超选择子宫动脉栓塞治疗子宫肌瘤的临床研究

目的　研究超选择子宫动脉栓塞治疗子宫肌瘤的临床研究。方法　于 2 0 0 0年 1月～ 2 0 0 1年 6月对 5 6例子宫肌瘤患者进行双侧子宫肌瘤供血动脉的栓塞治疗。结果　插管栓塞成功率 10 0 % ,随访 1～ 6个月。B超随访 1个月肌瘤体积平均缩小 2 5 %。随访 6个月 ,16例肌瘤消失 ,40例肌瘤体积平均缩小 66% ,并均有月经量的明显减少。结论　子宫肌瘤的介入治疗疗效肯定 ,对黏膜下肌瘤尤为适宜。     

经导管子宫动脉栓塞术治疗子宫肌瘤的临床应用

目的探讨经导管子宫动脉栓塞术(TUAE)治疗子宫肌瘤的疗效及安全性。方法对69例子宫肌瘤患者采用Seldinger's技术经导管子宫动脉注射碘海醇-真丝线段或聚乙烯醇-抗生素乳剂行TUAE治疗,随访6~24个月,观察术后临床症状改善情况、肌瘤和子宫变化情况。结果行TUAE治疗后,69例患者临床症状缓解,月经量减少至术前的(56.3±14.4)%,合并继发性贫血的子宫肌瘤患者,血红蛋白由术前的(81.2±17.1)g/l恢复至(112.7±15.3)g/l。治疗后6个月、12个月、18个月、24个月肌瘤体积分别缩小62.7%、82.9%、90.6%、94.0%,子宫体积分别缩小53.2%、65.8%、67.9%、69.0%。结论TUAE是治疗子宫肌瘤的一种新方法,疗效显著、安全性好。     

双侧子宫动脉栓塞术治疗子宫肌瘤36例疗效观察

目的：探讨子宫动脉栓塞治疗子宫肌瘤效果。方法：经B超检查确诊为子宫肌瘤患者36例，选择性子宫动脉插管，灌注平阳霉素碘化油混合乳剂，并用新鲜明胶海绵颗粒栓塞子宫动脉介入治疗。结果：介入治疗术后3月，除1例经手术切除后证实为子宫肉瘤患者无效外，35例介入治疗有效。结论：双侧子宫动脉栓塞术治疗子宫肌瘤是保全子宫治疗的可靠选择。     

Distinct molecular landscapes between endometrioid and nonendometrioid uterine carcinomas

Endometrial carcinoma (EC) is traditionally characterized as endometrioid and nonendometrioid based on histopathologic phenotypes. Molecular‐based classifications have been proposed, but are not widely implemented. Herein we examine molecular profiles between EC histologic subtypes. 3133 ECs were submitted between March 2011 and July 2014: 1634 Type I and 1226 Type II. In situ hybridization and immunohistochemistry were used to assess copy number and protein expression of selected genes. Sequenced variants in 47 genes were analyzed using the Illumina TruSeq Amplicon Cancer Panel. Type II EC included 628 cases of uterine serous cancer (USC), 136 cases of clear cell (CC), 361 cases of carcinosarcoma (CS), 38 cases of mucinous, and 36 cases of squamous cell. PI3K/Akt/mTOR pathway was most frequently dysregulated within Type I and mucinous histologies, least altered in CS and squamous. PD‐L1 expression was highest in mucinous, absent in squamous. ER/PR expression was common in Type II, most frequent in USC, mucinous, and squamous. Receptor tyrosine kinase was frequently dysregulated in Type II disease: HER2 amplification highest in USC and CC, EGFR mutations exclusively seen in mucinous EC, KRAS mutations common in mucinous, squamous, and Type I, and c‐MET overexpression high in CC and mucinous. BRCA1 and BRCA2 were most frequently mutated in CS. Grade 3 EC shares features of G1 tumor and Type II disease, most notably resembling CS. Endometrial carcinomas are a molecularly heterogeneous group of tumors. A histology‐based molecular map can identify rational targets to optimize treatment and guide future clinical trials.     

腹腔镜下分碎器误用于子宫肉瘤病例的回顾性分析

目的:回顾性分析因子宫肌瘤行腹腔镜手术的病例,探讨分碎器误用于子宫肉瘤的比率以及对其预后的影响。方法:选取2004年11月至2014年11月以诊断为子宫肌瘤入院并行腹腔镜下子宫切除术或子宫肌瘤切除术的患者,统计术后病理确诊或高度怀疑为子宫肉瘤的患者,分析其临床资料并随访其预后。结果:以诊断为子宫肌瘤入院并行腹腔镜子宫切除术或子宫肌瘤切除术的患者,共计2 278例,经术后病理确诊或高度怀疑为子宫肉瘤患者共8例,约占0.35%（8/2278）;术后2例病理经上级医院再次复核后考虑为良性,另有一例术后8个月复发行二次手术治疗,术中发现大网膜、肠系膜、腹膜已有多发转移病灶。其余无复发或死亡病例。结论:腹腔镜下分碎器误用于子宫肉瘤的机会非常小,其在腹腔镜子宫肌瘤手术中的应用仍是可行的,但同时应重视分碎器所带来的不良后果并采取措施规避之。     

Uterine Malignancy following Tamoxifen Use in Breast Cancer Patients in Iran: Case Series and Literature Review

Background: This study evaluated tumor characteristics and survival in women with breast cancer whosubsequently developed uterine cancer. Methods: Information about endometrial cancer in tamoxifen usersfollowing breast cancer refered to the gynecologic oncology clinic of Vali-Asr hospital between 1997-2007 wasevaluated. Results: Among 330 patients with endometrial cancer, 5 were in women previously diagnosed withbreast cancer. Two cancers were malignant mixed Mullerian tumors of the uterus (MMMT), 2 were endometrioidadenocarcinomas, and one was a papillary clear cell carcinoma. Patients received tamoxifen for 4-8 years. Theendometrial cancers occurred 2-11 years after initial treatment for the breast cancers. Four of the endometrialcancers featured abnormal uterine bleeding and one of them had increased vaginal discharge and all werediagnosed on endometrial curetting. All patients received standard surgical staging for endometrial cancer andall except one were stage I. At laparotomy of one patient, an advanced stage MMMT was found with diffusedperitoneal spread and ascites. In spite of the surgery, she died of disease, 3 months later. The other patientsremain recurrence-free for breast cancer and uterine cancer after 6-120 months. Conclusion: Breast cancerpatients who use tamoxifen and have early stage endometrial cancers demonstrate a good prognosis. Abnormaluterine bleeding or vaginal discharge is the most important symptom.     

Anti-Uterine Fibroid Effect of Standardized Labisia Pumila Var. Alata Extracts In Vitro and in Human Uterine Fibroid Cancer Xenograft Model

Background: Uterine fibroids are a common type of solid tumor presenting in women of reproductive age. There are very few alternative treatment available from conventional treatment involving surgeries. Labisia pumila var. alata or locally known as ‘Kacip Fatimah’ was widely used as traditional medicine in Malaysia. This plant has been used to maintain a healthy female reproductive system. The present study aimed to evaluate anti fibroid potential of L. pumila extracts through in vitro apoptosis activity against uterine leiomyoma cells (SK-UT-1) and in uterine leiomyoma xenograft model. Evaluation of bioactive markers content were also carried out. Methods: Apoptotic induction of the extracts was determined by morphological examination of AO/PI dual staining assay by flourescent microscopy and flow cytometry analysis on Annexin V-FITC/PI stained cells. In vivo study was done in immune-compromised mouse xenograft model. HPLC analysis was employed to quantify marker compounds. Results: Morphological analysis showed L. pumila induced apoptosis in a dose dependent manner against SK-UT-1 cells. In vivo study indicated that L. pumila significantly suppressed the growth of uterine fibroid tumor. All tested extracts contain bioactive marker of gallic acid and cafeic acid. Conclusion: This work provide significant data of the potential of L. pumila in management of uterine fibroids.     

Uterine arteriovenous malformation: A rare cause of uterine bleeding. Diagnosis and treatment

A case of uterine arteriovenous malformation following a dilatation and curettage is presented. Initial diagnosis with colour and pulsed Doppler ultrasound and treatment with transcatheter arterial embolization are described.     

米非司酮治疗子宫肌瘤166例疗效分析

目的：探讨米非司酮治疗子宫肌瘤的疗效。方法：子宫肌瘤166例行口服来非司酮治疗。12．5mg每日一次睡前口服,连服3个月,结果：患者在治疗期间均出现闭经,症状缓解,子宫体积平均缩小52．68％（P＜0．01）,肌瘤体积平均缩小49．86％（P＜0．05）,疗效评价CR25例（15．06％）,PR134例（80．72％）,有效率为（CR＋PR）95．78％,血红蛋白恢复正常（100％）,性激素各项均有下降,其中孕酮,催乳素下降明显（P＞0．05）,结论：米非司酮治疗子宫肌瘤有一定疗效,副作用小,适用于肌瘤直径小于6cm或者子宫小于妊娠70天大小的病例,是一种可行的有效保守治疗方法。     

Frequent Occurrence of p53 Gene Mutations in Uterine Cancers at Advanced Clinical Stage and with Aggressive Histological Phenotypes

The clinical and pathological significance of mutation of the p53 tumor-suppressor gene was examined in 108 cases of primary uterine cancers using single-strand conformation polymorphism and direct DNA sequencing analyses. Mutation of the p53 gene was detected in 19 (31%) of 62 cases of cancer of the uterine corpus and was more frequent in groups at an advanced clinical stage and/or with aggressive histology. Among four adenocarcinomas arising in the lowest portion of the uterine corpus, three showed integration of human papillomavirus (HPV) types 16 and/or 18 DNA, and two of them also showed p53 mutation. In cancer of the uterine cervix, p53 mutations were rare; 1% (3/46) in total, 3% (1/30) of cases with integration of HPV types 16 and/or 18 DNA and 13% (2/16) of cases without HPV DNA integration. Three mutations were detected among two cases at clinical stage IV and two cases of undifferentiated cervical carcinoma. Immunohistochemically, all five cases of uterine cancer which showed diffuse (>50% of cancer cells) nuclear staining of p53 protein also carried the p53 mutation. Therefore, p53 alterations were suggested to be involved in the development of uterine cancers showing aggressive biological behavior. Although a high incidence of HPV DNA integration and a low incidence of pS3 mutation were confirmed in cancer of the uterine cervix, there was no inverse association between integration of HPV types 16 and/or 18 DNA and p53 mutation.     

Serum microRNA profile enables preoperative diagnosis of uterine leiomyosarcoma

Uterine leiomyosarcoma (ULMS) is the major subtype of uterine sarcoma (US) and contributes to uterine cancer deaths. Although preoperative diagnosis of US remains challenging, frequent application of laparoscopic surgery for benign uterine leiomyomas (ULM) requires precise exclusion of US. MicroRNAs are stably present in the bloodstream, and the application of circulating miRNAs as disease biomarkers has been recognized. In the present study, we aimed to identify diagnostic biomarkers for distinguishing US from ULM by focusing on circulating miRNAs. All serum samples were collected preoperatively between 2009 and 2017, and all cases were histopathologically diagnosed. Whole miRNA profiles were obtained using a miRNA microarray. By analyzing expression levels of the miRNAs, candidate miRNAs were selected based on diagnostic performance in discriminating US from ULM, and a diagnostic model was then constructed. A total of 90 serum samples were analyzed, and clustering analyses revealed that the profiles of ULMS were distinct from those of controls. Based on leave‐one‐out cross‐validation, seven miRNAs were selected as biomarker candidates. Based on model construction, the optimal model consisted of two miRNAs (miR‐1246 and miR‐191‐5p), with an area under the receiver operating characteristic curve (AUC) for identifying ULMS of 0.97 (95% confidence interval [CI], 0.91‐1.00). In contrast, serum lactate dehydrogenase had an AUC of only 0.64 (95% CI, 0.34‐0.94). Seven serum miRNAs with high diagnostic performance for preoperative US screening were detected, and a promising diagnostic model for ULMS was generated.     

CT-Monitored Percutaneous Cryoablation of Uterine Fibroids after Uterine Artery Embolization

OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic (CT) guidance after uterine artery embolization. METHODS Twelve patients who failed to respond to uterine artery em- bolization were treated using percutaneous cryoablation. All patients had undergone previous uterine artery embolization an average of 1.2 years (0.7~1.6 years) ago. Two cases had abnormal bleeding, and the other 10 suf- fered from pressure and/or pelvic pain. Myoma diameters were 4 cm to 16.5 cm. By using CT guidance, 2.0, 2.4, 3.0 or 3.8 mm cryoprobes were placed into the fibroid, and two 15~20 min freezing processes were performed. He- mostasis was achieved only by pressing the incisions for several minutes. MR-imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow- up MR-imaging determined the reduc- tion of the lesions. RESULTS All patients were discharged within 48 h of treatment. Almost no hemorrhage was found in all of the cases. No bladder or bowel injury or significant postsurgery pain was reported. Ice spheres were readily visual- ized at CT. Beam-hardening artifact from the metal probes was present, but did not interfere with the procedure. Myomas regressed up to 76.3% after 12 months of treatment, and the primary symptoms improved in all treated women. CONCLUSION CT-monitored percutaneous cryoablation is an effective and minimally invasive therapy for symptom relief and fibroid shrinkage after the failure of uterine artery embolization.     

术后放疗在子宫肉瘤治疗中的意义

目的 探讨子宫肉瘤术后放疗的价值和预后因素。方法 回顾分析本院1994—2014年收治的经病理确诊的182例子宫肉瘤患者资料。49例术后放疗,133例未术后放疗。放疗采用盆腔野体外照射,处方剂量30~50 Gy分10~25次,5 次/周。采用Kaplan-Meier法计算LRRFS、OS并Logrank法检验差异,Cox法多因素预后分析。结果 全组5年样本量为114例,术后放疗、未放疗的分别为24、90例(分别为2008年10月前收治的例数)。全组5年LRRFS、OS分别为62.1%、56.2%,术后放疗、未放疗的LRRFS分别为78.0%、55.3%(P=0.013),OS分别为64.1%、51.7%(P=0.070)。多因素分析显示病理类型、组织学分级、分期是LRRFS及OS影响因素(P=0.032、0.008、0.000及P=0.046、0.000、0.000),术后放疗是LRRFS的影响因素(P=0.013)。结论 术后放疗显著提高子宫平滑肌肉瘤LRRFS和OS,为子宫平滑肌肉瘤术后个体化放疗提供证据,但仍需进一步探讨。     

Intravenous Leiomyomatosis of the Uterus

Three cases of intravenous leiomyomatosis (IVL) of the uterus, a rare benign smooth-muscle tumor, are described. A preoperative diagnosis of IVL was not made in any of the patients, all of which presented with a pelvic mass with the presumptive diagnosis of leiomyoma. Surgical exploration confirmed the presence of uterine mass and two of the three cases showed extra-uterine extension into the ovarian or uterine veins. Histological examination demonstrated a fascicular pattern of bland spindle-shaped smooth-muscle cells, which extended to veins inside the myometrium or to extrauterine veins. This was confirmed by immunohistochemical stain for desmin and factor VIII. Despite their histological benignity, these lesions have a tendency to metastasize and are closely related to the conditions called “benign metastasizing leiomyoma” and “intracaval mass and cardiac extension”. The primary treatment of IVL is hysterectomy and excision of any extrauterine tumor, when technically feasible. Anti-estrogenic therapy has been suggested as potentially useful in controlling of unresectable tumor. According to the literature, the follow-up must be long and periodic postoperative ultrasonic or magnetic nuclear resonance imaging studies may be useful in detecting growth of residual intravascular tumor.     

Locally advanced cervical cancer associated with complete uterine prolapse

LOIZZI V., CORMIO G., SELVAGGI L., CARRIERO C. & PUTIGNANO G. (2010) European Journal of Cancer Care
Locally advanced cervical cancer associated with complete uterine prolapse Although uterine prolapse and carcinoma of the uterine cervix are not rare event, their association is very uncommon. An 86‐year‐old patient gravida 8, para 5 was admitted for vaginal bleeding from a uterine prolapse of 20 years of duration. On physical examination, a complete third‐degree prolapsed uterus with an ulcerated lesion of 12 cm in maximum diameter involving both the anterior and posterior lips of the cervix was observed. Because of the poor performance status and high American Society of Anesthesiology scoring, the patient was admitted for a vaginal hysterectomy with upper vaginectomy in spinal anesthesia. However, she died of pulmonary embolism 20 days after surgery. A case of a cervical cancer with a complete uterine prolapse of 20 years of duration is reported. We believe that this case typically rare to see in a developed country might be a useful addition to the few published reports.     

Cardiac metastasis from uterine leiomyosarcoma

Cardiac metastases are more frequent than primary heart neoplasias. Nearly any malignant tumour may metastasize to the heart, but the most common are carcinomas rather than sarcomas. We report the case of a patient who presented with heart metastasis 6 years after resection of an uterine leiomyosarcoma. The patient died thirty months after surgical resection without evidence of cardiac recurrence. Although cardiac metastases from uterine leiomyosarcoma are exceptional, they should be suspected in the presence of suggestive symptoms, since they can be associated with long survival after surgical treatment.     

子宫肉瘤术后辅助治疗102例临床观察

[目的]探讨子宫肉瘤术后辅助治疗的疗效.[方法]回顾性分析102例子宫肉瘤,其中单纯手术25例,术后放疗23例,术后化疗32例,术后放化疗22例.[结果]5年生存率单纯手术组为32.0%,术后放疗组34.7%,术后化疗组31.2%,术后放化疗组36.4%;盆腔复发和远处转移率单纯手术组分别为48%和36%,术后放疗组为34%和30.4%,术后化疗组为40.6%和28.1%,术后放化疗组为31.8%和27.3%.总5年生存率为33.3%.[结论]子宫肉瘤术后辅助放疗可减少盆腔复发,辅以化疗可延缓和降低远处转移,两者均可提高无瘤生存率,但不能提高总的生存率.     

Hydroxyurea plus pelvic radiation versus placebo plus pelvic radiation in surgically staged stage IIIB cervical cancer

Forty-five evaluable patients with stage IIIB carcinoma of the uterine cervix were entered into a prospective, double-blind, randomized study to evaluate the possible radiation-potentiating properties of hydroxyurea. All patients were documented to be without para-aortic lymph node metastasis by pretherapy staging para-aortic lymphadenectomy. The original plan of therapy was for continuous therapy (200 rads/day) of 6,000 rads of pelvic radiation for 6 weeks plus intrauterine radium. However, 16 patients received 6,000 rads in 8 weeks by split-course therapy (2-week rest after 3,000 rads) plus radium. Twenty-nine patients received the planned continuous therapy. The median dose of pelvic radiation for patients who received continuous therapy or split-course radiation was 6,000 rads. Leukopenia (WBC less than 2,500/mm3) was significantly increased in the patients given hydroxyurea as compared to those given placebo (P less than .001). There was no statistically significant difference relative to anemia, thrombocytopenia, radiation skin reaction, diarrhea, or radiation-induced complications requiring surgical correction. The estimated 5-year progression-free survival rate for the combined, continuous, and split-course radiation therapy hydroxyurea patients was 60%, and its was 52% for the corresponding placebo patients (P = .49). However, the estimated 5-year progression free survival rate for the correctly treated patients (continuous therapy) was 91% for the hydroxyurea group and 60% for the placebo group (P less than .06).