Endometrial tumor invasiveness is related to metalloproteinase 2 and tissue inhibitor of metalloproteinase 2 expressions

Matrix metalloproteinase (MMPs) expression has been linked to gynecological tumor aggressiveness. The objective of this study was to determine MMP-2, MMP-7, and MMP-9 and tissue inhibitors of metalloproteinases (TIMP)-1 and TIMP-2 expression in endometrial malignancies and their relation to clinical and histologic parameters. Formalin-fixed, paraffin-embedded tumor samples from 50 patients with endometrial carcinoma treated between 1999 and 2004 were stained with specific monoclonal antibodies. The tumors were grouped according to the FIGO classification. The staining results were compared to histologic and clinical data. Semiquantitative analysis of MMP and TIMP expression showed a significant difference in TIMP-2 expression according to the histologic subtype (P = 0.03) and also a trend towards a difference in MMP-9 expression (P = 0.05). MMP-2 expression increased and TIMP-2 expression fell as the histologic grade increased (P = 0.0007, P < 0.0001, respectively). MMP-2 expression correlated with lymph node metastasis (P = 0.04), while TIMP-2 expression correlated with the depth of myometrial invasion (P = 0.01), vasculolymphatic space involvement (P = 0.02), and lymph node metastasis (P = 0.0003). These results support the involvement of MMPs and TIMPs in endometrial tumor growth and progression. High MMP-2 and low TIMP-2 expression were the most potent markers of endometrial tumors with a high risk of local and distant spread.     

Role of lymphadenectomy and pelvic radiotherapy in patients with clinical FIGO stage I endometrial adenocarcinoma: an analysis of 208 patients

Two hundred and eight patients with a clinical stage I endometrial carcinoma were studied (164 fulfilled the inclusion criteria). High risk was defined as nonendometrioid, or endometrioid tumors grade 3 (G3), or G2 with any or G1 with deep (>1/2) myometrial infiltration. The low-risk group consisted of the remaining patients. Surgical staging in the high-risk group included pelvic lymphadenectomy with para-aortic lymphadenectomy in selected cases. Twelve percent of the high-risk patients had nodal metastasis. Patients with low-risk (group A, n = 85) and high-risk disease confined to the uterus (group B, n = 57) did not receive adjuvant radiotherapy. Patients with nodal metastases (group C, n = 10) received postoperative irradiation. The total recurrence rate of the entire population was 12.5%, and the actuarial overall survival, disease-specific survival, and disease-free survival were 90%, 94%, and 88%, respectively. All patients with only vaginal relapse (n = 9) were cured locally with salvage radiotherapy until the date of analysis. The pelvic relapse rate was low as only one patient of group B recurred in the pelvis. In conclusion, lymphadenectomy remains indicated to better select patients at high risk of pelvic recurrence that may benefit from postoperative radiotherapy.     

子宫内膜癌染色体不稳定性研究

目的探讨子宫内膜癌染色体不稳定性。方法取21例子宫内膜癌患者外周血淋巴细胞体外常规培养、制片、GTG显带分析染色体畸变(CAR),Brdu法分化染色分析姊妹染色单体交换(SCE)、微核(MN)、核仁组织形成区(NOR)。结果内膜癌组(21例)染色体结构畸变以出现次数的多少排列为:1、3、2、5、7、8号,染色体数目、结构畸变率分别为12.86%6、.1%,SCE频率、MN率、Ag-NOR分别为7.4±1.5次/细胞(、6.6±1.9)‰、7.1±1.6个/细胞,对照组(10例)染色体数目、结构畸变率分别为3.4%、0.4%,SCE频率、MN率、Ag-NOR分别为4.8±0.6次/细胞(、2.0±0.9)‰、4.9±1.1个/细胞,内膜癌组均明显高于对照组(P<0.01)。结论子宫内膜癌病人外周血淋巴细胞染色体数目和结构畸变率增高。     

国产重组人粒细胞集落刺激因子在妇科恶性肿瘤化疗中的应用

目的:探讨不同剂量国产重组人粒细胞集落刺激因子(rhG-CSF)在妇科恶性肿瘤化疗中的疗效,并与进口rhG-CSF比较。方法:98例卵巢癌、宫体癌和宫颈癌患者随机分成3组,分别按75μg·d-1和150μg·d-1剂量皮下注射国产rhG-CSF和进口75μg·d-1 rhG-CSF,直到白细胞或中性粒细胞绝对数升至正常水平以上。结果:不同剂量国产或进口rhG-CSF均能使3组患者血WBC和ANC水平在用药d 4后升至正常水平以上;在初次化疗时,用不同剂量(75μg和150μ)国产和进口(75μg)rhG-CSF升WBC至正常水平的天数无显著差异(P>0.05),但重复化疗期间150μg国产,rhG-CSF升白细胞的疗效显著优于75μg国产或进口rhG-CSF;同等剂量国产rhG-CSF与进口rhG-CSF升WBC效果一致。结论:75μg小剂量国产rhG-CSF在妇科恶性肿瘤初期化疗中升WBC的疗效肯定,重复化疗时较大剂量(150μg)rhG-CSF升WBC的效果优于小剂量rhG-CSF。同等剂量国产rhG-CSF与进口rhG-CSF的疗效无明显差异。     

Extra-uterine low grade stromal sarcoma with JAZF1–PHF1 gene fusion presenting as a mesenteric mass

This case illustrates a low-grade endometrial stromal sarcoma presenting as an intra-abdominal mass. Intra-operatively, this was thought to arise within the mesentery and was classified as a mesenteric tumour. The solid and cystic mass was composed of relatively uniform cells organized in sheets. Up to 8 mitoses per high power field was noted. The stroma although scanty, contained both delicate capillary-type and more arteriolar-like vessels. Admixed with the tumour cells were smaller cells reminiscent of endometrial stromal granulocytes. The tumour was positive for: WT1, oestrogen receptor (ER), CD10, vimentin, and focally for progesterone receptor (PR), and very occasional cells for smooth muscle actin. Fluorescence in situ hybridization (FISH) showed the presence of JAZF1 and PHF1 genetic rearrangement.This confirmed a diagnosis of extra-uterine low-grade endometrial stromal sarcoma. It is unsure whether this represents a primary or secondary lesion as the patient had a previous hysterectomy for unknown pathology.     

氯米芬联合HCG对不孕症患者内分泌指标及子宫内膜容受性的影响

目的:探讨氯米芬联合人绒毛膜促性腺激素(HCG)对不孕症患者内分泌指标及子宫内膜容受性(ER)的影响。方法:回顾性分析某院妇产科2018年11月~2019年11月接收的96例不孕症患者临床资料,将采用氯米芬联合HCG治疗的患者归为观察组(49例),将单独采用氯米芬治疗的患者归为对照组(47例),对比两组患者治疗前、治疗3个月内分泌指标、ER及卵巢体积变化情况以及治疗期间不良反应发生情况。结果:治疗3个月后,两组促卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)及孕酮(P)水平均较治疗前高,且观察组FSH、LH、E_2及P水平高于对照组,差异有统计学意义(P<0.05);治疗3个月后,两组子宫内膜厚度(Em)指标较治疗前上升,卵巢体积较治疗前缩小,且观察组Em指标较大,卵巢体积较小,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:不孕症患者采用氯米芬联合HCG治疗效果良好,可有效改善内分泌指标,提升ER指标,且安全性较高,值得临床推广。     

Effect of GnRH-II on the ESC proliferation,apoptosis and VEGF secretion in patients with endometriosis in vitro

Objective: To study the effect of GnRH-II on the cell proliferation, apoptosis and secreting vascular endothelial growth factor (VEGF) of ectopic, eutopic and normal endometrial stromal cells (ESC) from patients with or without endometriosis (EMs) in vitro. Methods: The ectopic, eutopic and normal ESC were isolated, cultured and identified, then added 0 M, 10^-10 M, 10^-8 M, 10^-6 M GnRH-II. The growth and proliferation of three ESC were measured by MTT assay; the cell apoptosis were detected with the method of Hoechst staining and Flow Cytometry test; ELISA was used to measure the VEGF concentration change by three ESC secretion. Results: GnRH-II inhibited the proliferation of ectopic, eutopic ESC from patients with endometriosis and normal ESC from control patients, in a dose- and time-dependent manner (P<0.05); GnRH-II increased the apoptotic rate of three ESC in a dose-dependent manner (P<0.05); The concentration of VEGF in three ESC was significantly decreased after the treatment of GnRH-II, in a dose-dependent manner (P<0.01); And these above effects were the strongest on the ectopic than on the eutopic or normal, there were statistical significance (P<0.05); and three was no significantly difference between the eutopic and normal (P>0.05). Conclusions: GnRH-II significantly inhibited the cell proliferation, induced cell apoptosis and decreased the VEGF secreting of ectopic, eutopic and normal ESC in EMs in vitro, and these effects were the strongest on ectopic ESC, which suggested that GnRH-II may become a new effective treatment for endometriosis.     

Diagnostic dilemmas and potential pitfalls in the evaluation of endometrial adenocarcinoma

Endometrial adenocarcinoma is the most common malignancy of the gynaecologic tract, and therefore one of the most commonly encountered surgical pathology specimens. Accurate diagnosis, grading and staging are necessary to direct therapy for this common disease. Evaluation of these cases is usually straightforward. Some cases, however, may be complicated by a variety of issues such as difficulty assessing depth of invasion; difficulty assessing cervical involvement; possibility of synchronous ovarian primaries; evaluation of lymphovascular space invasion; difficulties with FIGO grade (especially in the company of altered differentiation); and subtle patterns of myoinvasion. The purpose of this review is to emphasize these problematic areas and offer straightforward guidelines to apply when these situations are encountered. Proper recognition of these diagnostic challenges will hopefully improve grading and staging accuracy, and subsequently therapy, for the multitudes of women affected by this disease.