Search Results (69)

Abdominal fat necrosis is a dystrophic–necrotic process that is relatively common in dairy cows. It is determined by productive strain (excess fat in the diet), negative energy balance after calving, a lack of physical activity, vitamin E and selenium deficiency, etc. Lipomatous masses are predominantly located in the omentum and mesentery in cattle, potentially causing intestinal obstruction. We report on an outbreak of abdominal fat necrosis that affected 135 of 220 cows and heifers (61.36%); this involved massive fat accumulation in the uterine and salpingian ligaments and severe reproductive disorders (reducing fertility to 20% in cows and 10% in heifers) caused by a hyperenergetic diet (supplementation with saturated fats). A transrectal ultrasound examination of the genital apparatus—both in heifers and in cows in the puerperium—revealed a diffuse pathological hyperechogenicity of the cervical folds, suggesting lipid infiltration, proliferation of the endocervical folds and hyperechogenic lipogranulomas located paracervically or in the uterine ligaments. An ultrasound examination of the ovaries showed the presence of parasalpingial lipogranulomas on the mesovarium, with a uniformly pixelated greasy appearance, that altered the topography of the salpinx, leading to the impossibility of oocyte retrieval. At the histopathological examination, in addition to the necrosis of adipocytes and the subacute–chronic inflammation of the abdominal and retroperitoneal adipose tissue, lipid infiltration of the uterine walls was also observed in the uterine ligaments and lymph nodes. Additionally, lipid infiltration was observed in the wall of the uterine artery. All muscular-type branches of the ovarian artery exhibited subendothelial (subintimal) amyloid deposits, severely reducing their lumen and leading to ischaemia. Amyloidosis was secondary to the systemic inflammatory process triggered by lipid deposition and necrosis. Fertility returned to normal 45–60 days after the exclusion of fat supplements from the diet and their replacement with a vitamin–mineral supplement rich in antioxidants. Full article

Chlamydia trachomatis infection is a public health problem. Serological tests can determine the disease burden and serve as a biomarker for identifying patients with infertility due to tubal obstruction. However, cross-reactions between chlamydial species have been reported, which causes problems with diagnosis. A real-time PCR commercial test for the detection of endocervical infection and two ELISAs with the recombinant major outer membrane protein (rMOMP) from C. trachomatis and C. abortus as antigens were used to diagnose both infections. The prevalence of endocervical infection by C. trachomatis was 7.77%, and that of IgG antibodies against C. trachomatis and C. abortus was 31.1% and 10.7%, respectively. The ELISA with C. trachomatis rMOMP showed a sensitivity of 75% and a specificity of 72.5%. The lowest sensitivity (25%) and high specificity (76.8%) were obtained with anti-C. abortus rMOMP ELISAs. A low cross-reactivity of 7% between ELISA tests was observed. Conclusion. The recombinant MOMP ELISA could help identify women who had contact with C. trachomatis or C. abortus and could be a tool to lower the costs of performing molecular testing on all patients attending an infertility clinic. Full article

In postmenopausal women with high-grade cervical intraepithelial neoplasia (CIN3), hysterectomy is frequently performed after loop electrosurgical excision procedure (LEEP) due to the concern for residual disease or occult carcinoma. However, the decision to proceed with hysterectomy is often made without validated predictive criteria, increasing the risk of overtreatment or underdiagnosis. The aim of this study is to identify independent predictors of residual CIN2+ (CIN2, CIN3, adenocarcinoma in situ, invasive carcinoma) or invasive disease in hysterectomy specimens following LEEP in this high-risk population. Methods: We conducted a multicenter retrospective study including 154 postmenopausal women (aged 50–75) who underwent total hysterectomy within 12 months after LEEP for histologically confirmed CIN3. Data collected included human papillomavirus (HPV) genotyping (pre- and post-LEEP), endocervical curettage (ECC), cone margin status, transformation zone type, and histopathological outcomes of the hysterectomy specimen. Logistic regression and ROC curve analysis were used to assess predictive factors. Results: Residual disease (CIN2+, AIS, or carcinoma) was found in 38 patients (24.7%), including 7 cases (4.5%) of occult carcinoma. Persistent high-risk HPV post-LEEP was the strongest independent predictor (adjusted OR for HPV 16/18: 74.0; p < 0.001), followed by positive ECC (OR: 3.64; p = 0.028). Cone margin status was not independently associated. The multivariate model showed good discriminative performance (AUC = 0.860; sensitivity 67.2%, specificity 72.8%). Conclusions: Our findings suggest that persistent high-risk HPV infection and positive ECC are reliable predictors of residual or occult disease. These markers should be integrated into post-LEEP follow-up protocols to better identify candidates for hysterectomy and minimize unnecessary surgeries. Full article

(1) Background: After receiving an abnormal Papanicolaou smear result, very often women fail to adhere to further procedures due to depression. Using a neural network approach, this research aimed to predict pre- and post-diagnostic depressive symptoms in women with abnormal Pap screening tests. (2) Methods: The study was conducted at the Clinical Center of Kragujevac, Serbia, among 172 women with a positive Pap screening result before and after diagnostic procedures (colposcopy/biopsy/endocervical curettage). Just before and 2 to 4 weeks after the diagnostic procedures, women filled out a socio-demographic questionnaire and the Hospital Anxiety and Depression Scale (HADS). Multilayer perceptron neural networks were modeled. (3) Results: Depression was present in 37.2% of women before diagnostic procedures and in 48.3% after. Feature selection showed four variables that correlated with depression before diagnostic procedures—anxiety (according to the HADS), depression according to the CESD scale, worry score on the POSM scale and use of sedatives. Model for predicting pre-diagnostic depression yielded an accuracy of 79.41%, with a value of 0.842 for area under the receiver operating characteristic curve (AUROC). The HADS anxiety score, place of residence and CESD score were the most important attributes for predicting post-diagnostic depression, with an ANN model accuracy of 88.24% and AUROC 0.939. (4) Conclusions: This research revealed a possible way of predicting depression occurrence in those women who received a positive Pap screening test and who are undergoing follow-up diagnostics, aiding medical doctors in the provision of successful and on-time psychological assistance. Full article

In this clinical case, we report an upper genital infection revealed on Computed Tomography by a greater omentum abscess. The infection was confirmed by endocervical swabs and ultrasound-guided sampling of the epiploic abscess, which found the same bacteria (Parvimonas micra). Omental absecesses are most often secondary to spontaneous or post-operative infarction of the greater omentum, and this observation provides a new cause for epiploic abscesses. Full article

Objectives: In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer. Methods: This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB–IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan–Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve. Results: Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% (p < 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters. Conclusions: In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients. Full article

Background and clinical significance: Large-cell neuroendocrine carcinoma (LCNEC) of the cervix is considered a rare type of cancer: it represents <1% of invasive cervical cancers. The optimal treatment protocol is not fully established because of its rarity and diagnostic challenges. Case Presentation: A 72-year-old Asian female presented to our outpatient clinic with postmenopausal vaginal spotting for 1 month. Vaginal sonography revealed a cervical tumor of 2.7 cm in diameter with hypervascularity. Tumor markers such as CA 125, CA 19-9, carcinoembryonic antigen, and squamous cell carcinoma antigen all showed no abnormality. Due to high suspicion of cervical cancer, a pap smear and endocervical curettage were performed and confirmed the diagnosis of LCNEC. A positron emission tomography–computed tomography scan demonstrated a glucose hypermetabolic lesion in the mid-pelvic region, localized to the uterus, consistent with LCNEC. Surgery with radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection was performed. The patient was finally diagnosed with pT1b2N1mi, FIGO IIIC1. Immunohistochemical stain shows that the neoplastic cells were CK (+), p63 (−), p16 (−), CEA (−), vimentin (−), ER (−), WT-1 (−), p53 (−), and CD56 (+), with a high Ki67 index (75%). Concurrent chemotherapy with cisplatin and radiotherapy was performed. Four cycles of etoposide and cisplatin were planned. A 3-month follow-up of this patient revealed stable tumor marker levels. Conclusions: This case highlights the diagnostic challenges and aggressive nature of LCNEC of the cervix, emphasizing the need for a standardized treatment approach to improve patient outcomes. Full article

Objectives: To analyze the microscopic anatomy of the human uterine cervix in two-dimensional (2D) and three-dimensional (3D) images obtained by microtomography (microCT). Methods: Human uterine cervixes surgically removed for benign gynecologic conditions were immersed in formalin and iodine solution for more than 72 h and images were acquired by microtomography. Results: In total, 10 cervical specimens were evaluated. The images provided by microCT allowed the study of the vaginal squamous epithelium, demonstrated microscopic 3D images of the metaplastic process between the exo and endocervix, and demonstrated the effects of metaplastic transformation on the thickness of the endocervical epithelium. Also reconstructed in 3D the endocervical folds and the repercussions of the metaplastic process on the endocervix, the changes of the endocervical epithelium along the cervical lumen and the relationship between the endocervix epithelium from the internal os and endometrium. In addition, 2D images could demonstrate the difference in tissue orientation of the collagen on the cervical stroma in a large field of view. Conclusions: MicroCT could demonstrate the microscopic anatomy of the human uterine cervix in 2D and 3D images, including the different stages of metaplastic process of the endocervical epithelium and reconstructed the endocervical lumen in 3D, preserving its natural anatomy without any mechanical effect for its dilatation. Full article

Understanding the interactions between the cervico-vaginal microbiome, immune responses, and sexually transmitted infections (STIs) is crucial for developing targeted diagnostic and therapeutic strategies. Although microbiome analyses are not yet standard practice, integrating them into routine diagnostics could enhance personalized medicine and therapies. We investigated the extent to which partial 16S short-read amplicon microbiome analyses could inform on the presence of six commonly encountered STI-causing pathogens in a patient cohort referred for colposcopy, and whether relevant taxonomic or diagnostic discrepancies occur when using vaginal rather than cervical swabs. The study cohort included cervical and vaginal samples collected from women referred for colposcopy at the University Hospital Bonn between November 2021 and February 2022, due to an abnormal PAP smear or positive hrHPV results. 16S rRNA gene sequencing libraries were prepared targeting the V1–V2 and V4 regions of the 16S RNA gene and sequenced on the Illumina MiSeq. PCR diagnostics for common STI-causing pathogens were conducted using the Allplex STI Essential Assay Kit (Seegene, Seoul, Republic of Korea). Concerning the bacterial microbiome, no significant differences were found between vaginal and cervical samples in terms of prevalence of taxa present or diversity. A total of 95 patients and 171 samples tested positive for at least one among Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Chlamydophila trachomatis or Neisseria gonorrhoeae. Sequencing the V1–V2 region enabled detection of one-third to half of the PCR-positive samples, with the detection likelihood increasing at lower cycle threshold (Ct) values. In contrast, sequencing the V4 region was less effective overall, yielding fewer species-level identifications and a higher proportion of undetermined taxa. We demonstrate that the vaginal microbiome closely mirrors the cervical microbiome, a relationship that has not been explored previously, but which broadens the possibilities for microbiome analysis and pathogen detection and establishes vaginal swabs as a reliable method for detecting the investigated pathogens, with sensitivities comparable with or superior to endocervical swabs. On the other hand, the sensitivity of partial 16S amplicon sequencing appears insufficient for effective STI diagnostics, as it fails to reliably identify or even detect pathogens at higher Ct values. Full article

Background: Sparc/osteonectin, cwcv, and kazal-like domains proteoglycan 1 (SPOCK1) is an oncogene that promotes tumor formation and progression in certain types of cancer and is associated with poor survival rates. However, there is limited information on the importance of SPOCK1 in gynecological cancers in the literature. The aim of this study was to explore the role of SPOCK1 in ovarian serous cystadenocarcinoma (OV), cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC), and uterine corpus endometrial carcinomas (UCEC). Methods: The data used in this study were obtained from the GEPIA2, TCGA, Kaplan–Meier Plotter, GeneMANIA, UALCAN, cBioPortal, and TIMER databases. Overall survival (OS) and relapse-free survival (RFS) rates were evaluated by Kaplan–Meier survival analysis. Spearman’s rho and statistical significance values were obtained for the correlation between SPOCK1 expression and tumor infiltration by different immune cells. Results: Lower SPOCK1 gene expression was observed in CESC and UCEC compared to normal tissue (p < 0.05), but the OV did not differ significantly (p > 0.05). In OV, SPOCK1 gene expression was solely linked to age; in CESC, it was linked to age, stage, weight, and histology; and in UCEC, it was linked to age, stage, weight, and menopausal status. Conclusions:SPOCK1 gene expression in UCEC showed weak positive correlations with CD8+ T cells and weak negative correlations with CD4+ T cells. SPOCK1 may be a potential prognostic and therapeutic target for gynecological cancers. Full article

Background: Ovarian cysts (OCs) are a common gynecological issue, with approximately 20% of women developing at least one pelvic mass during their lifetime. The incidence of large ovarian cysts has decreased substantially due to regular gynecological screenings. However, giant ovarian tumors still continue to pose significant diagnostic and therapeutic challenges. Methods: We report two cases of giant ovarian tumors (GOTs). Case 1 involves a 17-year-old woman who presented with a 2-year history of gradual abdominal enlargement, accompanied by repeated attempts at weight reduction. A computed tomography (CT) scan revealed a large tumor. It was excised by laparotomy. Histopathologic examination revealed ovarian cystadenofibroma. Case 2 presents a 25-year-old female who had a 3-month history of progressive, severe abdominal distension and weight gain, accompanied by nausea and diarrhea. CT imaging revealed a giant cystic neoplasm. The cyst was removed by laparotomy. The histopathological study revealed the intestinal–endocervical mucinous borderline tumor. In this context, we performed a narrative literature review, including cases of giant ovarian tumors in young women over the past five years. We centered on diagnoses and management in these cases. Results: The surgical management of both cases was successful, with complete tumor excision and favorable postoperative outcomes. hese cases underscore the importance of including giant ovarian tumors in the differential diagnosis of young women presenting with progressive abdominal distension. The narrative review analyzed 39 relevant publications on the management of giant ovarian tumors in young women. Conclusions: It is important to highlight a possible risk of malignancy, and risk of fatal complications during the surgical removal of giant ovarian cysts (GOCs). To ensure safer and more successful outcomes, multidisciplinary care should be provided. The early detection and diagnosis of OCs are challenging, as patients may not seek medical attention until the tumor has become large enough to cause symptoms. It is crucial to raise awareness among family doctors and other primary care providers (PCPs) regarding OCs to ensure optimal diagnostic and therapeutic management and improve the outcomes for patients with OCs. Full article

High-risk human papillomavirus (HR-HPV) and other sexually transmitted infections (STIs-O) are promoters to the development of cervical cancer (CC), especially when they co-exist. This study aims to determine the prevalence of the major STIs-O and the rate of co-infection in women previously diagnosed with HR-HPV infection. For this observational study, 254 women aged 25–65 years who were being followed up for HR-HPV infection (without a CC history) were recruited at a hospital’s Gynaecology Department from February 2024 to November 2024. Their endocervical specimens were collected and processed for HR-HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis detection by RT-PCR using commercially available reagents and equipment. The overall rate of infection was 38.6% for HPV and 4.3% for ITSs-O (3.8% in HPV-negative women and 5.1% in HPV-positive women). The presence of ITSs-O in women aged 25–34 was higher in those with a persistent positive result for HR-HPV (20.0% vs. 4.2%). Diverse multiple co-infections were found in HPV-positive women, whilst some single STIs-O were found in HPV-negative women. These results support the benefits of STI-O screening beyond an HR-HPV positive result, especially in those women under 35 years old. Full article

Hypoxia, a common feature in many malignancies, is particularly prominent in cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC). Investigating the mechanisms underlying hypoxia is essential for understanding the heterogeneity of CESC and developing personalized therapeutic regimens. Firstly, the CESC-specific hypoxia gene sets shared between single-cell RNA sequencing (scRNA-seq) and bulk data were identified through Weighted Gene Correlation Network Analysis (WGCNA)and FindMarkers analyses. A CESC-specific hypoxia-related score (CSHRS) risk model was constructed using the least absolute shrinkage and selection operator (LASSO)and Cox regression analyses based on these genes. The prognostic differences were analyzed in terms of immune infiltration, mutations, and drug resistance. Finally, a nomogram model was constructed by integrating clinicopathological features to facilitate precision treatment for CESC. This study constructed a CSHRS risk model that divides patients into two groups, and this model can comprehensively evaluate the tumor microenvironment characteristics of CESC, provide accurate prognostic predictions, and offer rational treatment options for patients. Full article

Recurrent pregnancy loss (RPL) of unknown genesis is a complex condition with multifactorial origins, including genetic, hormonal, and immunological factors. However, the specific mechanisms underlying endocervical cell proliferation disorders in women with RPL remain inadequately understood, particularly concerning the role of microbiota and viral infections. The aim of this study was to investigate the mechanisms of endocervical cell proliferation disorders in women with RPL of unknown genesis by examining microbiota, human papillomavirus (HPV) typing, and the expression levels of key molecular biological markers, including p16/Ki-67, BCL-2, miR-145, and miR-34a. A prospective observational comparative study was executed on women with RPL and healthy pregnant controls with full ethical approval. Samples were collected for HPV typing and immunocytochemical analysis to evaluate the expression of p16, Ki-67, BCL-2, and the anti-oncogenic microRNAs (miR-145 and miR-34a). The expression of mRNA for the progesterone receptor (PGR-A) was also assessed, alongside local immune status markers, including proinflammatory T-lymphocytes (Th17/Th1) and regulatory CD4+ Tregs. Overexpression of p16, Ki-67, and BCL-2 was observed in 52.5% of women with RPL who had an ASC-US/LSIL cytogram, with the average double expression of p16/Ki-67 being three times higher than in the healthy pregnant group. A significant decrease in PGR-A mRNA expression in the endocervix of women with RPL was noted, accompanied by a dysregulated local immune status characterized by an increased prevalence of Th17/Th1 cells and a reduction in regulatory CD4+ Tregs. Additionally, the expression of miR-145 and miR-34a in the endocervix and endometrium of women with RPL significantly differed from the physiological pregnancy group, particularly in the context of high-risk HPV infection. The findings describe that disorders of endocervical cell proliferation in women with RPL of unknown genesis are associated with overexpression of specific molecular markers, impaired immune regulation, and altered microRNA profiles. These alterations may contribute to the pathophysiology of RPL, highlighting the need for further research into targeted interventions that could improve reproductive outcomes in affected individuals. Full article

Background and Objectives: The aims of this study were to assess the impact of smoking on cervical histopathology in women with high-risk HPV types 16 and 18 (the most common types) utilizing comprehensive clinical data and to conduct a risk analysis based on smoking pack-years. Materials and Methods: Between 2022 and 2024, 1048 high-risk HPV-positive women aged 25 to 65 years were categorized into two groups: smokers and non-smokers. Data acquired from a histopathological examination of samples collected during a colposcopic evaluation of these women were compared individually regarding clinical and demographic factors, specifically age, gravida, parity, and alcohol consumption. Subsequently, the impact of prolonged and excessive smoking on histopathological cellular changes was assessed in women with the same characteristics. A case–control study was performed on 312 smokers and 312 non-smokers following mutual matching. Results: The women were matched one-to-one regarding gravida, parity, and alcohol consumption. Subsequently, they were paired within a ±2-year age range. The mean age of the smoker group was 47.1 ± 8.8, while that of the non-smoker group was 47.2 ± 8.5 (p: 0.904). In all cases of high-risk HPV positivity, the rate of normal cervical cytological results was 14% in women who smoked and 29% in women who did not smoke. The LGSIL, HGSIL, ASC-H, and AGC-NOS rates were elevated in the smoker group, and a statistically significant difference was observed between the two groups in terms of abnormal cervical cytological results (p < 0.001). After a colposcopic biopsy, the smoker group exhibited higher rates of HGSILs, LGSILs, AGC-NOS, and CIS pathological lesions (28% vs. 23%), whereas the non-smoker group exhibited higher rates of chronic cervicitis (23% vs. 16%). However, no statistically significant difference was found between the two groups (p: 0.092). In a comparison of endocervical curettage (ECC) samples, it was observed that the HGSIL, CIS, and AGC-FN rates in the smoker group were almost the same as those in the non-smoker group. However, the LGSIL histopathology results (32% vs. 18%) were higher, and the rate of negativity with no pathology was higher in the non-smoker group (72% vs. 59%). A statistically significant difference in ECC histopathology was noted between the two groups (p < 0.001). An ROC analysis conducted between smoking pack-years and the colposcopic and endocervical curettage biopsy results revealed that the cutoff value for the colposcopic abnormal histopathological results increased, with 40% sensitivity and 76% specificity above 20 pack-years (AUC: 0.592 and p: 0.025). Additionally, the abnormal histopathology rates for endocervical curettage exhibited 81% sensitivity and 32% specificity above 13 pack-years (AUC: 0.586 and p: 0.008). The rate of abnormalities in the colposcopic biopsy results was 2.19 times higher for individuals with over 20 pack-years, and the rate of abnormalities in the ECC results was 2.08 times higher for those with over 13 pack-years; additionally, statistically significant results were obtained (p-values of 0.027 and 0.008, respectively). Conclusions: The most important cause of neoplastic changes in the cervix uteri is high-risk HPV infection, with evidence indicating that prolonged excessive smoking significantly exacerbates the persistence and progression of HPV infection, thereby influencing neoplastic changes in the cervix uteri. It is crucial for women to cease smoking in order to eradicate HPV infection from the body. Full article