女性生殖系统多原发恶性肿瘤

目的 探讨女性生殖系统多原发恶性肿瘤（MPMT）的临床特点。方法 回顾分析7例女性生殖系统MPMT的临床病理资料并复习文献。结果 7例均为双原发癌，发病率占女性生殖系统恶性肿瘤的1.86%。4例（57.1%)同时累及卵巢，子宫，7例均行根治性手术，2例失访，2例死于肿瘤，3例无瘤生存，结论 女性生殖系统MPMT并不罕见，诊断主要依赖病理学检查，MPMT只要及时诊断，积极治疗，预后较好。     

妇科恶性肿瘤合并多原发性恶性肿瘤10例

 目的　探讨多原发性恶性肿瘤（MPMT）的诊断与治疗,提高对MPMT的认识和诊疗水平。方法　采用回顾性分析方法,对2004年1月至2010年1月收治的妇科恶性肿瘤合并MPMT 10例临床资料进行综合分析。结果　同时性癌7 例,其中手术+放疗2例,单纯手术治疗2例,手术+化疗2例,手术+放、化疗1例。7例同时性癌2、5年生存率分别为71.4 %、28.6 %。异时性癌 3例,第一癌时手术+放疗1例,单纯手术治疗1例,手术+化疗1例;第二癌时手术+化疗1例,单纯手术2例。3例异时性癌2、5年生存率分别为66.7 %、33.3 %。其中子宫颈、子宫内膜、卵巢、胃肠道肿瘤的发病率明显高于其他器官。结论　如果对第二癌的治疗原则同第一癌,做到早发现、早诊断、早治疗,MPMT患者仍会有较好的预后。     

外阴阴道黑色素瘤研究进展

女性生殖器官恶性黑色素瘤(恶黑)的发病率较低,占女性生殖系统恶性肿瘤的1%~3%[1],其中外阴黑色素瘤在女性生殖器黑色素瘤中居首位,占外阴恶性肿瘤的2%~10%,其次为阴道黑色素瘤,约占女性阴道恶性肿瘤的3%[2]。现就外阴及阴道恶黑的发病、诊断、治疗及预后作一综述。1发病相关因     

女性肾移植后新发生殖系统癌前病变及恶性肿瘤的临床分析

目的 探讨女性接受肾移植后新发生殖系统癌前病变及恶性肿瘤的临床特点、诊疗及预后情况。方法 收集郑州大学第一附属医院2012年1月至2021年12月进行肾移植女性患者的资料,回顾性分析并总结患者的一般资料,术后免疫治疗方案,术后新发生殖系统癌前病变及恶性肿瘤的特点、诊疗及预后情况。结果 肾移植后新发恶性肿瘤共28例(28/585),其中生殖系统7例。新发生殖系统癌前病变8例。15例患者均接受相应治疗。术后随访至今,所有患者均存活,1例患者肿瘤复发。结论 女性肾移植后生殖系统癌前病变及恶性肿瘤发病率比普通人群显著增高,尤其是人乳头瘤病毒感染相关病变。治疗原则是在保证肾功能的基础上控制恶性肿瘤进展,并辅以手术及放、化疗等综合治疗。术后需严密随访,对于高危人群在移植前就应进行相关肿瘤预警的检测。     

子宫颈液基细胞学诊断女性生殖系统腺癌的准确性分析

 目的揭示子宫颈液基细胞学(LBC)诊断女性生殖系统腺癌的准确性。方法选取中国医学科学院肿瘤医院2001~2005年组织学诊断的女性生殖系统腺癌与其LBC诊断对照,同时选取同期宫颈LBC诊断的腺癌细胞(AdcaC)、可疑腺癌细胞(Sus-AdcaC)和非典型腺细胞(AGC)与其组织学诊断对照,以LBC诊断的Sus-AdcaC为切入点,以组织学诊断为金标准,统计学分析数据。结果共259例纳入分析。子宫颈LBC诊断女性生殖系统腺癌的敏感性为42.6%,特异性为91.5%,阳性预测值和阴性预测值分别为93.0%和37.6%;对子宫颈腺癌、子宫内膜腺癌和卵巢输卵管腺癌的敏感性分别为65.6%、38.9%和36.1%,前者显著高于后两者(P=0.016)。子宫颈LBC诊断生殖系统腺癌的敏感性与其临床病理分期相关(P=0.001),随临床病理分期的增加诊断敏感性也有增加的趋势。结论子宫颈LBC诊断有助于提高对女性生殖系统腺癌诊断的敏感性,但有一定局限性。     

2型糖尿病并发恶性肿瘤风险的Logistic回归分析

目的：探讨2型糖尿病(Type 2 diabetes mellitus, T2DM)并发恶性肿瘤的相关危险因素。方法：连续收集2012年1月至2016年12月笔者单位收治的6202例T2DM患者的临床资料,进一步按照是否并发恶性肿瘤(恶性肿瘤在T2DM之后或同时确诊)分为病例组和对照组,采用多因素Logistic回归模型分析T2DM并发恶性肿瘤的相关危险因素。结果：T2DM并发恶性肿瘤患者的发病部位依次为：消化系统210例(44.87%)、呼吸系统112例(23.93%)、女性生殖系统75(16.03%)、泌尿男性生殖系统19例(4.06%)、血液系统16例(3.42%)、内分泌系统14例(2.99%)、其他22例(4.70%)。多因素Logistic回归分析显示：男性(OR=2.968)、高龄(OR=3.039)、糖尿病病程长(OR=4.383)、合并心血管疾病(OR=5.229)、胰岛素治疗(OR=2.492)是T2DM并发恶性肿瘤的独立危险因素(P<0.05)。结论：T2DM患者合并恶性肿瘤的检出率较高,以消化道恶性肿瘤最为常见,男性、高龄、糖尿病病程长、合并心血管疾病、胰岛素治疗是T2DM并发恶性肿瘤的独立危险因素。     

女性生殖系统非霍奇金淋巴瘤11例临床分析

要目的：探讨女性生殖系统非霍奇金淋巴瘤(NHL)的发病、诊断及治疗。方法：临床资料回顾性分析。结果：11例生殖系统非霍奇金淋巴瘤(NHL)中,发生于外阴1例、宫颈3例、宫体2例、卵巢5例。以宫颈与卵巢受累为主,占72．7％(8／11)。7例为原发,4例为继发。8例采用以根治性手术为主,辅以CHOP(COP)方案化疗的综合治疗方法,完全缓解6例,占75．0％。生存期最长已超过10年零8个月。结论：女性生殖系统非霍奇金淋巴瘤(NHL)有原发和继发。肿瘤标记物、细胞学检查、病理组织学及免疫组化技术均可作为诊断与鉴别诊断的手段。根治性手术 CHOP方案化疗的综合治疗方法可达根治目的。     

子宫内膜癌知识问答

什么是子宫内膜癌子宫是女性生殖系统的重要组成部分,它承担着妊娠、分娩的重任。子宫由子宫体和子宫颈两部分组成,子宫内膜癌是发生于子宫内膜的上皮源性恶性肿瘤,它是女性生殖系统常见的恶性肿瘤之一,占女性全身恶性肿瘤的7%,占女性生殖系统恶性肿瘤的20%-30%.     

妊娠合并卵巢恶性肿瘤8例临床分析

目的:分析总结妊娠合并卵巢恶性肿瘤的临床特征及诊治经验。方法:回顾性分析2000年1月至2011年11月中国医科大学附属盛京医院诊断及治疗的8例妊娠合并卵巢恶性肿瘤患者的临床资料。结果:近12年共诊断妊娠合并卵巢恶性肿瘤8例,发病率为0.150/1000次妊娠。上皮性癌共2例(25%),低度恶性肿瘤(交界性上皮性肿瘤和颗粒细胞瘤)共5例(62.5%),生殖细胞肿瘤1例(12.5%)。国际妇产科联盟分期:I期6例(75%),III期2例(25%)。7例(87.5%)行保守性手术治疗(患侧附件切除),其中2例行二次手术。1例(12.5%)病期偏晚(IIIc期),行肿瘤细胞减灭术。随访患者6-104个月,仅1例晚期患者术后2年半死亡,其余均存活至今,生存率87.5%。出生新生儿5例,其中早产窒息死亡1例,其余4例均无后遗症及畸形。结论:妊娠合并卵巢恶性肿瘤的恶性程度偏低,期别偏早,所以应重在早期发现及早期治疗。对于妊娠合并晚期卵巢恶性肿瘤,应及时终止妊娠,行恶性肿瘤的综合治疗。     

小肠原发性肿瘤33例临床分析

目的 :探讨小肠肿瘤临床特点和早期诊断手段。方法 :回顾性分析 33例原发性小肠肿瘤患者的临床资料。结果 :小肠良性肿瘤 5例均为平滑肌瘤 ;恶性肿瘤 2 8例 ,其中平滑肌肉瘤 13例 (4 6 4 % ) ,淋巴肉瘤 11例 (39 2 % ) ,腺癌 3例 (10 7% ) ,类癌 1例 (3 5 % )。临床上无特异性症状及可靠的诊断方法 ,内窥镜和全消化道钡餐造影是主要诊断手段。 5 3 6 %的恶性病例在手术时已有远处转移 ,仅 13例(4 6 4 % )行根治性切除。根治切除术后 5年生存率为 4 6 1%。结论 :早期诊断、早期治疗是提高小肠恶性肿瘤患者生存率的关键 ,对无远处转移者应争取行根治术。     

Histogenesis of clear cell adenocarcinoma in the urinary tract: evidence of urothelial origin.

PURPOSE: Clear cell adenocarcinoma in the urinary tract is a rare entity with an appearance resembling its counterpart in the female genital tract. Although several theories have been proposed about its origin, its exact histogenesis has remained uncertain. EXPERIMENTAL DESIGN: We integrated molecular genetic evaluation by fluorescence in situ hybridization and X-chromosome inactivation with conventional morphologic and immunohistochemical analyses in 12 patients with clear cell adenocarcinomas in the urinary tract. RESULTS: Concurrent urothelial carcinoma or urothelial carcinoma in situ was present in six cases (50%) and foci of cystitis glandularis were observed in four cases (33%). Neither intestinal metaplasia nor Müllerian component was identified in any case. Cytoplasmic expression of alpha-methylacyl-CoA racemase was demonstrable in 10 of 12 tumors (83%). Moderate to diffuse immunostaining for cytokeratin 7 was identified in all 12 tumors (100%), whereas only 3 of 12 (25%) tumors showed positive immunostaining for cytokeratin 20. Focal uroplakin III staining was seen in 6 of 12 tumors (50%). In five cases (42%), focal to moderate CD10 immunoreactivity was observed. Immunostains for OCT4 and CDX2 were completely negative in all tumors. In UroVysion fluorescence in situ hybridization assays, all tumors displayed chromosomal alterations similar to those commonly found in urothelial carcinoma. Identical patterns of nonrandom X-chromosome inactivation in concurrent clear cell adenocarcinoma and urothelial neoplasia were identified in two informative female cases. CONCLUSIONS: Our findings support an urothelial origin for most clear cell adenocarcinomas of the urinary tract, despite their morphologic resemblance to certain Müllerian-derived tumors of the female genital tract.     

多原发性恶性肿瘤

本文报告1975年5月至1990年12月发现的21例多原发癌,其中同时性2例,异时性19例。多原发癌的发生率逐年有增高趋势,因此当肿瘤病人出现另一个肿瘤时,不能轻易认为是转移或复发性肿瘤。多原发癌应予以根治。对于放射线诱发的肿瘤首选疗法是手术。患者预后与第二癌发生的部位、病理学类型、期别、治疗措施及两种癌发生的间隔时间有关。     

卵巢转移瘤109例临床分析

:[目的]了解卵巢转移瘤的临床特征 ,探讨其治疗和预后。[方法]对1985年～1996年109例卵巢转移瘤病人进行回顾性分析。[结果]109例卵巢转移瘤占同期收治的卵巢恶性肿瘤的9 7% ,双侧卵巢转移占62 4% ,单侧卵巢转移占37 6% ,伴腹腔转移占71 6%。1年生存率5 0% ,平均生存时间13个月。来源于乳腺癌、淋巴瘤和生殖道癌的卵巢转移瘤平均生存时间为27个月、32个月和22个月 ,来源于结肠癌、胃癌和肺癌的平均生存时间为9个月、8个月和3个月。肿瘤局限在盆腔内的平均生存时间比腹盆腔广泛转移的明显延长(21个月比9个月) ,有显著的统计学意义(P<0 01)。胃肠道和生殖道癌卵巢转移术后残存肿瘤的直径<2cm(理想肿瘤细胞减灭术)的平均生存时间明显长于>2cm者 ,亦有显著的统计学意义(P<0 01)。[结论]卵巢转移瘤常合并腹盆腔广泛转移 ,预后差 ,但手术达理想减瘤者可以明显延长生存     

24例女阴恶性黑色素瘤临床病理分析

 目的　研究女阴恶性黑色素瘤的临床和病理学特征。方法　复习临床、病理学资料 ,全部病例进行随访 ,免疫组织化学方法用S P法。结果　 2 4例中发生于外阴 13例 ,阴道 7例 ,宫颈 4例。 17例获得随访 ,1年内死亡 6例 ,2年 4例 ,3～ 4年 3例 ,4例存活 5年以上。免疫组织化学染色nm2 3阳性 14例中淋巴结转移者仅 2例阳性 ,9例者淋巴结转移者中 6例 p5 3蛋白染色阳性。 结论　女阴恶性黑色素瘤恶性程度高。nm 2 3的表达与淋巴结转移呈负相关 ;p5 3表达者淋巴结转移比淋巴结阴性病例高 ,有预后意义。     

女性生殖道恶性中胚叶混合瘤(29例临床资料分析)

女性生殖道恶性中胚叶混合瘤发病率低，恶性程度高。上海医科大学妇产科医院1965年～1993年共收治20例生殖道恶性中胚叶混合瘤，其中子宫20例，宫颈2例，卵巢6例，输卵管1例。占同期妇科住院患者的0．3‰、妇科肿瘤患者的5．9‰；。本病的临床表现主要有：阴道流血水（74．4％）、腹痛（27．6％）。在术前诊断中诊断性刮它对有阴道流血水的病例有一定帮助，确诊率为71％，而对拉他病例则意义不大。本病预后较差，29例中2年内死亡者12例。生存时间超过5年者7例。发生在子宫的恶性中胚叶混合瘤可能较发生在其他部位的预后好。五年存活率在较广泛的手术切除者比单纯全宫加双附件切除者要高。化疗对本病的治疗效果尚不肯定，但术后长期用以铂剂为主的联合化疗可得到明显缓解或完全缓解。临床分期与本病预后尚不明显。影响本病预后的可能因素有：1．手术治疗是否彻底。2术后是否加用以铂剂为主的联合化疗。3临床分期。     

Metastases to the female genital tract. Analysis of 325 cases

In order to better define the frequency and patterns of metastasis to the female genital tract, all cases of nonhematopoietic metastases to the adnexa, uterus, vagina, and vulva encountered in patients treated at Barnes Hospital between 1950 and 1981 were reviewed. Three hundred twenty-five metastatic cancers from 269 patients were recovered. One hundred forty-nine cases were from extragenital primaries; the remaining tumors were intragenital metastases. Ovary and vagina were the most frequent metastatic sites for both extragenital and genital primaries. The majority of the extragenital metastases were adenocarcinomas from the gastrointestinal tract, but a variety of other primaries did spread, on occasion, to the genital tract. Twenty-seven percent of the metastases presented as possible primary gynecologic lesions, and 75% of these tumors had an extragenital origin. It is shown that despite certain trends in the distribution of metastases, all sites in the female genital tract are at risk for the occurrence of metastases.     

Flow cytometric DNA-ploidy analysis of synchronously occurring multiple malignant tumors of the female genital tract

In this study the authors applied flow cytometric DNA-ploidy analysis to multiple female genital tract malignant tumors in 43 patients, most of whom (n = 37) had bilateral ovarian cancer. An algorithm was developed for calculation of the likelihood ratio of the probabilities that measured DNA index differences between multiple tumor localizations within the same patient could be attributed to measurement variation or to true biologic DNA content differences. The results of this statistical analysis show that in 72% of the cases (31 of 43) this probability ratio exceeded 1. Because the probability that two independent tumors will have a near-identical aneuploid DNA content is very low, this finding supports a metastatic process rather than the occurrence of multiple primary tumors in these patients. Thus, flow cytometric DNA-ploidy analysis can be helpful in the identification of metastatic disease in patients with multiple female genital tract malignant tumors.     

Role of exon 7 PTEN Gene in Endometrial Carcinoma

Background: Endometrial carcinoma is the most common malignant tumor of the female genital tract andthe fourth most common cancer in Iranian women after breast, colorectal and lung cancers. Various geneticalterations appear to be early events in the pathogenesis of endometrial carcinoma and it seems that PTEN isthe most commonly mutated gene in the endometrioid subtype. The aim of the present study was to investigatethe correlation between mutations in exon 7 of PTEN gene and endometrial carcinoma. Materials and Methods:Seventy-five patients with endometrial carcinoma and 75 females whose underwent hysterectomy for non tumoralindication were selected for evaluation of PTEN mutations in exon 7 by PCR-SSCP and sequencing. Correlationsbetween the frequency and type of mutation and the pathologic findings of the cancer (tumor subtype, stageand grade) were assessed. Results: All of the samples were obtained from Iranian patients. 60 % (45 cases) ofthe tumors were endometriod and 40% (30 cases) were of serous type. The grade distributions of the 75 casesaccording to the FIGO staging system were as follows: low grade, 20 cases; high grade 55 cases, low stage, 41cases; high stage 34 cases. For exon 7 of the PTEN gene, the analysis showed that there were no mutations in ourcases. Conclusions: Our findings in the present study suggest that exon 7 of PTEN does not play any significantrole in the development of endometrial carcinoma in Iranian cases.     

Carcinomas in childhood. A registry-based study of incidence and survival

During a 10 year period, 1971-80, there were 234 children in Great Britain younger than 15 years with a diagnosis of carcinoma registered in Great Britain. These cases represented approximately 2% of all childhood malignant disease. The most common primary site was the thyroid, followed by the nasopharynx and the adrenal cortex. With the exception of adrenocortical tumors, most of the carcinomas occurred in children older than 10 years. In some patients there was a genetic predisposition to neoplasia. Children with carcinomas of the thyroid and female genital tract have an excellent prognosis with 5-year survival rates of over 90%. The prognosis for other sites was generally less favorable; 60% of children with nasopharyngeal tumors were alive at 5 years from diagnosis but less than 20% of those with carcinomas of the gastrointestinal tract or the adrenal cortex.     

The Value of Peritoneal Washing Cytology During Intra-Abdominal Surgery for Female Genital Tract Neoplasms

BackgroundPeritoneal washing cytology is a technique performed during surgery for genital neoplasms to detect subclinical intraperitoneal metastases from these tumors. The aim of this study was to evaluate PWC utility in presumed benign and malignant female genital tract neoplasms by comparing the results of peritoneal cytology and corresponding histopathological specimens.Patients and MethodsThe 305 cases of female genital lesions with available staging (International Federation of Gynecology and Obstetrics) were considered. In cases with positive cytology, without neoplastic involvement of the ovarian and uterine surfaces, the salpinx was accurately examined to reveal primary malignant fallopian tubal neoplasms. For malignant ovarian neoplasms, the correlation rate between cytological and histopathological findings was statistically evaluated using the Fisher exact test. Statistical significance was defined as P < .05.ResultsHistopathological diagnosis revealed that of 32 cases with positive cytology, 21 examples corresponded to primary ovarian serous carcinomas (65.625%). Moreover, the serous carcinoma was the subtype that most frequently revealed neoplastic elements on PWC (21 examples in 22 cases, 95.4%). Only 1 of these malignancies with positive cytology and pT1a stage presented simultaneous invasive and in situ serous carcinoma of contralateral tubal fimbria. Only 1 of serous endometrial carcinomas that involved an endometrial polyp was associated with positive cytology and with simultaneous carcinoma of tubal fimbria.ConclusionIn conclusion, PWC remains a useful procedure for staging malignant genital tract neoplasms and can be necessary to detect occult fallopian tube malignancies.