Apostolia Galani

Endometrial hyperplasia (EH) comprises a spectrum of abnormal proliferative changes in the endometrium, ranging from benign glandular overgrowth to lesions with substantial malignant potential. The importance of risk stratification and early identification is highlighted by the growing recognition of EH as a precursor to endometrial cancer. The main causes of EH, according to epidemiological research, include obesity, polycystic ovarian syndrome (PCOS), metabolic dysfunction, and extended exposure to unopposed estrogen. Emerging molecular markers, histological analysis, and imaging are all necessary for a proper diagnosis of EH because it might appear with vague clinical symptoms such as irregular uterine bleeding. Surgical intervention or progestin therapy are two possible management techniques for EH, depending on the lesion’s intricacy and the patient’s medical history, including fertility issues. Personalized therapy techniques and recent developments in molecular profiling have the potential to enhance patient outcomes by matching treatment to tumor biology and individual risk profiles. This review highlights the translational potential of molecular insights while synthesizing the most recent data on the epidemiology, risk factors, diagnostic techniques, and therapy of EH. A deeper comprehension of these elements is necessary to maximize treatment results and stop the development of endometrial cancer.

Novel technologies are required to improve endometrial cancer diagnosis and enhance the early detection of preinvasive precursors. Herein, desorption electrospray ionization mass spectrometry imaging (DESI-MSI) was used to differentiate malignant from benign endometrial tissues and assess lipidomic differences among patients with obesity and diabetes. Reverse phase protein array (RPPA) analysis was performed in the same patients to gain insights into the altered signaling pathways and investigate the protein expression levels in endometrial cancer cases and controls. Tissues from 64 women (50 cancer, 14 benign) were analyzed with DESI-MSI achieving 90% sensitivity and 93% specificity. Discriminatory spectral features were primarily phospholipids [phosphatidic acid (PA), phosphatidylethanolamine (PE), phosphatidylserine (PS), and phosphatidylinositol (PI)], all elevated in cancer. Proteomics revealed upregulated proteins linked to commonly dysregulated pathways in endometrial cancer, namely PI3K/AKT/mTOR, MAPK/RAS, and Wnt signaling pathways. Lipidomic differences were found between high- (obesity/diabetes) and low-risk phenotypes (no obesity/diabetes), with PE and PS elevated in high-risk benign and PE reduced in high-risk cancer cases. A single phospholipid (PE(O-38:4)) was found as discriminatory in both normal and cancer cohorts, which may serve as biomarker in women with benign histology at high-risk of developing endometrial cancer. This study reports the application of DESI-MSI for lipidomic characterisation of endometrial cancer.

Background: The widespread use of the human papillomavirus (HPV) vaccine and the rise in digital technologies like artificial intelligence (AI) are causing significant changes in the paradigms surrounding cervical cancer screening. Objective: This review addresses potential future paths toward risk-based, customized screening and prevention while summarizing the available data on how vaccination and digital innovation are changing cervical cancer screening methods. Results: A shift from cytology-based screening to HPV-based primary testing with longer intervals has been supported by the notable decrease in high-grade cervical lesions brought about by HPV vaccination. However, AI and digital health tools, such as digital colposcopy, automated cytology, telemedicine, and self-sampling, have the potential to increase diagnostic access, accuracy, and efficiency, especially in low-resource environments. Implementation hurdles, data security, and algorithmic bias are major obstacles. Conclusions: Digital platforms, molecular diagnostics, and vaccination histories must all be incorporated into screening methods in order to keep up with the decline in HPV-related illness. The elimination of cervical cancer could be accelerated and equality and efficiency increased with customized, risk-based algorithms.

Ovarian cancer remains one of the most lethal gynecological malignancies, primarily due to its late diagnosis and limited prospects for successful treatment. MiRNAs have been shown to be important post-transcriptional regulators in a variety of cancer-related pathways in recent years. One of the principal mechanisms underlying the motility, invasiveness, and metastatic potential of ovarian cancer cells is the microRNA-mediated regulation of ABPs. As integral components of the cytoskeletal network, ABPs participate in dynamic cellular processes such as migration, adhesion, and invasion, and are critically involved in tumor development and progression. Recent data indicate that some miRNAs affect ABP expression and activity, which in turn affects cytoskeletal remodeling and, ultimately, tumor cell behavior. The role of miRNAs in cancer development is inherently complex due to their ability to function as both tumor suppressors and oncogenes, depending on the molecular context. Key ABPs that are targeted by particular miRNAs are discussed in terms of their clinical relevance, including their potential utility as diagnostic biomarkers or therapeutic targets. A deeper understanding of these regulatory pathways may offer new opportunities for early detection and personalized treatment strategies. In this narrative review, the current knowledge of how miRNAs affect ABP expression and function, and how this interaction contributes to the development and progression of ovarian cancer, is compiled.

The increasing use of assisted reproductive technologies (ARTs) globally, such as intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF), has highlighted the pressing need to determine the modifiable factors affecting the success of implantation and the outcomes of early pregnancy. Scientific interest in the role of nutrition in fertility is growing, but outside of celiac disease, little is known about gluten, a dietary protein with immunogenic and inflammatory properties. With an emphasis on ART results, this narrative review summarizes the most recent data regarding the possible effects of gluten consumption on reproductive health, focusing primarily on individuals with celiac disease (CD) and non-celiac gluten sensitivity (NCGS). In addition to discussing potential molecular processes connecting gluten-induced inflammation, increased gut permeability, autoimmune, and decreased endometrial receptivity, we further explore the documented link between CD and infertility and investigate new information on NCGS. These findings are tentative and based on scant low-quality evidence, although some case reports and small clinical studies have indicated that avoiding gluten may help some people undergoing ART, especially those with immune-mediated diseases or infertility that cannot be explained. There is currently no robust prospective evidence confirming that gluten restriction improves infertility outcomes. Therefore, before gluten elimination is advised in this situation, more carefully planned extensive research is required to generate reliable scientific proof. Beyond traditional celiac disease, we suggest that gluten sensitivity might be an underappreciated factor in ART failure that merits more research. A gluten-free diet may serve as a low-risk supplementary option for appropriately selected patients, pending the results of more extensive controlled studies.

Background/Objectives: Preeclampsia (PE), characterized by its complex and multisystemic nature, significantly compromises the health outcomes of both mothers and their newborns. According to recent research, its underlying pathophysiological mechanisms may be influenced by abnormalities in lipid metabolism. The purpose of this study is to assess the association between unfavorable pregnancy outcomes and increased lipoprotein(a) levels in the first trimester and the subsequent risk of PE. Methods: A prospective cohort study comprising 150 pregnant women with a gestational age of less than 12 weeks and no history of PE was carried out at the University Hospital of Ioannina. In the first trimester, lipoprotein(a) levels were assessed, and individuals were monitored for the emergence of preeclampsia, preterm birth, gestational hypertension without proteinuria, and fetal growth limitation. Selection bias was minimized through the use of sequential sampling and rigorous inclusion and exclusion criteria. Associations were assessed using logistic regression analysis. Results: Women with elevated lipoprotein(a) levels had a considerably greater risk of PE than those with normal levels (64.7% vs. 15.5%, p < 0.001). Additionally, elevated lipoprotein(a) was linked to higher odds of fetal growth restriction (p < 0.001), gestational hypertension without proteinuria (p = 0.024), and premature delivery (p = 0.009). These results imply that early lipoprotein(a) screening during pregnancy may help identify women who are at high risk for PE and its associated negative consequences. Conclusions: The association between PE and elevated first-trimester lipoprotein(a) levels highlights the necessity for a deeper understanding of the underlying pathophysiological mechanisms, which could ultimately improve outcomes for both mothers and newborns.

Primary malignant melanoma (MM) of the cervix uteri is a rare and aggressive malignancy of the female reproductive tract. Considering that clinical data on this cancer are scarce, we aimed to comprehensively examine the currently available literature and provide an overview of the reported cases of cervical MM focusing on the clinical characteristics, diagnosis and therapeutic management. We conducted a systematic review of the literature by screening three electronic databases until June 2022. The critical appraisal checklist provided by the Joanna Briggs Institute was employed to evaluate the overall quality of the studies. We included 96 reports, which comprised 137 patients diagnosed with MM of the cervix. The mean age of the patients was 56.5 (median: 58, age range: 33–88). Data regarding menopausal status were provided for 98 patients with 15 being premenopausal and 83 being postmenopausal. The most common presenting symptom was vaginal bleeding (83%, 100/121). Biopsy (either excisional or punch biopsy) was used as the first diagnostic modality in most of the patients (67%, 64/95), followed by cytology (18%, 17/95). In 74 cases, the FIGO staging system for cervical cancer was used with the most common stage being FIGO stage I (38%, 28/74), followed by FIGO stage II (36%, 27/74), FIGO stage III (19%, 14/74) and FIGO stage IV (7%, 5/74). Most of the patients were managed surgically (90%, 119/131) with a hysterectomy (either radical or total), and a salpingo-oophorectomy with/without lymphadenectomy was the most common approach utilized (40%, 48/119). The data of clinical outcomes were provided for 105 patients, of whom 61 died (58%, 61/105) and 44 survived (42%, 44/105). Knowledge regarding the rare occurrence of MM in the cervix and the increased awareness of clinicians can prevent clinical misdiagnosis and ultimately improve further the clinical outcomes of patients developing this rare malignancy.

Background. Obstetric hemorrhage is a frequent and life-threatening complication of either vaginal or cesarean delivery. It can be due to many causes, one of which is placenta accreta, the abnormal invasion of the placenta into the myometrial wall of uterus. Ultrasonography is the first line diagnostic method that can lead to the diagnosis of placenta accreta although, the depth of penetration is estimated by magnetic resonance imaging. Placenta accreta is a life-threatening situation requiring an experienced health care team for its management. Hysterectomy is usually performed although, conservative management might be preferred in carefully selected cases. Case Presentation. A 32-year-old woman (G2, P0) who had an inconsistently monitored pregnancy appeared at a regional hospital with contractions at 39th week of gestation. In her first pregnancy, she was subjected to cesarean section due to delay in second stage of labor and unfortunately her child died due to sudden cardiac death. During C-section, placenta accreta was identified. Given her previous history and her desire to maintain fertility, conservative management was initially planned to preserve her uterus. However, due to persisting vaginal bleeding immediately after delivery an emergency hysterectomy was performed. Conclusion. Conservative management of placenta accreta can be considered in some special cases with the aim to spare fertility. However, if bleeding cannot be controlled during the immediate postpartum period, emergency hysterectomy is unavoidable. A specialized multidisciplinary medical team is required to optimize management.

(1) Background: Nowadays, pregnancy can be achieved by in vitro fertilisation (IVF) or by intracytoplasmic sperm injection (ICSI) for many infertile couples. However, implantation failure still remains a significant problem and it can be stressful for both patients and doctors. One of the key players for pregnancy achievement is the uterine environment. Hysteroscopy is the most reliable method to evaluate the uterine cavity and to identify any intauterine pathology. The aim of this retrospective study was to compare live birth ranges in between women who after a first failed IVF/ICSI attempt underwent a hysteroscopy and those who were evaluated by a transvaginal scan. (2) The retrospective study took place at the Assisted Reproductive Unit of the University Hospital of Ioannina, Greece, from 2017 to 2020. It included 334 women with normal findings in a repeat ultrasound scan after a failed IVF/ICSI trial, 137 of whom underwent in turn diagnostic hysteroscopy before the next IVF/ICSI. (3) Results: Live birth rates were higher in the study group (58/137 vs. 52/197 p = 0.0025). Abnormal endometrial findings were identified in 30% of the patients of the study group. (4) Conclusions: The addition of hysteroscopy as an additional investigation to those patients with a first failed IVF/ICSI could improve the rates of live births. A properly conducted RCT could lead to a robust answer.

Intestinal atresia is the result of fetal bowel maldevelopment which leads to congenital bowel obstruction. It is a common cause of ileus of the newborn and can occur at any site of the gastrointestinal tract. Prenatal diagnosis relies on the demonstration of dilated loops of the fetal bowel and the presence of polyhydramnios at the end of the second or more frequently the third trimester of pregnancy. This condition requires surgical correction soon after birth, with timely diagnosis improving the prognosis. Here, we present the case of a fetus diagnosed with jejunal atresia at 33 weeks of pregnancy.