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Aim. To determine the clinical, anamnestic, and immunological predictors of adenomyosis by developing a prognostic model of uterine fibroids with concomitant adenomyosis. Materials and methods. A retrospective single-center study was conducted at Kurbatov Novokuznetsk City Clinical Hospital №1, from 2012 to 2019. The model included 284 women with histologically confirmed uterine fibroids, of which 34.9% (99/284) were fibroids with adenomyosis and 65.1% (185/284) were isolated uterine fibroids. Logistic regression was used to develop the mathematical model. Results. Predictors of adenomyosis in patients with uterine fibroids have been established: age 43 years and older, concomitant endometrial hyperplasia, chronic inflammatory diseases of the cervix, menometrorrhagia, history of childbirth, history of endometrial disorders, varicose veins of the lower extremities, history of appendectomy, blood serum lactoferrin of more than 1.8 mg/L, interleukin-6 levels more than 2.8 pg/mL. The model has an accuracy of 91%, a sensitivity of 90%, a specificity of 92%, a positive predictive value of 85%, and a negative predictive value of 94%. Conclusion. The established predictors of adenomyosis allow for predicting the risk of adenomyosis in patients with uterine fibroids, facilitating effective treatment choices.

RELEVANCE Pregnant uterus perforation during laparoscopy is a rare complication, accompanied by a higher risk of infection and miscarriage. Clinical management of pregnancy and its outcome have practical interest and need discussion.AIM To provide a clinical case of pregnant uterus perforation during laparoscopy.MATERIAL AND METHODS  Patient L., 34 years old, with a tumor of the right ovary and 21–22 weeks of pregnancy. Result The article describes a clinical case of independent childbirth on time after pregnant uterus perforation during laparoscopy with removing a significant volume of amniotic fluid in a 21–22 weeks pregnant woman.CONCLUSION The prolongation of pregnancy and independent childbirth on time after uterus perforation with a gestation period of 21 or 22 weeks is possible in case of timely diagnosis of the complication, careful restoration of uterine integrity and rational management of the postoperative period.

Objective. To perform comparative analysis of clinical data, serum levels of acute-phase proteins, cytokines, steroid hormones, and expression of genes encoding sex hormone receptors in tissues of patients with proliferative diseases of the uterus. Patients and methods. We analyzed clinical data of 349 patients with various proliferative diseases of the uterus. We also evaluated their serum levels of α2-macroglobulin, pregnancy-associated α2-glycoprotein, their immunocomplexes with IgG, lactoferrin, VEGF, IL-6, TNFa, IL-8, and sex hormones. Uterine tissue samples were tested for the expression of genes encoding estrogen receptors α and β (ЕRα, ЕRβ) and progesterone receptors (PGR). Data analysis was performed using the statistical packages of SAS 9.4, STATISTICA12, and IBM-SPSS Statistics 22. Results. The changes in the level of acute-phase proteins indicated inflammation. In isolated uterine fibroids, expression of genes encoding progesterone receptors prevailed, whereas in isolated adenomyosis, expression of genes encoding estrogen receptors prevailed. Patients with both uterine fibroids and adenomyosis demonstrated similar levels of expression of genes encoding sex steroid hormone receptors. Tissues of uterine leiomyosarcoma were characterized by downregulated expression of genes encoding sex steroid hormone receptors. Conclusion. Upregulation of genes encoding progesterone receptors in isolated uterine fibroids confirms that therapy with progesterone receptor blockers is appropriate in this case. The predominance of expression of genes encoding estrogen receptors in isolated adenomyosis indicates local hyperestrogenism, justifying the use of progestogens and antiestrogens. Equal expression of genes encoding estrogen and progesterone receptors in patients with combined disease, as wells as high frequency of inflammatory changes in tissues and increased serum levels of inflammatory markers, proves the need for antiinflammatory therapy. Key words: adenomyosis, inflammation, steroid receptor genes, leiomyosarcoma, uterine fibroids, gene expression