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Advanced Cell Therapy for Asherman's Syndrome
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Jordi Ventura, Xavier Santamaria
The endometrium is the inner layer of the uterus, which is composed of the basal layer and the functional layer. The functional layer is the one which thickens and sheds during the menstrual cycle, whereas the basal layer maintains its size and works as the starting point for the regeneration of the functional layer. The endometrium is composed mostly of stromal and epithelial cells, but recent evidence suggests that stem progenitor cells, mostly present in the basalis layer, participate in regenerating the tissue in each menstrual cycle (1–3). At first, the principal candidates for this role were the mesenchymal stromal progenitor cells and the epithelial progenitor cells (4–6), but some groups have reported that there are bone marrow progenitor cells which collaborate in the regeneration of the endometrium, which could be the bone marrow-derived mesenchymal stem cells or the endothelial progenitor cells (EPCs) (7–10). Although this is a controversial issue, an adequate thickness of the endometrium seems to be necessary for the embryo to implant, which is usually achieved between days 20 and 24 of the natural menstrual cycle (11–13). During this period, the endometrium undergoes pronounced structural and functional changes induced by ovarian steroidal hormones, mainly estrogen and progesterone, to allow the implantation of the embryo (14,15). Alteration in endometrial receptivity is one of the most common causes of infertility (16,17).
The Uterus
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Jure Knez, Veljko Vlaisavljević
The uterine wall consists of several layers. These are the serosa, myometrium, junctional zone, and endometrium. The serosa is a peritoneal covering of the uterus and is seen on ultrasound as a hyperechoic outline. The myometrium is composed of smooth muscle and uterine blood vessels. On ultrasound it is normally seen as a layer of low-level echogenicity. The junctional zone has only recently been recognized as a separate histological and embryological entity. The endometrium represents the innermost part of the uterus. It is the hormone responsive tissue that varies in appearance depending on the menstrual cycle. In the following text, we cover some of the most common pathologies that can affect different parts of the uterus and can influence the reproductive potential of women.
Obstetrics and Gynaecology
Published in Seema Khan, Get Through, 2020
Endometriosis is a condition in which the cells of the inner lining of the uterus, the endometrium, are deposited outside the uterine cavity. Up to 30% of women undergoing investigations for infertility have been found to have endometriosis at laparoscopy.
A method to protect the endometrium for microwave ablation treating types 1-3 uterine fibroids: a preliminary comparative study
Published in International Journal of Hyperthermia, 2023
Hong-Hui Su, Dong-Ming Guo, Pei-Shan Chen, Meng-Hong Cai, Yu-Xia Zhai, Zhe Chen, Wei-Jian Luo, Zhi-hui Lin, Wen-Bin Zheng
In this study, we performed hysteroscopy within 3 days after the operation for patients in the study group to assess thermal damage to the endometrium. Most of the patients in the study group showed no signs of thermal damage to the endometrium. Ten patients showed a disturbed endometrium with congestion and reddening, which was likely caused by heat. Such lesions were mild and were quickly repaired by the endometrium itself. In a 39-year-old patient with a FIGO type 2 fibroid, burnt necrosis with a range of < 1 cm on the functional layer surface of the endometrium was observed after ablation. However, the deep portion of the functional layer and the basal layer of the endometrium were intact. Due to the higher water content [18] and vascularity [19,20] of the endometrium, this type of impaired endometrium can be repaired spontaneously [14] without affecting reproductive function. This patient had superficial endometrial impairment and necrosis that was probably caused by the loss of the cooling effect due to failure to detect the displacement of the needle in a timely manner during the operation. Therefore, this method requires the operator to check for puncture needle displacement from time to time, especially when ablating fibroids adjacent to the endometrium.
Comprehensive Assessment of ERα, PR, Ki67, P53 to Predict the Risk of Lymph Node Metastasis in Low-Risk Endometrial Cancer
Published in Journal of Investigative Surgery, 2023
Yuzhen Huang, Peng Jiang, Wei Kong, Yuan Tu, Ning Li, Jinyu Wang, Qian Zhou, Rui Yuan
Endometrial cancer is a common malignant cancer in women, especially for perimenopausal and postmenopausal women. The incidence of endometrial cancer is growing in both developed and underdeveloped regions. With changes in fertility concept and economic development, the incidence in East Asia and South Asia showed a rapid growth trend [1]. According to the recommendations of the international guidelines [2], low-risk patients (low- and medium-grade endometrial cancer, without deep muscle infiltration, which means infiltration depth was less than 1/2, or cervical stromal infiltration) usually did not undergo lymph node resection (including lymph node biopsy, pelvic lymph node dissection, and para-aortic lymph node dissection). However, lymph node metastasis had already occurred in some of these patients [3]. Biopsy of sentinel lymph node has been generally proven to be effectual [4, 5], but its low sensitivity may lead to missing out some patients with lymph node metastasis [3]. The occurrence of lymph node metastasis without proper treatment will result in increasing risk of recurrence and poor prognosis. However, patients who had undergone lymph node resection (including lymph node biopsy, pelvic and para-aortic lymph node ressection) would probably have lower limb lymphedema [6], urinary incontinence [7], and other complications after surgery. Accurately determining whether a patient needs lymph node resection will strongly influence the survival and life quality of patient with endometrial cancer after surgery.
Protective effects of L-carnitine on X irradiation-induced uterus injury via antioxidant and anti-inflammatory pathways
Published in International Journal of Radiation Biology, 2023
Serkan Karacetin, Meryem Akpolat, Zehra Safi Oz, Ayse Ceylan Hamamcioglu
The inner surface of the uterus is covered by the endometrium. The endometrium is composed of the columnar epithelium and lamina propria. When the structure of lamina propria was evaluated, rich glandular components and highly cellular stroma was found. In both surface epithelial and glandular cells, the mitotic figures were visible. Not only myometrium but also uterine serosa was photographed in regular sizes when considering their histological appearances (Figure 1(A)). For both radiation-1 and radiation-2 groups, severe apoptosis appeared on the irregular endometrial surface as well as on the glandular epithelium. On the endometrial stroma, diffuse eosinophilic leucocyte and lymphocyte infiltration were occurred (Figure 1(B,C)). In the LC treated groups following irradiation, only a mild apoptosis appeared on the endometrial surface of the epithelial and glandular cells in comparison with the radiation groups. Similarly, in LC treated groups, eosinophilic leucocyte and lymphocyte infiltration were also reduced (Figure 1(D,E)).