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.     

锌指蛋白KLF12抑制人子宫内膜间质细胞体外蜕膜化过程中胰岛素样生长因子结合蛋白-1表达

目的人子宫内膜间质细胞蜕膜化标志蛋白胰岛素样生长因子结合蛋白-1(insulin-like growth factor binding protein-1,IGFBP-1)参与调控月经周期、排卵、蜕膜化、胚胎种植以及胎儿生长等生理过程,本研究旨在探索锌指蛋白KLF12对人子宫内膜间质细胞体外蜕膜化过程中IGFBP-1表达的影响。方法制备Ad-Flag-KLF12重组腺病毒,通过荧光定量聚合酶链式反应(PCR)和酶联免疫吸附试验(ELISA)结合重组腺病毒介导的KLF12过表达实验,阐述人子宫内膜间质细胞体外蜕膜化过程中KLF12对IGFBP-1表达调控作用。结果成功获得滴度为2×1011ifu/ml的重组KLF12腺病毒,该腺病毒可在人子宫内膜间质细胞中高表达Flag-KLF12融合蛋白;体外分离培养的人子宫内膜间质细胞经8-Br-cAMP和醋酸甲羟孕酮(medroxy progesterone acetate,MPA)联合诱导蜕膜化后,KLF12的mRNA表达随着诱导时间延长逐渐降低,72h降低最明显,较未刺激降低约70%;过表达KLF12显著抑制8-Br-cAMP和MPA诱导的人子宫内膜间质细胞中IGFBP-1mRNA的表达,并以时间依赖的方式明显抑制IGFBP-1的分泌(P0.01);过表达KLF12明显抑制人子宫内膜间质细胞体外蜕膜化过程中IGFBP-1启动子转录活性。结论锌指蛋白KLF12抑制人子宫内膜间质细胞体外蜕膜化过程中IGFBP-1的表达与分泌。     

子宫内膜癌中的Bmi-1表达及其与hTERT的关系

目的:研究Bmi-1、hTERT在子宫内膜癌、子宫内膜不典型增生、正常子宫内膜组织中的表达。方法:应用免疫组化检测105例子宫内膜癌、40例子宫内膜不典型增生、20例正常子宫内膜组织中Bmi-1、hTERT的表达。结果:在子宫内膜癌、子宫内膜不典型增生和正常子宫内膜组织中Bmi-1、hTERT阳性率分别为86.7%、55%和25%，94.3%、72.5%和5%。Bmi-1在子宫内膜癌和子宫内膜不典型增生中的表达均高于正常子宫内膜组，差异有统计学意义（P<0.05）。子宫内膜癌中，Bmi-1与浸润深度、血管浸润相关，差异有统计学意义（P<0.05），hTERT与组织学分级、组织学类型、浸润深度和血管浸润相关（P<0.05）。Bmi-1和hTERT呈正相关（P<0.01)。结论:Bmi-1和hTERT共同参与子宫内膜病变的恶性转化，联合检测Bmi-1和hTERT对早期判断子宫内膜癌的发生、发展有一定价值。     

多模态MRI在子宫内膜癌术前风险分层中的应用进展

子宫内膜癌（EC）的预后因素包括肿瘤FIGO分期、肌层侵犯深度、淋巴血管间隙浸润，肿瘤的病理分级，以及淋巴结转移与否。筛选高危患者术中淋巴结清扫，避免低危患者过度治疗，具有重要的临床意义。目前，MRI是EC 术前分期最有价值的检查手段之一，磁共振扩散加权成像、体素内不相干运动、MR 动态增强扫描以及MR 影像组学分析等多模态技术均已用于EC 的术前风险评价。本文将对多模态MRI 在EC 术前风险分层中的应用进展进行综述。