35例宫颈腺鳞癌临床分析

目的:分析宫颈腺鳞癌患者的临床特点、治疗方式。比较不同期别、不同组织分级患者的生存情况。方法:回顾性分析35例宫颈腺鳞癌患者的临床资料。结果:35例患者中位年龄45岁,均以阴道异常出血为首发临床症状。14例ⅠB1期～ⅡA期患者中,有2例ⅡA期患者接受了单纯放疗,另外12例接受了手术治疗,其中2例术后接受了化疗,2例术后接受了单纯放疗,2例术后接受了同步放化疗,其余6例术后未接受辅助治疗。18例ⅡB期～ⅢB期患者中9例接受了单纯放疗,9例接受了同步放化疗。3例Ⅳ期患者均接受了化疗+姑息性放疗。共有10例患者肿瘤复发,复发率为28.6%。中位复发时间为4.5个月。所有患者的3年和5年生存率分别为85.7%和78.0%。Ⅰ、Ⅱ和Ⅲ期患者的5年生存率分别为100%,93.3%和56.3%,3例Ⅳ期患者的生存时间分别为2、10和15个月。高、中分化患者的5年生存率为93.3%,低分化患者的5年生存率为66.9%,但无显著差异(P=0.208)。结论:宫颈腺鳞癌早期患者可以手术治疗或同步放化疗,预后较好。晚期患者应予同步放化疗,预后相对较差,特别是Ⅳ期患者,预后极差。     

卵巢子宫内膜异位囊肿术后复发患者的临床病理特点和手术疗效分析

目的 分析卵巢子宫内膜异位症(内异症)囊肿术后复发的临床病理特点和手术疗效.方法 回顾性分析2003年1月至2008年12月北京协和医院收治的69例卵巢内异症囊肿术后复发患者的临床资料,分析总结其复发特点及临床结局.前次手术双侧卵巢内异症囊肿29例(42％,29/69);单侧40例(58％,40/69),其中左侧19例(48％,19/40),右侧21例(52％,21/40).术后包块复发57例,单纯疼痛复发12例.结果 69例患者中位复发间隔时间38个月(1～144个月).57例包块复发患者中,双侧卵巢内异症囊肿术后复发24例,中位复发间隔时间31个月;单侧复发33例,中位复发间隔时间39个月;两者比较,差异无统计学意义(P =0.452).左侧复发37例,复发率77％(37/48);右侧复发34例,复发率68％ (34/50);两者比较,差异无统计学意义(P=0.396).12例单纯疼痛复发患者中10例合并子宫腺肌病(AM),4例合并深部浸润型内异症(DIE).29例合并AM和(或)DIE平均手术时间75.1 min,平均术中失血量114.9 ml;40例单纯内异症囊肿则分别为49.9 min和38.4 ml;两者分别比较,差异均具有统计学意义(P均＜0.05).69例患者术后均获随访,平均随访时间32个月(3个月～8年).6例患者内异症囊肿再次复发,中位复发间隔时间为3年(6个月～6年);38例患者有生育要求,仅4例完成生育.结论 临床诊断内异症复发确诊率高,疼痛主要与AM相关,内异症囊肿合并DIE和(或)AM是导致手术难度增大的主要原因;二次术后患者整体预后差.     

复发卵巢成人型颗粒细胞瘤13例临床分析

目的:探讨复发卵巢成人型颗粒细胞瘤(GCT)的临床特点及治疗方案选择。方法:回顾性分析我院诊治的13例复发卵巢成人型GCT患者的临床资料。结果:13例患者确诊复发距离初次治疗的中位间隔时间为6年(0.5~20年),远期复发(≥10年)患者5例,近期复发(10年)患者8例。5例远期复发患者均为Ⅰ期肿瘤,80.0%患者的核分裂相≤5/10 HPF。8例近期复发患者中晚期(Ⅱ~Ⅲ期)患者占62.5%,75.0%患者的核分裂相5/10 HPF,3例≥10/10HPF。13例患者中单纯盆腔局限复发4例,盆腔合并腹腔广泛转移5例,腹膜后转移4例。9例接受再次手术治疗,3例接受单纯化疗(1例联合内分泌治疗),1例接受单纯放疗。接受手术治疗的患者8例接受术后辅助化疗,1例接受术后辅助放疗。13例患者确诊复发后的中位生存时间为23个月(6~49个月);接受手术治疗的9例患者,确诊复发后的中位生存时间为27个月(18~49个月);行非手术治疗4例患者,确诊复发后的中位生存时间为10.5个月(6~16个月)。结论:复发卵巢成人型GCT复发时间间隔较长,需长期随访。晚期、核分裂相高的患者可能易出现近期复发。盆腔以外为常见的转移部位。手术为主的综合治疗为首选的治疗方案。     

IB期宫颈癌的卵巢转移

早期宫颈鳞癌的卵巢转移罕见。Mann 氏等最近报道2例 IB 期宫颈腺癌卵巢转移。以后有人提出对早期宫颈腺癌保留卵巢不如鳞癌那样安全。为此比较 IB 期的宫颈腺癌、腺鳞癌与宫颈鳞癌卵巢转移的危险。共分析 IB 期宫颈癌990例。鳞癌770例中有4例(0. 5%)卵巢转移,腺癌121例中卵巢转移2例(1. 7%)。2例腺鳞癌及17例其他组织类型癌中     

早期宫颈腺癌及腺鳞癌临床特征及预后分析

目的:探讨早期宫颈腺癌(AC)及宫颈腺鳞癌(ASC)患者的临床特征及预后相关影响因素。方法:回顾分析2013年1月至2018年3月就诊于郑州大学第一附属医院的早期宫颈腺癌及腺鳞癌(Ia～IIa期)患者213例,其中早期腺癌患者179例,早期腺鳞癌患者34例。比较两种病理类型患者的临床特征,分析患者3年无病生存率(DFS)的影响因素,以及宫颈腺癌和腺鳞癌患者的预后差异。结果:宫颈腺鳞癌患者的肿瘤大小大于宫颈腺癌患者,差异有统计学意义(P0.05);两者的年龄、肿瘤浸润深度和淋巴结转移等临床特征相比,差异均无统计学意义(P0.05)。宫颈腺癌和腺鳞癌患者的3年无病生存率分别为92.1%和69.8%,差异有统计学意义(P0.05)。患者的年龄、肿瘤大小、FIGO分期、辅助治疗、浸润深度及淋巴结转移是影响两种病理类型的预后因素,且肿瘤病理类型、浸润深度和淋巴结转移是影响宫颈腺癌和腺鳞癌预后的独立因素。肿瘤直径大于4cm、FIGO分期IIa期、肿瘤浸润深度大于1/2以及淋巴结转移组中,腺鳞癌患者的3年无病生存率低于腺癌患者,差异均有统计学意义(P0.05)。结论:早期宫颈腺癌和腺鳞癌患者的临床特征大致相似,仅腺鳞癌肿瘤体积大于腺癌。肿瘤大小、临床分期、浸润深度、淋巴转移和辅助治疗均为影响两者预后的因素,肿瘤病理类型、浸润深度和淋巴结转移是影响宫颈腺癌和腺鳞癌患者预后的独立因素。肿瘤直径大于4cm、FIGO分期IIa期、肿瘤浸润深度大于1/2以及淋巴结转移宫颈腺鳞癌患者的预后较差。     

女性生殖系统恶性中胚叶混合瘤22例临床特征分析

目的探讨女性生殖系统恶性中胚叶混合瘤(malignant mixed mesodermal tumors,MMMTs的临床特点、诊治难点及预后。方法回顾性分析2010年6月年至2017年6月南京大学医学院附属鼓楼医院妇科收治的经病理确诊的22例生殖系统MMMTs患者的临床资料。结果 22例患者中,子宫体MMMTs15例,输卵管卵巢MMMTs6例,宫颈MMMTs1例。子宫体MMMTs主要表现为异常阴道出血、排液;输卵管卵巢MMMTs主要表现为腹痛、盆腔包块;53.3%(8/15)的子宫体MMMTs在相对早期诊治,但首次病理诊断的准确率仅31.8%(7/22),95.5%(21/22)的患者分别接受了1～2次肿瘤切除手术。其中临床病理分期Ⅰ期患者10例,中位生存时间为33个月;Ⅲ期患者10例,中位生存时间为14个月;Ⅳ期患者1例,术后11个月复发,术后22个月死亡。结论恶性中胚叶混合瘤多发于围绝经期和绝经后妇女,恶性程度高,死亡率高,需制定个体化的综合治疗方案。     

宫颈透明细胞癌13例临床分析

目的:探讨宫颈透明细胞癌的临床特点、治疗及预后。方法:回顾性分析2013年4月—2017年12月郑州大学第一附属医院收治的13例原发宫颈透明细胞癌患者的临床资料及随诊资料,分析其临床特征、病理特点、治疗方案及预后情况。结果:13例患者平均年龄(53.6±13.9)岁,9例(69.2%)大于40岁,4例(30.8%)小于40岁,其中2例青少年患者。临床分期:Ⅰ期6例(46.15%),Ⅱ期6例(46.15%),Ⅲ期1例(7.7%);12例接受手术+放化疗,其中3例行新辅助化疗,9例术后放疗和(或)化疗,1例单纯放疗;中位随访时间24个月(6～60个月),4例死亡,2例多发转移,第1、2、5年累积生存率分别为12/13、11/13和9/13。结论:宫颈透明细胞癌发病率低,临床表现无特异性,伴淋巴结转移者预后极差,手术加放化疗的个体化综合治疗方案能明显改善患者病情及预后。     

宫颈透明细胞癌13例临床分析

目的:探讨宫颈透明细胞癌的临床特点、治疗及预后。方法:回顾性分析2013年4月—2017年12月郑州大学第一附属医院收治的13例原发宫颈透明细胞癌患者的临床资料及随诊资料,分析其临床特征、病理特点、治疗方案及预后情况。结果:13例患者平均年龄(53.6±13.9)岁,9例(69.2%)大于40岁,4例(30.8%)小于40岁,其中2例青少年患者。临床分期:Ⅰ期6例(46.15%),Ⅱ期6例(46.15%),Ⅲ期1例(7.7%);12例接受手术+放化疗,其中3例行新辅助化疗,9例术后放疗和(或)化疗,1例单纯放疗;中位随访时间24个月(6～60个月),4例死亡,2例多发转移,第1、2、5年累积生存率分别为12/13、11/13和9/13。结论:宫颈透明细胞癌发病率低,临床表现无特异性,伴淋巴结转移者预后极差,手术加放化疗的个体化综合治疗方案能明显改善患者病情及预后。     

宫颈绒毛膜管状腺癌11例临床分析

目的探讨宫颈绒毛管状腺癌(VGA)的临床病理特征、治疗及预后。方法回顾性分析重庆大学附属肿瘤医院妇瘤科2011年8月至2018年8月诊治的11例VGA患者的临床病理资料。结果 11例患者平均发病年龄为48.4岁(32~71岁)。根据宫颈癌FIGO2018分期系统ⅠB1期3例、ⅠB2期3例、ⅠB3期2例、ⅡA1期1例、ⅡB期2例。9例(ⅠB1~ⅡA1)患者行广泛子宫双附件切除术+盆腔淋巴结清扫术,仅1例存在深肌层浸润1个危险因素;术后4例观察,3例辅助单纯化疗,2例辅助单纯放疗。2例ⅡB期患者均合并宫颈鳞癌,行根治性放疗。随访截止2018年12月,中位随访时间21个月(4~84个月),2例复发,1例死亡。结论单纯宫颈VGA术后病理危险因素少,预后良好,术前CA125升高及合并宫颈鳞癌预后不良。是否可以用相对保守的治疗方法尚需要进一步研究。     

妊娠合并卵巢恶性肿瘤20例临床分析

目的 探讨妊娠合并卵巢恶性肿瘤的临床特征、处理方法 及预后. 方法 回顾性分析2001年7月至2008年12月在我院诊断及治疗的20例妊娠合并卵巢恶性肿瘤患者的临床及病理资料.结果8年中共诊断妊娠合并卵巢恶性肿瘤20例,发病率0.311/1000次分娩,其中孕期超声诊断14例(70.0%).病理类型中上皮性肿瘤共15例(占75.0%).低度恶性肿瘤(上皮交界性肿瘤和支持间质细胞瘤)共14例(70.0%).20例患者中19例(95.0%)国际妇产科联盟分期1期.16例(80.0%)行保守性手术治疗,4例(20.0%)二次行卵巢癌分期手术.化疗6例(30.0%),其中孕期化疗1例.20例中流产5例;出生新生儿15例,除1例重度窒息死亡外,余4例早产儿及10例足月儿均体健,无后遗症及畸形.随访患者6～80个月,除1例术后4个月死亡,余未见肿瘤复发,生存率95.0%(19/20). 结论 妊娠期妇女的卵巢癌发病率较非妊娠期低,且多为早期,经积极手术及化疗母婴预后大多较好.     

Poor prognosis in patients with adenosquamous cell carcinoma of the cervix

From 1 July 1974 to 31 December 1982, 127 patients with primary carcinoma of the cervix were assessed to determine the prognosis of patients with adenosquamous cell carcinoma. Of all patients, 34 are dead of disease for an overall corrected survival rate of 73.2%. The survival of 20 patients with adenosquamous cell carcinoma is 20%. Seventy-five percent of the adenosquamous cell patients had stage IB lesions. When patients with adenosquamous cell carcinoma were compared with patients with squamous cell carcinoma or adenocarcinoma, there was a statistically significant decrease in survival. Patients with adenosquamous cell carcinoma were relatively young with a mean age of 41.1 years. A normal appearing cervix was noted in 30% of all patients with adenosquamous cell carcinoma. The majority of adenosquamous cell patients (87.5%) dead from cancer had distant metastases. This report emphasizes that, independent of stage, adenosquamous cell cervical carcinoma is an extremely aggressive neoplasm and carries a poor prognosis.     

Adenosquamous carcinoma of the cervix: prognosis in stage IB

The outcome of women with adenosquamous carcinoma of the cervix has been a controversial issue. To assess the prognostic significance of this cell type, the medical records of 29 patients with stage IB primary adenosquamous carcinoma of the cervix were reviewed. Twenty-six had cervical tumors measuring 3 cm or less. With a median follow-up of 60 months, the overall disease-free 5-year survival was 85%. Pelvic lymph node metastases were found in three of 19 patients (16%) with stage IB, and periaortic lymph nodes were negative in eight. A log-likelihood chi 2 test comparing lymphatic spread, recurrence rate, and 5-year disease-free survival in patients with stage IB disease and tumors less than 3 cm versus a similar group of 58 patients with pure squamous cell carcinoma of equivalent stage and comparable size treated during the same time disclosed no significant differences in any of the indicators analyzed. We conclude that stage IB adenosquamous carcinoma of the cervix does not differ in its metastatic potential or outcome from the more common pure squamous cell carcinoma.     

Locally advanced adenocarcinoma and adenosquamous carcinomas of the cervix compared to squamous cell carcinomas of the cervix in Gynecologic Oncology Group trials of cisplatin-based chemoradiation

Objective

Conflicting results have been reported for adeno- and adenosquamous carcinomas of the cervix with respect to their response to therapy and prognosis. The current study sought to evaluate impact of adeno- and adenosquamous histology in the randomized trials of primary cisplatin-based chemoradiation for locally advanced cervical cancer.

Methods

Patients with adeno- and adenosquamous cervical carcinomas were retrospectively studied and compared to squamous cell carcinomas in GOG trials of chemoradiation.

Results

Among 1671 enrolled in clinical trials of chemoradiation, 182 adeno- and adenosquamous carcinomas were identified (10.9%). A higher percentage of adeno- and adenosquamous carcinomas were stage IB₂ (27.5% versus 20.0%) and fewer had stage IIIB (21.4% versus 28.6%). The mean tumor size was larger for squamous than adeno- and adenosquamous. Adeno- and adenosquamous carcinomas were more often poorly differentiated (46.2% versus 26.8%). When treated with radiation therapy alone, the 70 patients with adeno- and adenosquamous carcinoma of the cervix showed a statistically poorer overall survival (p = 0.0499) compared to the 647 patients with squamous cell carcinoma of the cervix. However, when treated with radiation therapy with concurrent cisplatin-based chemotherapy, the 112 patients with adeno- and adenosquamous carcinomas had a similar overall survival (p = 0.459) compared the 842 patients with squamous cell carcinoma. Adverse effects to treatment were similar across histologies.

Conclusion

Adeno- and adenosquamous carcinomas of the cervix are associated with worse overall survival when treated with radiation alone but with similar progression-free and overall survival compared to squamous cell carcinomas of the cervix when treated with cisplatin based chemoradiation.     

子宫颈癌脑转移

目的:研究子宫颈癌脑转移(CCMB)的发生机理与临床表现,探讨其治疗方法与预后。方法:回顾分析11例CCMB患者的临床病理资料及随访记录。结果:Ⅰb期2例,Ⅱa期2例,Ⅲb期7例;鳞状细胞癌6例,腺鳞癌2例,小细胞癌2例,腺癌1例;癌细胞分化程度均为低分化。8例伴有肺、肝等器官转移,3例无其它器官转移;原发宫颈癌控制2例,未控4例,进展5例。从诊断宫颈癌至诊断脑转移平均间隔14.6个月;头痛是CCMB最常见的症状。脑转移病灶≥2个8例,仅3例有1个病灶。手术+全脑放射治疗(WBRT)3例,立体定位性放射外科手术(SRS)3例,WBRT5例。11例平均生存时间为6.6个月(1～13个月)。结论:CCMB不一定是宫颈癌晚期的并发症,也可发生于早期患者,与组织学类型、癌细胞低分化、晚期等因素密切相关,手术和SRS是目前较为理想的治疗方法。     

Treatment results of adjuvant chemotherapy after radical hysterectomy for intermediate- and high-risk stage IB-IIA cervical cancer

OBJECTIVE: To determine the effectiveness of chemotherapy alone as postoperative adjuvant therapy for intermediate- and high-risk cervical cancer. METHODS: The study group comprised of 65 consecutive patients with stage IB or IIA squamous cell or adenosquamous cervical cancer who were initially treated with radical hysterectomy and pelvic lymphadenectomy between 1993 and 2002. Tumors were of intermediate-risk (stromal invasion > 50%, n = 30) or high-risk (positive surgical margin, parametrial invasion, and/or lymph node involvement, n = 35). In all cases, chemotherapy was administered adjuvantly: three courses of bleomycin, vincristine, mitomycin, and cisplatin for intermediate-risk cases and five courses for high-risk cases. Disease-free survival and complications of the combined therapy were investigated. RESULTS: Estimated 5-year disease-free survival was 93.3% for the 30 patients with intermediate-risk tumors (100% for those with squamous cell carcinoma and 71.4% for those with adenosquamous carcinoma) and 85.7% for the 35 patients with high-risk tumors (89.3% for those with squamous cell carcinoma and 71.4% for those with adenosquamous carcinoma). The incidence of locoregional recurrence was 3.3% in the intermediate-risk group and 8.6% in the high-risk group. Side effects of chemotherapy and complications of the combined therapy were within acceptable limits. No patient had severe bleomycin-related pulmonary toxicity. Only 1.5% of patients developed small bowel obstruction, which was cured by conservative therapy. CONCLUSIONS: The treatment results suggest the potential role of adjuvant chemotherapy alone for patients with cervical cancer.     

Carcinoma of the cervix, FIGO Stage IB: treatment failures

All patients with carcinoma of the cervix, FIGO Stage IB, treated at the University of Minnesota Hospitals during a 10-year period were reviewed. Of the 220 patients 31 (14.0%) developed recurrent disease and did not survive. Thirteen patients had pelvic wall recurrences, with concurrent cervical involvement. No patient had a resectable pelvic recurrence. Hysterectomy was subsequently performed on 10 of the 172 patients who received radiation therapy. Carcinoma was not present in any of the operative specimens although two patients with adenocarcinoma later died of metastatic cancer. Median time of recurrence was 9 months, with median survival following recurrence of 6 months. Cervical cytology was not of value in the early diagnosis of recurrent disease. The 5-year adjusted actuarial survival rate for patients with adenosquamous carcinoma was significantly lower than that for patients with squamous cell carcinoma. The median age of patients not surviving with adenosquamous carcinoma was significantly lower than that for patients not surviving with squamous cell carcinoma. Patients with invasive carcinoma presumably confined to the cervix may have disseminated disease. It is essential such selected patients receive primary treatment that includes systemic therapy.     

Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer

BACKGROUND: Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery. METHODS: This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study. RESULTS: Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not. CONCLUSION: Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.     

Optimal dose for stage IIIB adenocarcinoma of the uterine cervix on the basis of biological effective dose

PURPOSE: Prognosis of uterine cervical adenocarcinoma in locally advanced stage treated with radiation therapy has been considered to be much worse than that of squamous cell carcinoma because the optimal dose for the former one has not been determined. Thus, the current study was performed to investigate the optimal dose for Stage IIIB, locally advanced stage, adenocarcinoma of the uterine cervix on the basis of the biological effective dose (BED). METHODS: One-hundred and seventy-nine patients with Stage IIIB carcinoma of the uterine cervix were treated with curative intended therapy at Kitasato University Hospital between 1976 and 2000. Out of them, 13 patients had an adenocarcinoma component in pathological findings. Nine patients were diagnosed with adenocarcinoma and four patients were diagnosed with adenosquamous cell carcinoma. All patients were treated with external radiation therapy combined with intracavitary radiation therapy. The total BED10 (T-BED10) was caluculated from the BED of the external beam radiation therapy (E-BED10) plus the BED of the intra-cavitary radiation therapy (A-BED). RESULTS: Overall survival rate was 51%. Stratified by T-BED10 overall survival rate of the T-BED10 > or = 100 Gy group was 57% and that of the T-BED10 < 100 Gy group was 30%. There was a trend toward a better survival rate of the T-BED10 > or = 100 Gy group than the T-BED10 < 100 Gy group. CONCLUSION: The current study suggested that the optimal dose for Stage IIIB adenocarcinoma of the uterine cervix might be T-BED10 > or = 100 Gy.     

Adenocarcinoma of the uterine cervix metastatic to lymph nodes

OBJECTIVE: We set out to evaluate the prognostic factors in cervical adenocarcinoma metastatic to lymph nodes. STUDY DESIGN: We performed a retrospective review of 40 patients with cervical adenocarcinoma and lymph node metastasis from 1976 to 1996. RESULTS: Thirty-four patients had adenocarcinoma, and six had adenosquamous carcinoma. Median survival was 50 months. The median survival for patients with stage I disease was 69 months. Stage at diagnosis, treatment with radical hysterectomy, and receiving adjuvant therapy were associated with prolonged survival. A trend toward improved survival was noted with the use of concurrent radiation and chemotherapy as an adjuvant therapy. CONCLUSIONS: Adenocarcinoma metastatic to the lymph nodes does not have a uniformly poor prognosis, especially with early-stage disease. Improved survival was observed with the use of adjuvant therapy, specifically the use of combined chemotherapy and radiation after radical hysterectomy. The optimal therapy in this setting is yet to be determined. (Am J Obstet Gynecol 1998;178:1131-7.)