Principles of chemotherapy and radiotherapy

The current management of all gynaecological malignancy requires complex multidisciplinary investigation and discussion, leading to multi-modality treatment. The delivery of systemic therapy or radiotherapy can have different aims depending on the type of cancer, clinical context and patient wishes. This review explores the systemic treatment options and radiotherapy that form part of the standard management of this group of tumours and looks at current research that may help shape the treatment of the future.     

Noncatalytic PTEN missense mutation predisposes to organ-selective cancer development in vivo

Inactivation of phosphatase and tensin homology deleted on chromosome 10 (PTEN) is linked to increased PI3K–AKT signaling, enhanced organismal growth, and cancer development. Here we generated and analyzed Pten knock-in mice harboring a C2 domain missense mutation at phenylalanine 341 (Pten^FV), found in human cancer. Despite having reduced levels of PTEN protein, homozygous Pten^FV/FV embryos have intact AKT signaling, develop normally, and are carried to term. Heterozygous Pten^FV/+ mice develop carcinoma in the thymus, stomach, adrenal medulla, and mammary gland but not in other organs typically sensitive to Pten deficiency, including the thyroid, prostate, and uterus. Progression to carcinoma in sensitive organs ensues in the absence of overt AKT activation. Carcinoma in the uterus, a cancer-resistant organ, requires a second clonal event associated with the spontaneous activation of AKT and downstream signaling. In summary, this PTEN noncatalytic missense mutation exposes a core tumor suppressor function distinct from inhibition of canonical AKT signaling that predisposes to organ-selective cancer development in vivo.     

A practical guide to the evaluation of benign endometrial conditions in biopsy and curettage material

Sampling of the endometrium, via biopsy or dilation and curettage, is an important diagnostic tool in a wide variety of clinical scenarios, ranging from infertility and abnormal uterine bleeding to cancer surveillance in high-risk populations. This review describes the most common methods for endometrial sampling used currently and discusses the issue of specimen adequacy from an evidence-based perspective. It also focuses on select benign conditions involving the endometrium in the setting of abnormal uterine bleeding, ranging from anatomic/structural lesions to patterns indicative of a dysfunctional menstrual cycle. The topic of endometrial sampling evaluation in the context of recurrent pregnancy loss is also discussed, with insights on documentation of endometrial changes during the ovulatory phase and the diagnosis of endometritis.     

定坤丹治疗子宫内膜薄型不孕的临床效果

目的 观察定坤丹治疗子宫内膜薄型不孕的临床效果,为优化子宫内膜薄型不孕的治疗方案提供参考。方法 选取187例子宫内膜薄型不孕患者,在保证组间基本特征匹配原则上,利用计算机软件产生的随机数,按照1∶1的比例分为对照组(93例)和观察组(94例)。对照组给予雌二醇+地屈孕酮干预,观察组在对照组的基础上加用定坤丹。比较治疗3个周期后两组患者的子宫内膜厚度、孕激素浓度及临床妊娠率。结果 观察组患者排卵期平均子宫内膜厚度显著高于对照组(P<0.01),黄体期孕激素浓度显著高于对照组(P<0.01),累计临床妊娠率显著高于对照组(P<0.05)。结论 定坤丹可以明显改善子宫内膜薄型不孕患者排卵期子宫内膜厚度,提高黄体功能,改善妊娠结局。