An immunohistochemical analysis of CD3, PD-L1, and CTLA-4 expression in carcinosarcomas of the gynecological tract and their metastases

BackgroundCarcinosarcoma of the gynecological tract is a rare tumor with a dismal prognosis. Its immune micro-environment has not been sufficiently studied.Aim of the studyTo study the immune micro-environment of gynecological carcinosarcomas.Material and methodsSixty-nine surgical specimens from 37 different patients, including 34 primary tumors and 35 metastases, were immunohistochemically studied for the expression of CD3, PD-L1, and CTLA-4. Clinical and histological features were recorded and correlated with immunohistochemical factors.ResultsTwenty-two cases involved the uterine corpus, 1 the uterine cervix, and 14 the adnexa. The overall survival ranged from 2 to 156 months, with a median survival of 16 months. CD3 expression was more frequent at the sarcomatous than the carcinomatous component. CTLA-4 expression was higher at the carcinomatous than the sarcomatous component. PD-L1 was negative in all cases studied. Tumor relapse, metastasis presence, metastasis localization, and overall survival did not correlate with CD3 or CTLA-4 expression.ConclusionPD-L1 expression is not a feature of gynecological carcinosarcomas, despite a relatively frequent lymphocytic reaction. CTLA-4 expression is sometimes found in these tumors.     

一年内发生两次卵巢破裂一例

卵巢破裂主要包括卵泡破裂、黄体破裂或黄体血肿破裂,多发生于卵巢功能旺盛的年轻女性,与排卵密切相关[1].长期口服避孕药可抑制排卵,预防其再度发生.从这例患者复查B超情况看,还有可能再次发生类似症状,但该患者年龄尚轻,未婚,不适宜长期口服避孕药,应加强对该患者的随诊、观察.一旦再发生卵巢破裂,应根据其病情轻重、内出血的多少而定.如出血量多,影响到生命体征的稳定,应考虑微创手术止血;出血量不多,则予以止血药物等保守治疗,动态观察病情变化,待其结婚生子后再予以Ⅱ号避孕药预防此病的再发生.     

Insulin-like growth factor-3 (IGF-3) in male and female gonads of the tilapia: Development and regulation of gene expression by growth hormone (GH) and 17α-ethinylestradiol (EE2)

Recently, in addition to IGF-1 and IGF-2 the existence of a third form of IGF, termed IGF-3, limited to fishes, to be present only in the gonads and encoded by a separate gene has been reported. However, no further data have been presented on IGF-3. The present study on tilapia (Oreochromis niloticus) uses quantitative real-time PCR specific for tilapia IGF-1 and IGF-3. The organ distribution of IGF-3 mRNA in adult fish and the early ontogeny of IGF-3 in male and female gonads were studied. The potential sensitivity of IGF-3 to GH was revealed by intraperitoneal injections of bream GH using IGF-1 as control gene. The effects of 17α-ethinylestradiol (EE2) exerted after feeding of high EE2 doses and exposure to low environmentally relevant EE2 doses on IGF-3 expression in testis and ovary during early development were determined. Low IGF-3 mRNA expression levels were detected in most organs studied, with the highest extra-gonadal amount in the pituitary. During development, the IGF-3 gene was significantly upregulated in male but downregulated in female gonad. Injections of GH elevated IGF-1 mRNA in male and female liver and ovary. IGF-3 did not respond to GH treatment neither in ovary nor in testis. Both EE2 treatments resulted in significant downregulations of IGF-3 mRNA in testis while ovarian IGF-3 mRNA did not respond. Thus, IGF-3 may be involved in reproduction of fishes most likely in the male gonad only. Whether IGF-3 also has some physiological significance in ovary or other organs should be the topic of further studies.     

卵泡穿刺结合人工授精治疗多囊卵巢综合征不孕

目的:探讨一种有效治疗多囊卵巢综合征(polycystic ovarian syndrome,PCOS)不孕的方法。方法:对18例患者22个周期采用促性腺激素刺激卵泡发育配合经阴道超声下卵泡穿刺术释放卵母细胞再行人工授精。结果:18例患者中妊娠6例,妊娠率33%;未孕患者在2个月内月经恢复正常,且之后月经均恢复成以前状态;患者血黄体生成素(LH)和睾酮值治疗后明显低于治疗前(P<0.05)。结论:卵泡穿刺结合人工受精,具有创伤较小、疗效确切、简便等优点,可作为治疗PCOS不孕的一种选择。     

力朴素与奈达伯联合先期化疗对晚期卵巢上皮性癌的临床观察

目的观察力朴素与奈达伯联合行新辅助化疗对晚期卵巢上皮性癌近期的疗效及毒副反应。方法晚期卵巢上皮性癌80例，采用力朴素与奈达伯联合化疗方案（力朴素135mg／m2，奈达伯80mg／m2-100mg／m2），全身静脉化疗结合腹腔灌注化疗，3周为一个疗程，于术前完成1—2个疗程治疗后，行体检、影像学检查及手术治疗，从而判断治疗疗效及毒副作用。结果治疗有效率为92．5％（74／80）；白细胞下降发生率为50％（40／80），胃肠道反应发生率为77．5％（62／80）；所有患者均未因毒副反应中断或退出治疗。结论力朴素与奈达伯联合行先期化疗对晚期卵巢上皮性癌效果较好，毒副反应较轻。     

恶性肿瘤患者卵巢功能的保护

放化疗严重损害患者的卵巢功能和生育能力。保护卵巢功能和生育能力的方法有药物、卵巢移位、卵巢移植和冷冻保存技术等。最有效的药物为促性腺激素释放激素激动剂(GnRHa),对化疗引起的卵巢损害有效。卵巢移位对盆腔放疗引起的卵巢损害有效。胚胎冷冻技术成熟。卵巢冷冻移植、卵母细胞冷冻和未成熟卵母细胞体外成熟(IVM)技术尚不成熟,成功率低。     

FSH/LH值与控制性超排卵中卵巢反应性关系的临床研究

目的:探讨FSH/LH值在控制性超排卵(COH)中与卵巢反应性的关系。方法:对336个周期分为超排卵治疗不反应组(34个周期)、低反应组(59个周期)、正常反应组(243个周期),比较3组FSH、LH,以及使用促性腺激素释放激素激动剂(GnRHa)后FSH、LH水平,促性腺激素(Gn)的用量等。激素测定采用酶联免疫分析法。结果:不反应组的FSH基础值为9.9±4.9U/L,分别与低反应组的8.1±5.1U/L及正常反应组的6.6±2.5U/L比较,差异均有统计学意义(P<0.05)。不反应组的FSH/LH基础值为2.8,分别与低反应组(2.1)及正常反应组(1.5)比较差异均有统计学意义(P<0.05)。使用GnRHa启动日不反应组FSH/LH比值为5.1,低反应组为4.1,两者与基础水平比较均有明显增高,而正常反应组增高不明显。结论:GnRHa降调节后,FSH/LH值可用于预测卵巢对Gn的反应性而作为判断COH结果的预测指标。     

邻苯二甲酸二丁酯对小鼠卵巢功能的影响

目的 探讨邻苯二甲酸二丁酯(DBP)对小鼠卵巢功能的影响.方法 将雌性昆明小鼠按体重随机分为高(400mg/kg)、中(40mg/kg)、低(4mg/kg)DBP染毒组和1个溶剂对照组(二甲基亚砜),每组12只.每天腹腔注射1次[0.005ml/(g·d)],连续染毒14 d.阴道脱落细胞涂片法观察动情周期变化,分别于终止染毒第1、14天处死,分离卵巢和子宫,计算脏器系数,并观察卵巢病理变化.结果 各染毒组小鼠食欲降低,活动减少,精神萎靡不振,被毛光泽度下降,部分出现腹泻,体重下降;对照组小鼠食欲正常,精神较好,被毛有光泽.不同组别小鼠染毒前、后体重比较,差异均无统计学意义(P＞0.05).中、高剂量组小鼠动情后期、间期和动情周期时间长于对照组,高剂量组小鼠动情后期、间期和动情周期时间长于低剂量组,差异均有统计学意义(P＜0.05).随着染毒剂量的增加,小鼠动情周期时间逐渐延长,呈剂量-反应关系(rs=0.677,P＜0.001),并主要表现为动情后期和动情间期的延长.终止染毒第1、14天,高、中、低剂量组小鼠卵巢脏器系数与对照组相比,差异均无统计学意义(P＞0.05).终止染毒第1天,高、中、低剂量组小鼠子宫脏器系数高于对照组,终止染毒第14天,中、高剂量组小鼠子宫脏器系数高于对照组,差异均有统计学意义(P＜0.05).随染毒剂量的增高,子宫脏器系数有升高的趋势,呈剂量-反应关系(rs=0.564,P=0.010).终止染毒第1天,高剂量组成熟卵泡数低于对照组,中、高剂量组闭锁卵泡数高于对照组,差异均有统计学意义(P＜0.01);终止染毒第14天,高剂量组闭锁卵泡数高于对照组,差异有统计学意义(P《0.05).结论 邻苯二甲酸二丁酯可影响小鼠卵巢的内分泌功能及卵泡的发育、成熟,在体内可能具有类雌激素作用.     

卵巢超声图像在陈旧性宫外孕诊断中的价值

目的:探讨卵巢超声图像在陈旧性宫外孕中的超声诊断价值。方法:选择临床疑诊为陈旧性宫外孕,后经手术或腹腔镜证实的30例病例,对其超声检查资料进行回顾性分性。结果:超声诊断附件实质性包块,考虑为陈旧性宫外孕24例,子宫浆膜下肌瘤2例,盆腔脓肿4例,其中26例超声可同时显示卵巢图像,术后证实陈旧性宫外孕26例;盆腔腔肿2例;子宫浆膜下肌瘤2例,超声诊断误诊4例。结论:提高卵巢超声图像的显示率及正确地辩认卵巢图像,可以提高陈旧性宫外孕的诊断率。     

超声联合CA125CA199诊断卵巢恶性肿瘤的临床分析

目的:探讨彩色多普勒超声联合妇科肿瘤标志物CA125、CA199诊断卵巢恶性肿瘤的临床价值.方法:总结2002年至2006年间本院180例卵巢肿瘤患者的临床资料,其中卵巢良性肿瘤患者152例(A组),卵巢恶性肿瘤患者28例(B组).应用彩色多普勒超声分别经腹及经阴道观察两组患者的二维图像,并用超声Finkler评分系统对两组患者进行超声评分,同时进行频谱多普勒检测卵巢肿瘤的阻力指数(RI).应用放射免疫法测定两组患者血清CA125、CA199值.对比两组患者在超声评分、RI、CA125、CA199四个方面的差异.结果:B组患者的超声评分明显高于A组患者,而B组患者的RI值却明显低于A组患者,两组比较,差异有极显著性(P＜0.01).B组患者的CA125、CA199明显高于A组患者,两组比较,差异有显著性(P＜0.05).卵巢恶性肿瘤患者的超声评分、CA125、CA199值明显升高,而RI值却明显降低.结论:彩色多普勒超声联合血清CA125、CA199检查对卵巢恶性肿瘤的筛查及诊断有临床价值.