Joanna Skręt-Magierło

The Obstetrical History in Patients with Pfannenstiel Scar Endometriomas – An Analysis of 81 Patients

Introduction: The participation of immune tolerance during pregnancy was suggested to be an important factor predisposing to the implantation of decidual cells after cesarean section in Pfannenstiel scar. Delivery at term is related to the termination of immune tolerance to fetal antigens that is maintained throughout pregnancy. Substantial proportion of cesarean section deliveries is performed before the onset of true term labor. The aim of this study was to analyze the clinical symptoms of spontaneous beginning of labor in pregnant women in whom cesarean sections were performed and in whom Pfannenstiel scar endometriomas were observed during follow-up. Materials and Methods: We have retrospectively analyzed 81 patients following the surgical removal of scar endometrioma after cesarean section. Obstetrical histories of cesarean sections in the number of 5,370 preceding the occurrence of the scar endometrioma were analyzed. These data were collected in six different Gynecological and Obstetrical wards in Malopolska Province in Poland. Analysis of data was started by the retrospective evaluation of regular uterine contractions, uterine cervix ripening before cesarean section and the indications for surgery. Results: In 67 women from the group of 81 patients cesarean sections were performed with unripe uterine cervix and without the presence of regular uterine contractions. Elective indications for cesarean sections were predominant in this group of women. The relative risk of scar endometriomas occurrence following cesarean sections performed before onset of labor in comparison to cesarean sections following spontaneous onset of labor was statistically significantly higher [RR = 2.16, 95% CI = 1.21–3.83; OR = 2.18, 95% CI = 1.22–3.89]. Conclusions: Cesarean section performed before spontaneous onset of labor may increase substantially the risk of occurrence of scar endometriomas.

Radical hysterectomy during the transition period from traditional to nerve-sparing technique

OBJECTIVE The aim of the study was to compare peri- and postoperative data from patients operated on using the new nerve-sparing technique of radical hysterectomy with data gathered from those who underwent traditional radical hysterectomy. MATERIALS AND METHODS A total of 20 patients with cervical cancer were included in the study. The study was carried out at a time when the authors had started to perform the nerve-sparing technique by using the descriptions from the literature. During the study period 10 patients underwent the nerve-sparing procedure while the other 10 patients underwent traditional radical hysterectomy. The two groups of patients were comparable in terms of mean age, body mass index, FIGO stage, and histological type; additionally, the follow-up period was similar for both groups. RESULTS On the one hand, the mean total operative time (197.5+/-51.4 vs. 155.5+/-39.6 min) and the mean time for the hysterectomy itself (154.5+/-35.4 vs. 123.0+/-29.8 min) were significantly longer in the group operated on with nerve-sparing technique (p=0.05). Postoperatively, on the other hand, a post-void residual urine volume of less than 50 ml was noted to occur significantly faster in the patients who had undergone the nerve-sparing technique (3.5+/-1.4 vs. 9.1+/-4.2 days, p=0.00078). CONCLUSIONS Although during the introductory period nerve-sparing technique brings about an improvement in voiding function, it prolongs the total operative time in comparison to traditional radical hysterectomy.

The quality of life of women treated for cervical cancer

OBJECTIVE The objective of this work was to assess the quality of life of women treated surgically for early stage cervical cancer (FIGO IA2-IIA). METHODS Quality of life was evaluated at the preoperative period (T1), three months (T2) and six months after surgery (T3). The study employed two types of survey questionnaires: EORTC QLQ-C 30 and QLQ-CX 24. The study protocol was approved by the Bioethical Comitee at Rzeszów University. 100 women who signed an informed consent and completed questionnaires were included in the study. RESULTS Based on EORTC QLQ-30 it was found that global health status improved at T2. This improvement was stable until T3. The same was true in respect of emotional and cognitive functioning. Role and social functioning improved at T3. Stable improvement of insomnia, appetite and financial difficulties was noted at T2 and T3. Reduction of fatigue, nausea and vomiting, and diarrhea was observed until T3. Based on the modules of the QLQ-CX 24 questionnaire, a reduction in symptom experience was observed at T2 and T3. The opposite tendency was noted in the case of body image. CONCLUSIONS The present study was carried out in a period of vulnerability for cervical patients up to six months from the start of treatment. The cancer itself, surgery and adjuvant therapy and their side effects together had an effect on quality of life.

Analysis of Treg cell population alterations in the peripheral blood of patients treated surgically for ovarian cancer - a preliminary report.

Citation Wicherek L, Jozwicki W, Windorbska W, Roszkowski K, Lukaszewska E, Wisniewski M, Brozyna AA, Basta P, Skret‐Magierlo J, Koper K, Rokita W, Dutsch‐Wicherek M. Analysis of Treg cell population alterations in the peripheral blood of patients treated surgically for ovarian cancer – a preliminary report. Am J Reprod Immunol 2011; 66: 444–450

The Immunohistochemical Analysis of Antigens such as RCAS1 and B7H4 in the Cervical Cancer Nest and within the Fibroblasts and Macrophages Infiltrating the Cancer Microenvironment

The presence of the aggressive phenotype of the tumor seems to be indicated by the local infiltration of cancer cells and by the development of metastases in the lymph nodes. This phenotype is related to the intensity of the suppressive profile of the tumor microenvironment. The aim of our study has been to gather information about the expression of both RCAS1 and B7H4 proteins in the macrophages and fibroblasts present within both the microenvironment of cervical cancer tumors and the cancer cells present on the front of the cancer nest.

ORIGINAL ARTICLE: Differences in the Soluble HLA-G Blood Serum Concentration Levels in Patients with Ovarian Cancer and Ovarian and Deep Endometriosis

Citation Mach P, Blecharz P, Basta P, Marianowski P, Skret‐Magierlo J, Kojs Z, Grabiec M, Wicherek L. Differences in the soluble HLA‐G blood serum concentration levels in patients with ovarian cancer and ovarian and deep endometriosis. Am J Reprod Immunol 2010

The analysis of metallothionein immunoreactivity in stromal fibroblasts and macrophages in cases of uterine cervical carcinoma with respect to both the local and distant spread of the disease.

The tumor microenvironment is made up of tissue that is responsible for the growth and progression of the tumor as well as its ability to initiate metastases. The cancer cells on the front of the tumor together with the macrophages and fibroblasts help to constitute the aggressive phenotype of the tumor. The presence of this aggressive phenotype is indicated by the local infiltration of cancer cells and by the development of lymph node metastases. In cases of uterine cancer, the extent of the local and distant spread of the disease is crucial for determining the type of therapeutic strategy to be applied – surgery alone, surgery followed by radio‐chemotherapy, or radio‐chemotherapy alone. In the interest of trying to improve the patients quality of life, different studies supporting the therapeutic model of surgery alone have been conducted. While the cancer cells on the tumor front together with the macrophages and the fibroblasts help to constitute the aggressive phenotype of the tumor, metallothionein (MT) has been shown to have both pro‐proliferative and anti‐apoptotic activities and to participate in microenvironment remodeling. The aim of the current study was to determine the levels of MT immunoreactivity in the uterine cervical cancer cells as well as in the stromal fibroblasts and macrophages of the tumor microenvironment with respect to the depth of the local invasion and the extent of the distant metastases, so that its potential predictive value as a therapeutic strategy for cervical cancer can be ascertained.

Benign metastasizing leiomyoma in triple location: lungs, parametria and appendix

Benign metastasizing leiomyoma (BML) usually are situated in one organ, most often in lungs. BML patients typically have a history of uterine leiomyoma treated with hysterectomy, myomectomy or subtotal hysterectomy. The aim of the study was to present the case of a 53-year-old woman with triple location in the lungs, parametria and appendix. She had undergone a myomectomy 26 years earlier. In 2015, she was admitted to the surgical department because of abdominal pain, whereupon a cholecystectomy was performed. CT scans showed pelvic mass with pulmonary metastasis. Upon discharge the patient was referred to the Gynecology Clinic, where a laparotomy was performed. The intraoperative findings were: 1) uterus with multiple leiomyomas, 2) four tumors in the parametria, 3) tumor connected to the appendix. A subtotal hysterectomy, with a bilateral salpingo-oophorectomy, removal of the tumors from the parametria and appendectomy was performed. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining (strongly positive for estrogen receptors and SMA, while Ki67 was very low, below 1%). Upon postoperative recovery, the patient was referred to the Thoracic Surgery Department. During the thoracotomy, multiple nodes, surrounded by lung parenchyma, were revealed. Wedge resection was performed, for localized pulmonary lesions, and sent for pathological examination. The final pathological diagnosis was benign metastasizing leiomyomatosis. In conclusion, the triple location of BML could possibly be a result of a parallel different metastasizing mechanism, although it is impossible to exclude one mechanism, which may be the cause of the metastases in three locations.

ORIGINAL ARTICLE: The Increase in Metallothionein and Ectopic Decidual Immunoreactivity with Respect to the Progression of Labor at Term and the Lack of Analogical Changes in Placental Abruption

Problem  The coexistence of immune and decidual cells is related to the development of a resistance to immune‐mediated apoptosis in both ectopic and eutopic decidua. This unique feature of endometrial cells seems to be linked with the expression of metallothionein (MT), an inhibitor of apoptosis.

Primary vaginal squamous cell carcinoma with bladder involvement in uterine prolapsed patient: Case report

Rationale: Primary vaginal squamous cell carcinoma (SCC) is a rare disease. Primary SCC in prolapsed vagina is extremely rare. In the presented case additional bladder involvement was found. Patients concerns: Primary vaginal SCC may be misinterpreted as decubitus in prolapsed vagina and it may delay proper diagnosis and treatment. Diagnoses: Diagnosis was confirmed by the vaginal ulceration biopsy and cystoscopic biopsy of the involved bladder. Interventions: In the case presented percutaneous nephrostomy was the only possible treatment of hydronephrosis. Outcomes: In advanced primary SCC (Figo IVA) with nodal involvement palliative treatment is only option. Lessons: Primary SCC mimicking decubitus which appeared in prolapsed vagina, may be accompanied by bladder involvement.