卵巢绒癌（附6例分析）

卵巢绒癌是最罕见的妇科恶性肿瘤。本文收集1979～1990年卵巢绒癌6例,4例发生在青春期和青春前期妇女,1例少女有性早熟,全部患者尿HCG阳性.3例卵巢单纯绒癌(盆腔转移)中2例存活,1例死亡。3例混合绒癌死亡(2例肺和1例盆腔转移)。诊断根据肿瘤的临床特征和组织学成分。预后与肿瘤所含组织成分、转移以及对化疗的反应有关,机体的免疫能力和治疗方法也影响预后。     

绒癌脑转移的动脉灌注化疗

观察动脉灌注化疗对绒癌脑转移的治疗效果。方法；对１４例绒癌脑转移患者，采用脑转移灶同侧的颈动脉灌注化疗，结合全身静脉化疗，动脉化疗用ＭＴＸ或５－Ｆｕ，静脉化疗用５－ＦＵ，ＫＳＭ。结果；头痛，呕吐于治疗１－３周得到缓解，失语，颅神经损害和偏瘫等在３－８周缓解。４例经ＣＴ，ＭＲＩ检查证实脑转移灶于４－１２周消退。     

保尔佳对人绒癌JAR细胞株抑制作用的观察

应用保尔佳（Polyerga）对人绒癌JAR细胞株作用，观察其对肿瘤细胞生长与形态的影响，检测肿瘤细胞β-hCG分泌和乳酸脱氢酶（LDH）活性的变化。结果显示：保尔佳药物作用后，绒癌细胞数目减少并萎缩。细胞内乳酸脱氨酶反应颗粒明显减少或消失，细胞分泌β-hCG量下降。结果表明，保尔佳具有抑制人绒癌JAR细胞株糖酵解酶活性和细胞分裂增殖的作用，可用于绒癌的辅助治疗。     

Pure choriocarcinoma of the ovary: a case report

Pure ovarian choriocarcinomas are extremely rare and aggressive tumors which are gestational or non-gestational in origin. Due to the rarity of the tumor, there is a lack of information on the clinicopathologic features, diagnosis, and treatment. We report a case of a pure ovarian choriocarcinoma, likely of non-gestational origin, treated by cytoreductive surgery in combination with post-operative chemotherapy. The patient was free of disease after a 12-month follow-up.     

Primary gastric choriocarcinoma: two case reports and a pooled analysis of 53 cases

Primary gastric choriocarcinoma (PGC) is a rare tumor. In total, approximately 140 cases of PGC have been reported in the international medical literature. However, the clinical behavior, tumor characteristics, and prognostic parameters of PGC have not been clearly described. We conducted a pooled analysis to clarify the tumor characteristics and prognostic parameters in 53 patients with PGCs, including 2 patients treated at our hospital. The following variables were examined as potential prognostic factors: (1) sex, (2) age, (3) depth of invasion, (4) size, (5) histology, (6) nodal metastasis, (7) distant lymph node metastasis, (8) synchronous liver metastasis, (9) residual tumor, and (10) chemotherapy (not given or given). Univariate and multivariate analyses showed that the presence of residual tumor and synchronous liver metastasis and the absence of chemotherapy were significantly associated with an increased hazard rate (HR) of short overall survival (OS). Pooled analysis, including the two patients with PGC treated at our facility, demonstrated that the presence of a curative operation and chemotherapy, and the absence of synchronous liver metastasis were the strongest indicators of a favorable clinical course in patients with PGC.     

FAM21对绒毛膜癌细胞系JEG-3迁移和侵袭功能的影响

目的 探讨FAM21对人绒毛膜癌细胞系JEG-3迁移和侵袭功能的影响。方法 设计并合成2条FAM21特异性小分子干扰RNA（siRNA 1和siRNA 2）及1条随机序列siRNA（control siRNA）,瞬时转染JEG-3细胞,依次设为siRNA1组、siRNA 2组和control siRNA组。同时选取未行转染的JEG-3细胞作空白对照（空白组）。普通PCR法检测正常胎盘滋养细胞株HTR-8/Sveno和JEG-3细胞中FAM21 mRNA水平。分别于转染后24、48h采用实时荧光定量PCR和Western blotting检测各组FAM21的mRNA和蛋白水平,Transwell法检测各组转染24h后的细胞迁移和侵袭能力,实时荧光定量PCR检测各组转染24h后的迁移侵袭相关基因（KISS 1、BRMS1和INSL4）的mRNA水平。结果 JEG-3细胞的FAM21 mRNA水平高于HTR-8／Svneo细胞（P＜0.05）。siRNA 1组和siRNA 2组转染24h后的FAM21 mRNA和转染48h后的FAM21蛋白水平均低于control siRNA组和空白组（P＜0.05）,转染24h后的迁移和侵袭能力均低于control siRNA组和空白组（P＜0.05）。siRNA 1组和siRNA 2组转染24h后的KISS-1和BRMS1 mRNA水平降低,而INSL4 mRNA水平升高,与其余两组比较,差异均有统计学意义（P＜0.05）;control siRNA组和空白组上述指标的差异均无统计学意义（P＞0.05）。结论 FAM21在人绒毛膜癌JEG-3细胞中具有调节迁移和侵袭的功能,在绒毛膜癌的病理机制中发挥了重要的作用。     

Choriocarcinoma with Brain Metastasis: Report on Two Cases with Long-term Survivals

Choriocarcinoma is a potentially curable neoplasm. Althoughthe presence of brain metastases worsens the ultimate prognosis,aggressive therapeutic intervention is sometimes justified forbrain metastases of a potentially curable neoplasm. In the presentclinical report, we present two cases of choriocarcinoma withbrain metastasis manifesting neurological deterioration, anddiscuss treatment strategies. From the results of treatment,we conclude that surgical removal of the lesion, followed bychemotherapy combined with irradiation, should be the treatmentof choice in patients with progressive neurological deterioration.     

端粒酶RNA反义寡核苷酸对人绒毛膜癌裸鼠移植瘤的生长抑制作用

目的探讨端粒酶RNA反义寡聚核苷酸(anti-hTR)对绒癌的治疗作用。方法采用绒癌JAR细胞移植裸鼠成瘤,行anti-hTR的低浓度和高浓度治疗,并设立生理盐水组、随机序列组及药物放线菌素D(Act-D)对照组,动态观察并测定肿瘤的生长。采用TRAP-ELISA方法测定端粒酶活性。采用Western blot法测定hTERT蛋白的表达。结果anti-hTR低浓度组、高浓度组和药物Act-D组的抑瘤率分别为76．6％、93．8％和85．4％,三组对肿瘤生长的抑制,与随机序列组和生理盐水组相比,差异均有统计学意义,而三组之间差异无统计学意义。三组的端粒酶活性及hTERT蛋白表达下降,较随机序列组和生理盐水组相比,差异均有统计学意义,而三组之间差异无统计学意义。结论anti-hTR能够抑制绒癌移植瘤的生长,可能成为肿瘤治疗的新方法。     

hCG对绒癌细胞系MT-MMP和TIMP mRNA表达的影响

目的　探讨人类绒毛膜促性腺激素 (hCG)对绒癌细胞表达侵袭性相关基因的影响。方法　以绒癌组织来源的JEG 3细胞系为研究对象 ,采用逆转录多聚酶链反应 (RT PCR)方法 ,观察了hCG对JEG 3细胞膜型金属蛋白酶 (MT MMP)和金属蛋白酶组织抑制因子 (TIMP)mRNA表达的影响。结果　在所有 6型MT MMP中JEG 3细胞仅表达MT2 MMP ,且其表达量可被 2 5IU/mlhCG处理 5 0h而降低。而在TIMP的 4种亚型中 ,JEG 3细胞表达其中的TIMP 1和TIMP 2两型 ,在受hCG处理后JEG 3细胞中TIMP 1的表达量下降 ,TIMP 2则被诱导增加。结论　高浓度长时间的hCG作用可通过改变MT MMP和TIMP转录表达的变化影响绒癌细胞 /滋养细胞的侵袭性。     

绒毛膜癌全身广泛转移1例病例报告

绒毛膜癌是高度恶性的滋养细胞肿瘤,通过血行转移,其诊断依赖于组织病理学诊断和血清中高水平的人绒毛膜促性腺激素（ HCG）。通过报道1例绒毛膜癌伴有全身广泛转移的病例,回顾性总结分析其治疗方法,结合相关文献分析绒毛膜癌的临床特点及其治疗方案的选择。     

介入治疗绒毛膜癌的疗效分析

目的探讨经动脉灌注化疗(TAC)在绒毛膜癌的治疗中的优点及其临床应用价值.方法统计23例行TAC治疗绒癌病例,采用Seldinger法,动脉插管后选择性置管于肿瘤供血动脉内,灌注5-氟尿嘧啶(5-Fu)、平阳霉素(PYM),治疗间隔20～25天,随访观察临床表现、肿瘤情况和病人的生存时间.结果绒癌多发于生育期妇女,Ⅰ期绒癌治愈率达80%以上,有效率超过95%.结论介入治疗是绒癌的有效治疗手段,介入治疗效果显著,且保留子宫,提高生存及生命质量,治愈率高,较静脉化疗更为优越.     

Primary non-gestational uterine cervical choriocarcinoma with metaplastic transformation from squamous cells.

Background: Primary non-gestational uterine cervical choriocarcinoma is very unusual and although it has been hypothesized that it can arise by metaplastic transformation of cervical epithelium, solid evidence has been lacking. Case: Primary non-gestational uterine cervical choriocarcinoma was diagnosed in a 47-year-old, woman undergoing tubal resection 17 years previously. A histologically- and immunohistochemically-confirmed, non-gestational cervical choriocarcinoma could be diagnosed in which there was metaplastic transformation from squamous cells . The patient underwent 5 courses of an actinomycin-D chemotherapeutic regimen and radical hysterectomy with bilateral pelvic lymphadenectomy. Conclusion: Primary non-gestational uterine cervical choriocarcinoma may indeed arise from metaplastic transformation of epithelial tissue.     

Chemo-resistant choriocarcinoma metastatic to colon cured by low-anterior resection

The role of surgery in the treatment of patients with metastatic choriocarcinoma has diminished. We present a case of chemo-resistant metastatic choriocarcinoma salvaged by surgery. A 48-year-old patient presented with uterine perforation and severe intractable hemorrhage, and histological examination revealed a choriocarcinoma. After 6 years of disease-free state, recurrence occurred in the rectosigmoid colon. Seven cycles of EMACO chemotherapy was administered, and the human chorionic gonadotropin level was normalized. Three months after the chemotherapy, the rectosigmoid colon metastasis progressed. Low anterior resection with lymphadenectomy up to the level of the inferior mesenteric artery was conducted. After the operation, the human chorionic gonadotropin level decreased to within the normal range. There has been no evidence of disease for 13 months since the operation. Local resection of metastases seems to play a significant role in curing the disease in a small subset of patients.     

两种植物血凝素在滋养细胞疾病组织中的表达

目的：了解PHA—L、DSA这两种植物血凝素在人类胎盘早期绒毛、葡萄胎、侵蚀性葡萄胎和绒癌组织中的表达、方法;使用免疫胶体金技术，检测组织中的植物血凝素受体强度。结果：在人类早期股金组织中，植物血凝素受体仅在纺毛表面有一些轻微的染色，而葡萄胎、侵蚀性葡萄胎和城癌组织中的染色却非常强.统计表明、两种血凝素受体在正常组织与葡萄胎、侵蚀性葡萄胎和绒癌三组之间存在极显著差别（P＜0.001），葡萄胎与侵蚀性葡萄胎和绒癌之间也分别存在着显著差别（P＜0.05），但侵蚀性葡萄胎与绒癌两组之间，差别不明显（P＞0.05）。结论;滋养细胞表面的PHA-L染色强.表明了其组织中的β1，6寡糖支链的增加,因而这些细胞具有侵蚀子宫和其它器官的能力。     

Breast Carcinoma with Choriocarcinomatous Features: A Case Report

Nongestational choriocarcinoma differentiation is extremely rare in breast neoplasms. It is characterized by tumor cells similar to chorionic trophoblastic cells, which react with human placental lactogen and human chorionic gonadotropin (hCG). A 56-year-old woman presented with a palpable right breast mass without past history of trophoblastic tumors. An F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan revealed one focus with low accumulation of FDG in the right breast (maximum standardized uptake value, 1.98). The patient underwent a right mastectomy and biopsy of sentinel nodes. Microscopically, the tumor was a typical invasive ductal carcinoma with multiple foci of choriocarcinoma features. Immunohistochemistry showed that the tumor cells resembling choriocarcinoma were positive for hCG antibody, but negative for HER2/neu, estrogen receptor, and progesterone receptor. A pathologic diagnosis of breast carcinoma with choriocarcinomatous features was made. To our knowledge, this is the first report of invasive carcinoma with choriocarcinomatous features and an unusual finding of low accumulation in an F-18 FDG PET/CT scan in Korea.     

滋养细胞肿瘤180例临床分析

本文收集了１９８０～１９９０年滋养细胞肿瘤１８０例，其中侵饰性葡萄胎（恶葡）１１８例，绒毛膜癌（绒癌）６２例。治疗方法：采用化疗为主的综合治疗方案，首选药物为５－氟脲嘧啶（５－ＦＵ）和更生霉素（ＫＳＭ），８天或５天为一疗程，间隔时间分别为３周或２周。结果：恶葡的生存率为９８．３％；绒癌的生存率为８５．４％；总的死亡率为１４．５２％。结论：５天一疗程的化疗效果相似于８天的疗程效果，而且化疗副反应轻，周期间隔短，病人易于接受，故临床应推广；同时对于某些病例尚须手术治疗。     

Mechanism of Methotrexate-sensitivity of Choriocarcinoma Cells in Culture

Four cell lines established from choriocarcinoma were compared for sensitivity to methotrexate (MTX). In this paper, we have compared the relative gene copy number of dihydrofolate reductase (DHFR), the target enzyme of methotrexate (MTX), in order to clarify whether or not amplification of the gene is involved in the relative resistance to MTX observed for one of the cell lines, designated NaUCC-1, which is 4- to 5-fold more resistant to MTX as compared with the other cell lines and exhibits a reduced uptake of [³H]MTX. Neither dot blot nor Southern blot hybridization revealed any significant difference in the gene copy number among the four cell lines. Therefore, the resistance to MTX of the NaUCC-1 line is explained by a reduced uptake of the drug, rather than amplification of the target gene.     

hCG抑制JEG-3绒癌细胞系基质金属蛋白酶的表达

 目的　揭示人类绒毛膜促性腺激素 (hCG)对绒癌细胞侵袭力的影响。方法　采用逆转录多聚酶链反应 (RT PCR)检测方法 ,考察了hCG对JEG 3绒癌细胞系基质金属蛋白酶转录表达的影响。结果　绒癌细胞系JEG 3表达MMP 8、 10、 12、 19,而其它亚型MMP的表达在本研究中未检测到。将JEG 3细胞在 2 5IU/mlhCG中温育 5 0h后 ,细胞中MMP 8、 10、 12、 19的表达量均降低。结论　JEG 3绒癌细胞系的侵袭性与MMP 8、 10、 12、 19的表达有关 ,高浓度的hCG长时间温育可能通过降低MMP的表达而抑制绒癌细胞的浸润转移。     

Decreased expression of microRNA-199b increases protein levels of SET (protein phosphatase 2A inhibitor) in human choriocarcinoma

We compared microRNA profiles between choriocarcinoma and non-cancerous trophoblasts, and revealed that miR-199b was underexpressed in choriocarcinoma. By computational prediction and microarray studies, SET (protein phosphatase 2A inhibitor) was shown to be one of the target genes regulated by miR-199b. Ectopic expression of miR-199b inhibited endogenous SET protein levels and the activity of the luciferase reporter containing the 3′-UTR of SET. Further comparisons of formalin-fixed paraffin-embedded human choriocarcinoma, mole, and non-cancer trophoblast tissues confirmed the initial findings of low miR-199b expression and SET upregulation in choriocarcinomas, suggesting that microRNA-dysregulated SET protein may account for the rapid growth seen with choriocarcinomas.