Vimentin intermediate filament expression in uterine cervical carcinoma

The expression of vimentin intermediate filament has been examined in 62 cases of stage IB/IIA uterine cervical carcinoma as it has been demonstrated that some vimentin-positive epithelial neoplasms arising in the breast, stomach and kidney have an aggressive clinical behavior. No correlation was found between vimentin staining in cervical carcinomas and tumor differentiation, lymph node status or clinical outcome although vimentin-positive adenocarcinomas had a non-statistically significant tendency to lack metastases.
Despite being over-expressed in each of the three main tumor subtypes, it appears unlikely that vimentin analysis will prove to be useful as a prognostic indicator in uterine cervical carcinoma.     

c-erbB-3 proto-oncogene expression in uterine cervical carcinoma

Over-expression of epidermal growth factor receptor (EGFR) and c-erb B-2, in uterine cervical carcinomas, is associated with a worsened prognosis. A third member of this proto-oncogene family, c-erb B-3, has now been identified and its over-expression has been described in a variety of carcinomas. In this immunohistochemical study we have shown that c-erb B-3 is widely expressed in cervical carcinomas, but we have found no association between its over-expression and lymph node status or clinical outcome. In a similar study examining the expression of EGFR and c-erb B-2 it was possible to demonstrate an association between over-expression and a worse prognosis. We conclude, therefore, that it is unlikely that demonstration of c-erb B-3 over-expression will be of any value as a prognostic indicator in carcinoma of the uterine cervix.     

A phase II study of ifosfamide and bleomycin in advanced or recurrent cervical carcinoma

Thirty-seven patients with advanced or recurrent cervical squamous cell carcinoma were treated with ifosfamide 1.5 g m⁻² on days 1–5 (with mesna as a uroprotector), and bleomycin 30 mg on day 1, every 3 weeks. A partial response rate of 21% (95%CI: 6–36%) was obtained in patients who had not received prior chemotherapy, with a median duration of response of 5 months. No complete responses were seen. The median survival of all patients was 6 months. Nausea and vomiting, white cell suppression and encephalopathy were the main toxic effects. The results suggest that the addition of bleomycin to ifosfamide is not advantageous and increases toxicity, and that the interaction between these two agents is not contributory to the activity of the bleomycin, ifosfamide and cisplatin combination regimen (BIP). The potentially more severe toxicity of combination regimens must be considered when treating this group of patients.     

The reliability of the histologic diagnosis in colposcopically directed biopsies. A plea for LETZ

A total of 121 patients with cervical intraepithelial neoplasia (CIN) in their punch biopsies were treated by LETZ. In all cases, the transformation zone was fully visible and there were no signs of abnormal cylindrical epithelium. The final diagnosis was classified in accordance with the histologic report showing the most severe lesion. The biopsy diagnosis underestimated the final diagnosis in 27 out of the 121 cases. Invasion was present in five out of these 27 cases. The discrepancies between the biopsy diagnosis and the final diagnosis were not related to the number of colposcopically directed biopsies. It is concluded that an important advantage of LETZ, as compared with tissue-destructive techniques, is the detection of previously unrecognized invasive disease.     

Loss of epithelium cadherin expression is associated with reduced overall survival and disease-free survival in early-stage squamous cell cervical carcinoma

Epithelium cadherin (E-cad) is important for cell-to-cell adhesion of epithelial cells. Impairment of E-cad may have a role in the development and spreading of different malignancies and associated with poor differentiation, increased invasiveness, and poor prognostic factors in nongynecological carcinomas. However, prognostic significance of E-cad expression has not been investigated properly in cervical squamous cell carcinoma (SCC). The objective of this study was to investigate the association between reduced E-cad expression and clinicopathologic variables of cervical carcinoma. Specimens from 53 consecutive patients with stage IB-IIA SCC were evaluated immunohistochemically for E-cad expression, and the results were compared to grade, lymphvascular space invasion (LVSI), deep stromal involvement (DSI), parametrial involvement, lymph node metastasis, recurrences, and survival. Patients were divided into two groups arbitrarily: E-cad expression less than 10% (group 1) and E-cad expression more than 10% (group 2). There was no significant relationship between E-cad expression and DSI, LVSI, lymphatic metastasis. However, there was significant relationship between reduced E-cad expression and parametrial involvement (P= 0.024). Kaplan-Meier survival analysis revealed that reduced E-cad expression is significantly associated with reduced overall survival (OS) and disease-free survival (DFS). Furthermore, Cox regression analysis revealed that reduced E-cad expression is significantly associated with OS (P= 0.004, RR = 6.08, 95% CI: 1.75-21.1) and recurrences (P= 0.027, RR = 1.75, 95% CI: 1.06-2.88). We conclude that loss of E-cad expression is significantly associated with reduced OS and DFS in patients with SCC. Therefore, it might be used as an indicator of aggressive clinical behavior and tailoring aggressive adjuvant therapy in early-stage SCC. Further studies with larger number of patients are needed to evaluate the clinical significance of reduced E-cad expression in SCC.     

黏附分子CD44V6与唾液酸化Lewis-X抗原在宫颈癌组织中的表达及意义

目的　探讨黏附分子CD4 4V6与唾液酸化Lewis X(SLeX)抗原在宫颈癌组织中的表达及其意义。方法　 1 994年 1月至 1 999年 1月采用免疫组织化学法 (SP法 )检测CD4 4V6与SLeX在 30例正常宫颈组织及 82例宫颈癌组织中的表达。结果　正常宫颈组织CD4 4V6与SLeX均呈阴性表达。 82例宫颈癌组织中CD4 4V6与SLeX的阳性表达率分别为 6 4 6 %(5 3/ 82 )及 6 3 4 %(5 2 / 82 )。CD4 4V6与SLeX的阳性表达与宫颈癌的病灶大小、临床分期、细胞分化程度、转移及预后有关 (P <0 0 1或P <0 0 5 ) ;与宫颈癌的病理类型及患者年龄无关 (P >0 0 5 )。结论　CD4 4V6与SLeX的表达与宫颈癌的生长、浸润及转移密切相关 ,可作为反映宫颈癌恶性潜能及判断患者预后的新指标。     

α1β3、ICAM-1、E-cadherin、P-选择素对宫颈癌局部浸润作用的研究

目的探讨细胞黏附分子在宫颈癌局部浸润中的作用。方法应用组织芯片技术和免疫组织化学方法对比检测子宫颈鳞状细胞原位癌30例、微小浸润癌34例、浸润癌36例中α1β3、ICAM-1、E-cadherin和P-选择素的表达。结果α1β3在原位癌中的表达率明显低于微小浸润癌和浸润癌(P<0.05),微小浸润癌与浸润癌的表达率无显著差别(P>0.05);P-选择素的表达率在原位癌、微小浸润癌和浸润癌中无显著差别(P>0.05);ICAM-1、E-cadherin在原位癌中的阳性表达率均显著高于微小浸润癌(P<0.05),微小浸润癌中的阳性表达率均显著高于浸润癌(P<0.05)。ICAM-1、E-cadherin在微小浸润癌、浸润癌中的表达水平密切相关(P<0.01),ICAM-1、E-cadherin的阳性表达与子宫颈癌的浸润呈显著负相关(r=-0.8726,P<0.01和r=-0.7968,P<0.01)。结论α1β3、ICAM-1、E-cadherin与宫颈癌的局部浸润有关,其中ICAM-1、E-cadherin在宫颈癌局部浸润过程中可能起着重要作用。     

Erythropoietin receptor expression in biopsy specimens from patients with uterine cervix squamous cell carcinoma

Hypoxia, an important mechanism of radioresistance, is a strong stimulus for erythropoietin (EPO) production. The stimulatory effects of EPO are mediated through the activation of its receptors, EPO receptors (EPORs). The objective of this study is to determine whether EPORs are expressed in biopsy specimens of patients with squamous cell carcinoma of the cervix. Eighteen biopsy specimens were studied after obtaining Institutional Review Board-approved consent. Standard immunohistochemistry techniques were utilized. Expression of EPORs was present in 16 out of 18 (88.9%) specimens. The intensity (qualitative) and the frequency (semiquantitative) of EPORs expression showed a statistically significant correlation (P= 0.00379). Statistical analysis was performed to determine whether EPORs expression is related to other parameters such as age, FIGO stage, histologic grade, and hemoglobin levels. Only age showed a statistically significant correlation with EPORs frequency of expression (P= 0.00878). Currently, work is in progress in our laboratory to study the radiobiologic effects of EPO on the radiation response of cultured cancer cell lines in vitro.     

Small bowel perforation without tumor recurrence after radiotherapy for cervical carcinoma: report of seven cases

AIM: We describe the clinical presentation, evaluation, management and outcome of patients experiencing small bowel perforation following radiation therapy for cervical cancer. METHODS AND MATERIALS: A database consisting of 95 Japanese women with stage 0-4 A cervix cancer treated between 1991 and 2004 contained seven patients (7.4%) with small bowel perforation. RESULTS: The median age at the time of perforation was 72.5 years (range 62-78). The median time from completion of radiotherapy to perforation was 6 months (range 2-58). Surgery (one small bowel resection and anastomosis with diversion; six small bowel resection and anastomosis) was performed immediately in all seven patients. One of seven patients died of small bowel perforation (i.e. mortality rate was 14%). Bowel adhesion was detected during the operation in only three cases (43%). Signs of peritonitis were absent in six cases (86%). Severe abdominal pain was seen in all seven patients. The perforation site was ileum in all seven cases. In all patients, pathological changes were compatible with postirradiation injury of the gastrointestinal tract. CONCLUSIONS: The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.     

Gene expression profiles in squamous cell cervical carcinoma using array-based comparative genomic hybridization analysis

Our aim was to identify novel genomic regions of interest and provide highly dynamic range information on correlation between squamous cell cervical carcinoma and its related gene expression patterns by a genome-wide array-based comparative genomic hybridization (array-CGH). We analyzed 15 cases of cervical cancer from KangNam St Mary's Hospital of the Catholic University of Korea. Microdissection assay was performed to obtain DNA samples from paraffin-embedded cervical tissues of cancer as well as of the adjacent normal tissues. The bacterial artificial chromosome (BAC) array used in this study consisted of 1440 human BACs and the space among the clones was 2.08 Mb. All the 15 cases of cervical cancer showed the differential changes of the cervical cancer-associated genetic alterations. The analysis limit of average gains and losses was 53%. A significant positive correlation was found in 8q24.3, 1p36.32, 3q27.1, 7p21.1, 11q13.1, and 3p14.2 changes through the cervical carcinogenesis. The regions of high level of gain were 1p36.33-1p36.32, 8q24.3, 16p13.3, 1p36.33, 3q27.1, and 7p21.1. And the regions of homozygous loss were 2q12.1, 22q11.21, 3p14.2, 6q24.3, 7p15.2, and 11q25. In the high level of gain regions, GSDMDC1, RECQL4, TP73, ABCF3, ALG3, HDAC9, ESRRA, and RPS6KA4 were significantly correlated with cervical cancer. The genes encoded by frequently lost clones were PTPRG, GRM7, ZDHHC3, EXOSC7, LRP1B, and NR3C2. Therefore, array-CGH analyses showed that specific genomic alterations were maintained in cervical cancer that were critical to the malignant phenotype and may give a chance to find out possible target genes present in the gained or lost clones.     

Advanced cervical carcinoma associated with pregnancy

Sixty-two patients with frankly invasive (FIGO stages IB–IV) cervical carcinoma were diagnosed during pregnancy or within the first post-partum year. Thirty four (54.8%) had advanced disease (stages IIB–IV), a proportion higher than reported in comparable studies. This group was studied and compared with a control group of patients with advanced cervical cancer not associated with pregnancy. 'Pregnant' patients were significantly younger but overall treatment modalities and survival were no different. Mode of delivery (vaginal vs. abdominal) did not influence the survival of study patients. Although not significant, there was a worse outcome for patients diagnosed antenatally (as opposed to post-partum). These results are pertinent to the management of advanced cervical carcinoma associated with pregnancy.     

宫颈腺癌86例临床分析

目的探讨宫颈腺癌的临床特点和预后影响因素。方法回顾性分析2000年1月至2009年1月解放军总医院妇产科收治的86例宫颈腺癌患者的临床资料。结果 86例患者5年总生存率为62.3%,其中临床期别Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年生存率分别为83.3%、62.5%、13.7%和0。淋巴结转移患者5年生存率为21.4%,无淋巴结转移患者5年生存率85.1%,两者比较,差异有统计学意义(P0.05);血CA125、CA199水平升高均合并淋巴结转移;保留卵巢患者总5年生存率为80.0%,不保留卵巢患者总5年生存率是59.7%,两者比较,差异无统计学意义(P0.05)。结论临床期别、淋巴结转移是影响宫颈腺癌预后的主要因素;早期宫颈腺癌保留卵巢不影响生存率;CA125、CA199的检测对宫颈腺癌预后判断有一定的参考价值。     

A cervical smear review in women developing cervical carcinoma with particular reference to age, false negative cytology and the histologic type of the carcinoma

A review of all available cervical smears from 96 women who subsequently developed invasive cervical carcinoma was undertaken. The aim of the study was to determine the incidence of confirmed negative smears prior to the histologic diagnosis of carcinoma and investigate the relationship between the duration and grade of smear abnormality, the patients' age and the histologic types of cervical carcinoma. The results indicate that only 10% of women had confirmed negative smears, the majority occurring more than 7 years before the diagnosis of carcinoma. In contrast, 89% of young women (under 40 years of age) had a significant abnormality (moderate dyskaryosis or worse) up to 6 years before diagnosis. There is evidence to suggest that the preinvasive phase of cervical carcinoma may be shorter in younger women and that the less common types of cervical carcinoma occur more frequently in this group. The combination of inadequate clinical follow up and false negative cytology may have allowed a significant proportion of these women to develop invasive cervical carcinoma. Possible reasons for false negative smears have been identified and methods aimed at decreasing their frequency are discussed.     

卵巢肿瘤粘附分子吞噬细胞糖蛋白的测定

目的：探讨卵巢肿瘤粘附分子吞噬细胞糖蛋白－１（ＣＤ４４）检测的方法和临床意义。方法：应用流式细胞免疫学方法，对１０６例不同性质及组织学类型的卵巢肿瘤患者外周血淋巴细胞粘附分子ＣＤ４４进行测定，并与健康妇女及卵巢非赘生物患者进行对照。结果：恶性肿瘤组术前淋巴细胞ＣＤ４４阳性率明显高于对照组及良性肿瘤组（Ｐ＜０．０１，Ｐ＜０．０５）；癌细胞ＣＤ４４阳性率高于自身外周血淋巴细胞（０．０１＜Ｐ＜０．０５）；卵巢癌不同组织类型的ＣＤ４４含量差异无显著性；术后外周淋巴细胞ＣＤ４４含量逐渐下降。结论：卵巢肿瘤组织及外周血淋巴细胞ＣＤ４４检测，对鉴别卵巢肿瘤性质、早期发现肿瘤复发和转移，有重要的临床价值。     

Clinical significance of mucin production in post-irradiated cervical carcinoma

Summary Histological sections from 50 patients with clinical stage Ib to stage IIb squamous cell carcinoma of the cervix, initially treated by radiotherapy and followed by Wertheim hysterectomy, were reviewed and stained for mucin. The tissues from 17 (34%) of the patients contained no residual carcinoma. Mucin production was demonstrated in tumour tissue from 18 (55%) of the patients with residual tumour, none of who died of disease during the 5 to 10 years of follow up. Two patients who died of recurrent carcinoma had no mucin production in the post-irradiated tumour tissues. The presence of mucin in irradiated carcinoma of cervix seems to infer a better prognosis and this may prove useful in the follow-up of irradiated carcinomas.     

CD44V6、EGFR在卵巢上皮癌中的表达及临床意义

目的：探讨ＣＤ４４Ｖ６及ＥＧＦＲ在卵巢上皮癌中的表达及临床意义。方法： 以 ＳＰ免疫组织化学方法检测 ３３５例卵巢上皮癌, １８例卵巢上皮瘤和 １５例正常卵巢组织石蜡标本 ＣＤ４４Ｖ６及 ＥＧＦＲ的表达,并分析卵巢上皮癌的临床病理资料。结果：①正常卵巢组织 ＣＤ４４Ｖ６及 ＥＧＦＲ均呈阴性表达,卵巢上皮瘤及上皮癌中均有中ＣＤ４４Ｖ６及ＥＧＦＲ表达,正常卵巢与卵巢良恶性肿瘤之间的表达差异有高度显著性（Ｐ＜０．０１）,卵巢上皮癌与卵巢上皮瘤之间的表达差异无显著性（Ｐ＞０．０５）;（２）ＣＤ４４Ｖ６及ＥＧＦＲ的阳性表达与卵巢上皮癌的临床分期有关（Ｐ＜０．０５）,与组织分化程度及病理类型无关（Ｐ＞０．０５）;③ＣＤ４４Ｖ６及ＥＧＦＲ的阳性表达与卵巢上皮癌预后有关（Ｐ＜０．０５）;④ＣＤ４４Ｖ６及ＥＧＦＲ在卵巢上皮癌中的表达差异无显著性（Ｐ＞０．０５）,二者具有相关性（Ｐ＜０．０５）．结论：ＤＤ４４Ｖ６及ＥＧＦＲ可能是卵巢上皮癌发生的相关基因,与肿瘤的发展及转移有关。检测 ＣＤ４４Ｖ６及 ＥＧＦＲ可以估计卵巢上皮癌患者的预后,指导化疗。     

宫颈癌前病变与宫颈鳞癌组织中Foxp3的表达及临床意义

目的 观察宫颈鳞癌及癌前病变组织中Foxp3的表达情况.方法 采用免疫组化检测浸润性宫颈鳞癌(FIGOⅠ期或ⅡA期,共20例)、宫颈上皮内瘤样病变(CIN1、CIN2、CIN3各20例)、宫颈HPV感染(20例)及正常宫颈(20例)组织中Foxp3的表达情况.结果 浸润性宫颈鳞癌与CIN3患者宫颈组织中Foxp3表达明...     

Spontaneous bacterial peritonitis following treatment for cervical carcinoma

Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection usually associated with ascites and cirrhosis or is a complication of peritoneal dialysis. There are very few case reports of cancer patients who developed this disease. Furthermore, there have been no published case reports of successfully treated gynecological cancer patients who later developed SBP. We present a case involving a 41-year-old woman who was treated for cervical carcinoma in 1992. She underwent radical surgery and adjuvant chemoradiation therapy. Two years later, the patient presented with streptococcal group B cellulitis associated with left leg lymphedema. She recovered following antibiotic treatment but had recurrent episodes of streptococcal cellulitis in her leg over the past 10 years. In 2003, the patient was admitted to the hospital because of sepsis, acute renal failure, and SBP. She was treated and recovered following treatment. SBP is usually associated with cirrhosis. Although SBP is rarely seen in successfully treated gynecological cancer patients, oncologists should be aware of this clinical entity. Timely treatment is essential to maximize chances of survival.