Držislav Kalafatić

Introduction: Müllerianosis is a rare pathological entity characterized by ectopic Müllerian-derived tissues, including endometrium, endocervix, and/or endosalpinx. Most reported cases involve the urinary bladder, while uterine involvement is extremely uncommon. We present a case of müllerianosis presenting as a cystic lesion of the anterior uterine wall, and we provide a review of the available literature. Case Presentation: We report a 37-year-old woman with an asymptomatic anterior uterine wall lesion detected 11 years ago on routine ultrasound. Initially measuring 60 × 35 mm, the lesion was surgically excised and histopathologically confirmed as müllerianosis, containing endometrial and tubal-type tissue. Eleven years later, she presented with abnormal uterine bleeding. Ultrasound revealed a heterogeneous lesion with cystic areas and uterine asymmetry suggestive of adenomyosis. Conservative management, including curettage, failed, necessitating total abdominal hysterectomy. Histopathology confirmed adenomyosis and endometriosis in addition to prior findings. Discussion: This case is notable for the long follow-up, the uncommon anterior uterine location, and the large lesion size. It supports an embryologic or metaplastic origin of müllerianosis and suggests potential links with other uterine pathologies. Surgical excision remains the treatment of choice, while imaging, histopathology, and immunohistochemistry are essential for accurate diagnosis. Long-term monitoring is recommended due to recurrence risk and the rare potential for malignant transformation. Conclusions: Our report emphasizes the importance of awareness, careful diagnosis, and extended follow-up in managing rare uterine Müllerian lesions.

Introduction: Müllerianosis is a rare pathological entity characterized by ectopic Müllerian-derived tissues, including endometrium, endocervix, and/or endosalpinx. Most reported cases involve the urinary bladder, while uterine involvement is extremely uncommon. We present a case of müllerianosis presenting as a cystic lesion of the anterior uterine wall, and we provide a review of the available literature. Case Presentation: We report a 37-year-old woman with an asymptomatic anterior uterine wall lesion detected 11 years ago on routine ultrasound. Initially measuring 60 × 35 mm, the lesion was surgically excised and histopathologically confirmed as Müllerianosis, containing endometrial and tubal-type tissue. Eleven years later, she presented with abnormal uterine bleeding. Ultrasound revealed a heterogeneous lesion with cystic areas and uterine asymmetry suggestive of adenomyosis. Conservative management, including curettage, failed, necessitating total abdominal hysterectomy. Histopathology confirmed adenomyosis and endometriosis in addition to prior findings. Discussion: This case is notable for the long follow-up, the uncommon anterior uterine location, and the large lesion size. It supports an embryologic or metaplastic origin of Müllerianosis and suggests potential links with other uterine pathologies. Surgical excision remains the treatment of choice, while imaging, histopathology, and immunohistochemistry are essential for accurate diagnosis. Long-term monitoring is recommended due to recurrence risk and the rare potential for malignant transformation. Conclusion: Our report emphasizes the importance of awareness, careful diagnosis, and extended follow-up in managing rare uterine Müllerian lesions.

Stress urinary incontinence (SUI) is defined as unintentional urine leakage occurring as a consequence of increased intraabdominal pressure due to absent or weak musculus detrusor contractility. It affects postmenopausal women more often than premenopausal and is associated with quality of life (QoL) deterioration. The complex SUI etiology is generally perceived as multifactorial; however, the overall impact of environmental and genetic influences is deficiently understood. In this research report, we have disclosed the upregulation of 15 genes and the downregulation of 2 genes in the genetic etiology of SUI according to the accessible scientific literature. The analytical methods used for the analysis of gene expression in the studies investigated were immunohistochemistry, immunofluorescence staining, PCR, and Western blot. In order to facilitate the interpretation of the results, we have used GeneMania, a potent software which describes genetic expression, co-expression, co-localization, and protein domain similarity. The importance of this review on the genetic pathophysiology of SUI lies in determining susceptibility for targeted genetic therapy, detecting clinical biomarkers, and other possible therapeutic advances. The prevention of SUI with the timely recognition of genetic factors may be important for avoiding invasive operative urogynecological methods.

Background and Objectives: To estimate the effectiveness of Kegel exercises versus extracorporeal magnetic innervation (EMI) in the treatment of stress urinary incontinence (SUI). Materials and Methods: A parallel group, randomized clinical trial was conducted in the Department of Obstetrics and Gynecology, Clinical Hospital Centre Zagreb, Croatia. After assessing the inclusion/exclusion criteria, each eligible participant was randomized to one of the two observed groups by flipping a coin: the first group underwent treatment with Kegel exercises for 8 weeks, while the second group underwent EMI during the same time interval. The primary outcome was the effectiveness of treatment as measured by the ICIQ-UI-SF overall score, eight weeks after the commencement of treatment. Results: During the study period, 117 consecutive patients with SUI symptoms were assessed for eligibility. A total of 94 women constituted the study population, randomized into two groups: Group Kegel (N = 48) and Group EMI (N = 46). After 8 weeks of follow-up, intravaginal pressure values in the EMI group were 30.45 cmH₂O vs. the Kegel group, whose values were 23.50 cmH₂O (p = 0.001). After 3 months of follow-up, the difference was still observed between the groups (p = 0.001). After the end of treatment and 3 months of follow-up, the values of the ICIQ-UI SF and ICIQ-LUTSqol questionnaires in the EMI group were lower than in the Kegel group (p < 0.001). Treatment satisfaction was overall better in the EMI group than in the Kegel group (p < 0.001). Conclusions: Patients treated with EMI had a lower number of incontinence episodes, a better quality of life, and higher overall satisfaction with treatment than patients who performed Kegel exercises.

Ovarian cancer (OC) is the most lethal female gynecological malignancy, mostly due to diagnosis in late stages when treatment options are limited. Hedgehog-GLI (HH-GLI) signaling is a major developmental pathway involved in organogenesis and stem cell maintenance, and is activated in OC. One of its targets is survivin (BIRC5), an inhibitor of apoptosis protein (IAP) that plays a role in multiple processes, including proliferation and cell survival. We wanted to investigate the role of different GLI proteins in the regulation of survivin isoform expression (WT, 2α, 2B, 3B, and Δex3) in the SKOV-3 OC cell line. We demonstrated that survivin isoforms are downregulated in GLI1 and GLI2 knock-out cell lines, but not in the GLI3 knock-out. Treatment of GLI1 knock-out cells with GANT-61 shows an additional inhibitory effect on several isoforms. Additionally, we examined the expression of survivin isoforms in OC samples and the potential role of BIRC5 polymorphisms in isoform expression. Clinical samples showed the same pattern of survivin isoform expression as in the cell line, and several BIRC5 polymorphisms showed the correlation with isoform expression. Our results showed that survivin isoforms are regulated both by different GLI proteins and BIRC5 polymorphisms in OC.