Department of Laboratory Genetics, Laboratory Diagnostics, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Gynecology, Military University Hospital and the 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Laboratory Genetics, Laboratory Diagnostics, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
Chest. 2020 Feb;157(2):342-355. doi: 10.1016/j.chest.2019.09.008. Epub 2019 Sep 19.
The occurrence of catamenial pneumothorax (CP) is rare, and the awareness of this diagnosis among physicians is insufficient. CP is highly correlated with pelvic endometriosis and remains the most common form of thoracic endometriosis syndrome. Circulating endometrial cells (CECs) have been previously detected in patients with pelvic endometriosis. Could CECs bring new insights into pneumothorax management?
This study aims to describe the occurrence and molecular characteristics of CECs in women with spontaneous pneumothorax (SP) (N = 20) with high suspicion of its catamenial character. CECs were enriched from peripheral blood by size-based separation (MetaCell). In addition to cytomorphology, gene expression profiling of captured cells was performed for 24 endometriosis-associated genes.
CECs were present in all 20 patients with SP. Enriched CECs exhibited four character features: epithelial, stem cell-like, stroma-like, and glandular. However, not all of them were present in every sampling. Gene expression profiling revealed two distinct phenotypes of CECs in SP and/or CP: one of them refers to the diaphragm openings syndrome and the other to endometrial tissue pleural implantations. Comparisons of the gene expression profiles of CECs in pneumothorax (CECs-SP group) with CECs in pelvic endometriosis (CECs-non-SP group) have revealed significantly higher expression of HER2 in the CECs-SP group compared with the CECs-non-SP group.
This proof-of-concept study demonstrates successful isolation and characterization of CECs in patients with SP. Identification of CECs in SP could alert endometriosis involvement and help early referral to gynecologic consultation for further examination and treatment.
月经性气胸（CP）的发生率较低，医生对此诊断的认识不足。CP 与盆腔子宫内膜异位症高度相关，是胸子宫内膜异位症综合征最常见的形式。先前在患有盆腔子宫内膜异位症的患者中检测到循环子宫内膜细胞（CEC）。CEC 能否为气胸管理带来新的见解？
本研究旨在描述自发性气胸（SP）（N=20）中高度怀疑具有月经特征的 CEC 的发生和分子特征。通过基于大小的分离（MetaCell）从外周血中富集 CEC。除了细胞形态学外，还对捕获细胞进行了 24 个与子宫内膜异位症相关的基因表达谱分析。
20 例 SP 患者的外周血中均存在 CEC。富集的 CEC 表现出四种特征：上皮、干细胞样、基质样和腺体样。然而，并非所有特征都存在于每个样本中。基因表达谱分析揭示了 SP 和/或 CP 中 CEC 的两种不同表型：一种与膈开口综合征有关，另一种与子宫内膜组织胸膜植入有关。与 CECs 在盆腔子宫内膜异位症（CECs-non-SP 组）中的基因表达谱相比，气胸（CECs-SP 组）中 CECs 的基因表达谱显示 HER2 的表达明显更高。
本概念验证研究成功地分离和鉴定了 SP 患者的 CEC。SP 中 CEC 的鉴定可能提示子宫内膜异位症的参与，并有助于早期转介妇科咨询以进一步检查和治疗。
