Different expressions of aquaporin water channels and macrophages infiltration in human cervix remodeling during pregnancy

Despite aquaporin water channels (AQPs) play a critical role in maintaining water homeostasis in female reproductive tract and prompt a gradual increase in water content in cervical edema as pregnancy progressed, their relationship with macrophage infiltration and collagen content in human cervical remodeling need to be further investigated. This is the first study to examine the expression and localization of AQP3, AQP4, AQP5, AQP8 and macrophages simultaneously in human cervical ripening. The immunoreactivity of these AQPs was 2.6 to 6-fold higher on gestational weeks 26 (GD26W) than that on GD6W and GD15W, but AQP4 expression on GD39W dropped a similar extent on GD15W, other AQPs continued to rise on GD39W. The AQP3, AQP4 and AQP5 intensity seemed more abundant in cervical stroma than in the perivascular area on GD26W; the distribution of AQP3, AQP5 and AQP8 in cervical stroma was equivalent to that in the perivascular area on GD39W. Macrophage numbers were 1.7-fold higher in subepithelium region and 3.0-fold higher in center area on GD26W than that on GD15W; such numbers remained elevated on GD39W. The electron micrographs showed that cervical extensibility increased significantly on GD26W and GD39W accompanied with increased macrophage infiltration, cervical water content and much more space among collagen fibers. These findings suggest that the upregulation of AQPs expression in human cervix is closely related to enhanced macrophage infiltration during pregnancy; there may be a positive feedback mechanism between them to lead the increase of water content and the degradation of collagen.

Differences of Increased Bishop Scores Between Neutrophil Swab Vaginal ≤ 5 and > 5 in 41 Weeks of Pregnancy Induced With Misoprostol

The incidence of labor induction with various indications was to increase. The key to successful labor induction is a ripe cervix. Research shows that the degree of cervical rippening as assessed by the Bishop score is influenced by the level of neutrophils contained in the cervical stroma which can be detected by performing a vaginal swab. Neutrophils will produce collagenase in the form of matrix metalloproteinase - 8 (MMPs - 8) which will degrade cervical collagen fibers, so that the cervix becomes soft and ripe. Misoprostol is the drug most widely used in labor induction today. Purpose: This study was to determine the difference in Bishop score increase between vaginal swab neutrophils ≤ 5 and > 5 in pregnancy ≥ 41 weeks induced by misoprostol.Keywords: Bishop score, neutrophil, vaginal swab, misoprostol

Imaging modalities in fertility preservation in patients with gynecologic cancers

Fertility preservation is an integral component of clinical decision-making and treatment design. However, the selection criteria on imaging for patients eligible for fertility preservation is still unclear. The present review aimed to summarize the main findings reported in both the literature and international guidelines on the role of imaging in the selection of patients for fertility preservation. A search strategy was developed and applied to PubMed, Scopus, Web of Science, and EMBASE to identify previous citations reporting imaging and fertility preservation in patients with gynecological cancer. We also retrieved the published guidelines on the eligibility criteria for fertility-sparing treatment of gynecological neoplasms. A description of the internal multidisciplinary guidelines, clinically in use in our institution, is provided with representative clinical cases. The literature review revealed 1291 articles and 18 of these were selected for the analysis. Both ultrasound and MRI represented the primary imaging methods for selecting patients for fertility preservation in cervical and endometrial cancers. Eligibility criteria of fertility-sparing management in patients with cervical cancer were: tumor size <2 cm, tumor distance from the internal os >1 cm, and no parametrium invasion. For patients with endometrial cancer, these included no myometrial and cervical stroma invasion. Both ultrasound and MRI play a key role in characterizing adnexal masses. These modalities provide a useful tool in identifying small ovarian lesions, thus key in the surveillance of patients after fertility sparing surgery. However, efficacy in excluding disease beyond the ovary remains limited. This review provides an update of the literature and schematic outline for the counseling and management of patients with the desire for fertility preservation.

Premalignant and malignant disease of the cervix

Cervical cancer is a disease of poor and unscreened populations. Globally, it is the fourth most common cancer in women with over half a million new cases and over a quarter of a million deaths per year. About 85% of cases occur in less developed regions. Systematic high coverage and quality-assured population screening for precursors to cervical cancer is highly effective. Human papillomavirus (HPV) DNA testing will probably replace or complement cytology as the primary screening tool in many developed countries for women over 30 years of age. Because of the absolute relationship between oncogenic HPV and cervical cancer, its negative predictive value is very high. Management of cervical cancer is to determine the stage of the disease and to treat both the primary lesion and other extracervical disease. Cervical cancers spread by direct spread into the cervical stroma, parametrium, and beyond, and by lymphatic metastasis into parametrial, pelvic sidewall, and para-aortic nodes. Women should be fully staged using the International Federation of Gynecology and Obstetrics system and discussed in expert multidisciplinary forums with specialist surgeons, oncologists, pathologists, radiologists, and specialist nurses. Both surgery and radiotherapy are effective in early-stage disease, whereas locally advanced disease relies on treatment by radiation or chemoradiation. Surgery does provide the advantage of conservation of ovarian function. Women who have been treated for cervical precancer are much more likely to develop cervical cancer. Post-treatment HPV testing is the most sensitive test, has the best negative predictive values, and is the best test of cure.

A Deceptive Spread: Myoinvasion of Endometrial Carcinoma Imitating Adenoma Malignum

Endometrioid type of endometrial carcinoma is the most common form of uterine malignancy. The majority of patients in the developed world present with the low-grade, low-stage type of this malignancy. The current treatment of early-stage endometrioid carcinoma provides most patients with a favorable outcome. One of the important factors that determine the outcome of early-stage endometrial carcinoma is the involvement of cervical stroma. One of the very rare forms of cervical stromal involvement by endometrioid carcinoma is termed “adenoma malignum type” invasion due to its similarity to the infamously deceptive type of cervical adenocarcinoma called adenoma malignum. Since adenoma malignum is often discovered incidentally, finding adenoma malignum type of myoinvasion may deceive a pathologist to diagnose the simultaneous presence of endometrial carcinoma and adenoma malignum in the same patient as 2 separate entities. Also, this type of myoinvasion may be missed altogether for its subtle nature. In this article, we report a case of low-grade, low-stage endometrioid carcinoma with adenoma malignum type of myoinvasion. We have pointed out the subtle nature of this lesion and the important features to remember to successfully identify it.

Pelvic Ultrasound Findings in Women with Obstetric Fistula: A Cross-Sectional Study of Cases and Controls

Objective. Obstetric fistula (OF) is a morbid condition caused by prolonged obstructed labor. Women with OF experience profound injury and have high rates of infertility and poor obstetric outcomes. We examined endovaginal ultrasound parameters in women with and without OF. Design/Setting/Sample/Methods. This cross-sectional study enrolled women evaluated at the Fistula Care Centre in Lilongwe, Malawi. Eligibility criteria included age 18–45, prior pregnancy, and a uterus on ultrasound. Participants underwent endovaginal ultrasound with measurement of cervical dimensions. Comparisons were done using t-tests and Fisher's exact test. Among women with OF, linear regression was used to assess whether fistula stage was associated with cervical length. Results. We enrolled 98 cases and 12 controls. Women with OF had shorter cervical lengths (18.8 mm versus 27.3 mm, p < 0.01), as well as shorter anterior (7.0 mm versus 9.3 mm, p < 0.01) and posterior (9.5 mm versus 11.0 mm, p < 0.04) cervical stroma, compared to controls. Conclusion. Women with OF have shorter cervical lengths and anterior and posterior cervical stroma, when compared to women without OF. This may offer a partial explanation for subfertility and poor obstetric outcomes in OF patients. Additional studies to clarify the role of ultrasound in OF patients and prediction of future fertility are warranted.