Wiadomości Lekarskie

CLINICAL CASE OF FALLOPIAN TUBE CANCER IN PATIENT OF POSTMENOPAUSAL AGE

Fallopian tube cancer (FTC) is an extremely rare case in oncogynecological practice with an incidence of 0,14-1,8 % among all malignant diseases of the female genital organs. The lack of specific symptoms, imitation of other malignant gynecological diseases, significant similarity with endometrial and ovarian cancer make FTC a disease that is difficult to diagnose. At the preoperative stage, FTC can be detected in 0 to 21% of cases. We present a clinical case of FTC at an early stage in a 64-year-old woman. The patient was referred to the gynecological department of the hospital because of abnormal uterine bleeding (AUB) and pain in the lower abdomen, which had been bothering her for the last 2 months. During the gynecological examination, a tumor-like mass up to 5 cm in diameter was palpated on the left side, with a dense consistency, sensitive to palpation, and limited mobility. Transvaginal ultrasound, CT, oncological markers were made. 7 days later, after performing hysteroresectoscopy with polypectomy, the patient underwent Pfannenstil laparotomy, total hysterectomy with bilateral salpingo-oophorectomy and omentectomy, drainage of the abdominal cavity. Morphological result: in the wall of the left fallopian tube, the growth of adenocarcinoma, pT1a, G2 with foci of necrosis and invasion into the muscular layer of the wall of the fallopian tube is determined. Perineural and lymphovascular invasion in the studied material is not determined. This case of FTC in a postmenopausal woman confirms that it is difficult to detect malignant tumors of tubal localization at the preoperative stage.

Medical and social substantiation of early detection and prevention of visual forms of cervical cancer

Aim: The purpose of the study was to provide a comprehensive medical and social justification for the feasibility and necessity of timely detection of pathology, taking into account existing risk factors, barriers to access to health care services, and the potential for public influence to increase participation in screening. Materials and Methods: The following research methods were used in the study: sociological; systematic approach and analysis; monitoring and evaluation of indicators of the model implementation process; expert assessments. The focus is on the aspects of early detection and prevention of visual forms of cervical cancer. Women’s health indicators – incidence, prevalence and mortality from cervical cancer – are studied. Data from the State Statistics Service of Ukraine, the National Cancer Registry of Ukraine, the Center for Medical Statistics of the Ministry of Health of Ukraine, and the Department of Health of the Poltava Region for 2010–2021. Legislative acts and regulatory documents governing the organization of medical, physical, psychological, and social assistance to women with cervical cancer in Ukraine. Results of a sociological survey – 140 questionnaires. Results: The functional and organizational model of early detection and prevention of visual forms of cervical cancer is proposed, which allows a woman to undergo a preventive examination in two ways: through non-admission to work or voluntarily, when a woman becomes a subject of her own health, and her husband and relatives can support her on the way to the doctor. Conclusions: In the proposed model of early detection and prevention of cervical cancer, a woman is seen as an element of the ecosystem, which makes it possible to involve her family and friends in preventive examinations and provide support.

Trends in cervical cancer epidemiology and vaccination coverage in Ukraine

Aim: To evaluate regional aspects of cervical cancer epidemiology and adherence to vaccination in Ukraine. Materials and Methods: The data about cervical cancer age-standardised incidence rate in 2014-2019 in Ukraine was obtained from the archives of National Cancer Registry of Ukraine. The data about vaccination coverage were obtained from the reports by the Centre of Public Health of Ukraine. Results: The average cervical cancer age-standardised incidence rate in Ukraine in 2014-2019 was 14.9 per 100,000. Zhytomyr, Khmelnytskyi and Kirovohrad oblasts exhibited values 20% above the national level. The general trend of cervical cancer incidence at the national level in 2014-2019 was declining (from 15.0 to 14.1). Kyiv, Mykolaiv, Sumy and Chernihiv oblasts exhibited increasing trends in age-standardised incidence rate (>20%). The average zero-dose children proportion in Ukraine in 2016 -2024 was 30.3%. Vaccination coverage in Ukraine has been improving over the observation period in all oblasts. Conclusions: Ukraine in 2014-2019 was characterised by the decreasing cervical cancer age-standardised incidence rate. Vaccination coverage in Ukraine in 2016-2024 has been improving, which increases the likelihood of a good response to the planned HPV vaccination campaign. Several regions with deviations from the national levels of cervical cancer incidence and vaccination coverage were identified

Prognostic factors for low- and high grade squamous intraepithelial lesions in histological preparations following LLETZ procedure

Aim: To investigate the influence of the following prognostic factors: age, parity, hormonal status (premenopausal, postmenopausal), histological result from targeted biopsy (LSIL, HSIL), adequacy of colposcopic examination (satisfactory, unsatisfactory colposcopy), type of TZ (type 1, 2, 3), type of cervical lesions (type 1, 2, 3), the colposcopic impression (diagnosis) of the cervical lesion (LSIL, HSIL/Ca colli uteri in situ), lesion size (up to 1/3; up to 2/3; more than 2/3 of the cervical circumference) for the occurrence of LSIL and HSIL/Ca colli uteri in situ in the final histological result after LLETZ procedure. Materials and Methods: This is a prospective study (01.01.2017 – 31.07. 2021) including 189 patients with cervical precancerous lesions received LLETZ treatment One gynaecologic oncologist performed video colposcopy, targeted biopsy, and LLETZ. One histopathologist diagnosed histological specimens from the biopsy and LLETZ procedure Results: We found a statistically significant correlation between the histological result of the targeted biopsy factor and the colposcopic diagnosis factor concerning the final histological result of LLETZ. The cervical lesion size factor and cervical lesion type factor have prognostic significance for the histological outcome following LLETZ. Conclusions: The histological result of targeted biopsy and colposcopic diagnosis are significant factors for the final histological result after LLETZ. Cervical lesion invasion into the endocervical canal is a prognostic factor for HSIL, and its invisible borders – for carcinoma (in situ or microinvasive/invasive). Lesion size up to 1/3 of the cervix is a prognostic factor for LSIL and large lesions (2/3 of the cervix) – for HSIL and cervical cancer (in situ, microinvasive/invasive).

CONTEXTUAL FACTORS ASSOCIATED WITH CERVICAL CANCER

The aim: The aim of the study is to determine the risk factors associated with cervical cancer. Materials and methods: 195 participants took part in the study, including 100 cases and 95 healthy people; participation was voluntary. The association of risk factors with cervical cancer was tested using the chi-square test and odds ratio. The use of these methods has been agreed with the ethics commission of the Poltava State Medical University and meets the requirements of the Declaration of Helsinki. Results: Women who live in the village were 64.6% less likely to get sick than those who live in the city, those who assessed their financial situation as unsat¬isfactory 2.1 times more often have a chance of CC. Childless women are 2.4 times more likely to get sick than those who have children. Conclusions: Various groups of contextual risk factors for cervical cancer have been established. The main ones are behavioral factors related to the diet and diet; socio-economic factors and medical factors. It was also established that the place of residence of women influences the probability of the occurrence of RSM.

Pathomorphological characteristics of the supravaginal part of the cervix depending on the echogenicity ratios of the cervix to the uterine body

Aim: To analyze the morphological features of the supravaginal part of the cervix depending on the echogenicity ratios of the cervix to the body of the uterus. Materials and Methods: In 87 reproductive-age patients (30–40 years) with uterine leiomyoma (>14 weeks gestation), morphological features of the supravaginal cervix were analyzed in 23 hysterectomy specimens based on echogenicity ratios: Group I (n = 10): Cervical echogenicity > uterine body. Group II (n = 8): Cervical echogenicity = uterine body. Group III (n = 5): Cervical echogenicity < uterine body. Results: Histological analysis revealed that increased cervical echogenicity corresponded to a predominance of collagen fibers over smooth muscle bundles. Conversely, when cervical echogenicity was equal to or lower than the uterine body, smooth muscle bundles dominated. These specimens also exhibited destructive changes, connective tissue disorganization, and dystrophic alterations, which are pathognomonic signs of potential lower uterine segment failure during pregnancy. Conclusions: 1. Comparative studies show that in cases of excess echogenicity of the cervix over the body of the uterus, pathomorphological changes in the supravaginal part of the cervix were not detected. 2. Equal or reduced cervical echogenicity was associated with connective tissue disorganization and dystrophic changes in smooth muscle, indicating structural inferiority. 3. A change in the ratio of echogenicity of the cervix to the body, which is closely related to the morphological structure of the isthmus of the uterus, can serve as one of the criteria for predicting the failure of the lower segment of the uterus in women.

CYSTIC LYMPHANGIOMA ARISING FROM THE SMALL INTESTINE MESENTERY INCIDENTALLY FOUND DURING SURGERY FOR A LARGE OVARIAN TUMOR – A CASE REPORT

The aim of this study was presenting significance of diagnostic process in doctor’s daily routine. A 45-year-old patient for a planned laparotomy due to left ovarian cyst detected with a routine transvaginal ultrasound. She did not report any symptoms. Computer tomography of the abdomen and pelvis showed a cystic lesion with segmental wall thickening, measuring 133 x 83 x 135 mm, adjacent to the left ovary and the uterus on the left side. At the laparotomy exploration, a giant cyst, ca. 20 cm in diameter was found above the uterus, on the left side, in the area between the lower and middle abdomen. The histological exam results showed lymphangioma of the small and large intestine mesentery. In this case, lymphangioma was found in a rare location, in the mesentery of the ileocecal valve. It did not present any signs and symptoms. CT used in the present case failed to identify the exact point of origin of the lesion.

Uterine Leiomyoma in women of reproductive age: A Systematic Review

Aim: The objective of this literature review was to determine the current aspects of the clinic, diagnosis and treatment of uterine leiomyoma in women of reproductive age. Materials and methods: Pubmed, Google Scholar, Web of Science, and Scopus databases were used to search for materials on current aspects of the clinic, diagnosis, and treatment of uterine leiomyoma in women of reproductive age. Conclusions: Women who have a pregnancy in the background of leiomyomas of the uterus, constitute a high-risk group for the occurrence of obstetric and perinatal complications, therefore, in the most dangerous periods of pregnancy, hospitalization in a specialized obstetrical hospital is recommended. It is advisable to exclude the tactics of passive surveillance of women of childbearing age with leiomyoma of the uterus. Women of childbearing age with leiomyoma of the uterus are recommended to carry out organ-preserving operations in the volume of leiomyomectomy in order to preserve the reproductive function of the woman.

PERSONIFICATION OF VISUAL DIAGNOSTIC METHODS IN WOMEN WITH SUBMUCOSAL UTERINE FIBROIDS: A RETROSPECTIVE CLINICAL ANALYSIS

The aim: To determine the parameters of perioperative application of radiographic methods for visual diagnosis in women with submucous uterine fibroids. Materials and methods: We conducted a retrospective analysis of the data from 200 medical records of women with submucous uterine fibroids (SUF). Results: Preoperatively, nodes were diagnosed by ultrasound as follows: solitary nodes - SM0 type - 65 (46%) near the fundus; SMІ - 41 (29%) on the anterior or posterior wall; SMІІ - 35 (25%) on the lateral walls of the uterus and in the cornual areas of the fallopian tubes; multiple in combinations: О3-4 / SMІ - 16 (27.0%) and О3-6 / SMІІ - 14 (24.0%); with localization: О3-4 / SM0 - mainly in the fundus - 49%, О3-4 / SMІ and О3-4 / SMІІ on the posterior and lateral - 25.0%, 28.0%; О5-6 / SM0 - posterior and fundus - 38.0%, 49.0%; О5-6 / SMІ and О5-6 / SMІІ - posterior and lateral - 45.0% and 37.5%. The maximum average diameter was 20-30 mm, with a quantity of ≤ 3 per individual. When comparing ultrasound and MRI data, discrepancies in the number and localization of nodes were observed in cases of isolated SMІ / SMІІ (on the lateral walls and in the cornual areas of the uterus) at 29.0%; as well as in cases involving combinations of nodes of types О 3-4 / SMІ at 39.0% and О 3-4 / SMІІ at 23.0% (p<0.05). During hysteroscopy, in the group without intraoperative sonography, there were 30% more conversions from hysteroscopic to laparoscopic myomectomy, and 25% more combinations of hysteroscopic myomectomy with laparoscopic monitoring. Conclusions: Hysteroscopic myomectomy with intraoperative sonography is an effective method of treatment for isolated and multiple fibroids of types SMІ/ SMІІ and О3-4/SMІ as well as О3-4/SMІІ.

CONTROL FACTORS FOR SITE ERRORS MANAGEMENT OF RADIOTHERAPY DELIVERY

The aim: This study aimed to define the factors related to irradiation field equality and target accuracy which will further influence the irradiation result. Materials and methods: This is a prospective-qualitative study, conducted by observation of image data verification from cervical cancer patients in the Department of Radiotherapy, dr. Moewardi Hospital, Surakarta who had undergone several times a week irradiation utilizing Telecobalt60 device and by conducting an in-depth interview to ten Indonesian radiotherapy experts, in October 2018. The data was further analyzed using correlation – regression test. Results: From 30 verification image data of the irradiated patients, we conclude that the scheme, body size, and patient positioning factors have all revealed statistically significant correlations to the irradiation field equality. On the other hand, factors such as patient and tele-therapy device set-ups, tele-therapy device calibration, human resources quality, and tele-therapy device malfunctions have all revealed statistically significant correlations to the irradiation target accuracy. These facts were further strengthen by the supporting statements from 10 Indonesian radiotherapy experts. Conclusions: The impact factors of field equality and accuracy of the irradiation target could serve as an important control factors which is substantially required to manage and minimize site errors of the radiotherapy delivery.

PATTERN OF KRAS GENE EXPRESSION IN IRAQI WOMEN OVARIAN CARCINOMA

The aim: The goal of this study was to detect if KRAS gene and levels of had any clinical significance in the ovarian cancer by measuring levels of KRAS mRNA. Materials and methods: The investigation was conducted on 84 tissue samples from newly diagnosed patients with ovarian cancer. Twenty-eight tissue sections with benign ovarian tumors were used as a control group. The qRT- PCR technique was used for measuring and analyzing levels of KRAS mRNA. Results: Relative increasing of KRAS mRNA level in cancer samples was statistically significant (P<0.01) when compared to benign tumors. Statistically no significant differences were found between KRAS mRNA levels and menopausal status or family history. Gene expression has been substantially connected with age groups as the highest levels of KRAS mRNA was recorded in patients with age 50-74 years (P<0.01). Endometrium tumors exhibited significant correlations (P<0.01) across histopathological tumor types. In correlation with tumor stages, stage I was substantially linked compared to stage I (P<0.01). Conclusions: It was concluded that over expression of the KRAS gene is linked to early stages of ovarian cancer, which implying that mRNA levels could be used as a diagnostic and predictive factor for ovarian cancer. More research with larger groups of ovarian cancer specimens in both primary and advanced stages is needed.

Analysis of histopathological results of the endometrium in breast cancer patients treated with tamoxifen. Preliminary report.

Aim The study aimed to compare histopathological outcomes of the endometrium in breast cancer patients treated with tamoxifen. The analysis included asymptomatic women referred for abnormal ultrasound findings and symptomatic women with abnormal uterine bleeding. Material and methods The study included 86 patients hospitalized between 2013 and 2024 at the Medical University of Warsaw. Group I (n=42) comprised patients with abnormal ultrasonographic findings, while Group II (n=44) included women with abnormal uterine bleeding. All patients underwent hysteroscopy with subsequent histopathological tissue analysis. Results The most frequent histopathological diagnosis in both groups was the presence of endometrial polyps (Group I: 50.0%; Group II: 36.36%). Endometrial cancer was diagnosed in 7.14% of Group I and 9.09% of Group II patients, indicating a comparable prevalence of serious pathology. Statistically significant differences (p < 0.05) were noted between the groups only for non-atypical hyperplasia and proliferative endometrium. Conclusions The findings confirm that endometrial polyps are the most frequent pathology associated with tamoxifen use in this cohort. This preliminary report underscores the critical need for further targeted research focusing on population-specific factors and menopausal status to develop clear, personalized clinical guidelines for screening and surveillance, particularly for premenopausal women, independent of symptomatic presentation.

Role of diagnostic laparoscopy in abdominal disorders with uncertain diagnosis: a rare case report

Aimto evaluate the possibilities and advantages of diagnostic laparoscopy over non-invasive research methods in case of differences in diagnoses in different studies.Material and methodsFemale patient was hospitalized in the surgical of the Municipal Enterprise “2nd City Clinical Hospital of Poltava City Council” (Poltava, Ukraine) in 2023. The patient underwent a complete general clinical examination, a plain radiograph of the abdominal cavity, fibrogastroduodenoscopy, colonoscopy, ultrasound of the abdominal organs, CT scan of the abdominal organs. Diagnostic laparoscopy was performed to make a final diagnosis.ResultsA plain radiography of the abdominal cavity revealed no pathology. Ultrasound of the abdominal organs revealed a pelvic mass. A computed tomography scan revealed damage to the pelvic organs in the form of a neoplasm and an enlargement of the left ovary. The preliminary diagnosis was a pelvic tumor, tumor of the left ovary. Diagnostic laparoscopy was performed to make the diagnosis. A rounded formation was defined in Douglas space. The capsule of the formation was opened and pus was released. The abscess wall was opened, and a foreign body (gauze pad) was removed from the cavity. The patient was discharged from the hospital in satisfactory condition on the fifth day after surgery.ConclusionsThe case we examined emphasizes that when assessing the nature of an intra-abdominal neoplasm, it is necessary to remember about foreign bodies, especially in patients after surgical interventions. Diagnostic laparoscopy is a technically advanced and minimally invasive procedure for the diagnosis and treatment of intra-abdominal gossypiboma.

PREDICTIVE VALUE OF PLATELET COUNT AND PLATELET INDICES IN CERVICAL CANCER PATIENTS WITH EXTERNAL RADIATION THERAPY

The aim: This study aims to assess the role of platelets and platelet indices as a cost-effective predictive marker of the cervical cancer patient’s response before, 15th, and 25th external radiation. Materials and methods: A total of 54 cervical cancer patients at Dr. Kariadi Hospital were divided into good and poor therapeutic response groups. Measurements of platelet count and indices including PDW, P-LCR, and PCT were carried out before, 15th, and 25th external radiation. Results: There was no difference in platelet counts, MPV, PDW, P-LCR, and PCT in both groups, but patients with decreased MPV and P-LCR values on 15th-25th external radiation had a better therapeutic response (p= 0.005 and 0.007). Conclusions: MPV and P-LCR values at 15th to 25th external radiation appeared to decrease further in the group that responded better to therapy.