Cytological and quantitative cytochemical studies of post-radiation dysplasia

A total of 60 vaginal smears from 19 women treated with ionizing radiation for malignancies of the genital tract in the past seven years in the Division of Radiation Therapy of Emory University School of Medicine were studied for the presence of post-radiation dysplasia (PRD) by means of Feulgen cytospectrophotometry and cytological analysis. PRD was diagnosed on the basis of the presence of dysplastic cytological changes, absence of clinically detectable lesions, and presence of aneuploid DNA values in the dysplastic cells. PRD was detected in 21% of the studied cases. Uniform criteria for PRD, describing premalignant and malignant post-radiation lesions, diagnosed on the basis of aneuploid DNA values, as well as cytological observations is suggested.     

Relative risks for squamous intraepithelial lesions detected by the Papanicolaou test among Air Force and Army beneficiaries of the Military Health Care System

Squamous cell carcinoma of the uterine cervix typically has a curable precancerous phase of 5 to 10 years, during which the Papanicolaou (Pap) test can often detect characteristic cytologic features. The records of 126,024 Pap tests from January 1994 through June 1999 were reviewed. The distribution of cervical dysplasia was unequally distributed between age and military relationship groups, with younger women and active duty women being at increased relative risk for squamous intraepithelial lesions.     

Modifications of relaxation times induced by radiation therapy in cervical carcinoma: Preliminary results

Pelvic Magnetic Resonance Imaging (MRI) was performed in eight healthy women and in eight patients with carcinoma of the cervix, using a 0.5 T superconductive magnet, to evaluate relaxation times of the normal uterine cervix and carcinomas. Spin-lattice (T1) and spin-spin (T2) relaxation times for skeletal muscle, adipose tissue and bone marrow of the epiphysis of the femur were also measured in all cases. In the group of patients with carcinoma of the cervix MRI was performed before, during and after radiation therapy. The mean T1 and T2 values for the normal uterine cervix and cervical carcinoma were evaluated. Mean spin-lattice time for carcinomas were confirmed to be higher than the mean calculated value for the normal cervix, while no significant variation was observed with respect to spin-spin time. A high individual T1 and T2 variability was noted not only in the group of patients affected by cervical carcinoma, but among the healthy subjects too. After radiation therapy a mean T1 time reduction of approximately 20% was found in cervical carcinomas compared with pretreatment measurements, whereas no difference was evident for T2 time. These preliminary results confirm that reduction in spin-lattice time is demonstrated in tumours submitted to radiation therapy. More detailed biological information, such as percentages of vital and necrotic cells, tissue water content and cellular kinetics are probably necessary for a clearer understanding of this phenomenon even in an apparently homogeneous group of patients.     

Cytospectrophotometric analysis of DNA content in the invasive cancer of the vervix.

Fourteen cases of invasive, well differentiated squamous cell carcinoma were studied by means of spectrophotometry for relative DNA content in the tumor cells. Comprehensive review of literature on the subject is given. No correlation of relative DNA value in the tumor cells and clinical stage of the malignancy was found. Lack of the correlation between percentage of aneuploid cells and clinical stage of the tumor was observed. Based on the results of this paper and the literature on the subject, the interrelationship of the proportion of aneuploid cells with low arbitrary DNA value and radiosensitivity of the cervical lesion is suggested. The value of quantitative DNA study for treatment planning is emphasized.     

Peritoneal vaginal fistula and contrast extravasation during MRI

Gynecological malignancies including primary cervical cancers are frequently treated with chemotherapy and radiation. Fistulas affecting the gynecological organs and surrounding cavities are a known consequence of radiotherapy due to focal necrosis of the regional mucosa. In this report, we will demonstrate a rare case of a posterior vaginal wall rupture with resulting fistulization into the peritoneal cavity in a 50-year-old female patient with squamous cell carcinoma of the cervix status postchemoradiotherapy. Magnetic resonance imaging (MRI) showed a discontinuity in the posterior vaginal wall near the fornix with extravasation of ultrasound gel used as contrast into the intraperitoneal compartment. Patient later presented with peritonitis like signs and symptoms and was treated successfully with antibiotics. Vaginal gel should be used with caution in patients with prior history of radiation due to the possibility of vaginal rupture which may lead to peritoneal vaginal fistula and contrast extravasation.     

肠型胃癌及癌前组织分裂期细胞核DNA含量测定的意义

应用显微分光光度计对肠型早期胃癌8例、肠型不典型增生28例(轻、中度各10例,重度8例)和单纯肠化10例中分裂期细胞核进行DNA定量测定,发现DNA均值由肠化经轻、中和重度不典型增生以致发生胃癌的顺序而递增,各组之间DNA均值均有显著差别(P<0.05～0.01)。超2倍体(简称超2 C)及超4 C细胞的比率亦随病变的去分化程度而增高。单纯肠化及轻度不典型增生组未发现有非整倍体细胞(即超5 C细胞),中度不典型增生组超5 C细胞的比率为3.3％,重度为9.2％,早期胃癌为29.2％。结果表明,检测分裂期细胞的DNA含量和非整倍体细胞对肠型胃癌及其癌前病变的客观诊断和分级有重要意义。     

宫颈毛玻璃细胞癌临床病理观察

 目的 探讨宫颈毛玻璃细胞癌（glassy cell carcinoma, GCC）的诊断、临床病理特征及免疫组化特点。方法 分析3例宫颈GCC的临床特征、组织病理学诊断特点及免疫组织化学表达及HPV感染情况。对照组为宫颈基底细胞样鳞状细胞癌3例,腺癌3例,鳞状细胞癌3例及腺鳞癌3例,无肿瘤病变宫颈组织3例。结果 3例GCC患者平均33.7岁,症状为阴道流血,其中2例有明显肿块,1例无明显肿块,3例组织学特点相似,均为细胞呈巢状,小灶状分布,细胞界限清楚,肿瘤细胞呈毛玻璃样、胞质丰富、含大量嗜酸性颗粒、核膜薄、染色质细腻、核仁嗜酸性且较大。核分裂象及凋亡易见,间质有嗜酸性粒细胞、浆细胞浸润;免疫组化标记：p63、CK34 βE12、CAM5.2、MUC1均阳性,HER-2有2例阳性（2/3）,Ki-67指数80%,ER、PR、CK8、CK10、Syn、S-100均阴性。治疗均采取广泛全子宫切除+盆腔淋巴结清扫+术后辅助化疗,术后无癌生存时间3～28个月。结论 宫颈GCC是腺鳞癌的特殊亚型,有独特的组织病理学特点及免疫组化表达谱,准确诊断该肿瘤对临床治疗有较大意义。     

Maspin蛋白和p53蛋白在宫颈鳞癌中的表达及与乳头瘤病毒感染的相关性研究

目的 研究maspin蛋白及p53蛋白在宫颈鳞癌及宫颈上皮内瘤样变组织中的表达及与高危型人乳头瘤病毒(HPV)感染的相关性.方法 应用免疫组化SP法检测maspin蛋白和p53蛋白在宫颈鳞癌、宫颈上皮内瘤样变、正常宫颈3种组织中的表达.分析maspin蛋白表达与宫颈鳞癌各临床病理参数之间的关系,以及宫颈鳞癌组织中maspin蛋白与p53蛋白表达的相关性.HPV检测采用PCR扩增-导流杂交的方法进行分型检测,并将高危性感染率与maspin表达率进行相关性分析.结果 (1)从正常宫颈上皮组织→宫颈上皮内瘤样变→宫颈鳞癌maspin蛋白表达逐渐下调,三者比较差异有统计学意义(P<0.05);(2)临床分期越高,分化程度越低的宫颈鳞癌组织中,maspin阳性表达越少.有淋巴结转移的宫颈鳞癌中,maspin阳性率低于无淋巴结转移者,2者比较差异有统计学意义(P<0.05);(3)maspin蛋白与p53蛋白在宫颈鳞癌组织中的表达呈负相关(r_s=-0.399,P<0.01);(4)maspin蛋白的表达与高危型HPV感染呈负相关(r_s=-0.294,P<0.01).结论 maspin蛋白在宫颈鳞癌的发生发展过程中起重要的抑制作用,可作为判断宫颈鳞癌患者病情进展及预后的指标之一.maspin蛋白在高危性HPV感染后可能受p53等因子的调控表达下调,可用于宫颈癌的基因治疗研究.     

多b值DWI在宫颈癌及CIN Ⅲ诊断中的应用

目的 分析正常宫颈及宫颈癌、宫颈高级别上皮内瘤变(CIN Ⅲ)的多b值扩散加权成像(DWI)的特点,探讨其对宫颈癌诊断和判断病理类型的价值.方法 收集经手术或活检证实宫颈癌患者54例(腺癌15例,鳞癌36例、神经内分泌癌3例)和CIN Ⅲ 9例,行常规MR和多b值DWI扫描.对比正常宫颈组织和宫颈癌组织的多b值表观扩散系数(ADC)值.对测得的不同病理类型宫颈癌、CIN Ⅲ与正常宫颈的ADC值进行比较.结果 正常宫颈的宫颈内膜、结合带及肌层3层结构可以在不同b值的DWI上显示,各层之间的ADC值差异有统计学意义(P<0.05);宫颈癌的多b值ADC值与正常宫颈之间的差异有统计学意义(P<0.05);宫颈鳞癌、腺癌、CIN Ⅲ、神经内分泌癌的平均ADC值差异有统计学意义(P<0.05).结论 多b值DWI的ADC值有助于宫颈癌及CIN Ⅲ的诊断,并与宫颈癌的病理类型存在相关性.应用多b值DWI检查可以提高宫颈癌、CIN Ⅲ定性诊断的准确性.     

Spontaneous and gamma-ray-induced sister chromatid exchanges in patients with carcinoma of cervix uteri

The aim was to investigate whether there are differences in the spontaneous and gamma-ray-induced genomic instability in peripheral blood lymphocytes between untreated cervical cancer patients and healthy women using the sister chromatid exchange (SCE) assay as an indicator of chromosomal instability. Lymphocyte cultures from whole venous blood of 10 patients with cervical neoplasia and 10 healthy female volunteers were cultivated in vitro and irradiated using a 60Co-gamma source. Slides were prepared using the standard air-drying procedure and stained by the fluorescence-plus Giemsa (FPG) technique. The number of SCE and the number of chromosomes were assessed in second-division metaphases. A radiation dose-dependent increase of SCE/cell and SCE/chromosome values were found in healthy women as well as in patients, while statistical analysis has shown significantly higher SCE frequencies in healthy women as compared with patients. Cellular kinetics expressed as replication indices (RI) calculated from the frequency of cells in first cell division (M1), second cell division (M2) and third cell division (M3) were also significantly different, while observed RI were higher for patients than for control individuals. The results suggest that patients with carcinoma of the cervix uteri have chromosomal stability changes reflected in statistically different levels of spontaneous and induced SCE in comparison with healthy individuals. Despite the unknown mechanisms of SCE formation, it is felt that the changed SCE frequency, especially after mutagen treatment, may be used as a marker of increased cancer risk.     

CD109对人宫颈鳞状细胞癌临床病理表现的影响

目的 探讨CD109表达与人宫颈鳞状细胞癌临床病理表现之间的关系.方法 选取天津医科大学附属肿瘤医院正常宫颈组织14例、宫颈上皮内瘤变3级(CIN3)组织14例、宫颈浸润性鳞状细胞癌及其淋巴结转移瘤组织12例.采用免疫组化法检测不同病理学分级宫颈组织中CD109和Ki-67的表达,并采用Western blotting进一步验证.采用Spearman等级相关分析CD109和Ki-67表达的相关性.结果 CD109的表达随病变进展逐渐增强,在宫颈浸润性鳞癌及其淋巴结转移瘤组织中的表达明显高于正常宫颈和CIN3组织中的表达(P＜0.05).Ki-67的表达随着宫颈病变的进展呈现增高趋势,各组间差异具有统计学意义(P＜0l05).CD109与Ki-67的表达阳性率呈正相关(r=0.953,P＜0.01).结论 CD109与宫颈鳞癌细胞增殖相关,且在宫颈鳞状细胞癌的发生、发展及浸润、转移过程中起重要作用.     

Quantitative magnetic resonance imaging in cervical carcinoma: a report on 30 cases

T1 and T2 relaxation times were calculated, before radiation therapy, in 30 patients with cervical carcinoma. Eight healthy young women were submitted to magnetic resonance imaging (MRI) to determine T1 and T2 times of the normal cervix. Magnetic resonance imaging was repeated, in 22 patients, during radiation therapy and at follow-up. During treatment and follow-up, patients with complete tumour response showed a significant T1 reduction compared with the pre-treatment values. With persistence of palpable or visible tumour, T1 times showed a small decrease during therapy, and a marked increase at subsequent examinations. The results suggest that the modifications of T1 times, during radiation therapy and follow-up, could be considered as a useful discriminant between patients with differing tumour response.     

MMP-9在子宫颈鳞状细胞癌中的表达及意义

目的：检测NMP-9在子宫颈鳞状细胞癌中的表达情况,并探讨其与临床病理特征之间的关系。方法：采用免疫组织化学法分别检测MM-9在84例宫颈癌,20例慢性宫颈炎病例中的表达,分析其与临床分期、肿瘤分化程度、淋巴结转移之间的关系。结果：MMP-9在宫颈癌中的阳性表达率为79．8％,显著高于慢性宫颈炎10％（P〈0．05）。在高、中、低分化癌中的阳性表达率分别为52．6％、79．5％、100％,其差异具有统计学意义（P〈0．05）。在TNMI期组中阳性表达率为58．3％,显著低于TNMⅡ期组95．8％（P〈0．05）,在淋巴结转移组阳性率为88％显著高于无淋巴结转移组67．6％（P〈0．05）。结论：在宫颈癌组织中MMP-9呈高表达,MMP-9可能与宫颈癌的浸润转移有关,对判断宫颈癌患者的预后具有一定意义。     

The effects of moderate exercise training on immune response

The relationship between moderate exercise training (ET) (five 45-min sessions per week, brisk walking at 60 heart rate reserve for 15 wk) and changes in immune system variables and function was investigated in a group of 36 sedentary, mildly obese women. The study was conducted using a two (exercise (EX) and nonexercise (NEX) groups) by three (baseline, 6 wk, and 15 wk testing sessions) factorial design, with data analyzed using repeated measures ANOVA. The pattern of change over time between groups for number of peripheral blood lymphocytes (total), T cells (CD5), B cells (CD20), and serum IgG, IgA, and IgM levels was significantly different. This was not the case for spontaneous blastogenesis or number of T helper/inducer cells (CD4) or T cytotoxic/suppressor cells (CD8). Within-EX-group changes were characterized by significant decreases in percentage and number of total lymphocytes, and in T cell number after 6 wk, and significant increases in each of the serum immunoglobulins after both 6 and 15 wk of training. B cell number increased significantly in NEX subjects relative to baseline values at both 6 and 15 wk, with no significant changes experienced in EX subjects. In summary, these data suggest that moderate ET is not associated with an improvement in lymphocyte function but is associated with a 20% increase in serum immunoglobulins and several small changes in circulating numbers of immune system variables, highlighted by significant decreases in circulating numbers of lymphocytes, particularly the T cell subpopulation. These changes were especially apparent after 6 wk of training, with some attenuation by 15 wk.     

Localization of the apex of the vagina: implications for radiation therapy planning.

PURPOSE: To evaluate (a) the displacement of the vaginal apex by a rod during radiation therapy simulation for gynecologic malignancy and (b) apical localization with implanted radiopaque markers. MATERIALS AND METHODS: Metallic markers were implanted in the cervix or vaginal cuff in nine patients with cervical or endometrial carcinoma who underwent irradiation. In all but one patient, radiographs were obtained with and then without the vaginal rod. Displacement of the markers relative to bone landmarks was measured. The total displacement was the square root of the sum of the squares of displacement in each axial direction. RESULTS: All patients showed displacement of the cervical markers by the vaginal rod (mean total displacement, 1.9 cm; range, 0.6-3.6 cm). The greatest displacement was cephalic (mean, 1.5 cm; range, 0.5-2.4 cm). Anteroposterior displacement occurred in all patients but was not as predictable as cephalic displacement. Displacement was anterior in five of the eight patients, posterior in three patients, and lateral in four patients. CONCLUSION: Displacement of the vaginal apex and/or cervix with placement of the vaginal rod during simulation was marked in all patients. Use of implanted cervical markers to localize the vaginal apex or the cervix during simulation is more accurate than use of a vaginal rod.     

Cervical cytology screening in the Army

A survey of 748 Army women showed an excellent screening rate for cervical cytology without the use of a screening programme. The women's knowledge regarding results of smears was, however, poor, even in cases with proven carcinoma. Frequent movement of the women because of postings makes follow-up cytology difficult, and a proposal is put forward for a positive reporting system. In this survey severe dyskaryosis suggestive of carcinoma of the cervix was seen presenting under the age of 35 years.     

磁共振扩散加权成像在宫颈癌诊断中的应用

目的评价MR弥散加权成像(DWI)在宫颈癌诊断中应用的价值。方法对30例非宫颈肿瘤女性的子宫颈和50例宫颈癌患者的子宫颈进行常规MRI扫描和横断面DWI(b=600s/mm2),比较正常宫颈和宫颈癌病灶的表观弥散系数(apparent diffusion coefficient,ADC)值。结果正常子宫颈DWI表现为粘液,内、中、外带四层结构,其平均ADC值〔(1.71±0.14)×10-3 mm2/s)〕显著高于宫颈癌的ADC值〔(0.97±0.13)×10-3 mm2/s)〕(P<0.01)。结论 ADC值可有效地定量区分宫颈癌与正常宫颈,DWI更容易显示宫颈癌及其周围侵犯和盆腔淋巴结转移。     

宫颈腺癌及其血管内介入治疗

与鳞癌比较,年轻患者中宫颈腺癌发病呈上升趋势,预后亦较差。传统的放疗和静脉途径化疗在肿瘤的治疗中均难以取得好的疗效。宫颈腺癌的分子生物学行为有别于鳞癌。其原发灶与局部浸润灶均较长时间局限于盆腔内,这为宫颈腺癌的血管内介入治疗提供了可靠的临床病理学基础。本文就宫颈腺癌的临床病理特点、分子生物学研究及血管内介入治疗作一综述。     

贵州省德江县宫颈癌普查分析

目的　了解经济落后地区宫颈癌的发病率。方法　在德江县和厦门市将参与普查的25-60岁妇女分别为310例和1080例,进行宫颈刮片检查。结果　德江地区的中、重度不典型增生和浸润癌发病率明显高于厦门地区,差异非常显著(P<0.01)。结论　改善经济落后地区的经济状况,生活环境和卫生习惯,广泛开展宫颈癌普查及早期行癌前病变的阻断治疗是当务之急。     

DNA倍体分析对宫颈低度鳞状上皮内病变的诊断价值

目的为宫颈低度鳞状上皮内病变（LSIL）的临床诊治寻求一项合理而客观的区分方法。方法选取212例液基薄层细胞学诊断为LSIL病例样本,每个样本均行宫颈脱落细胞核DNA倍体分析和阴道镜下宫颈活检。在DNA倍体分析阳性病例中,以〉5C细胞或有异倍体细胞峰出现为分流指标,〉5C细胞或有异倍体细胞峰的为A组,〈5C细胞或无异倍体细胞峰的为B组,比较两组间CIN的发生率。结果DNA倍体分析阳性病例中,A组119例,B组51例;A组和B组CIN的发生率分别为99．12％及21．57％,两组比较有显著性差异（χ2=117．40,P=0．000〈0．01）。结论DNA倍体分析可以对璐IL患者进行筛查分流,以〉5C细胞或有异倍体细胞峰为分流指标,是合理的、客观的,〉5C细胞或异倍体细胞峰出现的建议阴道镜下活检,〈5C细胞或无异倍体细胞峰出现的则建议3～6个月随诊复查。