O embrião equino apresenta um desenvolvimento dinâmico por um longo período entre a fertilização, sua entrada no útero, fixação e posterior invasão trofoblástica após o 36º dia da gestação. Durante todo este período o concepto é sustentado pelo histotrofo endometrial. Estas características dos equídeos favorecem o seu uso com modelo experimental in vivo para estudos nos desenvolvimentos e interações fetal e maternal. Os estudos em endométrio equino tiveram foco em eventos fisiológicos nas diferentes fases do ciclo estral, enquanto os estudos aos primeiros momentos da gestação são escassos. O entendimento do processo de remodelação e morfofisiologia do endométrio após a entrada do embrião no útero não é completamente entendido. O objetivo deste trabalho foi estudar a morfofisiologia endometrial da gestação na égua envolvendo os períodos pós-fixação e peri-implantação, por histologia e microscopia eletrônica de varredura. A característica mais marcante da transformação ou adaptação endometrial à gestação foi o quase total desaparecimento das células ciliadas na superfície epitelial em ambos cornos uterinos. A capacidade de secreção das células microvilosas também passou por mudanças com o avanço gestacional. Muitas células secretórias ingurgitadas e protusas formam a maioria da população do epitélio, onde o histotrofo se acumula, e apresentaram erosões em sua superfície, provavelmente pela secreção apócrina de vesículas. A superfície epitelial apresentou pleomorfismo celular e pseudoestratificação, promovida por intensa hiperplasia celular, acompanhada de adensamento das glândulas endometriais, desde o 21º dia da gestação diminuído após o 36º dia. Linfócitos, provavelmente uNK, foram encontrados no epitélio luminal do endométrio já aos 21 dias de gestação em ambos cornos, gravídico e não gravídico. Foi evidenciado o septamento no epitélio luminal, com sulcos formados aos 35 e 36 dias, tornando-se mais profundos aos 42 dias de gestação. Toda esta evolução e adaptação contínua aconteceram principalmente no corno gravídico acompanhados em menor intensidade pelo corno não gravídico. / The equine embryo plays a dynamic development for a long period between fertilization, its entry into the uterus, fixes and subsequent trophoblastic invasion after day 36 of gestation. Throughout this period, the conceptus is supported by endometrial histotrophe. These equids characteristics favor their use as an in vivo experimental model for studying the changes and interactions in fetal and maternal development. Studies in equine endometrium were focused on physiological events in the different phases of the estrous cycle, while studies in early moments of pregnancy are scant. The process of endometrial remodeling and morphophysiology after the maternal recognition of pregnancy is not completely understood. The objective of this work was to study the endometrial morphophysiology in the mare comprising post-fixation and peri-implantation periods, by histology and scanning electron microscopy. The most striking feature of endometrial transformation or adaptation to pregnancy was the almost total ciliated cells disappearance of the epithelial surface in both uterine horns. In addition, the secretory capacity of microvillus cells underwent changes with gestational age. Many engorged and protruded secretory cells were the majority epithelium population where histotroph accumulates, and showed erosions on its surface, probably by apocrine vesicle secretion. The epithelial surface also showed cellular pleomorphic and pseudostratified epithelium as a result of intense cell hyperplasia. It was accompanied by thickening of the endometrial glands from day 21 of gestation, then decreasing after the 36th day. Lymphocytes, probably uNK, were found in the luminal epithelium of the endometrium since 21st day of gestation in both pregnant and not pregnant horns. Septation was evidenced in the luminal epithelium, with sulci formed at 35 days, becoming deeper at 42 days of pregnancy. All this continued evolution and adaptation occurred mainly in the gravid horn accompanied in less intensity by non-gravid horn.

Orientador: Lucia Helena Simões da Costa Paiva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T02:35:20Z (GMT). No. of bitstreams: 1 AntunesJunior_Armando_M.pdf: 830742 bytes, checksum: 720d4a80c57839204e1deb9d91aa059e (MD5) Previous issue date: 2006 / Resumo: Os pólipos endometriais são achados freqüentes em mulheres na pós-menopausa e têm sido associados a lesões precursoras e neoplasia endometrial. Entretanto seu potencial de malignidade ainda está pouco esclarecido. Devido à alta prevalência dos pólipos uterinos na pós-menopausa e possível potencial de malignidade, torna-se importante a sua detecção e remoção. Objetivo: Avaliar a prevalência de lesões precursoras e malignas endometriais e associação com estado menopausal, uso de terapia hormonal e características clinicas em mulheres na pré e pós-menopausa submetidas à ressecção histeroscópica de pólipos endometriais. Sujeitos e métodos: Realizou-se um estudo de corte transversal através da identificação em base de dados de cirurgias histeroscópicas onde foram selecionadas as mulheres na pré e pós-menopausa submetidas à ressecção histeroscópica de pólipos endometriais no CAISM/Unicamp, no período de janeiro de 1998 a dezembro de 2005. Foram incluídas 475 mulheres com idade acima de 40 anos que apresentassem diagnóstico histológico do pólipo endometrial ressecado. Foram avaliadas as características clínicas como presença de hipertensão arterial, diabetes, obesidade, uso de terapia hormonal, tamoxifeno, achados histeroscópicos e diagnóstico histológico dos pólipos ressecados.A análise estatística foi realizada através de freqüência, médias e desvio padrão. Para avaliar os fatores associados à pré-malignidade ou malignidade utilizou-se a razão de prevalência. Resultados: A média etária das mulheres foi de 58,5 anos (DP±10) e 77,3% estavam na pós-menopausa. A maioria das mulheres apresentava lesões endometriais benignas, sendo 78,53% pólipos endometriais e 13,47% pólipos com hiperplasia endometrial simples ou complexa. Pólipos com hiperplasias endometriais associados a atipias estiveram presentes em 1,05% e 2,74% apresentaram carcinoma endometrial no pólipo ressecado. A análise através da razão de prevalência mostrou que a maior prevalência de lesões pré-malignas e malignas estiveram associadas à idade e ao sangramento pós-menopausa. Mulheres com mais de 60 anos apresentaram uma razão de prevalência de 5,31 (IC95%1,22-23,09) e com sangramento na pós-menopausa uma razão de prevalência de 3,71 (IC 95% 1,21-11,34). A hipertensão arterial, diabetes mellitus, obesidade, uso de terapia hormonal ou tamoxifen não mostraram associação significativa com pré-malignidade ou malignidade. Conclusões: Os pólipos endometriais apresentam uma baixa prevalência de lesões pré-malignas e malignas. Mulheres com idade avançada e sangramento na pós-menopausa apresentam maior risco de malignidade e devem ser submetidas à ressecção histeroscópica de pólipos endometriais / Abstract: Endometrial polyps are frequent findings in postmenopausal women and have been associated with precursor lesions and endometrial neoplasia. Nevertheless, their potential for malignancy is yet to be fully clarified. Due to their high prevalence in the postmenopause and their possible potential for malignancy, detection and removal of uterine polyps is an important issue. Objective: To evaluate the prevalence of precursor and malignant endometrial lesions and their association with menopausal status, the use of hormone therapy and the clinical characteristics of pre- and postmenopausal women submitted to hysteroscopic resection of endometrial polyps between January 1998 and December 2005 at CAISM/UNICAMP. Methods: A total of 475 women over 40 years of age with histological diagnosis of a resected endometrial polyp, were included in the study. Their clinical characteristics, such as presence of arterial hypertension, diabetes, obesity, use of hormone therapy or tamoxifen, hysteroscopic findings and histological diagnosis of the resected polyps, were evaluated. Statistical analysis was carried out using frequency, means and standard deviations. Prevalence ratios were used to evaluate factors associated with premalignancy or malignancy. Results: The mean age of women in this study was 58.5 ± 10 years (mean ± SD), and 77.3% were postmenopausal. The majority of women had benign endometrial lesions, 78.53% of which were endometrial polyps and 13.47% polyps with simple or complex endometrial hyperplasia. Polyps with endometrial hyperplasia associated with atypia were found in 1.05% of women, while endometrial carcinoma was found in the resected polyp in 2.74% of cases. Analysis of prevalence ratios detected a greater prevalence of premalignant and malignant lesions associated with age and postmenopausal bleeding. Women over 60 years of age had a prevalence ratio of 5.31 (95%CI:1.22-23.09), while those with postmenopausal bleeding had a prevalence ratio of 3.71 (95%CI:1.21-11.34). No significant association was found between arterial hypertension, diabetes mellitus, obesity, use of hormone therapy or tamoxifen and premalignancy or malignancy. Conclusions: There is a low prevalence of premalignant and malignant lesions in endometrial polyps; however, there is a greater risk of malignancy in elderly women and those with postmenopausal bleeding, and these patients should be submitted to hysteroscopic resection of endometrial polyps / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Le développement de nouvelles options thérapeutiques est à l’origine d’un changement de paradigme dans le processus de décision médicale. L'émergence de la médecine individualisée et la complexité croissante des données médicales ont conduit à l'avènement des modèles de prédiction. Pour le cancer de l'endomètre, ces modèles (algorithmes, scores et nomogrammes) ont été développés pour stratifier, estimer et prédire le risque de métastase ganglionnaire et de récidive. Le principal enjeu clinique est d’intégrer ces outils en vu d’optimiser les stratégies de prévention, de diagnostic et de traitement. Nous nous sommes intéressés au risque de récidive et d’envahissement ganglionnaire sur la base d’une analyse en population, puis individuelle. À l’échelle de la population, nous avons proposé : i) un travail de comparaison des principales classifications internationales, ii) une nouvelle classification clinicopathologique reposant sur l’incorporation d’un prédicteur histologique, iii) le développement de scores de stratification du risque. À l’échelle individuelle, nous avons développé : i) une méthodologie de validation externe des modèles prédictifs, point de départ indispensable à leur utilisation en pratique, ii) un nomogramme clinicopathologique spécifique d’envahissement ganglionnaire et son seuil de décision clinique. La modélisation mathématique en cancérologie est susceptible de transformer notre façon d’appréhender les stratégies préventives et curatives dans le cancer de l’endomètre. Les pistes d’optimisation sont multiples et laissent entrevoir la possibilité, dans un avenir proche, d’une application clinique à ces outils. / With the abundance of new options in diagnostic and treatment modalities, a shift in the medical decision process for endometrial cancer has been observed. The emergence of individualized medicine and the increasing complexity of available medical data have lead to the development of prediction models. In endometrial cancer, those clinical models (algorithms, nomograms, and risk scoring systems) have been reported, for stratifying and subgrouping patients, with various unanswered questions regarding such things as the optimal surgical staging for lymph node metastasis as well as the assessment of recurrence and survival outcomes. Through this manuscript we developed the question of the risk stratification for recurrence at the population level and the probability of lymph node involvement estimation at an individual level in early stage endometrial cancer. This double approach was adopted with the aim to illustrate the interest of these tools in clinical practice. At the population level, we proposed: i) a comparison of the main international clinicopathological classifications ii) a new clinicopathological classification based on a pathological predictor iii) two risk stratification systems for recurrence and lymph node metastasis. At the individual level we developed: i) a reproducible methodology for external validation of predictive models, ii) a specific clinic pathological nomogram for lymph node metastasis. In the future, the emerging field of molecular or biochemical markers research may substantially improve the predictive approach for preventive and curative strategies in endometrial cancer.

Endometrial cancer is the fourth most common cancer in women and the most common gynecological malignancy. While patient outcome has improved for the majority of cancers, the outlook for endometrial cancer has steadily decreased. In order to address this problem, we must better understand the different mechanisms involved in endometrial cancer development and progression. To this end, we quantified expression of 667 miRNAs in four endometrioid adenocarcinoma and four serous adenocarcinoma using Taqman Low Density Arrays (TLDAs). miR-888 was one of the most highly overexpressed miRNAs in both endometrial cancer subtypes. Analysis of miR-888 expression across multiple cancer types using the The Cancer Genome Atlas database revealed that miR-888 was selectively expressed in endometrial cancer, with a significant association to invasive and high grade tumors. In addition, miR-888 was most predominantly expressed in endometrial carcinosarcoma, a rare but deadly form of endometrial cancer. Therefore, we conclude that miR-888 expression marks an aggressive endometrial tumor phenotype. One of the top predicted targets of miR-888 by TargetScan is the progesterone receptor (PR). PR is a potent tumor suppressor of the endometrium whose expression is often lost in advanced endometrial cancers. We quantified PR mRNA expression in a panel of endometrial tumors and found a statistically significant, negative correlation between miR-888 and PR mRNA expression. Furthermore, overexpression of miR-888 in endometrial cancer cell lines was capable of decreasing PR at the protein level. To determine if miR-888 directly targets PR, we cloned each of the four miR-888 binding sites downstream of Renilla luciferase into the psiCHECK2 reporter vector. miR-888 overexpression was capable of decreasing luciferase activity for all four binding sites, with the second and third binding sites producing the most prominent results. Here we describe a novel mechanism by which miR-888 inhibits PR mRNA translation to negatively regulate PR expression in endometrial tumors. To determine the endogenous function of miR-888 in human cells, we quantified miR-888 in a panel of 21 normal human tissues. Interestingly, miR-888 was highly expressed in testes, with minimal or absence of expression in all other tissues investigated. The restricted expression pattern of miR-888 in testes and cancer suggested that miR-888 may qualify as a novel cancer-testis (CT) antigen. CT-antigens are a large class of genes that demonstrate selective expression normally in testes germ cells and abnormally in various types of cancer. Furthermore, CT-antigen genes are predominantly located on the X chromosome and are part of evolutionarily novel multicopy gene families. Indeed, miR-888 is part of a multicopy, primate-specific miRNA gene family located on the X-chromosome. Furthermore, miRNA in situ hybridization localized miR-888 expression to the early stages of spermatogenesis, as is often observed for CT antigens. Together, these data identify miR-888 as the first miRNA CT antigen and expand the CT antigen field to noncoding RNAs.

Apoptosis is a process of the programmed cell death in response to severe mutations in DNA or cell stress. Apoptosis plays a key role in tissue maintenance by eliminating senescent and damaged cells. Various molecules take part in apoptosis, main participants are Bcl-2 protein family and caspases. The latter one are responsible for apoptosis execution, while Bcl-2 protein family regulates apoptotic pathway. Failure of this regulation may cause several pathologies, including development of neoplastic tissue. Human endometrium is a speci c tissue, in which apoptosis is present in cycling pattern. Present study shows expression level of Bcl-2, Bax, Bad, Bid, pro-caspase-3, caspase-3 and PARP in normal, atrophic, hyperplastic and cancerous (Grade I and II) human endometrium. Bad and Bid proteins can be possible breakpoints in neoplastic transfer due to opposit expression in cancerous and hyperplastic endometrium.

Background: Resveratrol is emerging as a novel anticancer agent. However, the mechanism(s) by which resveratrol exerts its effects on endometrial cancer (EC) are unknown. We previously reported that β-arrestin 2 plays a critical role in cell apoptosis. The role of β-arrestin 2 in resveratrol modulation of endometrial cancer cell apoptosis remains to be established. Scope of Review: EC cells HEC1B and Ishikawa were transfected with either β-arrestin 2 RNA interfering (RNAi) plasmid or β-arrestin 2 full-length plasmid and control vector. The cells were then exposed to differing concentrations of resveratrol. Apoptotic cells were detected by TUNEL assay. Expression of total and phosphorylated Akt (p-Akt), total and phosphorylated glycogen synthase kinase 3 beta (p-GSK3β), and caspase-3 were determined by Western blot analysis. Our data demonstrate that inhibition of β-arrestin 2 increases the number of apoptotic cells and caspase-3 activation. Additionally β-arrestin 2 exerted an additive effect on resveratrol-reduced levels of p-Akt and p-GSK3β. Overexpression of β-arrestin 2 decreased the percentage of apoptosis and caspase-3 activation and attenuated resveratrol-reduced levels of p-Akt and p-GSK3β. Taken together, our studies demonstrate for the first time that β-arrestin 2 mediated signaling plays a critical role in resveratrol-induced apoptosis in EC cells. Major Conclusions: Resveratrol primes EC cells to undergo apoptosis by modulating β-arrestin 2 mediated Akt/GSK3β signaling pathways. General significance: These inspiring findings would provide a new molecular basis for further understanding of cell apoptotic mechanisms mediated by β-arrestin 2 and may provide insights into a potential clinical relevance in EC.

Ziel der Studie war die morphologisch-funktionelle Charakterisierung der Endometrose mittels konventioneller histopathologischer und neuer immunhistologischer Methoden. Die Ergebnisse wurden mit den Abfohlraten der untersuchten Stuten verglichen, um eine genauere Prognose hinsichtlich der Fertilität zu erhalten. Innerhalb der physiologischen Decksaison wurden von 159 klinisch gesunden, östrischen Stuten (3 bis 21 Jahre alt) Endometriumbioptate entnommen. Die Stuten wurden danach im selben Jahr besamt und nach Erfassen der Abfohlraten im folgenden Jahr in zwei Gruppen eingeteilt: güste Stuten und nicht güste Stuten. Im Rahmen einer Doppelblind-Studie wurden endometriale Alterationen lichtmikroskopisch erfasst sowie Grad und Qualität der Endometrose histomorphologisch definiert. Repräsentativ ausgewählte Bioptate (n=82) wurden immunhistologisch auf die Expression der Steroidhormonrezeptoren (Östrogenrezeptor, ER; Progesteronrezeptor, PR) und ausgewählter endometrialer Proteine (Uteroglobin, UG; Uterokalin, UK; CalbindinD9k, CAL; Uteroferrin, UF) untersucht. 101/159 Stuten zeigen eine, qualitativ und quantitativ variierende, Endometrose. Die fibrotischen Uterindrüsen weisen, im Vergleich zu unveränderten Drüsen, ein zyklusasynchrones, teilweise innerhalb eines Drüsenquerschnittes ungleichmäßiges endometriales Proteinmuster auf. Das ungleichmäßige Expressionsmuster kann als Zeichen einer endometrialen Fehldifferenzierung innerhalb fibrotischer Areale interpretiert werden. Die Aktivität der Endometrose hat keinen Einfluss auf das endometriale Proteinmuster. Güste Stuten besitzen häufiger einemittelgradige, vorwiegend destruierende, inaktive oder gemischte Endometrose. Insbesondere in Arealen mittelgradiger destruierender Endometrosen ist eine deutlich verminderte Expression von UG und UK nachweisbar. Auch in der geringgradigen Endometrose werden häufiger beide Proteine gleichzeitig zyklusasynchron exprimiert. UF wird innerhalb höhergradiger destruierender fibrotischer Herde überweigend intensiver exprimiert als in den unveränderten Epithelien, während CAL vielfach ein variables Proteinmuster besitzt. Nicht güste Stuten hingegen zeigen häufig eine geringgradige aktive oder inaktive Endometrose. Bei diesen Stuten weist ein hoher Anteil betroffener glandulärer Epithelien in der mittelgradigen Endometrose entweder eine zyklussynchrone oder geringgradig zyklusasynchrone Expression von UG, UK und CAL auf. UF wird auch in dieser Gruppe häufig intensiver in fibrotischen Drüsen exprimiert. Zwischen güsten und nicht güsten Stuten bestehen charakteristische Unterschiede im Expressionsmuster von UG und UK: nicht güste Stuten besitzen in gering- und mittelgradig fibrotisch veränderten Uterindrüsen häufiger eine zyklussynchrone Proteinexpression als güste Stuten und seltener deutliche Abweichungen in der Expression von entweder UG oder UK. Stuten beider Gruppen besitzen eine zyklusasynchrone Expression der ER und PR sowohl in den periglandulären fibrotischen Stromazellen als auch im Drüsenepithel. Die glanduläre Hormonrezeptorexpression ist tendenziell abhängig von der Aktivität der Endometrose. Diese Resultate sprechen für eine Abkopplung fibrotischer Areale von den uterinen Kontrollmechanismen. Im Rahmen dieser Studie konnte überwiegend bei güsten Stuten in der Endometrose, im Vergleich zu unveränderten Drüsen, ein deutlich abweichendes endometriales Proteinmuster von UG und UK dargestellt werden. Insbesondere bei Tieren, die an einer mittelgradigen destruierenden Endometrose leiden, könnte diese Tatsache als Hinweis auf eine fertilitätsmindernde Beeinflussung des uterinen Mikromilieus im Rahmen der Endometrose interpretiert werden. Die vorliegende Untersuchung unterstreicht die Notwendigkeit einer genaueren Klassifizierung der Endometrose und empfiehlt, zusätzlich zum Grad auch die Qualität der Endometrose sowie das endometriale Expressionsmuster von UG und UK in der Epikrise für eine präzisere Fertilitätsprognose zu berücksichtigen.:1 EINLEITUNG........................................................................................................... 1 2 LITERATURÜBERSICHT ....................................................................................... 2 2.1 Fertilität in der Pferdezucht.............................................................................................. 2 2.2 Die Endometriumbiopsie bei der Stute ............................................................................ 4 2.2.1 Indikationen................................................................................................................... 4 2.2.2 Repräsentativität............................................................................................................ 4 2.2.3 Kategorisierung ............................................................................................................. 5 2.3 Der Sexualzyklus der Stute................................................................................................ 7 2.3.1 Allgemeine Betrachtungen............................................................................................ 7 2.3.2 Histomorphologie des Endometriums in den Zyklusphasen......................................... 9 2.3.3 Regulation des endometrialen Zyklus......................................................................... 12 2.3.4 Immunhistologische Untersuchungen zur Expression der Östrogen- und Progesteronrezeptoren am Endometrium der Stute im Zyklusverlauf ........................ 13 2.4 Sekretorische Aktivitäten des Uterus ............................................................................. 15 2.4.1 Allgemeine Betrachtung........................................................................................... 15 2.4.2 Endometriale Proteine .............................................................................................. 16 2.4.2.1 Uteroglobin............................................................................................................... 16 2.4.2.2 Uteroferrin................................................................................................................ 17 2.4.2.3 Uterokalin................................................................................................................. 18 2.4.2.4 CalbindinD9k ............................................................................................................. 19 2.4.2.5 Regulation der endometrialen Proteine.................................................................... 19 2.4.2.6 Die endometrialen Proteine im Zyklusverlauf bei der Stute.................................... 21 2.4.2.7 Die endometrialen Proteine während der Gravidität bei der Stute .......................... 22 2.5 Die equine Endometrose .................................................................................................. 24 IV 2.5.1 Allgemeine Betrachtungen....................................................................................... 24 2.5.2 Histomorphologische und elektronenmikroskopische Untersuchungen der Endometrose............................................................................................................. 25 2.5.3 Immunhistologische Untersuchungen der Endometrose.......................................... 29 2.5.3.1 Östrogen- und Progesteronrezeptoren...................................................................... 29 2.5.3.2 Sekretorische Proteine.............................................................................................. 30 2.5.4 Die Endometrose während der Gravidität und im Puerperium................................ 31 2.5.5 Mögliche Einflussfaktoren auf die Endometrose ..................................................... 32 2.5.6 Ansätze zur Ätiologie und Pathogenese der Endometrose ...................................... 33 3 TIERE, MATERIAL UND METHODEN ................................................................. 36 3.1 Tiergut und Probenherkunft........................................................................................... 36 3.2 Nähere Charakterisierung des Tiergutes....................................................................... 36 3.3 Methoden.......................................................................................................................... 37 3.3.1 Probenentnahme und Probenaufbereitung .................................................................. 37 3.3.2 Anfertigung und Färbung der Schnitte........................................................................ 37 3.3.3 Lichtmikroskopische Auswertung und Kategorisierung............................................. 37 3.4 Immunhistologische Methoden ....................................................................................... 39 3.4.1 Immunhistologische Kontrollen.................................................................................. 39 3.4.2 Auswertung der immunhistologischen Untersuchungen............................................. 39 3.5 Statistische Untersuchungen ........................................................................................... 41 4 ERGEBNISSE....................................................................................................... 42 4.1 Allgemeine histopathologische Befunderhebung im eigenen Untersuchungsgut....... 42 4.1.1 Gruppeneinteilung der Stuten mit einer Endometrose ................................................ 43 4.1.2 Prävalenz der Endometrose im Untersuchungsgut...................................................... 44 4.1.3 Endometrose und Endometritis ................................................................................... 46 4.1.4 Endometrose und Angiosklerose................................................................................. 46 V 4.1.5 Endometrose und Perivaskulitis.................................................................................. 46 4.1.6 Kategorisierung ........................................................................................................... 46 4.2 Histomorphologische Charakteristika der Endometrose im eigenen Untersuchungsgut unter Berücksichtigung der anamnestischen Daten ..................... 48 4.2.1 Aktive Endometrose.................................................................................................... 51 4.2.2 Inaktive Endometrose.................................................................................................. 52 4.2.3 Gemischte Endometrose.............................................................................................. 53 4.2.4 Aktive destruierende Endometrose ............................................................................. 53 4.2.5 Inaktive destruierende Endometrose ........................................................................... 54 4.2.6 Gemischte destruierende Endometrose ....................................................................... 54 4.3 Gruppenspezifischer Vergleich zwischen Stuten mit einer Endometrose und Stuten mit einer Endometrose und Endometritis ......................................................... 55 4.4 Immunhistologische Untersuchungen der unterschiedlichen Erscheinungsformen der Endometrose im eigenen Untersuchungsgut........................................................... 58 4.4.1 Immunhistologische Ergebnisse der Steroidhormonrezeptor-Analyse.................... 58 4.4.1.1 Aktive Endometrose................................................................................................. 58 4.4.1.2 Inaktive Endometrose............................................................................................... 59 4.4.1.3 Gemischte Endometrose........................................................................................... 60 4.4.1.4 Aktive destruierende Endometrose .......................................................................... 61 4.4.1.5 Inaktive destruierende Endometrose ........................................................................ 61 4.4.1.6 Gemischte destruierende Endometrose .................................................................... 62 4.4.2 Immunhistologische Ergebnisse zum Nachweis der endometrial synthetisierten Proteine..................................................................................................................... 64 4.4.2.1 Aktive Endometrose................................................................................................. 64 4.4.2.2 Inaktive Endometrose............................................................................................... 66 4.4.2.3 Gemischte Endometrose........................................................................................... 67 4.4.2.4 Aktive destruierende Endometrose .......................................................................... 69 4.4.2.5 Inaktive destruierende Endometrose ........................................................................ 70 4.4.2.6 Gemischte destruierende Endometrose .................................................................... 71 VI 4.5 Gruppenspezifischer Vergleich der immunhistologischen Ergebnisse zwischen Stuten mit einer Endometrose und Stuten mit einer Endometrose und Endometritis ... 73 4.6 Vergleichende Zusammenfassung der histopathologischen und immunhistologischen Befunde unter Berücksichtigung der anamnestischen Daten ........................ 78 5 DISKUSSION ........................................................................................................ 82 5.1 Ziele der Arbeit................................................................................................................. 82 5.2 Kritische Beurteilung des Untersuchungsmaterials und der Untersuchungsmethoden ........................................................................................................................... 82 5.3 Die equine Endometrose .................................................................................................. 83 5.3.1 Allgemeine Betrachtungen zur Endometrose.............................................................. 83 5.3.2 Morphologie der Endometrose.................................................................................... 84 5.3.3 Einflussfaktoren auf die Endometrose ........................................................................ 87 5.3.4 Kategorisierung ........................................................................................................... 88 5.3.5 Veränderungen im sekretorischen Proteinmuster im Rahmen der Endometrose........ 90 5.3.6 Mögliche Konsequenzen eines defizienten Proteinmusters auf die Fertilität ............. 94 6 ZUSAMMENFASSUNG ........................................................................................ 97 7 SUMMARY............................................................................................................ 99 8 LITERATURVERZEICHNIS .................................................................................101 9 ANHANG..............................................................................................................112 9.1 Charakterisierung des Tiergutes mit einer Endometrose .......................................... 112 9.2 Für die Immunhistologie verwendete Antikörper, Seren und Positivkontrollen..... 115 9.3 Verfahrensschritte der immunhistologischen Untersuchungen ................................ 118 9.3.1 Vorbehandlung .......................................................................................................... 118 VII 9.3.2 Besondere Verfahren................................................................................................. 118 9.3.3 Antigennachweis mittels monoklonaler AK nach der PAP-Methode....................... 119 9.3.4 Antigennachweis mittels polyklonaler AK nach der PAP-Methode......................... 119 9.3.5 Standard zur Nachbehandlung .................................................................................. 120 9.3.6 Lösungen und Puffer ................................................................................................. 120 9.4 Bilddokumentation

Approximately 40,000 women in the U.S. are diagnosed with endometrial cancer annually. Biological data suggest coffee or tea consumption may lower endometrial cancer risk through estrogenic and insulin-mediated pathways. Epidemiologic data are inconsistent, with two of three prospective cohort studies showing an inverse association with coffee consumption and two prospective cohort studies finding no association with tea consumption. We used publicly available data from the Women's Health Initiative Observational Study to evaluate the association between coffee, tea and endometrial cancer risk. We identified 48,912 eligible post-menopausal women with a mean follow-up time of 7.5 years. During this period there were 452 incident endometrial cancer cases. We used Cox-proportional hazard models to evaluate the effects of coffee and tea consumption on endometrial cancer risk, while adjusting for potential confounders including age, body mass index and hormone therapy use. Overall, we did not find an association between coffee consumption and endometrial cancer risk. Compared to women who did not drink coffee on a daily basis (none or < 1 cup/day), the multivariable adjusted hazard ratios for women who drank 2-3 cups/day was 0.95 [95% confidence interval (CI) 0.74,1.22] for total coffee, 0.91 (95% CI 0.68,1.23) for regular coffee, and 0.94 (0.62,1.42) for decaf coffee. Compared to obese women who did not drink coffee on a daily basis (none or < 1 cup/day), the multivariable adjusted hazard ratios (HR) for obese women who drank ≥ 2cups/day as reported at baseline were: 0.79 (95% CI 0.53,1.17] for total coffee, 0.62 (95% CI 0.39,1.00) for regular coffee, and 0.78 (95% CI 0.40,1.50) for decaf coffee. Furthermore, obese women who consistently reported drinking ≥2 cups of regular coffee/day had an even further reduced risk [HR 0.40 (95% CI 0.18,0.91)]. In comparison to women who did not drink tea on a daily basis, obese women who drank 1 cup and ≥ 2cups of tea/day had multivariable adjusted hazard ratios of 0.45 (95% CI 0.22,0.92) and 0.99 (95% CI 0.60,1.62), respectively. The results from our study suggest that regular coffee consumption may be protective against endometrial cancer among obese postmenopausal women, with inconclusive results for tea. Our study adds to the biological understanding and to the small body of prevalent epidemiologic literature on coffee consumption and endometrial cancer risk.

Structured abstract Study objectives: Ovarian carcinoma 1/ comparison of sensitivities among monitored markers CA 125, HE4, CA 19-9, CEA, TK, TPS, MonoTotal 2/ comparison of false positivity of markers CA 125 and HE4 3/ use of CA 125, HE4 and ROMA index in the diagnostics of ovarian carcinoma 4/ use of CA 125 and HE4 in the follow-up of ovarian cancer Endometrial carcinoma 1/ feasibility of use of biomarkers CA125 and HE4 in patients with endometrial cancer in pre- operative management Study design: Retrospective data analysis Settings: Department of Obstetrics and Gynecology, Medical Faculty and Teaching Hospital in Pilsen Patients and Methods: Ovarian cancer 1/ Sensitivity of markers CA 125, HE4, CA 19-9, CEA, TK, TPS, and MonoTotal was assessed in 266 patients - 19 with ovarian cancer and 247 with benign disorders. 2/ False positivity of markers CA125 and HE4 was evaluated in a total of 390 patients with benign diagnoses - 60 women with endometriosis, 70 pregnant patients, 67 patients with ascites, 60 with pleural effusion, 25 with cardiac failure , 80 with renal insufficiency and 28 with hepatic failure. 3/ As a part of this objective we evaluated 552 patients with abnormal pelvic abnormality - 30 women had a histologically confirmed malignant ovarian tumor. Other 522 women had a benign condition. The...

No description available.