Cervicovaginal involvement in pemphigus vulgaris: a clinical study of 77 cases

BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune blistering disease which is known to involve the female genital tract, but the frequency at which this occurs is unknown. There are few reports in the literature of the cytological appearance of PV on cervicovaginal smears. OBJECTIVES: To evaluate involvement of the female genital tract and the appearance of cervicovaginal Papanicolaou (Pap) smears in PV. METHODS: The study included 77 patients with PV who attended between April 2005 and February 2007. Each patient was subjected to gynaecological examination and cervicovaginal Pap smear. RESULTS: Genital lesions were observed in 39 patients (51%). Of these, the labia minora were involved in 36 patients (92%), the labia majora in 11 (28%), the vagina in 14 (36%) and the cervix in six (15%). Cervicovaginal Pap smears of 20 of 77 patients (26%) showed PV. Of 72 satisfactory Pap smears, the cervical Pap smear was normal in 25 patients (35%), inflammatory in 43 patients (60%), and dysplastic (low-grade squamous intraepithelial neoplasia) in four patients (6%). CONCLUSIONS: Involvement of the female genital tract with PV might not be as infrequent as was previously thought; it is probably the second most common mucosal site of PV after the oral mucosa. Genital lesions may be missed and the need for thorough pelvic examination should not be overlooked.     

阴道镜在诊断子宫颈疾病中的应用

目的:是评价阴道镜在子宫颈疾病中的诊断价值,以便早期发现和早期治疗宫颈疾病。通过对2009年1月至12月350例宫颈疾病患者的阴道镜诊断进行回顾性分析,结果:350例患者在阴道镜下行宫颈活检术,病理结果显示慢性宫颈炎308例、宫颈癌10例,CINⅠ7例,CINⅡ1例,CINⅢ4例,CINⅠ-Ⅱ2例,CINⅡ-Ⅲ5例。结论:是阴道镜下能及时发现宫颈小病灶,能够较准确定位活检,对早期发现宫颈癌和癌前病变具有重要作用。     

DEK overexpression in uterine cervical cancers

The purpose of the present paper was to investigate the significance of DEK protein expression in uterine cervical lesions and its relationship with HPV infection status. DEK protein expression was studied in 253 cervical lesions, including 30 non-neoplastic cervix with or without squamous metaplasia, 64 cervical intra-epithelial neoplasias (CIN; CIN-1, n  = 28; CIN-2, n  = 17; CIN-3, n  = 19), 102 squamous cell carcinomas (SCC), 51 adenocarcinomas, and six adenosquamous cell carcinomas (adenoSCC) on immunohistochemistry. For comparison, HPV-positive and -negative cervical cancer cell lines were also included. The HPV screening was performed using TaKaRa polymerase chain reaction. On immunohistochemistry DEK was found to be negative in all 30 non-neoplastic cervical epithelia, but it was positive in 96.1% of SCC (98/102), 92.2% of adenocarcinomas (47/51), 100% of adenoSCC (6/6), 85.7% of CIN-1 (24/28), 94.1% of CIN-2 (16/17), and 89.5% of CIN-3 (17/19). There was no significant difference between HPV-positive and -negative cervical lesions. Also, strongly positive staining was observed in all aforementioned cervical cancer cell lines regardless of HPV infection, according to immunocytochemistry. In summary, DEK plays an important role in the carcinogenesis of cervical cancers, and can be helpful for early diagnosis, and is a potential therapeutic target.     

大鼠宫颈MMP-2、MMP-8动态表达的研究

目的 通过检测大鼠宫颈基质金属蛋白2(MMP-2)、基质金属蛋白8(MMP-8)的动态表达,探讨胶原降解与宫颈成熟的关系.方法 清洁级大鼠分为未孕动情间期、妊娠10d、妊娠16d、妊娠19d和分娩后即刻组,每组各6只.宫颈称湿重.HE 常规染色显示宫颈大体结构,VG染色进行胶原纤维和肌纤维显色,免疫组织化学染色显示MMP-2、MMP-8.结果 (1)HE染色显示大鼠宫颈主要由大量纤维(胶原纤维和肌纤维)组成,分娩后即刻组宫颈间质见少量中性粒细胞.其余组未见中性粒细胞.(2)临产前宫颈湿重已有增加,至分娩后即刻增加更明显.(3)宫颈纤维组织由胶原纤维和平滑肌纤维组成,所占比例无明显差别.分娩后即刻组胶原纤维和肌纤维排列较非分娩时松散.(4)MMP-2(棕染)在所有组别间质均有表达,鳞状上皮无表达,胶原纤维、平滑肌纤维、上皮及少量血管壁呈阳性表达;妊娠19d和分娩后即刻组阳性表达的密度较其他组增强.(5)分娩后即刻组MMP-8染色见间质散在中性粒细胞棕染.其他组的组织或细胞均未见阳性表达.结论 宫颈成熟后,官颈纤维组织松散、断裂,中性粒细胞由外源性血管浸润到宫颈间质,这一变化在分娩时尤其明显;MMP-2、MMP-8这两种不同来源的基质金属蛋白酶共同降解了宫颈纤维,导致宫颈软化、扩张.

Abstract：

Objective To elucidate the relationship between collagen degradation and cervical ripening by detecting dynamic expressions of matrix metalloproteinases 2 (MMP-2) and 8 (MMP-8) in rat cervix. Method SPF rats were divided into 5 groups (n=6), namely non-pregnancy estrus interval group, gestational days 10, 16, and 19 groups, and immediately postpartum group. The wet weight of the cervix was measured and HE staining was used to display the general structure of the cervix. VG staining was applied to visualize the collagen fibers and muscular fibers. Immunohistochemistry was performed to observe the expressions of MMP-2 and MMP-8 in the cervix. Results HE staining showed that the rat uterine cervix consisted mainly of ?broblasts and ?brous connective tissues. A small quantity of neutrophils could be seen in the cervix stroma of the rats immediately after immediately parturition, but not at the other time points. The wet weight of the antepartum cervix had increased, and a more obvious increase was seen in the wet weight of the cervix immediately after parturition. The collagen fibers of the cervix consisted of collagen fibers and smooth muscle fibers, and their proportions showed no significant variation at the time points around the parturition. Immediately after parturition, the collagen fibers and muscular fibers in the cervix became loosened as compared with that before parturition. MMP-2 expression was found in the cervical stroma but not in the squamous epithelium in nonpregnancy, term pregnancy, and immediately after parturition; the smooth muscle cells, vascular wall, and stromal ?broblasts showed positive expression of MMP-2. Enhanced intensity of MMP-2 staining was seen in term pregnancy and postpartum group in comparison with that in the other groups. MMP-8 expression was observed in the cervix of rats immediately after parturition, with scattered neutrophils positive for MMP-8 spotted in the stroma of the ripened cervix. MMP-8 expression was not detected in the other groups. Conclusion Ripened cervical fibrous tissue becomes loose and broken, and cervical ripening is accompanied by infiltration of neutrophils from exogenous vessels. These changes are particularly evident after parturition. MMP-2 and MMP-8 cooperate to degrade the cervical fibers, leading to cervical softening and expansion.     

子宫动脉药物灌注及栓塞治疗原发性宫颈绒癌一例

Primary choriocarcinoma of the uterine cervix (PCC) is an extremely rare disease. The conventional treatment of PCC is a combination of hysterectomy and chemotherapy. We present one rare case proved by cervical biopsy. The patient was an 36-year-old Chinese woman with irregular vaginal bleeding for 60 days. A cervical tumoral mass was seen in the pelvic examination and biopsy revealed active hyperplasia of trophoblastic cell. Because of massive vaginal haemorrhage, the patient accepted uterine artery drug pouring and embolism emergently. This management had gained a satisfactory effect. Thus, Uterine artery drug pouring and embolism is one new and effective weapon for PCC, which can preserve the patient’s productive ability.     

多柔比星对人宫颈癌Hela细胞凋亡的形态学观察

目的:从形态学方面探讨多柔比星影响Hela细胞生长的作用机制.方法:采用MTT法观察多柔比星对人宫颈癌Hela细胞生长的影响,并采用倒置显微镜、荧光显微镜、透射电镜和激光扫描共聚焦显微镜观察Hela细胞形态变化.结果:MTT实验发现,2 mg/L的多柔比星对Hela细胞的生长有显著的抑制作用,培养4 d后,其生长抑制率达到55.51%,而对L929细胞的生长抑制率仅为18.51%.形态学观察结果表明,多柔比星作用4 d后的Hela细胞呈典型的凋亡形态学改变.结论:2 mg/L多柔比星是通过诱导Hela细胞凋亡而抑制其生长的.     

Cervical carcinoma in Southern Mexico: Human papillomavirus and cofactors

Background: This study was conducted to determine human papillomavirus (HPV) types in women with cervical cancer (CC) and normal cervical cytology in the Southern region of Mexico, and to know the contribution of HPV types and cofactors in cervical cancer etiology. Methods: A case-control study was performed in 133 women with CC and 256 controls. HPV detection was done by MY09/11 and GP5+/GP6+ PCR systems and typing by restriction fragment length polymorphism or DNA sequencing. Results: HPV was found in 100% of CC and 35.5% of controls. The genotype distribution in CC was: HPV 16 (66.8%), 18 (9%), 31 (7.5%), 45 (4.5%), 58 (3.7%), 69 (3%), 52 (1.6%), 6, 11, 33, 56, and 67 (0.8% each). Among controls, HPV 33 followed by HPV 16 were the most frequent. Cervical cancer was associated with HPV 16 (OR = 573.5), HPV 18 (OR = 804.4), and undetermined risk HPV (types 67 and 69) (OR = 434.3). Age at first intercourse <16 years (OR = 9.6) and ≥3 births (OR = 16) were significant risk factors for CC. Conclusions: HPV 16, by far, is the most frequent type in CC, HPV 16 and 18 are responsible for 75.8% of the CC cases and high-risk HPV for 94.7%, which is useful data to take into account in vaccination programs. HPV 33 is the most frequent type in controls and high-risk HPV are more common than low-risk HPV.     

早期子宫颈癌淋巴结转移34例临床观察

目的探讨早期子宫颈癌术后淋巴结转移同步放疗、化疗与预后关系。方法回顾性分析34例早期子宫颈癌术后淋巴结转移的患者,全部行广泛性子宫切除＋盆腔淋巴结清扫术。其中Ⅰa期5例,Ⅰb期16例,Ⅱa期13例;术前放疗、化疗13例,术后全部行同步放疗、化疗;单个淋巴结转移26例,2个或2个以上淋巴结转移8例。结果淋巴结转移率22.1%（34/154）,34例淋巴结转移患者全部行术后同步放疗、化疗,5年生存率82.4%。转移淋巴结直径〈2cm者,5年生存率86.7%;转移性淋巴结直径≥2cm者,5年生存率57.9%;1个淋巴结转移至1级组患者,5年生存率76.6%;转移至2级组患者,5年生存率45.0%。结论淋巴结转移是影响子宫颈癌预后的重要因素,而术后对有淋巴结转移患者行同步放疗、化疗,可有效地提高5年生存率。     

3.0 T MR及DWI在宫颈癌放射治疗中的应用研究

目的 探讨3.0 T MR及扩散加权成像(diffusion weighted imaging,DWI)在宫颈癌放射治疗(放疗)中的应用价值.资料与方法 16例宫颈癌患者放疗前及放疗40 Gy后均进行MR平扫及自由呼吸状态下轴位DWI,b值取0、1000 s/mm~2,分别测量放疗前后肿瘤区表观扩散系数(ADC)值,并作统计学分析.结果 宫颈癌放疗前T_1 WI示病灶呈等信号、T_2WI呈较高信号,DWI呈均匀明显高信号,ADC值平均约(0.99±0.07)×10~(-3)mm~2/s;放疗后病灶明显缩小,DWI信号减低,呈低信号或高低混杂信号,ADC值平均约(1.52 ±0.08)×10~(-3)mm~2/s.放疗前后ADC值差异具有统计学意义(P<0.01).结论 宫颈癌放疗前DWI呈明显高信号,放疗后DWI信号减低,且不均匀,ADC值较放疗前明显增高,DWI可以作为官颈癌放疗监测的理想手段之一.