4^th International Conference on Gynecology and Obstetrics Pathology May 11-12, 2020 Munich, Germany

Biography:

Víctor Sánchez-Margalet graduated in Medicine in 1988 in the University of Seville, PhD degree in the Dept. Medical Biochemistry and Molecular Biology, School of Medicine, University of Seville in 1991. Intern and resident, Clinical Biochemistry, Dept. Clinical Biochemistry, Virgen Macarena University Hospital 1990-93. Postdoctoral fellow, Diabetes Research Center, Mt Zion Hospital, UCSF, CA 1993-1994. Full professor of Biochemistry and Molecular Biology since 2004 in the University of Seville, School of Medicine. He has published more than 150 articles, with  7465 citations (h index 43). He is now head of the department of Medical Biochemistry and Molecular Biology, and Immunology .

Abstract:

Polycystic ovary síndrome (PCOS) is a complex endocrine disorder that affects 5-10% of women in reproductive age. PCOS is considered as a multifactorial pathology with both genetic, and metabolic abnrmalities, including insulin and leptin resistance. We have previously found that granulosa from PCOS women has leptin resistance and decreased expression of aromatase. Altered miRNAs expression have been associated with diabetes, insulin resistance and inflammation. Different studies have found differential amounts of miRNA in blood, folicular fluid and granulosa in PCOS patients. Therefore, in the present work we aimed to study the expression of several miRNA previously found to be related with insulin resistance or estrogen synthesis.

Ä¢ranulosa cells from control (20) and polycystic ovary syndrome women (20) were obtained as waste product from in vitro fecundation, after informed consent. The Project was approved by the local IRB. Total RNA was isolated, miRNA retrotranscribed, and quantified by qPCR.. Statistical significance was assessed by analysis of the variance followd by Bonferroni´s post hoc test. P value < 0.05 was considered to be statistically significant

Most miRNA expression determined in granulosa from PCOS women was not statistically different compared with granulosa from control donors. However, miRNA107 expression (a miRNA that negatively regulates proliferation) was significantly decreased in granulosa from PCOS women compared with granulosa from control donors, and it could mediate the proliferation of the follicles. On the other hand, miRNA320a expression was  found significantly increased in granulosa from women with PCOS. Leptin or insulin stimulation of control granulosa cells produced an increase in miRNA107 expression, and a decrease in the expression of miRNA-320a

The expression of several miRNA is altered in PCOS, decreased miRNA107 may not induce insulin resistance but may promote proliferation, mediating the increased number of follicles; whereas the increased miRNA320a expression in granulosa from PCOS could mediate the insulin and leptin resistance that occurs in this syndrome

Biography:

Dr. Emmanouella Chatzidaki has completed his PhD at the age of 26 years from the Univeristy of Cambridge, UK and postdoctoral studies from Karolinska Isntitute, Sweden and the Institute of Molecular Biotechnology, Austria. She is a senior PostDoc at the Institute of Molecular Biotechnology, Austria. She has published several papers in reputed journals with over 3,000 citations

Abstract:

The frequency of egg aneuploidy and trisomic pregnancies increases with maternal age. Since multiple causes contribute to egg aneuploidy, it is likely challenging to prevent the “maternal age effect” using a single approach. To test our hypothesis that ovulations contribute to oocyte ageing and chromosome missegregation, we used genetics, hormonal contraception and successive pregnancies to reduce ovulations. We observed that ovulation reduction is sufficient to prevent egg aneuploidy and age associated errors during meiosis I division of the oocyte, in aged mice. By interrupting ovulations with successive pregnancies, we discovered that eggs from aged mated females display lower aneuploidy and reduced precociously separated sister centromeres compared to those from aged virgin females. When putting mice on hormonal contraception we find a near 2 fold reduction in aneuploidy incidence. To reduce ovulations further, we generated Gpr54 knockout mice, which remain in a pre-pubescent state. Remarkably, aneuploidy is reduced 3-fold in eggs from Gpr54^-/- versus Gpr54^+/+ aged females. These data suggest protection is due to reduced ovulations. We further observed that ovulations contribute to loss of Rec8-cohesin, which is essential for sister chromatid cohesion in meiosis. Single-nucleus Hi-C revealed a deterioration of 3D chromatin organization that depends on ovulation frequency and Rec8, which restricts loops extrusion. We conclude that ovulation suppression leads to retention of Rec8, which maintains chromatin structure and promotes chromosome segregation and production of euploid eggs. Our work implies that hormonal contraception can reduce the risk of Down’s syndrome pregnancies at advanced maternal age.

Biography:

Andrei Mihai Malutan it is an Obstetrics and Gynecology Associated Professor at “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania has completed his PhD at the age of 32 years from “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. He has published more than 50 papers in reputed journals and 8 books in different areas of obstetrics and gynecology.       

Abstract:

Retrorectal cystic hamartomas (“Tailgut cysts”) are rare developmental cysts that appear in the retrorectal space, arising from aberrant remnants of the post-anal primitive gut in case of an incomplete embryogenetic involution. We present the case of a 30-year-old woman with a history of chronic lower abdominal pain. Other digestive symptoms, like rectal fullness, constipation, pain on defecation, rectal bleeding or genitourinary obstruction symptoms were not associated. During a period of 3 years she had undergone several surgical procedures for ovarian cysts, without relieving the symptomatology. CT scan showed a presacral tumor with a right pararectal development. A surgical resection of the lesion using an anterior approach was performed, with the final pathological diagnosis of a retrorectal cystic hamartoma (“tailgut cyst”). This case underlines the fact that retrorectal masses can be challenging to diagnose and tailgut cysts must be taken into consideration in cases of perirectal tumors at patients with a history of multiple failed procedures and surgeries

Biography:

Ari Irawan Romulya has completed her MD at the age of 23 years from jenderal Achmad Yani University, Bandung, Indonesia and currently undergo residency in Obstetric and Gynecology Department at Padjajaran University, Bandung, Indonesia

Abstract:

Adenomyosis is a condition in which endometrium is ectopically placed in the myometrium. The most frequent symptoms of adenomyosis is chronic pelvic pain. Pain is a sensoric stimuli that can be affected by COX-2. Some studies found that 25-Hidroxy-Vitamin D₃ serum level has the ability to affect COX-2 serum level and modulate pain sensation. The aim of this study is to analyze correlation between 25-Hidroxy-Vitamin D₃ and COX-2 serum level in patient with adenomyosis.

Methods. This was an analytical observational study. Subjects were women diagnosed with adenomyosis who met the study criteria (n = 35). Their 25-Hidroxy-Vitamin D₃ and COX-2 serum level were measured. The study was conducted at the Gynecologic Clinic of Obstetrics and Gynecology Department, Hasan Sadikin Hospital, Bandung Indonesia in June until November 2019.

Results. There was a significant correlation between 25-Hidroxy-Vitamin D₃ and COX-2 serum level in woman with adenomyosis.

Conclusion. 25-Hidroxy-Vitamin D₃ serum level can affect COX-2 serum level in woman with adenomyosis.

Biography:

Ayu Angelina has completed her MD at the age of 23 years from Padjajaran University, Bandung, Indonesia and currently undergo residency in Obstetric and Gynecology Department at the same University.

Abstract:

Placenta accreta is an abnormal trophoblast invasion of the placenta to the myometrium, instead of the decidua.¹ It refers to the range of pathologic adherence of the placenta, including placenta accreta, placenta increta, and placenta percreta. This condition is associated with severe obstetric hemorrhage usually necessitating hysterectomy.² An important risk factor for placenta accreta is the previous cesarean section (CS), with the incidence increasing with the number of prior CS. According to American Journal of Obstetric and Gynecology (AJOG), the risk for placenta acrcreta was 0,03% for those at their first CS and increasing if there was placenta previa. The association between placenta accreta after a primary CS regardless to the co-existence of placenta previa in the subsequent pregnancy has not been fully evaluated.³ Three cases of placenta accreta on September 2019 in Hasan Sadikin General Hospital confirmed histologically were seemed to have similar risk factors. Two cases of placenta previa percreta and one increta were treated with total hysterectomy. In the present study, we report women with a primary CS had a higher risk for placenta accrete-associated maternal complications. This condition should be considered in the clinical judgment of whether to perform a primary cesarean delivery.

Biography:

Abstract:

Background: Worldwide there has been a dramatic increase in the prevalence of overweight and also obesity was recently described by the World Health Organization (WHO) as one of the most blatantly visible but most neglected public health problems that threaten to overwhelm both developed and developing countries. Obese women have a higher risk of complications during pregnancy and delivery. Actually, maternal obesity is a serious problem in obstetric-gynecological practice in the world. Some of the studies showed antenatally, obesity increases the risk of adverse pregnancy outcomes.  We performed a population-based study on a cohort consisting of Iranian women to estimate the association between overweight and obesity third trimester hemorrhage.

Method: A prospective cohort study was carried out on 2156 pregnant women with singleton gestations from the first trimester to delivery. The study was conducted among pregnant women receiving prenatal care in centers under the coverage of Shahid Beheshti University of Medical Sciences. Third trimester hemorrhage were identified in normal weight (body mass index [BMI] 18.5–24.9 kg/m2), underweight (BMI <18.5 kg/m2) overweight (BMI 25.0–29.9 kg/m2,), moderately obese (BMI 30.0–34.9 kg/m2), and severely obese (BMI ≥ 35.0 kg/m2) pregnant women and were compared according to the level of obesity.

Results: The final study population consisted of 2156 women, 45.9% being normal weight, 5.7% underweight,  35.3% overweight, 10.3% moderately obese I, and 2.9% severely obese. Third trimester hemorrhage were significantly higher in severely obese compare with normal weight [0.5% (n=5) normal weight and 4.1% (n=2) severely obese], p<0.005]. There was a positive correlation between mother and birth weight (p<0.000)

Conclusion: Maternal obesity is associated with an increased risk of third trimester hemorrhage. Taking into account the high risk of adverse pregnancy outcomes associated with obesity, it is necessary to develop therapeutic and diagnostic measures and implement dynamic monitoring of pregnant women to minimize these risks.

Biography:

Abstract:

Background: Ovary is the third most common site of neoplastic lesions in female genital tract. Ovarian tumors occur right from childhood to postmenopausal age group. Ovarian neoplasms have become increasingly important not only because of their large variety, but more because they have gradually increased the mortality rate due to female genital cancers.

Objectives: To find out the histopathological pattern of ovarian tumors in College of Medical sciences and Teaching Hospital (CMS-TH), Bharatpur and to evaluate correlation between clinical and histopathological diagnosis.

Methods: This descriptive study was carried out on 75 cases of surgically resected ovarian tumor specimens fulfilling the inclusion criteria at Department of Pathology in CMS-TH, Bharatpur from January 2016 to June 2017. Clinical data was recorded  in a predesigned proforma. The specimens were grossed, processed and embedded using standard procedures, were stained with Haematoxylin and Eosin stain and were analyzed using light microscopy. Statistical analysis was done using SPSS (Statistical Pacakage for Social Sciences) 20.0 and a correlation was done between clinical and histopathological diagnosis using Chi-square test (liklihood ratio) and Spearman correlation, and p value was calculated.

Results: Age range of the patients was from 10 to 70 years with maximum cases (32.0%) in the age group of 21-30 years. The most common presenting complaint was pain abdomen (57.4%). Clinical diagnosis was mature cystic teratoma in 29 (38.7%) cases, serous cystadenoma in 24 (32.0%) cases, mucinous cystadenoma in 11 (14.7%) cases, dysgerminoma 7 (9.3%) in cases, serous cystadenocarcinoma in 3 (4.0%) cases and mucinous cystadenocarcinoma in 1 (1.3%) case. Histopathological diagnosis was mature cystic teratoma in 29 (38.8%) cases, serous cystadenoma in 22 (29.4%) cases, mucinous  cystadenoma  in  6 (8.0%) cases,  borderline mucinous  tumor in  4  (5.3%) cases, serous cystadenocarcinoma in 3 (4.0%) cases, dysgerminoma in 3 (4.0%) cases, steroid cell tumor in 2 (2.7%) cases, and borderline serous tumor, mucinous cystadenocarcinoma, mature cystic teratoma transforming into squamous cell carcinoma (SCC), immature teratoma, Sertoli Leydig cell tumor  and fibroma in each 1 (1.3%) case. There was significant statistical correlation between clinical and histopathological diagnosis (p<0.001).

Conclusion: Benign tumors were more common than malignant tumors for all age group. Most of the tumors were of surface epithelial cell origin. Mature cystic teratoma was the most common ovarian tumor as well as the most common benign tumor. Serous cystadenocarcinoma and dysgerminoma were most common malignant tumors. Malignant surface epithelial tumors usually occurred in older age whereas malignant germ cell tumors occurred in younger age. There was significant statistical Clinico-pathological correlation.

Biography:

Michelle O. Hubilla M.D. is a 4th year resident in the Department of Obstetrics and Gynecology in Makati Medical Center. At the age of 23 years old, she completed her degree in Medicine at the De La Salle Health Sciences Institute and her one year inetrnship at the Department of Health hospitals. Currently, she is on her last year of training in one of the top hospitals in the country, The Makati Medical Center, and aspires to be a gynecologic oncologist and serve the Filipino people.

Abstract:

A 45 year old nulligravid presented with changes in sensorium after losing balance and hitting her head, with noted symptoms of restlessness, disorientedness and intermittent febrile episodes. Upon work-up, serum calcium and parathyroid hormone were noted to be significantly elevated. Investigating the pathology of hypercalcemia led to an incidental finding of a pelvoabdominal mass. Computed tomography (CT) scan of the whole abdomen showed a heterogeneously enhancing mass noted in the bilateral hemipelvis measuring 8.5 x 5.0 x 6.4 cm in the right and 3.4 x 2.5 x 4.1 cm in the left and pelvic and retroperitoneal lymphadenopathy, for which a neoplastic process was considered, probably gynecologic in origin.  With the aforementioned signs and symptoms, patient was managed as a case of Pelvoabdominal mass, to consider Anti-NMDAR encephalitis vs. Parathyroid hormone-secreting tumor vs. Germ Cell tumor of the ovary. Patient underwent extrafascial abdominal hysterectomy with bilateral salpingoophorectomy, bilateral lymph node dissection with frozen section. Intraoperatively, tumor was found to be on the paratubal area of the right fallopian tube. It was then sent for frozen section revealing a histopathologic diagnosis of metastatic high grade papillary adenocarcinoma. Other specimens that were submitted include the cervix, uterus, ovaries left fallopian tube had a final histopathologic diagnosis of a mixed endometrioid and undifferentiated carcinoma with carcinoma involving more than half of the myomterial depth with invasion into the cervix, right and left parametria, right and left fallopian tube and ovaries. Lymph node dissection also revealed an extensive lymphovascular invasion. The specimens were stained with synaptophysin and chromogranin A, two of the most common used neuroendocrine markers.  It was then confirmed that there are two separate malignancies present in the patient, the Endometrial Endometrioid Adenocarcinoma (Figo Grade 1) well differentiated, confined to the endometrium and the other, a Large cell Neuroendocrine carcinoma involving the right and left ovaries with extension to bilateral fallopian tube, bilateral parametria and invasion into the myometrium and cervix 

Metastatic large cell neuroendocrine carcinoma to the pelvic lymph nodes.

Neuroendocrine tumors are spectrum of malignancies that arise from the diffuse neuroendocrine cell system that can cause debilitating symptoms and potentially life threatening conditions for patients. At present, neuroendocrine tumors of the gynecologic tract are increasingly common, and pose a significant clinical challenge because of the tumor heterogeneity and lack of standardized guidelines for treatment (Gardner, Reidy-Lagunes & Gehrig, 2011).

Biography:

Michelle O. Hubilla M.D. is a 4th year resident in the Department of Obstetrics and Gynecology in Makati Medical Center. At the age of 23 years old, she completed her degree in Medicine at the De La Salle Health Sciences Institute and her one year inetrnship at the Department of Health hospitals. Currently, she is on her last year of training in one of the top hospitals in the country, The Makati Medical Center, and aspires to be a gynecologic oncologist and serve the Filipino people.

Abstract:

A 45 year old nulligravid presented with changes in sensorium after losing balance and hitting her head, with noted symptoms of restlessness, disorientedness and intermittent febrile episodes. Upon work-up, serum calcium and parathyroid hormone were noted to be significantly elevated. Investigating the pathology of hypercalcemia led to an incidental finding of a pelvoabdominal mass. Computed tomography (CT) scan of the whole abdomen showed a heterogeneously enhancing mass noted in the bilateral hemipelvis measuring 8.5 x 5.0 x 6.4 cm in the right and 3.4 x 2.5 x 4.1 cm in the left and pelvic and retroperitoneal lymphadenopathy, for which a neoplastic process was considered, probably gynecologic in origin.  With the aforementioned signs and symptoms, patient was managed as a case of Pelvoabdominal mass, to consider Anti-NMDAR encephalitis vs. Parathyroid hormone-secreting tumor vs. Germ Cell tumor of the ovary. Patient underwent extrafascial abdominal hysterectomy with bilateral salpingoophorectomy, bilateral lymph node dissection with frozen section. Intraoperatively, tumor was found to be on the paratubal area of the right fallopian tube. It was then sent for frozen section revealing a histopathologic diagnosis of metastatic high grade papillary adenocarcinoma. Other specimens that were submitted include the cervix, uterus, ovaries left fallopian tube had a final histopathologic diagnosis of a mixed endometrioid and undifferentiated carcinoma with carcinoma involving more than half of the myomterial depth with invasion into the cervix, right and left parametria, right and left fallopian tube and ovaries. Lymph node dissection also revealed an extensive lymphovascular invasion. The specimens were stained with synaptophysin and chromogranin A, two of the most common used neuroendocrine markers.  It was then confirmed that there are two separate malignancies present in the patient, the Endometrial Endometrioid Adenocarcinoma (Figo Grade 1) well differentiated, confined to the endometrium and the other, a Large cell Neuroendocrine carcinoma involving the right and left ovaries with extension to bilateral fallopian tube, bilateral parametria and invasion into the myometrium and cervix 

Metastatic large cell neuroendocrine carcinoma to the pelvic lymph nodes.

Neuroendocrine tumors are spectrum of malignancies that arise from the diffuse neuroendocrine cell system that can cause debilitating symptoms and potentially life threatening conditions for patients. At present, neuroendocrine tumors of the gynecologic tract are increasingly common, and pose a significant clinical challenge because of the tumor heterogeneity and lack of standardized guidelines for treatment (Gardner, Reidy-Lagunes & Gehrig, 2011).

Biography:

Michelle O. Hubilla M.D. is a 4th year resident in the Department of Obstetrics and Gynecology in Makati Medical Center. At the age of 23 years old, she completed her degree in Medicine at the De La Salle Health Sciences Institute and her one year inetrnship at the Department of Health hospitals. Currently, she is on her last year of training in one of the top hospitals in the country, The Makati Medical Center, and aspires to be a gynecologic oncologist and serve the Filipino people.

Abstract:

A 45 year old nulligravid presented with changes in sensorium after losing balance and hitting her head, with noted symptoms of restlessness, disorientedness and intermittent febrile episodes. Upon work-up, serum calcium and parathyroid hormone were noted to be significantly elevated. Investigating the pathology of hypercalcemia led to an incidental finding of a pelvoabdominal mass. Computed tomography (CT) scan of the whole abdomen showed a heterogeneously enhancing mass noted in the bilateral hemipelvis measuring 8.5 x 5.0 x 6.4 cm in the right and 3.4 x 2.5 x 4.1 cm in the left and pelvic and retroperitoneal lymphadenopathy, for which a neoplastic process was considered, probably gynecologic in origin.  With the aforementioned signs and symptoms, patient was managed as a case of Pelvoabdominal mass, to consider Anti-NMDAR encephalitis vs. Parathyroid hormone-secreting tumor vs. Germ Cell tumor of the ovary. Patient underwent extrafascial abdominal hysterectomy with bilateral salpingoophorectomy, bilateral lymph node dissection with frozen section. Intraoperatively, tumor was found to be on the paratubal area of the right fallopian tube. It was then sent for frozen section revealing a histopathologic diagnosis of metastatic high grade papillary adenocarcinoma. Other specimens that were submitted include the cervix, uterus, ovaries left fallopian tube had a final histopathologic diagnosis of a mixed endometrioid and undifferentiated carcinoma with carcinoma involving more than half of the myomterial depth with invasion into the cervix, right and left parametria, right and left fallopian tube and ovaries. Lymph node dissection also revealed an extensive lymphovascular invasion. The specimens were stained with synaptophysin and chromogranin A, two of the most common used neuroendocrine markers.  It was then confirmed that there are two separate malignancies present in the patient, the Endometrial Endometrioid Adenocarcinoma (Figo Grade 1) well differentiated, confined to the endometrium and the other, a Large cell Neuroendocrine carcinoma involving the right and left ovaries with extension to bilateral fallopian tube, bilateral parametria and invasion into the myometrium and cervix 

Metastatic large cell neuroendocrine carcinoma to the pelvic lymph nodes.

Neuroendocrine tumors are spectrum of malignancies that arise from the diffuse neuroendocrine cell system that can cause debilitating symptoms and potentially life threatening conditions for patients. At present, neuroendocrine tumors of the gynecologic tract are increasingly common, and pose a significant clinical challenge because of the tumor heterogeneity and lack of standardized guidelines for treatment (Gardner, Reidy-Lagunes & Gehrig, 2011).

Biography:

Dr. Sarah Fatima Siddiqui completed her graduation (MBBS) from the prestigious Lady Hardinge Medical College and is currently pursuing her postgraduation (MS) in Obstetrics & Gynecology from the highly reputed Maulana Azad Medical College , New Delhi, India.

Abstract:

Aggressive Angiomyxoma (AAM) is a rare locally invasive mesenchymal tumor that most commonly arises in the vulvovaginal region, perineum and pelvis of women. We present here 2 rare cases of AAM with varying presentations one arising from pelvis and other from the vulva. A 45-year-old lady referred from a private hospital with provisional diagnosis of cervical fibroid based on her MRI findings. On examination, a large mass was felt in the vagina which was firm, smooth, nontender and immobile. CT scan revealed a large (13 x 12x 10 cms) mass displacing bowel, uterus, ureters, causing, hydroureteronephrosis and bilateral renal metastasis. Her chest x-ray too revealed probable metastasis. Biopsy of the mass was performed which confirmed diagnosis of Angiomyxoma and Immunohistochemistry further confirmed it. She opted for neoadjuvant GnRH therapy. Unfortunately, the patient expired soon after initiating the therapy. The second patient, 25-year-old, presented with mass growing on right side of vulva having increased massively in size during her recent pregnancy, now measuring 10 x 8 cms with a pedicle of 10 x 2cms. Histopathology and immunohistochemistry confirmed AAM for which wide local excision was done, no evidence of recurrence noted till date. AAM has a very high risk for local relapse even though metastasis is very rare. Hence we need to differentiate it from other mesenchymal tumors occurring in this region. Complete resection with negative margin is the mainstay of treatment. Since incidence of recurrence is high, follow-up is advised as long as 15 years.