rola Khamisy-Farah ◽  
Nicola Luigi Bragazzi ◽  
Giorgio Bogani ◽  
Fabio Martinelli ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Female Genital Tract ◽  
Young Patients ◽  
Developed Countries ◽  
Significant Shift ◽  
High Quality Evidence ◽  
Fertility Sparing ◽  
Rich Countries ◽  
Common Malignancy ◽  
Female Genital

Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries. Although it is more common in postmenopausal women, it may affect up to 25% in the premenopausal age and 3–5% under the age of 40 years. Furthermore, in the last decades a significant shift to pregnancy at older maternal ages, particularly in resource-rich countries, has been observed. Therefore, in this scenario fertility-sparing alternatives should be discussed with patients affected by EC. This study summarizes available literature on fertility-sparing management of patients affected by EC, focusing on the oncologic and reproductive outcomes. A systematic computerized search of the literature was performed in two electronic databases (PubMed and MEDLINE) in order to identify relevant articles to be included for the purpose of this systematic review. On the basis of available evidence, fertility-sparing alternatives are oral progestins alone or in combination with other drugs, levonorgestrel intrauterine system and hysteroscopic resection in association with progestin therapies. These strategies seem feasible and safe for young patients with G1 endometrioid EC limited to the endometrium. However, there is a lack of high-quality evidence on the efficacy and safety of fertility-sparing treatments and future well-designed studies are required.

scholarly journals Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

2021 ◽  
Vol 11 (1) ◽  
pp. 196
Author(s):  
Gulzhanat Aimagambetova ◽  
Sanja Terzic ◽  
Antonio Simone Laganà ◽  
Gauri Bapayeva ◽  
Philip la Fleur ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Young Women ◽  
Early Stage ◽  
Young Patients ◽  
Surgical Techniques ◽  
Risk Groups ◽  
Reproductive Age ◽  
Management Options ◽  
Minimally Invasive Surgical ◽  
Fertility Sparing

Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups’ stratification along with specific biomarkers’ identification will ensure low recurrence and decrease mortality rates in young women with EC.

Innovative approaches to operational treatment of women of reproductive eligibility age with hyperplastic processes of the endometrium

2016 ◽  
pp. 41-45
Author(s):  
V.N. Goncharenko ◽  
Keyword(s):  
Endometrial Hyperplasia ◽  
Histopathological Examination ◽  
Intraoperative Complications ◽  
Transvaginal Ultrasound ◽  
Treatment Algorithm ◽  
Hormone Treatment ◽  
Endometrial Ablation ◽  
Reproductive Age ◽  
Dynamic Monitoring ◽  
Atypical Form

The aim of the study: was improvement of results of surgical treatment of patients of reproductive age eligibility with hyperplastic processes of endometrium (HPE) through the introduction of individualized treatment algorithm with the use of monopolar radio wave and hysteroscopic endometrial ablation. Materials and methods. The study included 62 women with non-atypical form of hyperplasia of the endometrium who were treated at the Center of General gynecology of the clinical hospital «Feofania», gynecological Department at the city maternity hospital № 3 of Kyiv. Depending on the age group, nature of the pathological process and method of treatment is randomized, the distribution of women according to groups: group 1 – 41 women's reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), who were subjected to hysteroscopic monopolar endometrial ablation; group 2 – 21 female reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), which was held radiowave ablation of the endometrium (RHAE). In the 1st group the age of patients ranged from 42 to 54 years, mean age was 49.9±4.7 years. In the 2nd group the age of patients ranged from 41 to 53 years, mean age of 51.6±4.3 years. Results. A comparative analysis of the techniques for hysteroscopic monopolar ablation and RHEE showed the fact that for RHEE used local anesthesia, while carrying out hysteroscopic monopolar ablation was necessary intravenous anesthesia. The duration of the hysteroscopic monopolar endometrial ablation was 28.6±5.5 min, RAE – according to the standard method – 44.3±0.3 min. When performing hysteroscopic monopolar endometrial ablation in 2 patients (3.7%) patients observed the signs of intravasation of fluid, increased blood pressure and tachycardia. This syndrome was successfully docked, but in the future, women have conducted a thorough examination. When you run RHAE intraoperative complications have been identified. Conclusion. 1. Women with netipichnaya forms of endometrial hyperplasia eligibility and late reproductive age who do not have reproductive plans as an alternative to hysterectomy, in the presence of contraindications or ineffectiveness of hormone treatment may be recommended or radiowave monopolar hysteroscopic ablation of the endometrium. 2. Monopolar hysteroscopic endometrial ablation is indicated for women with netipichnaya forms of endometrial hyperplasia, can be used in the presence of submucous form of uterine fibroids, postoperative scars on the uterus, but in the absence of adenomyosis II–III degree. The effectiveness of monopolar hysteroscopic endometrial ablation in women with non-atypical form of hyperplasia of the endometrium is 87.8%. 3. Women after endometrial ablation should be under observation for two years. The method of choice for dynamic monitoring of the condition of the uterus in women who underwent endometrial ablation is transvaginal ultrasound which should be performed after 1, 3, 6, 12 and 24 months of follow up. 4. In case of recurrence of hyperplastic process of the endometrium (bleeding, thickening of the M-mode echo according to the ultrasound) shows a hysteroscopy with a mandatory histopathological examination and verification of the diagnosis. Key words: endometrial hyperplasia, women eligibility age, women of reproductive age, ablation of the endometrium.

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