低分化子宫内膜样腺癌分型归属探讨

目的:探讨低分化子宫内膜样腺癌分型归属问题。方法:收集2000年1月1日—2010年12月31日广东省妇幼安康工程子宫内膜癌防治项目医院高分化和中分化子宫内膜样腺癌(grade 1 and grade 2 endometrioid endometrial carcinoma,G1EEC/G2EEC)4 026例,低分化子宫内膜样腺癌(grade 3 endometrioid endometrial carcinoma,G3EEC)619例,子宫浆液性腺癌(uterine serous carcinoma,USC)和透明细胞癌(clear cell carcinoma,CCC)166例,进行回顾性分析,比较3组患者的临床病理特征和预后,探讨G3EEC分型归属问题。结果:1G3EEC组与USC+CCC组的超重/肥胖(40.6%vs.37.7%,P=0.625)以及未产的比例(4.2%vs.2.5%,P=0.323)相比较差异无统计学意义,且低于G1EEC/G2EEC组;G3EEC组与USC+CCC组的绝经患者(64.1%vs.70.5%,P=0.127)、首发症状为腹痛和腹胀(4.7%vs.6.0%,P=0.481)以及手术病理分期为晚期患者的比例(32.8%vs.31.3%,P=0.720)相比较差异均无统计学意义,且高于G1EEC/G2EEC组。2G3EEC组与USC+CCC组肿瘤局限于宫腔下部(14.1%vs.18.1%,P=0.279)、深肌层浸润(43.6%vs.39.8%,P=0.372)、淋巴血管间隙受累(9.4%vs.11.4%,P=0.425)、宫颈间质侵犯的比例(23.6%vs.21.7%,P=0.607)以及盆腔淋巴结转移率(24.7%vs.24.3%,P=0.927)相比较差异无统计学意义,且高于G1EEC/G2EEC组。3G3EEC组与USC+CCC组的生存时间和无进展生存时间比较差异无统计学意义(P分别为0.544和0.939)。Cox回归分析显示,G3EEC组的生存时间(HR=4.147,95%CI:2.573~6.683,P0.001)和无进展生存时间(HR=3.365,95%CI:2.300~4.923,P0.001)低于G1EEC/G2EEC组。结论:G3EEC与USC及CCC有相似的临床病理特征及预后,而不同于G1EEC/G2EEC,低分化子宫内膜样腺癌归为Ⅱ型子宫内膜癌更为合理。     

血管内皮生长因子与雌孕激素受体在子宫内膜腺癌中的表达及意义

目的:探讨子宫内膜腺癌组织中血管内皮生长因子(VEGF)表达与雌激素受体(ER)α及β、孕激素受体(PR)的表达及其与临床病理特征的关系。方法:采用免疫组化(SP)方法检测93例子宫内膜腺癌(内膜腺癌组)和31例正常子宫内膜(正常内膜组)VEGF、ERα、ERβ及PR的表达。结果:1内膜腺癌组VEGF阳性表达率(58.1%)明显高于正常内膜组(32.3%),而ERα的阳性表达率(59.1%)明显低于正常内膜组(80.6%),差异均有统计学意义(P0.05)。ERβ、PR的阳性表达率差异无统计学意义(P0.05)。2在子宫内膜腺癌组织中,VEGF的阳性表达在病理分期和有无淋巴结转移中比较,差异有统计学意义(P0.05);ERα的阳性表达率在病理分期、组织学分级、肌层浸润深度中比较,差异有统计学意义(P0.05);PR的阳性表达率在病理分期和组织学分级中比较,差异有统计学意义(P0.05);ERβ的阳性表达率在临床病理特征中的比较,差异均无统计学意义(P0.05)。3VEGF与ERα的表达呈负相关(r=-0.273,P=0.046)。结论:VEGF及ERα的表达与子宫内膜腺癌的发生发展及预后有关,VEGF及ERα的检测可能有助于评估子宫内膜腺癌的生物学行为和预后。     

特殊类型子宫内膜癌的临床特征及预后分析

目的:比较特殊类型子宫内膜癌不同病理类型的临床特征及预后,探讨影响特殊类型子宫内膜癌预后的危险因素及辅助治疗。方法:回顾性分析2009年1月至2017年9月青岛大学附属医院初治的135例特殊类型子宫内膜癌的临床资料,比较分析79例子宫浆液性癌(USC组)、15例透明细胞癌(CCC组)、17例癌肉瘤(CS组)和24例混合细胞腺癌(MCA组)的临床特征及预后。结果:①4组患者在年龄≥60岁、绝经、肿瘤大小、盆腔淋巴结转移及大网膜转移比例方面比较,差异均有统计学意义(P0.05)。②USC组、CCC组、CS组和MCA组患者的5年总体生存率(OS)分别为63.1%、79.4%、37.6%、87.5%,4组间差异有统计学意义(P0.05)。I期患者术后行单纯化疗、化疗联合放疗和无治疗组的5年OS分别为94.4%、100.0%、58.1%,不同治疗方式组间差异有统计学意义(P0.05),前2组患者的预后均明显优于无治疗组(P0.05)。③经Cox回归多因素分析筛选后,深肌层浸润(HR 1.833,95%CI 1.017～3.306)、分期(HR 1.763,95%CI 1.324～2.347)及腹主动脉旁淋巴结转移(HR 1.340,95%CI 1.065～1.686)是影响其预后的独立危险因素。结论:特殊类型子宫内膜癌不同病理类型的临床特征及预后有所差异,对于有独立危险因素的患者,临床上应重视腹主动脉旁淋巴结的切除以及术后辅助个体化的放化疗。     

前列腺素受体EP2在子宫内膜癌中的表达

目的研究前列腺素(PGE2)受体EP2在子宫内膜癌中的表达,探讨EP2在子宫内膜癌中的表达变化与雌激素受体依赖的关系,以及在子宫内膜癌的发生、发展过程是否存在非雌激素受体的作用.方法50例子宫内膜癌组织(Ⅰ期29例、Ⅱ期7例、Ⅲ期12例、Ⅳ期2例,G1级26例、G2级15例、G3级9例),正常子宫内膜10例,术前未经放化疗及激素等内分泌治疗.应用逆转录-聚合酶链反应(RT-PCR)技术,半定量研究各组中EP2的mRNA表达.结果子宫内膜癌G1组、G2组、G3组均高于正常组,差异有统计学意义(P＜0.05),而且随细胞分化越差,EP2受体表达水平呈上升趋势,差异有统计学意义(P＜0.001);子宫内膜癌Ⅰ期组、Ⅱ～Ⅳ期组均高于正常组,差异有显著统计学意义(P＝0.001),并随分期变化,分期越晚,表达值升高,期别之间相比差异无统计学意义(P＝0.17);在子宫内膜癌中,雌激素受体表达阴性组比阳性组的EP2表达水平显著升高,差异有统计学意义(P＜0.001);而孕激素受体表达阴性组与阳性组的EP2表达相比较差异无统计学意义(P＞0.05);绝经前(20例)与绝经后(30例)患者的子宫内膜癌中EP2的表达分别为0.905±0.251和0.941±0.336,二者差异无统计学意义(P＝0.684).结论在子宫内膜癌中EP2表达水平高于正常子宫内膜,并且随分期和分级升高有上升趋势,在雌激素表达阴性的子宫内膜癌比阳性者明显升高,提示PGE2及其受体EP2可能参与了子宫内膜癌的形成.在子宫内膜癌的形成过程中,前列腺素及其受体EP2与非雌激素作用的子宫内膜癌形成过程存在某种联系,可能是PGE2通过EP2受体介导的信号通路的传导起作用.     

子宫内膜去分化癌与低分化癌的临床预后比较

目的:探讨子宫内膜去分化癌和子宫内膜低分化癌的预后差异,为临床治疗方案提供依据。方法:回顾性分析天津市中心妇产科医院2011年1月1日至2015年2月1日收治的子宫内膜去分化癌(14例,去分化癌组)及子宫内膜低分化癌(FIGOⅢ级,28例,低分化癌组)患者的临床资料,比较两组的3年生存率及与预后相关临床病理因素。结果:去分化癌组的3年生存率低于低分化癌组,差异有统计学意义(64.29%vs 96.43%,P0.05)。与低分化癌组比较,去分化癌组的雌激素受体(ER)、孕激素受体(PR)阳性率较低(ER:21.43%vs 57.14%;PR:7.14%vs 60.71%),差异有统计学意义(P0.05)。去分化癌组年龄≥60岁者所占比率较低分化癌组低,差异有统计学意义(7.14%vs 39.29%,P0.05)。两组患者FIGO分期、肿瘤肌层浸润深度、肿瘤直径、脉管癌栓、肿瘤标志物(CA_(125)、CA_(199))相比,差异均无统计学意义(P0.05)。结论:子宫内膜去分化癌患者较子宫内膜低分化癌3年生存率低,预后更差。子宫内膜去分化癌患者较低的ER、PR阳性率与年龄≥60岁者比例较低可能与较差的预后有关。     

子宫内膜样腺癌伴鳞状上皮分化46例临床病理特征及预后分析

目的:探讨子宫内膜样腺癌伴鳞状上皮分化的临床病理特征及预后。方法:回顾性分析46例子宫内膜样腺癌伴鳞状上皮分化患者(观察组)的临床病理特征、治疗情况及预后,并抽取相同时期住院的63例子宫内膜样腺癌患者为对照组,进行分析比较。结果:观察组患者的年龄及临床特征与对照组较一致,两组比较差异无统计学意义(P>0.05)。观察组患者肿瘤高分化比例(30.4%)明显低于对照组(57.1%),差异有统计学意义(P=0.007);肿瘤中分化(41.3%)和低分化(28.3%)比例均高于对照组(30.2%,12.7%),但差异无统计学意义(P>0.05)。观察组与对照组的肿瘤分期、肿瘤细胞浸肌深度、淋巴结转移情况等病理特征比较差异均无统计学意义(P>0.05)。两组治疗方法比较差异无统计学意义(P>0.05)。两组平均随访31.4±17.6个月,观察组死亡及复发共4例(8.7%,4/46),对照组共3例(4.8%,3/63),差异无统计学意义(P>0.05)。结论:子宫内膜样腺癌伴鳞状上皮分化以中低分化为主,但其临床病理特征、预后与普通型子宫内膜样腺癌无明显差别,临床处理与子宫内膜样腺癌一致。     

子宫内膜异位症相关性卵巢癌临床病理特征及预后分析

目的:探讨子宫内膜异位症相关性卵巢癌(EAOC)患者的临床资料及预后特点。方法:选择2011年1月至2014年1月于武汉大学人民医院妇科手术确诊为卵巢透明细胞癌(OCCC)及卵巢子宫内膜样腺癌(OEC)患者共181例,依据卵巢癌与卵巢子宫内膜异位症(卵巢EMT)间的关系分为卵巢EMT恶变组(EAOC组,35例)、合并卵巢EMT组(31例)、未合并卵巢EMT组(115例)。回顾性分析3组在临床、病理特征以及化疗、预后方面的异同点。结果:(1)3组患者在发病年龄、产次、合并不孕症、CA_(125)值升高比例、病理分期、淋巴结转移方面差异有统计学意义(P0.05)。(2)3组患者在化疗耐药、肿瘤复发方面差异无统计学意义(P0.05)。5年累积生存率分别为74.3%(EAOC组)、48.4%(合并卵巢EMT组)、47.8%(未合并卵巢EMT组),差异有统计学意义(P0.05)。生存曲线比较:EAOC组优于合并卵巢EMT组、未合并卵巢EMT组(P0.05),合并卵巢EMT组略优于未合并卵巢EMT组,差异无统计学意义(P0.05)。(3)预后影响因素分析:在EAOC组与合并卵巢EMT组中,EMT恶变是唯一影响因素(P0.05);EAOC组与未合并卵巢EMT组中,病理分期、EMT恶变是影响预后的独立重要因素(P0.05)。结论:EAOC患者具有一些特有的临床病理特征,病理分期、EMT恶变是影响卵巢癌预后的重要因素,与EMT相关的卵巢癌预后相对较好。     

广泛性或改良广泛性子宫切除术与筋膜外子宫切除术对Ⅱ期子宫内膜癌患者预后的影响

目的比较行子宫广泛性切除术(RH)或改良子宫广泛性切除术(mRH)与筋膜外子宫切除术(SH)的Ⅱ期子宫内膜癌(EC)患者预后的差异, 并分析影响Ⅱ期EC患者预后的相关因素。方法选取2006年1月—2021年1月于北京大学人民医院接受分期手术且术后病理检查证实为国际妇产科联盟2009年(FIGO 2009)分期Ⅱ期的47例EC患者的临床病理资料进行回顾性分析, 患者的年龄为(54.4±10.7)岁, 中位随访时间为65个月(9～138个月)。根据手术范围的不同分为RH或mRH(RH/mRH)组(14例)、SH组(33例), 比较两组患者预后的差异, 同时探究影响Ⅱ期EC患者预后的相关因素。结果 (1)RH/mRH组、SH组患者合并高血压的比例分别为2/14、45%(15/33), 术中出血量分别为(702±392)、(438±298)ml, 术后并发症发生率分别为7/14、15%(5/33), 上述指标两组间分别比较, 差异均有统计学意义(P均<0.05)。(2)RH/mRH组与SH组患者的中位随访时间分别为72、62个月, 两组比较, 差异无统计学意义(P=0.515)。Kapl...     

子宫内膜腺癌组织中AdipoR1、AdipoR2及IRS-1的表达及临床意义

目的:探讨子宫内膜腺癌组织中脂联素受体(AdipoR1、AdipoR2)和胰岛素受体底物1(IRS-1)的表达及临床意义。方法:采用免疫组化(Max Vision)方法检测广西医科大学肿瘤医院2014年1月到2016年3月间首次接受治疗的80例子宫内膜腺癌、26例不典型增生以及23例正常子宫内膜组织中AdipoR1、AdipoR2、IRS-1蛋白的表达,分析其与子宫内膜腺癌临床病理参数的关系。结果:(1)子宫内膜腺癌组织中AdipoR1、AdipoR2阳性表达率明显低于正常子宫内膜组,差异有统计学意义(P均0.05);而子宫内膜腺癌组织与不典型增生组织中AdipoR1、AdipoR2的阳性表达率相比,差异均无统计学意义(P0.05);IRS-1在3组的阳性表达率,两两比较差异均无统计学意义(P0.05)。(2)AdipoR1的阳性表达率与子宫内膜癌腺癌患者的临床病理分期、病理分级、肌层浸润深度、淋巴结转移情况、淋巴脉管受累有关(P均0.05);而AdipoR2的阳性表达与患者病理分级有关(P0.05);IRS-1的阳性表达率与患者FIGO分期、病理分级以及淋巴结转移有关(P均0.05)。(3)在子宫内膜腺癌组织中,AdipoR1与IRS-1的表达呈负相关(r=-0.361,P0.05);AdipoR2与IRS-1的表达亦呈负相关(r=-0.368,P0.05)。结论:AdipoR尤其是AdipoR1及IRS-1的表达与子宫内膜腺癌的发生、发展及病理特征有一定关系。     

子宫肉瘤40例临床分析

目的:探讨子宫肉瘤的临床病理特征、超声表现、诊治及预后,以期提高对该病的认识.方法:回顾性分析40例子宫肉瘤患者的临床病理资料及诊治情况.结果:平均年龄58.6岁.40例中绝经后22例(55.0％);阴道不规则流血18例(45.0％);病理分型中子宫内膜间质肉瘤19例(47.5％).仅9例(27.3％,9/33)术前确诊为子宫肉瘤.超声下主要表现为子宫增大、肿块内部回声不均、界限不清、肿块周边或内部血流信号.均手术治疗并辅以化疗.总3年及5年生存率分别为65.0％和45.0％.是否绝经及不同临床分期患者的3年及5年生存率比较,差异均有统计学意义(P＜0.05);不同病理类型患者的5年生存率比较,差异有统计学意义(P＜0.01).结论:子宫肉瘤早期症状以阴道流血为主,但无特异性,术前诊断困难.超声下表现具有一定特异性,应受到重视.病理类型以子宫内膜间质肉瘤为多见.手术治疗为主,综合治疗是关键.绝经后、临床分期晚、恶性中胚叶混合瘤患者的预后差.     

Papillary Serous Carcinoma of the Uterus: Increased Risk of Subsequent or Concurrent Development of Breast Carcinoma

OBJECTIVE: Some women with endometrial cancer may be at increased risk for developing breast cancer. The histologic type of endometrial cancer associated with synchronous or subsequent breast cancer has not been clearly established. Our purpose was to determine if a certain histologic type of endometrial cancer was associated with an increased risk of synchronous or subsequent breast cancer. METHODS: The University of Iowa Hospitals and Clinics tumor registry was queried to ascertain all patients with the diagnosis of uterine cancer from January 1, 1983, to December 31, 1994. Statistics were performed utilizing SPSS for Windows version 9.0 (SPSS Inc., Chicago, IL), including Student's t tests and chi(2) tests. RESULTS: Five hundred ninety-two patients had endometrial adenocarcinoma during the study period. Five hundred thirty-six women had endometrioid adenocarcinoma, 23 women had papillary serous carcinoma (UPSC), 21 women had adenosquamous carcinoma, 10 women had clear-cell carcinoma, and 1 woman each had mucinous or squamous carcinoma. Twelve patients had previously been diagnosed with breast carcinomas. Twenty-five patients were diagnosed with breast cancer either concurrently or subsequent to their diagnosis of endometrial cancer. Synchronous or subsequent breast cancers developed in 3.2% of patients with endometrioid carcinoma and in 25% of patients with UPSC (P < 0.001). CONCLUSION: Patients with UPSC have an increased risk of development of breast cancer as compared to patients with endometrioid adenocarcinoma of the uterus.     

Cancer de la glande de Bartholin

Bartholin gland carcinoma is a rare tumor. Treatment is not consensual due to the absence of prospective and randomized controlled trials. Bartholin gland carcinoma is actually treated similarly to primary median squamous cell carcinoma of the vulva. Here we report two cases of 42- and 67-year-old females who developed respectively an adenoid cystic carcinoma, and a squamous carcinoma of Bartholin gland.     

Serum squamous cell carcinoma antigen levels in women with neoplasms of the lower genital tract and in healthy controls

Summary Squamous cell carcinoma antigen levels in 74 healthy volunteers, 57 patients with CIN and 91 patients with cervical carcinoma were determined by radioimmunoassay. 5.4% of healthy volunteers were above and all patients with CIN were below 3.0 ng/ml. 63.1% of 65 patients with primary squamous cell carcinoma, 1 out of 7 adenocarcinomas and 68.4% of 19 patients with recurrence of squamous cell carcinoma of the cervix had elevated SCC antigen levels. Elevated posttreatment levels carried a high risk factor of tumor persistence. Increases in SCC antigen levels during follow up usually signified recurrent carcinoma.     

Large-cell neuroendocrine carcinoma of the cervix associated with cervical-type invasive adenocarcinoma: a report of case and discussion of histogenesis

A case of cervical large-cell neuroendocrine carcinoma with mucinous-type cervical adenocarcinoma component adjacent to it is presented, and its histopathogenesis and clinical course are discussed under the light of the literature.     

A stage Ia vulvar carcinoma with an inguinal lymph node recurrence after local excision. A case report and literature review

A patient with a stage Ia vulvar squamous cell carcinoma (< 1 mm invasion) is reported in which an inguinal recurrence one and a half years after partial radical vulvectomy and superficial inguinal lymph node sampling was noted. After the initial biopsy showing a tumor invading 0.3 mm into the stroma, residual tumor could not be shown in the vulvectomy specimen nor in the superficial lymph nodes. A review of the literature indicates that this is only the second reported case of stage Ia vulvar carcinoma with lymph node metastases.     

线粒体DNA在妇科恶性肿瘤中的研究进展

线粒体DNA（mtDNA）是细胞核外唯一的遗传物质，编码参与氧化磷酸化和ATP生成所必需的多肽。与核基因组相比，mtDNA分子质量小，缺乏组蛋白的保护，易受致癌物攻击，是致癌物的重要靶点，容易发生氧化损伤和突变。近年来，mtDNA结构和功能的异常在多种恶性肿瘤中已有研究，mtDNA与肿瘤发生发展的关系已成为新的研究热点。妇科恶性肿瘤中，目前在与其相关的核内基因组研究较多，而在核外基因组中研究相对较少。将核外基因组mtDNA在宫颈癌、卵巢癌、子宫内膜癌中研究进展做文献综述。     

Ovarian neuroendocrine carcinoma, non-small cell type, associated with serous carcinoma

BACKGROUND: Neuroendocrine carcinoma of the non-small cell type of the ovary is a rare aggressive tumor, interestingly associated with either a surface epithelial tumor or teratoma. CASE: A 71-year-old woman presented with a pelvic mass and underwent a total abdominal hysterectomy with a bilateral salpingo-oophorectomy. Pathology examination showed a 6.5 cm in greatest dimension ovarian tumor composed of neuroendocrine carcinoma of the non-small cell type and serous carcinoma. Immunohistochemical studies including keratin 7, WT-1, and neuroendocrine markers demonstrated differences in the two components. Microsatellite instability (MSI) analysis using five polymorphic markers also showed a different pattern in the two components. CONCLUSION: This is the first report of an ovarian neuroendocrine carcinoma, non-small cell type, associated with a serous carcinoma. Immunohistochemistry and MSI are very helpful in making a definite diagnosis.     

The treatment of uterine papillary serous carcinoma (UPSC): are we doing the right thing?

Abstract. Tay EH, Ward BG. The treatment of uterine papillary serous carcinoma (UPSC): are we doing the right thing?
In an earlier study ⁽¹⁾ of 21 patients with uterine papillary serous carcinoma (UPSC), Ward et al . found a poor 3-year survival, even for patients with surgically documented localized disease, and a high rate of recurrence outside the field of treatment. Eight years later, we performed a retrospective study on 67 patients who were treated initially by surgery, which included the 21 patients previously reported, to evaluate any changes in the management approach since 1990 and its impact on the survival of such patients. The clinical characteristics of patients treated before and after 1990 were similar. However, after 1990, more patients had omentectomy and complete surgical staging (42% vs. 17%); chemotherapy was more widely used (63% vs. 33%); all chemotherapies were platinum-based regimens and less radiotherapy was administered (47% vs. 83%). The overall 3-year survival was 43% and 5-year survival was 35%, with a median survival period of 31 months. There was no significant difference in the survival outcome between patients managed before and after 1990, after adjusting for stage and spread of disease. Based on the results of this retrospective study, it appears that the current treatment strategy has not resulted in an improvement in the survival of patients with UPSC.     

Coexistence of verrucous and squamous carcinoma of the vulva

AIM: To evaluate the coexistence of verrucous and squamous carcinoma of the vulva and to assess the clinical course, survival and rate of recurrent disease of these patients. METHODS: The records of 17 patients who were diagnosed with verrucous carcinoma of the vulva over a 12-year period were studied retrospectively. Presence of genuine verrucous carcinoma or coexistence of verrucous and squamous carcinoma of the vulva on vulvar biopsies, results of histopathological assessment of final vulva and inguino-femoral node specimens and histological evaluation of recurrent disease specimens were the main outcome measures. RESULTS: Five of the 17 patients (29.5%) initially underwent radical vulvectomy and inguino-femoral lymphadenectomy. Histology of the specimens verified the coexistence of verrucous and squamous carcinomas in four of the five cases. Twelve women (70.5%) underwent simple vulvectomy for genuine verrucous carcinoma; in the final histology, 10 of these women (58.8%) were confirmed as having genuine verrucous carcinomas while two (11.7%) were found to have both verrucous and squamous carcinomas and were further managed by lymphadenectomy. None of our patients died of the disease. Three women (17.5%) presented with local relapse of the tumour, and were managed by wide local excision of the tumour. CONCLUSIONS: In the present study, 35% of patients with verrucous carcinomas of the vulva had coexistent squamous carcinoma. Separation of the cases of genuine verrucous carcinoma from coexistent verrucous and squamous tumours is based on the establishment of correct diagnosis by a large and deep vulvar biopsy as well as the meticulous assessment of the specimen by the pathologist. This will result in the decrease of the rate of over- and under-treatment of these patients.