Peritoneal washing cytology in cervical carcinoma. Analysis of 109 patients

The peritoneal washing cytologies of 109 patients (112 procedures) undergoing laparotomy for cervical carcinoma were evaluated retrospectively and compared with the clinical and pathologic findings. Nine patients (8.3%) had malignant peritoneal washings (including three of four with washings initially termed "inconclusive"). Four (4.9%) of the 82 patients with squamous carcinoma and 3 (16.7%) of 18 with adenocarcinoma had positive washings. Five (5.6%) of 90 washings obtained at initial explorations were positive, as compared with 4 (18.2%) of 22 washings obtained as follow-up operations in recurrent cases. The 111 peritoneal washing cytologies with a corresponding histologic evaluation of the peritoneal cavity showed a good correlation; peritoneal washing cytology had an efficiency of 91.0%, a sensitivity of 52.9% and a specificity of 100%. Two cases in which the cytologies were considered positive only after review had negative peritoneal histologies; both patients died of progressive disease within 11 months. Peritoneal washing cytology was positive in 5 (5.9%) of 84 cases with FIGO stage 1 cancers, 2 (18.2%) of 11 cases with stage 2 cancers, 1 (33.3%) of 3 cases with stage 3 cancers, and 1 (10%) of 10 cases with recurrent tumors. Eight (88.9%) of nine patients with malignant peritoneal washings died of disease from 3 to 15 months following surgery; one showed no evidence of disease at 9 months. These results suggest that: (1) cervical carcinomas are infrequently associated with a positive peritoneal washing; (2) peritoneal washing cytology is more likely to be positive in cases of adenocarcinoma than in cases of squamous carcinoma; (3) peritoneal washings obtained at the time of surgery for recurrence are more likely to contain malignant cells than are washings obtained during initial exploration; (4) nonkeratinizing malignant squamous cells may be confused with reactive mesothelial cells; and (5) peritoneal washing cytology is a relatively insensitive technique for detecting advanced cervical disease, but correlates with a poor prognosis when positive.     

Endometriosis origin from primordial germ cells

Endometriosis is defined by the presence of endometrial ectopia. Multiple hypotheses have been postulated to explain the etiology of endometriosis to understand various clinical evidences. The etiology of endometriosis is still unclear.The primary question to understanding the etiology of endometrial ectopia (endometriosis) is determining the origin of eutopic (normally cited) endometrium.According to the new theory, primordial germ cells migrate from hypoblast (yolk sac close to the allantois) to the gonadal ridges. The gonadal ridges which composed of primordial germ cells derive to the: eutopic endometrium, ovary, ovarian ligament and ligamentum teres uteri.There are 2 principal processes in uterine organogenesis: the intersection of gonadal ridges with mesonephral ducts to form the uterine folds with an endometrial cavity and the fusion of the both uterine folds together to form the unicavital (normal) uterus. In the uterine folds there are closer cell-to-cell communications, polypotential germ cells differentiate and grow into myometrium and endometrial layers.Some of the polypotential germ cells fail to reach the ridges and stay in the peritoneal cavity, where they may be transforming into external endometrial heterotopies.The main insight in the etiology of endometriosis is polypotential germ cells origin, which may explain its potency, pathogenesis and expansion.     

Modified method of obtaining washings of the large intestine for determining coproantibodies and immunoglobulins in the dynamics of acute dysentery]

The study of the washings obtained during rectoscopy from the mucous membrane of the large intestine with the use of a special attachment for a rectoscope revealed that this method had a number of advantages when compared with the study of coprofiltrates; in particular, this method allowed to obtain pure secretions of the mucous membrane free of fecal admixtures and to concentrate the gamma globulin fraction. The study of the dynamics of coproantibody secretion in acute dysentery revealed that coproantibodies were most frequently detected on the second week of the disease (reaching 85.7%), while immunoglobulins occurred in the protein fraction of the washings with almost the same frequency during the whole period of the disease.     

Cytology of benign multicystic peritoneal mesothelioma in peritoneal washings

Objective:  To describe the cytological aspect of peritoneal washings in benign multicystic peritoneal mesothelioma (BMPM).
Methods:  Three peritoneal washing specimens stained by standard cytological and histological procedures and analysed by light microscopy.
Results:  The specimens showed an abundance of monomorphous mesothelial cells devoid of atypia or mitoses. The mesothelial cells were calretinin positive. They also showed numerous squamous metaplastic cells arranged in flat sheets or isolated cells. The background contained some inflammatory cells.
Conclusion:  The combination of cytology of the peritoneal washing, histology (cell block and surgical specimen) and clinical history allow differentiation of BMPM from other cystic lesions (cystic lymphangioma and malignant mesothelioma).     

Cytology of peritoneal washings in gynecologic patients. Diagnostic criteria and pitfalls

A total of 226 peritoneal washing specimens obtained from gynecologic patients over a three-year period was reviewed. The diagnostic problems encountered were: differentiating reactive mesothelium from low-grade malignancies; distinguishing between benign ovarian tumors, ovarian tumors of borderline malignancy and low-grade ovarian malignancies; and potential false-positive diagnoses in endometriosis. Low-grade malignancies could be distinguished from reactive mesothelium by evaluating subtle cytologic criteria and by comparing the cells to those of the tumor on histologic section. The differentiation of low-grade epithelial malignancies from benign epithelial lesions caused difficulties that could only be resolved by evaluating the histologic material. Positive peritoneal washings increased the stage in 8 of 110 patients undergoing initial surgery for gynecologic malignancy. Two of 76 patients undergoing a second-look laparotomy had positive washings without histologic evidence of tumor. These ten patients did less well than did those with similar histology but negative washing cytology, despite receiving additional therapy because of the cytologic findings.     

Circulating miRNAs Related to Epithelial–Mesenchymal Transitions (EMT) as the New Molecular Markers in Endometriosis

Endometriosis is a chronic gynecological disease defined by the presence of endometrial-like tissue found outside the uterus, most commonly in the peritoneal cavity. Endometriosis lesions are heterogenous but usually contain endometrial stromal cells and epithelial glands, immune cell infiltrates and are vascularized and innervated by nerves. The complex etiopathogenesis and heterogenity of the clinical symptoms, as well as the lack of a specific non-invasive diagnostic biomarkers, underline the need for more advanced diagnostic tools. Unfortunately, the contribution of environmental, hormonal and immunological factors in the disease etiology is insufficient, and the contribution of genetic/epigenetic factors is still fragmentary. Therefore, there is a need for more focused study on the molecular mechanisms of endometriosis and non-invasive diagnostic monitoring systems. MicroRNAs (miRNAs) demonstrate high stability and tissue specificity and play a significant role in modulating a range of molecular pathways, and hence may be suitable diagnostic biomarkers for the origin and development of endometriosis. Of these, the most frequently studied are those related to endometriosis, including those involved in epithelial–mesenchymal transition (EMT), whose expression is altered in plasma or endometriotic lesion biopsies; however, the results are ambiguous. Specific miRNAs expressed in endometriosis may serve as diagnostics markers with prognostic value, and they have been proposed as molecular targets for treatment. The aim of this review is to present selected miRNAs associated with EMT known to have experimentally confirmed significance, and discuss their utility as biomarkers in endometriosis.     

Humoral factors of local and systemic immunity in the multiple peroral administration of a corpuscular pertussis vaccine

Multiple oral immunization with pertussis corpuscular vaccine was shown to lead to the considerable stimulation of local and systemic humoral immunity. The data on the titers of specific and normal secretory antibodies, on the levels of IgA in washings from the oral cavity, the small intestine and the lungs, on the titers of agglutinins and hemagglutinins in the blood serum, as well as on the morpho-functional transformation of the mucous membrane and the associated lymphoid tissue in the digestive tract, are presented in their dynamics. Specific pertussis antibodies in high titers were detected in both intestinal and pulmonary washings. The multiple administration of the vaccine did not produce pathological changes in internal organs.     

An investigation of the effects of endometriosis on the proteome of human eutopic endometrium: a heterogeneous tissue with a complex disease

The pathogenesis of endometriosis includes the proliferation of heterogeneous endometrial cells and their invasion into ectopic sites within the peritoneal cavity. This may be due to abnormalities of the eutopic endometrium itself, predisposing the cells to survive and implant ectopically. We investigated the applicability of 2-DE gels and peptide mass mapping to identify candidate endometrial proteins with a role in endometriosis. Despite the heterogeneous nature of endometrium, our results show that combining the analysis of 2-DE gels and peptide mass mapping yields consistent data. We identified dysregulated proteins in women with endometriosis which included: (i) molecular chaperones including heat shock protein 90 and annexin A2, (ii) proteins involved in cellular redox state, such as peroxiredoxin 2, (iii) proteins involved in protein and DNA formation/breakdown, including ribonucleoside-diphosphate reductase, prohibitin and prolyl 4-hydroxylase, and (iv) secreted proteins, such as apolipoprotein A1. These proteins have functions which suggest that they could play a role in the pathogenesis of endometriosis. This study demonstrated that 2-DE gel analysis and mass spectroscopic protein identification are suitable for the identification of proteins with candidate associations with endometriosis. These techniques should be used on a larger scale to identify endometriosis-related proteins, thus improving the understanding of this complex disease.     

子宫内膜异位症小鼠腹腔巨噬细胞吞噬功能的变化规律

目的研究子宫内膜异位症发生进程中腹腔巨噬细胞吞噬功能的变化规律。方法构造小鼠子宫内膜异位症模型,用流式细胞术检测造模前后腹腔巨噬细胞吞噬荧光微球数,计算吞噬率和吞噬指数代表巨噬细胞的吞噬能力。结果巨噬细胞吞噬率和吞噬指数分别为：未造模组[（10．1±0．82）％,0．17±0．01]、造模后第1d[（32．78±2．43）％,0．60±0．02]、第2d[（33．82±1．23）％,0．61±0．02]、第3d[（35．93±2．81）％,0．72±0．03]、第4d[（27．92±1．24）％,0．51±0．03]、第5d[（24．34±0．91）％,0．40±0．02]、第6d[（17．91±1．03）％,0．28±0．01]、第9d[（17．56±0．80）％,0．26±0．01I、第12d[（19．42±1．02）％,0．36±0．01]、第15d[（26．78±2．05）％,0．54±0．02]、第18d[（27．46±1．61）％,0．50±0．02]、第21d[（25．99±2．31）％,0．54±0．03]。造模后的小鼠腹腔巨噬细胞吞噬能力均显著高于未造模组,且呈现出三个阶段的改变：第1—5d为第1阶段,第6-12d为第2阶段,第15—21d为第3阶段,第1和第3阶段显著高于第2阶段（P〈0．01）。结论 子宫内膜异位症小鼠腹腔巨噬细胞的吞噬功能增强,且随时间呈现规律性变化特征,可能与子宫内膜的清除和异位存活有关。     

Cytohistologic correlation of peritoneal washing cytology in gynecologic disease

The peritoneal washings and cul de sac aspirates from 204 patients undergoing 217 procedures for the evaluation of gynecologic disease were examined retrospectively and correlated with the histologic diagnoses. Of the 73 washings from patients with histologically benign genital disease, cytology diagnosed 64 (87.7%) as negative, 6 (8.2%) as inconclusive and 3 as malignant. One malignant washing was a true positive from a nongenital primary. False positives thus occurred in 2.7% of the benign cases on blind review. Of 144 cytologic examinations of washings from patients with histologically confirmed malignant disease of the female genital tract, 38 (26.4%) were considered positive after cytohistologic correlation. Four malignant cases (2.1%) were undercalled on blind review while 3 (2.0%) were considered overcalls. Eleven of 47 cases (23.4%) with biopsy-proven peritoneal disease had negative cytology after histologic correlation. Recurring problems in interpreting peritoneal washings included: (1) the differential diagnosis of the spectrum encompassed by reactive mesothelium, endosalpingiosis, borderline serous tumors and well-differentiated serous cystadenocarcinoma; (2) morphologic similarities between some tumor cells and mesothelial cells associated with treatment effects; and (3) a paucity of malignant cells in some washings, resulting in false-negative interpretations. Ineffective cytopreparation, particularly of bloody specimens, hampered interpretation of some specimens. Correlation with previous histology and cytology enhanced the accuracy of peritoneal washing cytology in this study.     

Detached ciliary tufts in female peritoneal washings. A common finding

Detached ciliary tufts (DCTs) have been observed in sputum, in cervicovaginal smears and, rarely, in fluid from the pouch of Douglas. DCTs occur frequently in peritoneal washings from female patients. Twenty-five consecutive peritoneal washings were studied for DCTs. Fourteen specimens were from women in the reproductive age group (21 to 47 years); all contained DCTs. All of these 14 patients, except for one in the 14th week of pregnancy, were in the secretory phase of the menstrual cycle. The 11 patients without DCTs in their peritoneal washing had an age range of 23 to 88 years. Three were postmenopausal, seven were in the proliferative phase of the menstrual cycle, and one had had a previous hysterectomy and bilateral salpingo-oophorectomy. DCTs most likely represent a physiologic process of cyclic shedding of cilia from the cells of the fallopian tubes during the luteal phase of the menstrual cycle.     

Prostaglandin E1 reversibly induces morphological changes in macrophages and inhibits phagocytosis

Light microscopy and scanning electron microscopy (SEM) show that PGE₁ induces a strong morphological change of cultured macrophages which are accompanied by a loss in membrane activity, cell locomotion and phagocytosis. All effects induced by PGE₁ are fully reversible and seem specific, since they are not induced by PGF_2α. Characterization of the cytoskeleton by immunofluorescence microscopy reveals that neither microfibrils nor microtubuli are drastically changed. All prostaglandin E₁ induced morphological and functional change are fully reversible: after repeated washings the cells restore their normal appearance, membrane movements and phagocytic capacity.     

Autologous Transplantation of Oral Mucosal Epithelial Cell Sheets Cultured on an Amniotic Membrane Substrate for Intraoral Mucosal Defects

The human amniotic membrane (AM) is a thin intrauterine placental membrane that is highly biocompatible and possesses anti-inflammatory and anti-scarring properties. Using AM, we developed a novel method for cultivating oral mucosal epithelial cell sheets. We investigated the autologous transplantation of oral mucosal epithelial cells cultured on AM in patients undergoing oral surgeries. We obtained specimens of AM from women undergoing cesarean sections. This study included five patients without any history of a medical disorder who underwent autologous cultured oral epithelial transplantation following oral surgical procedures. Using oral mucosal biopsy specimens obtained from these patients, we cultured oral epithelial cells on an AM carrier. We transplanted the resultant cell sheets onto the oral mucosal defects. Patients were followed-up for at least 12 months after transplantation. After 2–3 weeks of being cultured on AM, epithelial cells were well differentiated and had stratified into five to seven layers. Immunohistochemistry revealed that the cultured cells expressed highly specific mucosal epithelial cell markers and basement membrane proteins. After the surgical procedures, no infection, bleeding, rejection, or sheet detachment occurred at the reconstructed sites, at which new oral mucous membranes were evident. No recurrence was observed in the long-term follow-up, and the postoperative course was excellent. Our results suggest that AM-cultured oral mucosal epithelial cell sheets represent a useful biomaterial and feasible method for oral mucosal reconstruction. However, our primary clinical study only evaluated their effects on a limited number of small oral mucosal defects.     

Tracing location by applying Emerald luciferase in an early phase of murine endometriotic lesion formation

The pathogenesis of endometriosis has not been fully elucidated. We focused on the behavior of the ectopic endometrium, that is, the origin of the endometriotic lesion, before adhering to the peritoneal cavity. To observe lesion formation in the very early phase, we developed a novel endometriosis animal model using bioluminescence technology. We established a new transgenic mouse that expressed Emerald luciferase (ELuc) under the control of the CAG promoter. This transgenic mouse, called the CAG-ELuc mouse, showed strong bioluminescence emission; we succeeded in tracing the lesion location by the emission of ELuc. The accuracy of tracing by ELuc was high (57.7–100% of correspondence) and depended on the dosage of E2 administration. In the very early phase after transplantation, the process of lesion formation can be observed non-invasively and chronologically. We have verified that the preferred location of the uterus (transplanted grafts) was fixed immediately after the transplantation of the grafts.     

DIFFUSION CHAMBER CULTURE OF A SINGLE EMBRYOID BODY FROM THE TESTICULAR TERATOMA OF STRAIN 129 MOUSE

When single embryoid bodies of teratocarcinoma OTT 6050 were cultured by the diffusion chamber technique in the peritoneal cavity of a mouse, they lost their characteristic three-dimensional structure early in the culture period and proliferated logarithmically up to the 60th day of culture with a doubling time of 3.7 days, forming cell layers that adhered to the surface of the membrane filters of the diffusion chamber. They continued further to proliferate at a lower rate up to the 80th day of culture. At the 60th day, many round cells, classified by diameter into about three classes, were observed on the membrane filters. The tumorigenicity of these cells derived from the chamber cultures was much less than that of embryoid bodies injected directly into the abdominal cavity, judging from the number of days the mice survived.     

Modulation of the recognition and lysis of EL4 tumor target cells by cytotoxic T lymphocytes

When the EL4 targets were harvested from the peritoneal cavity (in vivo), they had less than half as much cell-surface sialic acid as EL4 cells harvested from tissue culture (in vitro), apparently due to the presence of a neuraminidase activity in the peritoneal cavity. Both the recognition and the lysis of either EL4 in vivo or EL4 in vitro target cells by allogeneically primed cytotoxic T lymphocytes were enhanced upon removal of cell-surface sialic acid by neuraminidase treatment. However, even after neuraminidase treatment, there still remained a difference in the lytic profile when using EL4 targets that were harvested in vivo versus in vitro. Both conjugate formation between the target and the T cells and anti-H-2D^b adsorption by the target cells were unaffected by the culture conditions of the target line. However, antibody-induced capping and exocytosis of vesicles differed between the differently cultured target cells, suggesting that there was a membrane organizational difference between them that was detected by the cytotoxic T cells. These data are consistent with the idea that cell surface sialic acid as well as the membrane organization can influence T-cell recognition and lysis of target cells.     

On the source of uterine 'luminal fluid' proteins in the mouse

Examination by light-, transmission electron- and scanning electron-microscopy showed that flushing the lumen of the mouse uterus with small volumes of fluid damaged the endometrium by rupturing and removing luminal epithelial cells, splitting the epithelial basement membrane and connective tissue stroma, and rupturing and leaching stromal cells and blood vessels. The damage increased with increasing progestation of the uterus and between Days 4 and 5 of pregnancy. I conclude that many so-called 'luminal fluid' proteins originate from luminal and stromal cells, intercellular fluid and blood and that apparent changes in luminal fluid protein content during early pregnancy may largely reflect alterations in the extent and type of damage produced by flushing, as a consequence of changes in the physical state of the uterus induced by hormones and the presence of blastocysts.     

Soluble Ligands for the NKG2D Receptor Are Released during Endometriosis and Correlate with Disease Severity

Background

Endometriosis is a benign gynaecological disease. Abundant bulk of evidence suggests that patients with endometriosis have an immunity dysfunction that enables ectopic endometrial cells to implant and proliferate. Previous studies show that natural killer cells have a pivotal role in the immune control of endometriosis.

Methods and Findings

This is a prospective laboratory study conducted in a tertiary-care university hospital between January 2011 and April 2013. We investigated non-pregnant, younger than 42-year-old patients (n= 202) during surgery for benign gynaecological conditions. After complete surgical exploration of the abdominopelvic cavity, 121 women with histologically proven endometriosis and 81 endometriosis-free controls women were enrolled. Patients with endometriosis were classified according to a surgical classification in three different types of endometriosis: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE). Peritoneal fluid samples were obtained from all study participants during the surgery in order to detect soluble NKG2D ligands (MICA, MICB and ULBP-2). When samples with undetectable peritoneal fluid levels of MICA, MICB and ULBP-2 were excluded, MICA ratio levels were significantly higher in endometriosis patients than in controls (median, 1.1 pg/mg; range, 0.1–143.5 versus median, 0.6 pg/mg; range, 0.1–3.5; p=0.003). In a similar manner peritoneal fluid MICB levels were also increased in endometriosis-affected patients compared with disease-free women (median, 4.6 pg/mg; range, 1.2–4702 versus median, 3.4 pg/mg; range, 0.7–20.1; p=0.001). According to the surgical classification, peritoneal fluid soluble MICA, MICB and ULBP-2 ratio levels were significantly increased in DIE as compared to controls (p=0.015, p=0.003 and p=0.045 respectively). MICA ratio levels also correlated with dysmenorrhea (r=0.232; p=0.029), total rAFS score (r=0.221; p=0.031) and adhesions rAFS score (r=0.221; p=0.031).

Conclusions

We demonstrate a significant increase of peritoneal fluid NKG2D ligands in women with endometriosis especially in those cases presenting DIE. This study suggests that NKG2D ligands shedding is a novel pathway in endometriosis complex pathogenesis that impairs NK cell function.     

Cytology of mesothelioma of the tunica vaginalis metastatic to the lung

The case of a 63-year-old man with malignant mesothelioma of the tunica vaginalis testis confirmed by electron microscopy is presented. The tumor recurred in the scrotal skin and subsequently metastasized to the inguinal and retroperitoneal lymph nodes. Four and a half years after the original diagnosis, pulmonary metastases were discovered by cytologic examination of bronchial washings and confirmed by transbronchial lung biopsy. The cytologic features of the metastatic malignant mesothelial cells are described and compared to those of mesothelioma cells in body cavity fluids. The role of cytology in the early detection of such tumors is discussed.     

Potential Role of Semaphorin 3A and Its Receptors in Regulating Aberrant Sympathetic Innervation in Peritoneal and Deep Infiltrating Endometriosis

Previous studies have demonstrated the involvement of nerve repellent factors in regulation of the imbalanced innervation of endometriosis. This prospective study aims to explore the role of Sema 3A in regulating aberrant sympathetic innervation in peritoneal and deep infiltrating endometriosis. Ectopic endometriotic lesion were collected from patients with peritoneal endometriosis (n = 24) and deep infiltrating endometriosis of uterosacral ligament (n = 20) undergoing surgery for endometriosis. Eutopic endometrial samples were collected from patients with endometriosis (n = 22) or without endometriosis (n = 26). Healthy peritoneum (n = 13) from the lateral pelvic wall and healthy uterosacral ligament (n = 13) were obtained from patients who had no surgical and histological proof of endometriosis during hysterectomy for uterine fibroids. Firstly, we studied the immunostaining of Sema 3A, Plexin A1 and NRP-1 in all the tissues described above. Then we studied the nerve fiber density (NFD) of endometriosis-associated (sympathetic) nerve and para-endometriotic (sympathetic) nerve by double immunofluorescence staining. Finally we analyzed the relationship between expression of Sema 3A in stromal cells of endometriotic lesion and the aberrant innervation of endometriosis. Semi-quantitative immunostaining demonstrated that (1) Higher immunostaining of Sema 3A were found in the eutopic endometrial glandular epithelial cells from patients with endometriosis (p = 0.041) than those without endometriosis; (2) Sema 3A immunostaining was higher in glandular epithelial cells of peritoneal endometriosis (P<0.001) and deep infiltrating endometriotic lesions of uterosacral ligament (P = 0.028)compared with glandular epithelial cells of the endometrium from women with endometriosis, while its expression in ectopic stormal cells in both groups were significantly lower than that from eutopic endometrium of women without endometirosis (P<0.001, P<0.001, respectively). NFDs of Anti-TH (+) endometriosis-associated sympathetic nerve of peritoneal endometriosis (p<0.001) and deep endometriosis of uterosacral ligament (p<0.001) were significantly lower than NFDs of para-endometriotic sympathetic nerve. Our results suggest that Sema 3A may contribute to the regulation of aberrant sympathetic innervation in peritoneal and deep infiltrating endometriosis.