鳞状细胞癌抗原与宫颈鳞状上皮癌

鳞状细胞癌抗原是鳞状上皮癌特异的一种肿瘤相关抗原，虽然正常鳞状上皮组织ＳＣＣＡｇ浓度可升高，但血清中高浓度的ＳＣＣＡｇ仅见于鳞状上皮细胞癌，ＳＣＣＡｇ对早期宫颈癌血清学检测意义不大，但可用于监测恶性肿瘤的临床过程，对病情的好转、发展或复发的判断具有重要意义。     

卵巢原发性鳞状细胞癌

卵巢原发性鳞状细胞可分为三种；（１）起源于卵巢皮样囊肿的鳞状上皮或分癌变（ＳＣＣＤ）；（２）推没起源于卵巢子宫内膜异位症的鳞化（ＳＣＣＥ）；（３）纯鳞状细胞癌（ＳＣＣＰ），此型尤为罕见，迄至１９９６年仅有１２例文献报道，本文系统介绍其组织来源，临床，病理及预后，目前第（２）及（３）类已列入世界卫生组织卵巢组织分类中表面上皮一间质肿瘤组内。     

卵巢原发性鳞状细胞癌一例

患者６１岁，因绝经８年，发现盆腔包块１年多，于１９９７年８月２０日入院。既往健康。孕４产２，人工流产２次。内科检查：头颈部无异常，心肺无异常，肝脾肋下未扪及。妇科检查：外阴及阴道未见异常。宫颈光滑。子宫萎缩，子宫右后方可扪及大小约５ｃｍ×５ｃｍ×６ｃ...     

外阴鳞状细胞癌组织中microRNA表达谱的临床意义

目的探讨micro RNA(miRNA)在外阴鳞状细胞癌组织中的表达及其临床意义。方法选择中国医科大学附属盛京医院妇产科2010年3月至12月诊断为外阴鳞状细胞癌并行手术治疗的3例患者的外阴癌新鲜组织做为观察组,观察组患者癌旁组织作为对照组。提取总RNA,经质量鉴定后进行荧光标记,利用miRNA芯片技术检测两组组织中miRNA的表达。结果通过对基因杂交芯片进行数据分析,从中共鉴定到430个miRNA差异表达,其中42个miRNA表达差异具有统计学意义(P<0.05),其中20个miRNA表达上调,22个miRNA表达下调。结论外阴鳞状细胞癌组织与癌旁组织中miRNA表达存在明显差异,从中筛选的差异表达miRNA(miR-99b、miR-211、miR-21)可能成为评估外阴癌发病风险的参考指标。     

癌基因—c—erbB2与子宫颈鳞状上皮细胞癌生物学行为的关系

目的：探讨癌基因ｃ－ｅｒｂＢ２在人宫颈鳞癌中的表达及其与生物行为及预后的关系。方法：采用免疫组织化学方法，检测宫颈鳞癌６２例、宫颈上皮内瘤变（ＣＩＮ）９例及正常宫颈（１０例）的宫颈上皮组织中ｃ－ｅｒｂＢ２的表达。结果：６２例鳞癌中，１９例细胞呈阳生染色，９例ＣＩＮ中１例呈一染色，下沉宫颈上皮无一例阳性染色。细胞学１、２和３有阳性率分别为１２．５％、２７．６和５２．９％，１级及２级与３级比较，差异有     

子宫颈鳞状细胞癌复发患者血清鳞状细胞癌抗原监测的意义

目的探讨血清鳞状细胞癌抗原（SCCAg）在监测宫颈鳞癌患者复发中的意义。方法对1999-2005年收治的72例宫颈鳞癌复发患者血清SCCAg水平与诊断、预后的关系进行单因素和多因素分析。结果72例复发患者中,术后复发30例、放化疗后复发42例,其中血清SCCAg水平升高者61例（占85％）。此61例患者中,20例在随诊中首先出现血清SCCAg水平升高而临床及影像学检查未发现肿瘤,血清SCCAg水平提前升高的中位时间为3个月,平均4．6个月（1～13个月）。72例复发患者中,45例患者无任何临床症状,仅因血清SCCAg水平升高或常规随诊发现复发;27例患者有症状,其中单侧下肢水肿或疼痛15例,阴道不规则流血7例,出现远处转移相关症状5例。细胞或组织病理学检查诊断复发者33例;临床及影像学检查结合血清SCCAg水平诊断复发者39例,其中29例仅依靠血清SCCAg水平升高及影像学检查即诊断复发。72例复发患者的中位生存时间为11个月,平均生存时间为23个月（2～62个月）,总的3年生存率为25％,5年生存率为19％。单因素分析发现,初治前患者血清SCCAg水平、病理分级、复发部位、复发后治疗方式以及复发时、复发后治疗中、治疗后血清SCCAg水平对患者的3年生存率有明显影响（P〈0．01）;但20例血清SCCAg水平提前出现升高的患者与52例血清SCCAg水平未提前升高的患者相比,3年生存率分别为22％、27％,差异无统计学意义（P=0．5761）。多因素分析发现,复发患者仅病理分级、复发后的治疗方式是独立的预后影响因素（P〈0．05）;而复发部位及各种血清SCCAg状态不是独立的预后影响因素（P〉0．05）。结论血清SCCAg水平监测在宫颈鳞癌复发患者中的诊断及其对预后的判断中有一定的价值。     

鳞状细胞癌抗原与子宫颈鳞状细胞癌的临床病理特征及预后的关系

目的 探讨治疗前血清鳞状细胞癌抗原（SCCAg）滴度与宫颈鳞状细胞癌（鳞癌）临床病理特征的关系,以及作为预测预后的因素的意义。方法 选择114例治疗前检测过血清SCCAg并经治疗后长期随访的Ⅰb1～Ⅱa期宫颈鳞癌患者,结合临床资料对SCCAg与临床病理特征及预后的关系进行单因素和多因素分析。结果 单因素分析显示,治疗前血清SCCAg滴度升高（正常值≤1．5mg／L）与肿瘤直径、深肌层浸润及盆腔淋巴结转移相关（P〈0．05）;多因素分析显示,SCCAg滴度升高与深肌层浸润（P=0．029）、盆腔淋巴结转移（P=0．049）相关。114例患者的5年累积无瘤生存率为78．6％,总复发率为27．2％。单因素分析显示,SCCAg滴度升高、盆腔淋巴结转移与5年累积无瘤生存率及复发相关（P〈0．05）;多因素分析显示,影响预后的独立因素为SCCAg滴度升高（P=0．030）和盆腔淋巴结转移（P=0．003）,影响复发的显著相关因素为盆腔淋巴结转移（P=0．006）。盆腔淋巴结转移且SCCAg滴度正常者与盆腔淋巴结转移且SCCAg滴度升高者,5年累积无瘤生存率（分别为50．0％、50．9％）、复发率[分别为60．0％（6／10）、47．1％（8／17）]、局部复发率[分别为3／8、20．0％（3／15）]和远处复发率[分别为1／8、20．0％（3／15）]分别比较,差异均无统计学意义（P〉0．05）。盆腔淋巴结无转移且SCCAg滴度正常者与盆腔淋巴结无转移且SCCAg滴度升高者,5年累积无瘤生存率（分别为98．0％、71．8％,P=0．003）、复发率[分别为9．8％（5／51）、33．3％（12／36）,P=0．006]、局部复发率[分别为2．1％（1／47）、26．5％（9／34）,P=0．001]分别比较,差异均有统计学意义。结论 治疗前血清SCCAg滴度升高和盆腔淋巴结转移是影响Ⅰb1～Ⅱa期宫颈鳞癌患者预后的独立因素。治疗前血清SCCAg滴度升高且盆腔淋巴结无转移患者的局部复发风险显著升高。     

宫颈基底细胞样鳞状细胞癌合并多原发恶性肿瘤一例并文献复习

基底细胞样鳞状细胞癌(basaloid squamous cell carcinoma,BSCC)是鳞状细胞癌的特殊亚型,发生于宫颈者极为罕见。因病例数较少,对其认识亦不足,尚未建立标准诊疗方案。而合并多原发恶性肿瘤(multiple primary malignant tumors,MPMT)者更为少见。现报告1例经腹直肠癌根治术(Dixon术)4年后发生宫颈BSCC的病例资料,并复习相关文献,以增加对该病的认识,同时通过本病例引起临床对多原发恶性肿瘤的重视。     

果蝇zeste基因增强子蛋白在宫颈鳞状细胞癌中的表达及意义

目的 研究EZH2蛋白在宫颈鳞状细胞癌中的表达及其与宫颈癌临床病理参数之间的关系.方法 用SP免疫组织化学染色的方法检测正常宫颈组织30例,宫颈上皮内瘤变78例和宫颈鳞状细胞癌78例组织中EZH2的表达.结果 EZH2蛋白在正常宫颈组织、宫颈上皮内瘤变、宫颈鳞癌中表达率依次增强,分别为0、48、7%、78.2%.鳞状细...     

子宫肌瘤中环氧合酶-2的表达与前列腺素E-2的测定及临床意义

目的探讨子宫肌瘤、肌瘤假包膜组织及肌瘤周围正常子宫肌层组织中环氧合酶2(COX2)的表达及其相关产物前列腺素E2(PGE2)水平与子宫肌瘤发生的关系。方法对2002年12月至2003年5月东莞市人民医院53例子宫肌瘤组织、46例肌瘤假包膜组织及肌瘤周围正常子宫肌层组织用SP免疫组化方法检测COX2表达,放射免疫法测定PGE2水平。结果(1)COX2在子宫肌瘤组织中的阳性表达率明显高于子宫肌层组织及肌瘤假包膜组织(P<0.05);COX2表达与患者的年龄、肌瘤大小、肌瘤个数及其类型无明显相关(P>0.05)。(2)肌瘤组织的PGE2水平明显高于子宫肌组织及肌瘤假包膜组织(P<0.05)。(3)肌瘤组织中COX2表达与PGE2水平成正相关,而肌瘤假包膜和肌层组织中则无明显相关性。结论COX2蛋白高表达可能导致前列腺素类物质生物合成增加,可能与子宫肌瘤的发生相关。     

The role of angiogenesis and COX-2 expression in the evolution of vulvar lichen sclerosus to squamous cell carcinoma of the vulva

OBJECTIVES: We aimed to determine whether premalignant changes in vulvar lichen sclerosus (LS) could be identified by analysing markers of angiogenesis and the expression of the enzyme cyclooxygenase-2 (COX-2). METHODS: Eight cases of histologically diagnosed vulvar LS, which showed an evolution to carcinoma of the vulva histologically documented, were compared to 10 cases of vulvar LS, for which follow-up information was available for at least 9 years, and to 10 cases of LS adjacent to squamous cell carcinoma (SCC) of the vulva. The microvessel density (MVD), and the expression of vascular endothelial growth factor (VEGF) and of COX-2 were analysed. RESULTS: Difference of MVD between unchanged LS cases and LS cases evolving to SCC and LS adjacent to SCC cases was statistically significant (P=0.008, Wilcoxon Mann-Whitney test). Difference of VEGF and COX-2 expression between unchanged LS cases and LS cases evolving to SCC and LS adjacent to SCC cases were statistically significant (P=0.007 and P=0.01, respectively; Fisher's exact test). CONCLUSIONS: Our study addresses the possibility that immunohistochemical studies may add information to permit the identification of LS as a precursor lesion that has a greater potential to evolve into SCC. These data may identify characteristics of vulvar LS disclosing alterations that indicate the further development to cancer; therefore, it may allow the identification of a group of LS patients who need a careful follow-up and adjunctive biopsies.     

COX-1 and COX-2 expression in stage I and II invasive cervical carcinoma: relationship to disease relapse and long-term survival

COX-1 and COX-2 are members of the cyclooxygenase (COX) family, which influence tumor invasion and apoptosis. The objective of the study was to assess the relationship between COX-1 and COX-2 expression in early-stage disease and subsequent disease relapse and long-term survival. Women with FIGO stage I and II cervical carcinoma, younger than 50 years, treated between 1981 and 1990 were included. COX-1 and COX-2 expressions in the tumors were assessed by immunohistochemistry. COX-1 and COX-2 were expressed in 61% (17/28) and 57% (16/28) of tumors, respectively. COX-1 nonexpressers showed an improved overall survival compared to expressers (log-rank test, P= 0.09). There was no significant difference in the overall survival in COX-2 nonexpressers compared to expressers (P= 0.6). Out of eight women with disease relapse, COX-1 or COX-2 expression was noted in six of eight tumors, and both were expressed in five of eight tumors. Our preliminary data suggest an adverse prognosis with COX-1 expression in early-stage cervical carcinoma and a trend toward COX-1 expression in disease relapse. The association between COX-2 expression and a worse prognosis was not proven in this study.     

CuIUD对妇女子宫内膜环氧化酶表达的影响

目的:　研究置固定式铜宫内节育器(FCuIUD)前后妇女子宫内膜组织中环氧化酶(COX-1、COX-2)的表达。方法:　选择符合受试条件的育龄妇女10 例,于月经净后3-7　d放置FCuIUD,置器前及置器后一个月于相同时期、相同部位刮取子宫内膜。RT-PCR法与Western　blot法分析放置FCu-IUD前后妇女子宫内膜组织COX-1、COX-2　mRNA及蛋白表达水平。免疫组化S-P法测定COX-2在子宫内膜的定位与分布。结果:置FCuIUD一个月后,子宫内膜COX-2　mRNA和蛋白表达水平均显著增加,与置器前比较,差异显著(P<0.05)。COX-1　mRNA及蛋白的表达在置器前后无明显差异。COX-2主要分布于腺上皮细胞的胞浆内。结论:　置FCuIUD后妇女子宫内膜COX-2表达在转录和翻译水平均显著增加;COX-2可能是节育器引起的无菌性炎症中PGs释放增加的主要同工酶。     

宫颈癌中环氧合酶2与血管内皮生长因子C的表达及相关研究

目的：探讨环氧合酶2（COX-2）和血管内皮生长因子C（VEGF—C）在宫颈癌中的表达及意义。方法：应用免疫组织化学S—P法检测42例宫颈癌、20例宫颈上皮内瘤样变（CINⅠ～Ⅲ）、10例正常宫颈组织中COX-2和VEGF—C的表达。结果：宫颈癌组COX-2和VEGF—C阳性表达率分别高于CIN组及正常宫颈组（P〈0．05）。不同年龄、预后COX-2表达无差异（P〉0．05）,但不同病理类型和临床分期间表达差异有统计学意义（P〈0．05）。不同年龄、病理类型、预后VEGF-C表达无差异（P〉0．05）,但不同临床分期间表达差异有统计学意义（P〈0．05）。COX-2和VEGF-C在宫颈癌组织中的表达呈正相关（r=0．41,P〈0．05）。结论：COX-2和VEGF—C在宫颈癌的发生发展中起重要作用。可能作为宫颈癌早期诊断和判断预后的重要指标。     

Signet-ring cells in squamous cell carcinoma of the cervix and in non-neoplastic ectocervical epithelium

Two cases of cervical carcinoma and two cases of normal ectocervical epithelium with a squamous signet-ring cell component are presented. In one carcinoma the vacuolization was so prominent that it partially obliterated the epithelial pattern of the tumor. Paraffin specimens were studied with a panel of histo- and immunohistochemical stains and by electron microscopy. The vacuoles of the squamous signet-ring cells did not contain glycogen, mucopolysaccharides or masses of intermediate filaments. The findings are discussed in relation to possible human papillomavirus and Chlamydia trachomatis infection. The true nature and possible clinicopathologic implications of the squamous carcinoma with signet-ring cells remain to be established, but the phenomenon may cause diagnostic difficulties, especially in biopsy specimens.     

Phase II trial of capecitabine in recurrent squamous cell carcinoma of the cervix

PURPOSE: To determine the efficacy and safety of capecitabine in women with inoperable, recurrent, or metastatic squamous cell cervical cancer. PATIENTS AND METHODS: In a phase II IRB approved trial, capecitabine was given at a dosage of 2000 mg/m2/day orally in a divided dose daily for 14 days followed by a 7-day rest period. A standard dose modification scheme was used with one allowed dose reduction or dose escalation. National Cancer Institute criteria for progression, response, and toxicity were utilized. Quality of life data were obtained using the Memorial Symptom Assessment Scale and Functional Assessment for Cancer Therapy, which included a subscale for cervical cancer. RESULTS: Twenty of 23 enrolled patients were evaluable for response. Stable disease was noted in 5 patients, with a median duration of response of 3.5 months (range, 3-6.5 months). No partial or complete responses were seen. Common grade 3 toxicities were fatigue (30.4%); abdominal pain, constipation, hand-foot syndrome, nausea, and vomiting (8.7% each); as well as dyspnea, headache, and coagulopathy (4.3% each). There were no grade 4 toxicities. All patients with previous exposure to infused 5-FU had evidence of progression. No statistically significant changes in quality of life were noted from baseline to post-cycle 2. CONCLUSION: Single-agent capecitabine in patients with recurrent cervical cancer resulted in no objective responses. Although capecitabine is a well-tolerated regimen, as a single agent, it offers minimal benefit in a poor-prognosis cervical cancer population.     

Cyclooxygenase-2 expression in cervical intraepithelial neoplasia III and squamous cell cervical carcinoma, and its correlation with clinicopathologic variables

The objective of the study was to compare cyclooxygenase-2 (COX-2) expression in cervical intraepithelial neoplasia III (CIN III) and squamous cell carcinoma (SCC) of the cervix, and its correlation with clinicopathologic factors of SCC with a review of the available literature. This study included 25 patients with CIN III and 67 patients with stage I-IIa SCC. All patients in the SCC group were treated with radical hysterectomy plus pelvic and para-aortic lymphadenectomy and postoperative chemoradiotherapy based on their histopathologic risk factors. Immunohistochemical analysis was performed on paraffin-embedded sections with COX-2 antibody. COX-2 expression in the SCC group was significantly higher than in the CIN III group (55.2% [37/67] vs 24% [6/25]; P= 0.008). Significantly higher expression of COX-2 was observed in patients with lymphovascular space invasion (LVSI) compared to patients without LVSI (61.9% [34/55] vs 33.3% [3/9]; P= 0.02). Additionally, patients with tumor sizes >4 cm had significantly higher COX-2 expression than patients with tumor sizes <4 cm (65.9% [27/41] vs 39% [10/26] P= 0.028). There was no significant relationship with respect to COX-2 expression and parametrial involvement, lymph node metastasis, recurrences, and survival. In multivariate analysis, LVSI was the only statistically significant determinant for COX-2 expression (P= 0.024; OR = 2.35; 95% CI = 1.1-4.9). Our results and a review of the literature both suggest that COX-2 expression may have a role in the development and progression of CIN III and it is related to some clinicopathologic variables of cervical carcinoma. Further studies are needed to clarify the role of COX-2 inhibitors in the management of CIN and SCC.