Blog dedicated to the continuous education in Gynecology and Endocrinology


Influence of sex hormones in women on breast elasticity measured by shearwave sonoelastography – a cross-sectional study.

DGYE-2011-0006.R1 5

Rzymski Pawel ; Wilczak Maciej; Opala Tomasz

The physiology of breast depends on age, hormonal status, menstrual cycle, lactation and others. The aim of our study was to evaluate correlations between hormonal status and breast glandular and fat tissue elasticity in healthy women. We examined 77 women aged 20-55 with shear wave sonoelastography and estimated their hormonal levels. There were no important correlations between breast elasticity, Follicle-Stimulating Hormone, Estrogen, prolactine and thyroid hormones (p>0.05). Androgens negatively influenced glandular to fat elasticity ratio (Rs=-0.25,p<0.005). Luteinizing Hormone to Follicle-Stimulating Hormone ratio correlated positively with glandular and fat elasticity, especially in outer-upper quadrant (Rs=0.24,p=0.003).

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From struma ovarii to Hashimoto disease – an unusual diagnosis of primary hypothyroidism: case report

DGYE-2010-0363.R1 3

Berendt-Obolonczyk Monika ; Siekierska-Hellmann Malgorzata; Wojtylak Szymon; Obolonczyk Lukasz; Sworczak Krzysztof

Case summary – Struma ovarii is a type of mature teratoma in which thyroid tissue forms the main component. In most cases struma ovarii is composed of normal thyroid tissue while lymphocytic thyroiditis in struma ovarii occurs very rarely.

The authors report a case of a 52-year-old woman after ovarian tumor excision. In histopatholgical examination struma ovarii with chronic lymphocytic inflammation was diagnosed. Additional studies revealed a typical ultrasonographic picture of Hashimoto disease in the thyroid gland and an increased concentration of thyroglobulin antibodies. A final diagnosis of Hashimoto disease was confirmed. Initially thyroid gland function was normal but eleven months after surgery, supplementation therapy with thyroxin was administered.

In this case an early diagnosis of Hashimoto disease resulted from excision of struma ovarii with chronic lymphocytic inflammation. It induced early thyroxin treatment and allowed to reduce hypothyroidism symptoms.

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DGYE-2010-0372.R1 4

Macchia Enrico ; Lupi Isabella; Fessehatsion Rezene; Manca Alessandra; Cossu-Rocca Paolo; Martino Enio

Ectopic thyroid tissue in ovarian teratoma or in struma ovarii appears to be histologically identical to the thyroid gland tissue and may virtually exhibit all the pathological patterns found in the thyroid gland. However, the concurrent lymphocytic infiltration of the thyroid gland, as found in Hashimoto’s thyroiditis, and of the ectopic thyroid tissue is extremely rare.

We describe the case of an 18-years old nulliparous patient, asymptomatic, in which a right ovarian 4 cm cyst has been found during pelvic ultrasound exam. The cyst was resected by laparoscopic surgery. Microscopic examination of the mass revealed a mature cystic teratoma in which epidermal-like lining with skin adnexa, admixed with respiratory type epithelium, and areas of mature fatty, chondroid and dentigerous tissues were found. In a peripheral area of 0.7×0.5 cm, a prominent lymphocytic infiltrate surrounding thyroid follicles was identifiable. Thyroid function evaluation at different time points after surgery, revealed the development of mild hypothyroidism. Serum anti-TPO and anti-Tg autoantibodies were elevated. Thyroid ultrasound showed an enlarged gland with multiple bilateral hypo-echoic pseudo-nodular areas. At fine needle aspiration biopsy a lymphocytic infiltrate, compatible with Hashimoto’s thyroiditis, was present.

We report here a rare case of Hashimoto’s thyroiditis occurring both in the thyroid and in the ectopic thyroid tissue in the context of a benign cystic teratoma of the ovary.

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DGYE-2010-0373.R1 5

Mannella, Paolo (contact); Tosi Veronica; Russo Eleonora Zullino, Sara Pancetti, Federica Gompal, SantHosh Polak Kinga; Genazzani Andrea; Genazzani  Alessandro; Simoncini Tommaso.

Postmenopausal hormone therapy is associated with increased incidence of breast cancer. For this reason alternative therapeutic options to treat menopausal symptoms have been developed. Red clover extracts are rich in isoflavones, particularly genistein and daidzein, and they have been proved to be effective in reducing vasomotor symptoms in a number of studies. Due to their partial selectivity of action on estrogen receptors (ERs) these compounds have been claimed to be safer on the breast. In this paper we explored the action of red clover extracts on motility and invasion of ER positive breast cancer cells and we partially characterized the signaling mechanisms. The principal isoflavones contained in red clover extracts acted as weak estrogenic compounds when administered alone. However, when provided in association with physiological amounts of estradiol, red clover extracts acted as estrogen antagonist on remodeling of actin cytoskeleton that are requested to enact cell movement and with related modifications of the activity of actin-binding proteins, such as moesin. These results offer novel information on the molecular actions of isoflavones contained in red clover on breast cancer cells, supporting a possible action of these molecules as natural selective estrogen receptor modulators in the presence of physiological amounts of estrogens.

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Weight loss significantly reduces serum lipocalin-2 levels in overweight and obese women with polycystic ovary syndrome

DGYE-2010-0327.R3 5

Tziomalos, Konstantinos (contact); Koiou, Ekaterini; Katsikis, Ilias; Kandaraki, Eleni; Kalaitzakis, Emmanuil; Delkos, Dimitrios; Vosnakis, Christos; Panidis, Dimitrios

Serum lipocalin-2 levels are elevated in obese patients. We assessed serum lipocalin-2 levels in polycystic ovary syndrome (PCOS) and the effects of weight loss or metformin on these levels. Forty-seven overweight/obese patients with PCOS [body mass index (BMI) >27 kg/m2] were instructed to follow a low-calorie diet, to exercise and were given orlistat or sibutramine for 6 months. Twenty-five normal weight patients with PCOS (BMI<25 kg/m2) were treated with metformin for 6 months. Twenty-five normal weight and 25 overweight/obese healthy female volunteers comprised the control groups. Serum lipocalin-2 levels did not differ between overweight/obese patients with PCOS and overweight/obese controls (p=0.258), or between normal weight patients with PCOS and normal weight controls (p=0.878). Lipocalin-2 levels were higher in overweight/obese patients with PCOS than in normal weight patients with PCOS (p<0.001). In overweight/obese patients with PCOS, weight loss resulted in a fall in lipocalin-2 levels (p<0.001). In normal weight patients with PCOS, treatment with metformin did not affect lipocalin-2 levels (p=0.484). In conclusion, PCOS per se is not associated with elevated lipocalin-2 levels. Weight loss induces a significant reduction in lipocalin-2 levels in overweight/obese patients with PCOS.

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