Expression of p27 and p53: comparative analysis of uterine carcinosarcoma and endometrial carcinoma

The aim of the study was to assess both p27 and p53 expression in the stromal and epithelial component of carcinosarcoma and to assess if their expression in the latter is different than in endometrial carcinoma. Immunohistochemical staining for p27 and p53 was performed on paraffin-embedded tissue blocks of 18 uterine specimens with carcinosarcoma and their expression assessed. Their expression in the epithelial element was also compared to that in 35 paraffin-embedded tissue blocks of endometrial endometrioid carcinoma. Reduced p27 expression was observed in a similarly high proportion of the stromal (77.8%) as well as of the epithelial component (66.7%) of carcinosarcoma. Although statistically not significant, the proportion of reduced p27 expression in endometrial carcinoma (85.7%) was higher than in the epithelial element of carcinosarcoma. The percentage of p53 overexpression in both elements of carcinosarcomas and in endometrial carcinomas was low and also similar (27.8 and 20.0%, respectively). Our results indicate that reduced p27 expression is common and p53 overexpression is infrequent in carcinosarcoma. Their similar rates of expression in the stromal and epithelial elements of the tumor support the contention of a monoclonal origin of carcinosarcoma. Unexpectedly, reduced p27 expression is more common in endometrial carcinoma than in the epithelial element of carcinosarcoma, in spite of the less favorable prognosticators and outcome in the latter. Further studies of p27 expression in carcinosarcoma are indicated to establish its clinical value in this aggressive malignancy.     

无排卵性功能失调性子宫出血患者子宫内膜雌、孕激素受体及基质金属蛋白酶表达变化的研究

目的研究无排卵性功能失调性子宫出血(功血)患者子宫内膜雌激素受体(ER)、孕激素受体(PR)、IV型胶原、基质金属蛋白酶-9(MMP-9)及其抑制物-1(TIMP-1)的表达,探讨无排卵性功血的发病机制。方法采用免疫组化法检测20例正常增殖期子宫内膜(对照组)和66例无排卵性功血患者(病例组)子宫内膜腺上皮和基质细胞ER、PR、IV型胶原、MMP-9及TIMP-1表达。结果病例组子宫内膜腺上皮和基质ER、PR表达高于对照组(P<0.05),MMP-9水平明显增加(P<0.05),MMP-9/TIMP-1比值升高(P<0.01),IV型胶原含量明显下降(P<0.01)。相关分析显示,无排卵性功血患者子宫内膜MMP-9水平与ER、PR均呈正相关(r=0.605,P<0.05;r=0.697,P<0.05)。结论无排卵性功血患者子宫内膜出血原因可能与雌激素作用下ER、PR表达失调有关,且MMP-9水平异常升高,导致细胞外基质过度降解,临床表现为子宫不规则出血。     

等离子电切治疗前列腺增生症

目的探讨经尿道等离子双极电切治疗前列腺增生症(PKRP)的安全性和疗效。方法回顾分析经尿道等离子双极电切治疗前列腺增生112例,比较术前术后尿流率,前列腺症状评分,残余尿量;记录手术失血量,体重变化,切除前列腺组织重量。结果所有手术顺利完成,切除前列腺重量65±15.5g,手术时间40±7.5min,平均出血量150ml,最大尿流率(Qmax)术前7.4±2.6ml/s术后3个月为18.6±4.6ml/s;国际前列腺症状评分(IPSS)术前生活质量评分22.6分,术后3个月为6.5;残余尿量(RUV)术前>60m1,术后<20ml。结论等离子双极电切治疗前列腺增生症具有安全,有效,经济,技术易于掌握等优点,适合基层医院开展。     

A case of alpha-fetoprotein–producing adenocarcinoma of the endometrium with a hepatoid component as a potential source for alpha-fetoprotein in a postmenopausal woman

Although case reports of alpha-fetoprotein (AFP)-producing adenocarcinoma other than hepatocellular carcinoma have gradually increased in number, AFP-producing adenocarcinoma of the endometrium is very rare. The patients universally complain of abnormal vaginal bleeding. The patient presented with complaints of epigastric discomfort. No vaginal bleeding was observed. Serum AFP concentration was 453 ng/mL, and lens culinaris agglutinin-reactive AFP percentage of total AFP was increased to 67%. Radiologic imaging and endoscopy did not provide evidence of any primary carcinoma in the liver and gastrointestinal tract. To investigate the unknown origin of high AFP, Pap smear of the endometrium followed by fractional curettage was performed and revealed adenocarcinoma of the endometrium. Radical hysterectomy with pelvic lymph node dissection and partial omentectomy was performed. Histologic study showed a mixture of major AFP-negative endometrioid adenocarcinoma and minor medullary proliferation of the AFP-positive hepatoid adenocarcinoma cells with eosinophilic cytoplasm and hyaline globules. After the surgery followed by four courses of weekly carboplatin and paclitaxel administration, serum levels of AFP dropped into normal range. The possible existence of AFP-producing adenocarcinoma of the endometrium should be considered in a postmenopausal woman even if there is no vaginal bleeding, when AFP-producing tumor is clinically suspected and the imaging studies fail to confirm the diagnosis.     

经尿道前列腺电切术和汽化电切术并发症48例分析

目的 分析经尿道前列腺电切术（TURP）与经尿道前列腺汽化电切术（TVP）术中、术后常见并发症的原因、预防及治疗，提高手术安全性和有效性。方法 回顾性分析1999年5月-2006年6月我院TURP和TVP术48例并发症患者的临床资料。结果 平均手术时间75min，平均切除组织41g。术中、术后出血20例，电切综合征（TURS）5例，暂时性尿失禁11例，膀胱颈部挛缩5例，尿道狭窄8例，尿路感染7例，膀胱穿孔1例。结论 TURP和TVP是良性前列腺增生症安全有效的外科治疗方法，术前详细采集病史，术中正确操作。术后对病人正确指导及处理可有效减少手术并发症。     

经尿道等离子双极电切术和TURP治疗BPH术后阴茎勃起功能障碍的比较

目的探讨经尿道等离子双极电切术(PKRP)治疗良性前列腺增生(BPH)术后对阴茎勃起功能的影响。方法PKRP、经尿道前列腺电切术(TURP)治疗BPH各95例,评价其术后1个月、3个月及1年阴茎勃起功能。结果PKRP、TURP术后1个月、3个月及1年阴茎勃起功能障碍(ED)发生率分别是3．2％、2．1％、2．1％和13．7％、10．5％、9．5％。结论PKRP术后ED发生率比TURP低,是一种对阴茎勃起功能较为安全的治疗良性前列腺增生的方法。     

宫腔镜辅助下分段诊刮术与单纯分段诊刮术诊断子宫内膜癌的比较

为比较宫腔镜辅助下分段诊刮术与单纯分段诊刮术在诊断子宫内膜癌中的临床意义 ,将经手术后病理证实的子宫内膜癌患者分为 2组 :宫腔镜辅助下分段诊刮组 (A组 ) 3 1例 ;单纯分段诊刮组 (B组 ) 3 9例。比较 2组术前诊断子宫内膜癌的准确性及开腹手术时腹水细胞学的检查结果。 2组患者的年龄、临床病理分期、病理分级及组织学类型差异无显著性。A组诊断宫颈受累的准确率为 96.77% (3 0 / 3 1 ) ,假阳性率为 3 .2 3 % (1 / 3 1 ) ;B组分别为 79.49%(3 1 / 3 9) ,1 5 .3 8% (6/ 3 9)。 2组准确率比较 ,差异有显著性 (P <0 .0 5 )。取腹水或腹腔冲洗液行细胞学检查。A组细胞学阳性率为 6.45 % (2 / 3 1 ) ,B组为 1 4.2 9% (3 / 2 1 ) ,2组间差异无显著性 (P >0 .0 5 )。提示 :宫腔镜辅助下分段诊刮术可提高术前诊断子宫内膜癌的准确性 ,从而避免不必要地扩大手术范围 ,而且不增加腹腔内播散的危险。     

经尿道等离子体双极电切术治疗良性前列腺增生及膀胱肿瘤

目的　探讨经尿道等离子体双极电切的安全性与有效性。　方法　用经尿道等离子体双极电切行前列腺切除 (PKRP) 30 0例 ,前列腺 2 1～ 12 6 g ,平均 (49.7± 35 .8) g ;行浅表性膀胱肿瘤切除 (PKRBT) 37例 ,肿瘤分级G12 5例 ,G2 12例。术后随访 1～ 6个月。　结果　PKRP手术时间 13～ 98min ,平均 (48± 31)min ;切除前列腺组织重量 7～ 91g ,平均 (31± 2 9)g。无 1例需输血 ,无电切综合征发生。术后 1、3、6个月 ,最大尿流率 (Qmax)由术前的 (5 .2± 3.9)ml/s分别上升至 (19.2±4 .1)、(2 1.8± 4 .6 )、(2 2 .3± 5 .7)ml/s;国际前列腺症状评分 (IPSS)由术前的 2 4 .7下降至 5 .7、5 .4、5 .1;生活质量评分 (QOL)由术前的 5 .3分别下降至 1.7、1.8、1.2。 3项指标手术前后比较差异均有显著性意义 (P <0 .0 5 )。PKRBT手术时间 5～ 39min ,平均 (2 4± 13)min。 17例侧壁肿瘤切除时 ,5例发生闭孔神经反射 ,其中 1例发生膀胱穿孔。随访 1～ 6个月无复发。　结论　用等离子体双极电切进行PKRP和PKRBT安全有效。