Mucinous histology is a risk factor for nodal metastases in endometrial cancer

Objectives

Mucinous adenocarcinoma of the endometrium (MUC) is a rare histological variant of endometrial carcinoma accounting for 1-9% of endometrioid tumors. Few studies have characterized its clinical behavior. This is a case-control study at a single institution comparing the risk factors and clinical course of MUC relative to endometrioid adenocarcinoma.

Methods

A case-control study was performed including patients treated for endometrial cancer between 1996 and 2006. 41 cases of mucinous adenocarcinoma were identified. Each case was matched with two controls of endometrioid histology by age and histological grade. Cases and controls were compared with regard to known risk factors for endometrial cancer and the extent of disease at diagnosis. Chi-square tests were used to compare proportions and Student's t-tests for the comparison of means. Multivariate regression was used to identify the independent predictors of lymph node metastases. Overall survival was calculated using the Kaplan-Meier method and compared with the Log-rank test. p < .05 was considered significant for all tests.

Results

Cases and controls were matched by age and FIGO grade and were found to be similar in regard to ethnicity, body mass index and medical history. No significant difference in myometrial invasion (MI) > 50% or the presence of lymph-vascular space invasion was found between cases and controls, however, 17% of patients with MUC had lymph node metastases compared to 3% of controls (p = .01). Multivariate analysis controlling for both tumor grade and depth of MI identified mucinous histology as an independent predictor of lymph node metastasis (p = .02). There was no difference in adjuvant treatment, recurrence rate or survival between the two groups.

Conclusion

Mucinous differentiation was found to be an independent predictor of lymph node metastasis in the study population. Comprehensive surgical staging including retroperitoneal node dissection should be strongly considered in all endometrial cancer patients with predominantly mucinous histology.     

子宫内膜混合型腺癌1例

1病历摘要患者46岁。因阴道排液3个月余,少量阴道流血2d于2010年9月28日来湖北省公安县人民医院就诊。患者平素月经规律,末次月经2010-07-14。月经量中,色红,无痛经史。孕3产2。超声检查提示:子宫颈内实性占位病变。子宫内膜增厚并回声不均。TCT提示:ASC-US。于     

β-catenin在子宫内膜异位症患者在位内膜中的表达

目的:探讨β-catenin在子宫内膜异位症(EMs)患者在位内膜的增殖与凋亡活性的关联,及其在EMs发病中的作用。方法:共收集68例EMs患者在位内膜组织(EMs组)和70例非EMs患者子宫内膜(对照组),采用免疫组织化学技术分析子宫内膜组织β-catenin的表达情况。TUNEL检测分析子宫内膜组织的凋亡活性,Ki67免疫组织化学染色分析子宫内膜组织的增殖活性。结果:与对照组比,EMs患者在位内膜Ki67表达明显增强,TUNEL阳性细胞明显减少(P<0.05)。在位内膜腺上皮及间质β-catenin表达明显高于对照组(P<0.05)。β-catenin在胞质及胞核的表达明显高于对照组(P<0.05)。直线相关分析结果显示无论是正常内膜还是EMs患者在位内膜,β-catenin的表达与Ki67表达均呈正相关,与TUNEL结果均呈负相关。结论:EMs患者在位内膜β-catenin的异常高表达可能通过上调内膜组织的增殖活性,下调其凋亡性而参与EMs的发病。     

mmu-miR-141在早孕小鼠胚胎着床前、后子宫内膜中的表达及作用

目的:探讨mmu-miR-141在早孕小鼠胚胎着床前、后子宫内膜组织中的表达及作用。方法:荧光定量PCR(FQ-PCR)及原位杂交检测早孕小鼠胚胎着床前、后子宫内膜mmu-miR-141的表达;MTT和流式细胞术检测孕第4日(d 4)子宫内膜基质细胞被mmu-miR-141抑制剂作用72 h后其细胞活力和细胞凋亡情况。结果:mmu-miR-141在小鼠胚胎着床后(d 6)子宫内膜组织中的表达明显低于着床前(d 4)(P<0.05),且表达于基质细胞;其表达下调能使基质细胞增殖活力下降(P<0.05),细胞凋亡增加(P<0.01)。结论:mmu-miR-141通过调控子宫内膜基质细胞的增殖或凋亡,在早孕小鼠胚胎着床前、后的子宫内膜组织中发挥重要的作用。     

类赖氨酰氧化酶1、转化生长因子β1在子宫腺肌病中的表达及临床意义

目的:探讨类赖氨酰氧化酶1(LOXL1)、转化生长因子β1(TGFβ1)在子宫腺肌病(AM)中的作用及临床意义。方法:采用免疫组织化学法检测30例AM患者在位内膜和异位内膜组织及20例正常子宫内膜组织中LOXL1、TGF-β1的表达,并对其蛋白表达量进行相关性分析。结果:LOXL1在AM异位内膜组、AM在位内膜组及对照组中表达的平均光密度(MOD)值分别为:0.22±0.10、0.15±0.09、0.15±0.06。AM异位内膜组LOXL1的表达高于AM在位内膜组和对照组(P<0.05),而AM在位内膜组和对照组的LOXL1表达无统计学差异(P>0.05);TGFβ1在AM异位内膜组、AM在位内膜组及对照组的相对表达量分别为:0.26±0.02、0.16±0.03、0.15±0.02,AM异位内膜组TGFβ1的表达高于AM在位内膜组和对照组(P<0.05),AM在位内膜组和对照组间TGF-β1的表达无统计学差异(P>0.05)。AM异位内膜组LOXL1蛋白与TGFβ1蛋白的表达呈正相关(r=0.402,P<0.05)。AM在位内膜组LOXL1蛋白与TGFβ1蛋白的表达无相关关系(r=0.24,P>0.05)。LOXL1在子宫大小>孕12周及腺肌瘤>5 cm的AM异位内膜组表达强于子宫大小≤孕12周和腺肌瘤≤5 cm的AM异位内膜组(P<0.05),LOXL1的表达量与患者痛经与否、月经量差异亦无明显关系(P>0.05)。TGFβ1在AM异位内膜中表达与患者痛经、月经量、AM病灶大小的差异均无明显相关性(P>0.05)。结论:LOXL1、TGFβ1在子宫腺肌病的异常表达可能参与子宫腺肌病的发生和发展。     

子宫内膜癌诊治策略的几点思考

子宫内膜癌是女性生殖道常见的恶性肿瘤,其发病率仅次于子宫颈癌。近年来,随着现代生活节奏的加快,饮食不均衡,缺乏锻炼,伴随高血压、高血脂-肥胖和糖尿病的增加,子宫内膜癌发病有增高并呈年轻化的趋势。2002年全球约有子宫内膜癌19.9万例,其发病率6.5/10万,为女性全部恶性肿瘤的第七位,死亡率为1.6/10万[1]。2008年全球发病患者上升为28.7万,无论是发病率还是死亡率,发达国家远高于发展中国家[2]。     

New rat to mouse xenograft transplantation of endometrium as a model of human endometriosis

BackgroundEndometriosis can lead to infertility. Since there is no definitive treatment for endometriosis, animal modelling seems necessary to examine the possible treatments. Mouse endometrium cannot be separated for endometriosis induction. In addition, transplantation of uterus into the abdominal viscera to induce endometriosis causes organ damage. In this study, we defined a new model of endometriosis leading to separability of endometrium and a safe anatomical region for transplantation.MethodsForty female mice were allocated to 5 groups: 1, sham; 2, allograft uterus transplantation of mice to anterior abdominal wall of mice; 3, allograft uterus transplantation of mice to mesentery of mice; 4, xenograft endometrial transplantation of rat to anterior abdominal wall of mice; 5, xenograft endometrial transplantation of rat to mesentery of mice. Adult female rats with a previous pregnancy experience were selected and placed in the vicinity of male rats for 2 weeks to induce estrogen secretion and increase endometrial thickness.ResultsIn the 4th group of animals, compared to sham, the peritoneal concentrations of VEGF‐A, TNF‐α, NO, MDA, and serum levels of CA‐125 and IL‐37 were increased and total body weight was decreased, while weight and size of endometrial lesions were increased significantly (P < .05). Genes expression of HOXA10 and HOXA11 were decreased significantly (P < .05) in groups 2 and 4 compared to sham.ConclusionsXenograft transplantation of endometrium from rat to anterior abdominal wall of mice can potentially mimic human endometriosis morphologically, histologically, and genetically.     

人子宫内膜间质细胞的体外培养

目的：建立分离培养符合实验要求的人在位及异位子宫内膜间质细胞的方法,为进一步探讨子宫内膜异位症发生、发展的分子生物学机制提供一个理想的实验模型。方法：胶原酶消化在位和异位内膜组织,进行原代培养,胰蛋白酶消化法传代培养,光镜、免疫细胞化学染色进行细胞鉴定。结果：角蛋白、波形蛋白染色证实细胞纯度达95%以上。 结论：胶原酶消化法简便易行,可获得符合实验要求的人子宫内膜间质细胞,可以用于子宫内膜异位症发病机制、药物筛选等研究。     

正常与异位子宫内膜Bcl-2与PCNA的表达

目的：探讨B细胞淋巴瘤/白血病-2(Bcl-2)蛋白和增殖细胞核抗原（PCNA）蛋白与正常及异位子宫内膜的关系。 方法：应用免疫组化法检测46例正常月经周期子宫内膜和15例卵巢子宫内膜异位症患者的异位子宫内膜中的Bcl-2蛋白和PCNA蛋白。 结果：Bcl-2蛋白和PCNA蛋白在正常月经周期子宫内膜增生期升高(两组均为61.5%),分泌期低落(22.2%和5.5%),月经期消失(0和33.3%);在异位内膜中的表达(均为100%)高于增生期（P<0.05）。 结论：正常月经周期子宫内膜中Bcl-2蛋白和PCNA蛋白表达有周期性变化,且与异位子宫内膜中的表达不同,异位子宫内膜通过多种方式获得生存优势。     

灭囊灵对体外培养的猪囊尾蚴虫体蛋白质组分及含量的影响

目的　探讨灭囊灵杀灭猪囊尾蚴的作用机理。方法　应用PAGE和薄层扫描技术 ,观察灭囊灵对体外培养猪囊尾蚴虫体蛋白质组分及含量的影响。结果　灭囊灵组囊尾蚴蛋白经PAGE可分离出 17～ 2 5条蛋白带。经薄层扫描分析 :灭囊灵 0 6ml、1 2ml和 2 4ml三个剂量组在 70～ 75区段蛋白扫描无峰 ;0 6ml组在 10 5～ 110区段峰值最高 ,1 2ml和 2 4ml剂量组在 110～ 115区段峰值最高。峰面积积分值占 8%以上者为高峰带 ,0 6ml和 2 4ml组可见 6个高峰 ,1 2ml组可见 5个高峰。以上三项指标与原囊尾蚴和空白对照组均有明显差别。结论　灭囊灵对猪囊尾蚴虫体蛋白组分和含量均有明显影响