Kim HK, et al. J Menopausal Med. 2015 Aug;21(2):65-71. http://dx.doi.org/10.6118/jmm.2015.21.2.65

Hydrosalpinx is a common adnexal lesion that may occur either in isolation or as a component of a complex pathologic process (eg, pelvic inflammatory disease, endometriosis, fallopian tube tumor, or tubal pregnancy) that leads to distal tubal occlusion. On magnetic resonance (MR) images, hydrosalpinx appears as a fluid-filled C- or S-shaped tubular structure that arises from the upper lateral margin of the uterus. Although hydrosalpinx is most often seen on ultrasonographic images, it also may be delineated on multiplanar MR images. MR imaging also may be useful for determining the cause of a hydrosalpinx or its associated adnexal process by characterizing the nature of the contents of the dilated tube. Tubal fluid with high signal intensity on T1-weighted images is suggestive of hematosalpinx associated with endometriosis and tubal pregnancy. A thickened wall of a dilated fallopian tube that displays variable or heterogeneous signal intensity may be indicative of pyosalpinx as a component of a tubo-ovarian abscess. The presence of an enhancing solid mass within a dilated tube is suggestive of fallopian tube carcinoma, whereas enhancement of the dilated tubal wall surrounding a saclike cystic mass may be indicative of a tubal pregnancy. Understanding the pathogenesis and clinical manifestations of conditions associated with hydrosalpinx may aid in the timely diagnosis of complex adnexal masses at MR imaging, enabling avoidance of unnecessary procedures.

Sohn GS, et al. Obstet Gynecol Sci. 2018 Mar;61(2):192-201. https://doi.org/10.5468/ogs.2018.61.2.192

Recurrent somatic mutations in MED12 exon 2 have recently been reported in uterine leiomyomas. The recurrent nature of the mutations strongly suggests that the mutations may play important roles in the pathogenesis of uterine leiomyomas. The aim of our study was to see whether MED12 exon 2 mutations occur in other human tumors besides uterine leiomyomas. We also attempted to confirm occurrence of the MED12 mutations in uterine leiomyomas of Korean patients. For this, we analyzed 1,862 tumor tissues, including a variety of carcinomas, leukemias and stromal tumors by single‐strand conformation polymorphism analysis. We found MED12 mutations in 35 uterine leiomyomas (35/67; 52.2%) and one colon carcinoma (0.3%), but none in other tumors. The MED12 mutations consisted of missense (77%) and inframe insertion‐deletion (23%) mutations, the pattern of which was similar to the earlier report. Our data indicate that MED12 exon 2 mutations may be tissue‐specific to uterine leiomyoma and rare in other tumors. Our study suggests that the MED12 mutations play unique roles in the pathogenesis of uterine leiomyomas and mutated MED12 could be therapeutically targeted in uterine leiomyomas.

Endometriosis causes significant chronic pelvic pain, dysmenorrhea, and infertility and affects 10% of all women. In endometriosis, ectopic endometrium surviving after retrograde menstruation exhibits an abnormal immune response characterized by increased levels of activated macrophages and inflammatory cytokines. Particularly, dysfunctional natural killer (NK) cells play an important role in the pathogenesis of the disease by either facilitating or inhibiting the survival, implantation, and proliferation of endometrial cells. NK cells in the peritoneum and peritoneal fluid exhibit reduced levels of cytotoxicity in women with endometriosis. Several cytokines and inhibitory factors in the serum and peritoneal fluid also dysregulate NK cell cytotoxicity. Additionally, increased numbers of immature peripheral NK cells and induction of NK cell apoptosis are evident in the peritoneal fluid of women with endometriosis. The high rate of endometriosis recurrence after pharmaceutical or surgical treatment, which is associated with dysfunctional NK cells, indicates that new immunomodulatory management strategies are required. A good understanding of immune dysfunction would enable improvement of current treatments for endometriosis.