坤宝颗粒改善子宫内膜容受性的研究

目的观察坤宝颗粒改善子宫内膜容受性的疗效。方法210例患者随机分为2组,对照组根据患者的情况选用合适的促排卵药物,同时自月经第5天服用补佳乐,治疗组在对照组的基础上加用坤宝颗粒(本院自制),观察2组疗效。结果治疗组在HCG注射日子宫内膜显著增厚,Ⅰ型子宫内膜的比率及妊娠率明显高于对照组(P均<0.05),且子宫内膜螺旋动脉PI、RI与对照组相比有显著性差异(P均<0.05)。结论坤宝颗粒改善子宫内膜容受性的疗效显著。     

上皮型钙粘附蛋白在子宫内膜癌中的表达及意义

目的　探讨上皮型钙粘附蛋白 (E -cad)在正常子宫内膜、子宫内膜不典型增生、子宫内膜癌中的表达 ,及其与临床参数间的关系。方法　应用免疫组化S -P法检测 14例正常子宫内膜、10例子宫内膜不典型增生及 5 0例子宫内膜癌中E -cad表达情况。结果　在正常子宫内膜、子宫内膜不典型增生及子宫内膜癌中 ,E -cad阳性表达率分别为 10 0 %、80 0 %、42 0 %,各组差异具有显著性 (P <0 .0 5 )。在G1、G2 、G3 子宫内膜癌中 ,E -cad阳性表达率分别为 72 2 %、30 0 %、16 7%(P <0 .0 5 )。在限于内膜组、浸润浅肌层及浸润深肌层组 ,E -cad阳性表达率分别为 6 8 4 %、35 3%、14 3%(P <0 .0 5 ) ,在临床Ⅰ、Ⅱ、Ⅲ期 ,E -cad阳性表达率分别为 6 0 9%、31 3%、18 2 %(P <0 .0 5 )。结论　E -cad异常表达与子宫内膜癌的发生发展密切相关。     

p16、Cyclin D1在增生性子宫内膜及子宫内膜癌中的表达

目的 :探讨 p16和 Cyclin D1在内膜癌发生、发展中的作用。方法 :采用免疫组化 S—P法对 12例正常子宫内膜、2 2例增生性子宫内膜及 4 1例子宫内膜癌中 p16和 Cyclin D1表达进行了研究。结果 :在单纯加复合增生、不典型增生及子宫内膜癌中 ,p16表达呈下降趋势 ,内膜癌与正常内膜及增生性内膜有显著性差异 (P<0 .0 1,P <0 .0 5 ) ;而Cyclin D1表达呈上升趋势 ,增生性子宫内膜、子宫内膜癌与正常内膜有显著性差异 (P<0 .0 5 ,P<0 .0 1)。不典型增生与单纯加复合增生 Cyclin D1过表达有显著性差异 (P<0 .0 1)。子宫内膜癌中 ,p16表达随细胞分化程度下降而降低 ,而Cyclin D1则随分化程度下降而上升 ,二者呈负相关。结论 :p16、Cyclin D1异常参与子宫内膜癌的发生 ;p16低表达、Cyclin D1过表达与内膜癌的恶性生物学行为有关 ;Cyclin D1核过表达可能是一个早期分子事件     

放置TCu220c宫内节育器15年左右子宫内膜形态学的研究

目的：探讨国产TCu220c宫内节育器（IUD）放置15年左右（13－17年）子宫内膜的形态学改变及其安全性，并为临床放置年限提供科学依据。方法：采用光镜、透射电镜，从组织病理学和超微结构病理学角度，对24例放置国产TCu220cIUD15年左右妇女的子宫内膜进行形态学研究。结果：TCu220cIUD放置15年左右，铜离子的作用在逐渐减弱，对子宫内膜的影响也在逐渐减轻，但TCu220cIUD仍然具有抗生育作用。子宫内 膜没有癌变倾向。对进入更年期的妇女，放置TCu220cIUD15年左右，子宫内膜仍无间变和癌变。结论：TCu220cIUD放置15年左右是较为安全的。     

肿瘤转移抑制因子CD9/MRP-1基因在小鼠围着床期子宫内膜的动态表达

目的:探讨肿瘤转移抑制基因(CD9)/运动相关蛋白(MRP-1)mRNA和蛋白在胚胎着床过程中的作用。方法:应用RT-PCR和免疫组化技术观察CD9/MRP-1mRNA和蛋白在早孕和假孕小鼠子宫中的表达规律。结果:早孕d1-4小鼠子宫组织均有CD9/MRP-1mRNA表达,且d4表达最多;其蛋白主要表达在d1-4的子宫内膜上皮细胞,且早孕d2-4CD9/MRP-1在子宫基质细胞散在阳性表达。假孕d1-8小鼠子宫组织均有CD9/MRP-1mRNA表达,假孕d5表达开始增加,至d6达到峰值。而CD9/MRP-1蛋白在假孕d1-8子宫内膜腺上皮均有表达,而子宫内膜腔上皮均无表达。假孕d2-5,子宫基质细胞出现散在阳性表达。结论:①CD9/MRP-1在早孕小鼠子宫中呈动态表达,提示它在胚胎精确侵袭子宫内膜的调节中发挥作用。②CD9/MRP-1在妊娠小鼠子宫的表达是非胚胎依赖性的。     

Mixed serous—endometrioid carcinoma of the uterus: pathologic and cytopathologic analysis of a high-risk endometrial carcinoma

A review of the pathology and cytopathology of 295 endometrial adenocarcinomas treated surgically at King Edward Memorial Hospital for Women, with full 5-year follow-up, revealed 16 cases of pure serous carcinoma (USC), 10 cases of mixed serous and endometrioid carcinoma with a predominant serous component (mixed USC-EAC) and six cases of mixed serous and endometrioid carcinoma with a predominant endometrioid component (mixed EAC-USC). The mixed carcinomas may be characterized microscopically by classical serous features side by side with classical endometrioid features, or additionally by features intermediate between the two. Many of these features are reproduced in preoperative cervicovaginal smears. USC and mixed USC-EAC were found to be indistinguishable clinically and prognostically, with an identical corrected 5-year survival of 40%, although numbers are small. Mixed EAC-USC (which contained 10–25% serous differentiation in this series), however, were similar in many respects to a control population of 95 EAC of Grade 2 and 3. The corrected 5-year survival in these two groups was 67% and 79%, respectively, which is not statistically significant in this small series. This study suggests that the behavior of a mixed tumor containing 50% or more serous differentiation is similar to that of pure serous carcinoma, and that the behavior of a mixed tumor containing less than 25% serous differentiation is similar to that of the other component. Given the poor correlation between pathologic findings in curettage and subsequent hysterectomy specimens, however, identification of any significant serous element in curettage material may prove vital in optimizing surgical and adjuvant therapy.     

Metastatic small cell carcinoma of the endometrium: prolonged remission and possible cure following chemotherapy

A 54-year-old woman with inoperable metastatic small cell carcinoma (SCC) of the endometrium was treated with cisplatin and etoposide chemotherapy on the basis of the histologic similarity to pulmonary SCC. The response to treatment was monitored using serum neuron specific enolase (NSE) levels. A complete remission was obtained with resolution of symptoms and disappearance of the mass. The patient is alive and well 4½ years later. Considering the aggressive behavior and short survival usually associated with this tumor and the presence of such advanced disease, a complete response to chemotherapy was unexpected. It would appear that chemotherapy should always be considered in the management of metastatic endometrial SCC, even in the presence of large-volume disease.     

Retrieval, Maturation, and Fertilization of Immature Oocytes Obtained from Unstimulated Patients with Polycystic Ovary Syndrome

Purpose: Our purpose was to determine whether immature oocytes could be retrieved under local anesthesia, whether these oocytes would mature and fertilize in vitro, and whether adequate endometrium development could be obtained after hormonal supplementation. Methods: Ovum pick-up was performed under local anesthesia. Immature oocytes were cultured and inseminated. To prepare the endometrium, estradiolvalerate was administered in combination with micronized progesterone. Results: Immature oocytes were obtained in all cases. Fifty-six percent (n = 30) of the oocytes developed into metaphase II (MII) after 48 hr of culture, and another 20% reached the MII stage by 72 hr. Normal fertilization was observed in only 10% of oocytes inseminated. No embryonic development occurred, and therefore embryo transfer was not performed in any of the patients. Endometrial microbiopsy was performed in all subjects and endometrial development was considered sufficient in eight patients. Conclusions: We collected immature oocytes from patients with polycystic ovary syndrome without general anesthesia. In vitro maturation of these oocytes seemed adequate but fertilization rates were poor. Sufficient endometrial quality was obtained after hormonal substitution.     

Influence of the menstrual cycle on aminolevulinic acid induced protoporphyrin IX fluorescence in the endometrium: in vivo study

BACKGROUND AND OBJECTIVES: In vitro studies indicated that compared to postmenopausal women, premenopausal women had increased aminolevulinic acid induced protoporphyrin IX (ALA-induced PpIX) fluorescence expression in the endometrium. The aim of this study was to evaluate menstrual cycle dependency of ALA-induced PpIX fluorescence in the endometrium in vivo. STUDY DESIGN/PATIENTS AND METHODS: Thirteen patients were included for in vivo spectrofluorometric measurements of ALA-induced PpIX in the endometrium and 51 patients for fluorescence hysteroscopy. Two milliliter of a 2% 5-ALA-solution at pH = 4.0 (ASAT AG/Zug, Switzerland) was topically administrated just before spectrofluorometry and 4 hours before hysteroscopy. Spectrofluorometry: Optical fiber based. Fluorescence hysteroscopy: STORZ-D-Light system (Storz, Tuttlingen, Germany). Histological classification of curettage and bioptic endometrial tissue stained with hematoxylin and eosin (H&E). RESULTS: Hysteroscopic and in vivo spectrofluorometric measurements showed an increase of ALA-induced PpIX fluorescence in the secretory and hyperplastic endometrium compared to proliferative and atrophic endometrium. CONCLUSIONS: The accuracy of fluorescence hysteroscopy and the success of the photodynamic endometrial ablation using ALA-induced PpIX may depend on the hormonal influence of the menstrual cycle. The mechanisms responsible for the increased ALA-induced PpIX fluorescence in the secretory versus proliferative phase of the menstrual cycle deserve further studies.     

Surface ultrastructure of human endometrium. Effect of hormonal status and neoplastic progression

The structure, size and number of uterine endometrial surface epithelial cells and specialized structures, cilia and microvilli were analyzed by light microscopy, transmission and scanning electron microscopy. The purpose was to further our understanding of the biological, morphological and prognostical implications of change in hormonal status and neoplastic progression. The results of this study showed that the quantitative and qualitative alterations followed a similar pattern: the cilia and microvilli were minimally developed in atrophic endometrium, and gradually progressed in size and number in relation to the hormonal cycle and hyperplastic endometrium, unless associated with cellular atypia. Lesions with atypical adenomatous hyperplasia showed irregular and disorganized surface structure, progressively more apparent in specimens from adenocarcinomas. Decreasing degree of differentiation of the tumor and radiation treatment caused a reduction in number and size, as well as derangement in the structure of cilia and microvilli. The results showed the sensitivity of the uterine lining to hormonal changes, the distinction between different types of endometrial hyperplasia and the close interrelationship between atypical adenomatous hyperplasia and early adenocarcinoma, as well as the extent and severity of different clinical entities, including radiation treatment.