促黄体激素释放激素激动剂的临床应用及对骨代谢的影响

应用促黄体激素释放激素激动剂（ＬＨＲＨ－Ａ）２００μｇ，每日肌内注射，连续３个月为１疗程，治疗轻、中型子宫内膜异位症、子宫肌瘤、子宫腺肌症共２０例。结果：用药结束时，促卵泡成熟激素（ＦＳＨ）、黄体生成素（ＬＨ）、雌二醇（Ｅ＿２）均受抑制，分别为４．８±２．９ＩＵ／Ｌ（Ｐ＞０．０５）、４．０±３．５ＩＵ／（Ｐ＜０．０５）、１６０．３±１１０．７ｐｍｏｌ／Ｌ（Ｐ＜０．００１）。临床上体征改善，痛经消失，副反应轻，易为病人接受。２０例用药前后骨钙素（ｏｓｔｅｏｃａｌｃｉｎ）与尿钙、磷测定比较，差异均无显著性（Ｐ＞０．０５）。双能Ｘ线吸收法（ＤＥＸＡ）测量腰椎２～４骨密度，用药３个月下降２％，停药３个月下降１％，尚属正常范围（Ｐ＞０．０５）；单光子吸收法（ＳＰＡ）测量桡、尺骨骨密度也未见影响（Ｐ＞０．０５）。     

胎儿血流速度波形预测围产儿预后的价值

应用彩色多普勒超声对１０４例晚期妊娠妇女进行胎儿脐动脉（ＵＡ）、肾动脉（ＲＡ）及大脑中动脉（ＭＣＡ）的血流速度波形（ＦＶＷｓ）检查。多普勒指标包括ＵＡ、ＲＡ和ＭＣＡ的搏动指数（ＰＩ）、ＭＣＡ与ＵＡ的ＰＩ比值（Ｍ／ＵＮ）和ＭＣＡ与ＲＡ的ＰＩ比值（Ｍ／ＲＰＩ）。围产儿预后不良的标准包括：（１）新生儿Ａｐｇａｒ评分＜７分。（２）新生儿出生体重≤相应胎龄的第１０百分位数。（３）羊水过少或羊水混浊。结果显示：所有多普勒指标与围产儿预后均有明显相关性（Ｐ＜０．０５）；作为预测围产儿预后的指标，它们的特异性差异均无显著性（Ｐ＞０．０５），Ｍ／ＲＰＩ和Ｍ／ＵＰＩ的敏感性明显高于ＵＡＰＩ、ＲＡＰＩ和ＭＣＡＰＩ（Ｐ＜０．０５）；而且，Ｍ／ＲＰＩ、Ｍ／ＵＰＩ、ＭＣＡＰＩ和ＲＡＰＩ预测围产儿预后的敏感性和特异性在正常妊娠和高危妊娠之间无明显差别，而ＵＡＰＩ在高危妊娠时的敏感性明显高于正常妊娠（Ｐ＜０．０５）。说明：所有多普勒指标与围产儿预后有关，但是作为预测围产儿预后的指标，Ｍ／ＲＰＩ和Ｍ／ＵＰＩ比其它指标准确，而且，不受各种高危因素影响。     

米索前列醇用于足月妊娠引产的临床观察

目的：探讨米索前列醇用于足月妊娠引产的安全性及效果。方法：将６０例有引产指征的孕足月单胎头位、无宫缩的初产妇，随机分成两组，研究组（３０例）用米索前列醇５０μｇ阴道用药，每３小时１次至正式临产；对照组（３０例）用蓖麻油鸡蛋餐口服。结果：两组引产总有效率无显著差异，研究组引产时间显著少于对照组（Ｐ＜０．０５），研究组需静脉滴注催产素人数为１０．０％，显著少于对照组的４０．０％，（Ｐ＜０．０５），用药６小时后研究组宫颈评分提高５．５分，对照组提高３．１分，评分结果比较，差异有显著性（Ｐ＜０．０５），研究组子宫收缩过频的发生率为１６．７％，对照组为３．０％。结论：阴道放置米索前列醇用于足月妊娠引产能促宫颈成熟及发动子宫收缩，是安全、有效的引产方法     

正常妊娠妇女外周血可溶性白细胞介素－2受体及淋巴细胞亚群的变化

测定了８７例妊娠晚期及２９例正常非孕妇女外周血可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）水平，同时对其中３６例孕妇及１０９例正常非孕妇女（正常对照）进行外周血淋巴细胞亚群检测。结果：妊娠晚期妇女ｓＩＬ－２Ｒ水平及Ｔｓ细胞（ＣＤ＿８）明显高于正常对照，分别为：２１４６００±７０４００Ｕ／Ｌ比１６２１００±８４１Ｄ０Ｕ／Ｌ，　Ｐ＜０．０１及３７．６％±５．３％比３１．３％±７．０％，Ｐ＜０．０１。妊娠妇女Ｔｈ细胞／Ｔｓ细胞（ＣＤ＿４／ＣＤ＿８）比例明显低于正常对照（１．２±０．２比１．５±０．５，Ｐ＜０．０１）。但总Ｔ淋巴细胞（ＣＤ＿３），ＣＤ＿４，细胞与正常对照相比，差异无显著性，分别为：６４．１％±７．３％比６６．０％±９．９％，Ｐ＞０．０５及４４．１％±５．８％比４３．８％±９．Ｏ％，Ｐ＞０．０５。相关分析表明孕妇ｓＩＬ－２Ｒ水平与ＣＤ＿３、ＣＤ＿４、ＣＤ＿８细胞及ＣＤ＿４／ＣＤ＿８均无显著相关性（ｒ分别为０．２０３２，０．２０７７，０．１０３７及０．１２１４，Ｐ均＞０．０５）。提示：孕妇外周血Ｔ淋巴细胞亚群及血清ｓＩＬ－２Ｒ的变化对维持正常妊娠有重要作用，ｓＩＬ－２Ｒ可能是促进胎儿正常生长的重要介质之一。     

卵巢上皮性癌肿瘤浸润淋巴细胞与腹水中肿瘤相关淋巴细胞生物学特性的比较

目的比较卵巢上皮性癌肿瘤浸润淋巴细胞（ＴＩＬ）及腹水中肿瘤相关淋巴细胞（ＴＡＬ）的生物学特性。方法收集１２例上皮性卵巢癌组织及腹水，并将其分为实体瘤、血性腹水和非血性腹水３组。将３组标本分别在体外进行ＴＩＬ及ＴＡＬ分离，并在自体肿瘤细胞（ＡＴＣ）以及重组白细胞介素２（ｒＩＬ２）存在的条件下共同培养。其间应用流式细胞仪及４小时５１Ｃｒ释放实验分别测定每组标本的淋巴细胞表型及其抗肿瘤活性。结果３组淋巴细胞具有相似的ＣＤ３、ＣＤ４、ＣＤ８及ＣＤ２５４种表型。差异无显著性（Ｐ＞０．０５）。在全部培养过程中，每组标本ＣＤ４／ＣＤ８始终大于１。３组效应细胞均显示较高的ＮＫ杀伤活性（Ｐ＞０．０５）。实体瘤组ＴＩＬ和非血性腹水组ＴＡＬ在５０∶１的效靶比时具有明显的抗ＡＴＣ特异性，而血性腹水组ＴＡＬ未显示这种特异性，经５１Ｃｒ检测的杀伤活性分别为３０２％～５１０％和１０８％～１５８％，差异有极显著性（Ｐ＜０．０１）。结论卵巢上皮性癌ＴＩＬ及其非血性腹水组ＴＡＬ具有相似的生物学特性。     

卵巢功能早衰患者抗卵巢抗体及细胞免疫功能的测定

目的：探讨卵巢功能早衰（ＰＯＦ）患者细胞免疫功能的变化及其与抗卵巢抗体（ＡＯＡｂ）之间的关系。方法：检测３０例正常妇女（对照组）和３０例ＰＯＦ患者（ＰＯＦ组）的血清ＡＯＡｂ、外周血Ｔ淋巴细胞亚群及对卵巢抗原的白细胞促凝血活性（ＬＰＣＡ）。结果：对照组血清ＡＯＡｂ水平为１．３９±０．７２ｋＵ／Ｌ，ＰＯＦ组血清ＡＯＡｂ水平为６．８０±１．９１ｋＵ／Ｌ，两者比较，差异有极显著性（Ｐ＜０．０１）。与对照组比较，ＰＯＦ组ＣＤ＋３、ＣＤ＋４细胞百分率（分别为６５．４２±５．３１％和４４．７９±５．９０％）明显升高，ＣＤ＋８细胞百分率（２５．６３±４．２６％）明显降低，ＣＤ４＋／ＣＤ＋８比值（１．６６±０．２７）增加（Ｐ＜０．０１）。ＣＤ＋４／ＣＤ＋８比值升高者的ＡＯＡｂ阳性率（８５．７％，１８／２１），明显高于ＣＤ＋４／ＣＤ＋８比值正常者（３／９，Ｐ＜０．０１）。ＡＯＢｂ阳性的ＰＯＦ患者ＬＰＣＡ水平上升，且与ＡＯＡｂ之间有非常显著的相关性（χ２＝８．３７８，Ｐ＜０．０１）。结论：ＰＯＦ患者对卵巢抗原同时产生细胞免疫和体液免疫反应，ＰＯＦ的发病可能与免疫因素有关。     

妊娠肝内胆汁淤积症患者雌孕激素水平及免疫功能的变化

目的探讨雌孕激素水平及免疫功能变化与妊娠肝内胆汁淤积症（ＩＣＰ）的关系。方法采用放射免疫法、单向免疫扩散法、碱性磷酸酶及抗碱性磷酸酶法（ＡＰＡＡＰ）检测ＩＣＰ孕妇５０例（ＩＣＰ组）及正常妊娠妇女５０例（对照组）雌孕激素水平的变化、体液免疫和细胞免疫功能的水平。结果ＩＣＰ组雌激素水平（２５．８９±６．８５μｇ／Ｌ）较对照组（１６．９２±４．９８μｇ／Ｌ）明显升高,（Ｐ＜０．０１）,孕激素水平差异无显著性（Ｐ＞０．０５）;ＩＣＰ组细胞毒性抑制性Ｔ细胞（ＣＤ８＋）水平（１９．０６±１．９３％）较对照组（２６．４３±２．８９％）降低（Ｐ＜０．０５）,辅助性诱导性Ｔ细胞（ＣＤ４＋）与ＣＤ８＋比值（２．２３±０．３８）较对照组（１．７３±０．２３）升高（Ｐ＜０．０５）;雌激素水平与ＣＤ８＋呈负相关,与ＣＤ４＋／ＣＤ８＋比值呈正相关。结论ＩＣＰ患者雌激素水平增高,雌激素通过ＣＤ８＋上的雌激素受体而发挥作用,导致免疫功能的改变,而引起ＩＣＰ的发生     

放置IUD后宫腔微生物及子宫内膜病理学研究

研究ＩＵＤ与盆腔感染及子宫内膜恶变或其他病理改变的关系,探讨 ＩＵＤ长期使用的安全性。方法：将 ８８例分为 Ａ、Ｂ、Ｃ、Ｄ ４组,Ａ组 ２０例使用带尾丝活性 ＩＵＤ;Ｂ组２４例使用惰性 ＩＵＤ;Ｃ组 ２４例为正常对照组;Ｄ组 ２０例为盆腔感染组。所有病例取宫腔冲洗液进行需氧菌、厌养菌、解脲支原体、沙眼衣原体等培养,并取子宫内膜进行病理学检查,结果：Ａ、Ｂ组主要表现为正常增生期、分泌期或月经期子宫内膜,部分是单纯性或腺囊性增生,与Ｃ组、Ｄ组差异无显著性（Ｐ＞０．０５）,４组均未见不典型增生及恶变。Ａ、Ｂ、Ｃ３组子宫内膜均无慢性炎症改变,Ｄ组８例存在慢性子宫内膜炎改变,与Ａ、Ｂ、Ｃ组差异有显著性（Ｐ＜０．０５）。Ａ、Ｂ、Ｃ组淋巴细胞、浆细胞、中性白细胞、纤维细胞计数差异无显著性（Ｐ＞０．０５）,Ｄ组淋巴细胞、浆细胞、中性白细胞计数较以上３组明显增加（Ｐ＜０．０５）,间质细胞及纤维细胞计数与以上３组差异无显著性（Ｐ＞０．０５）。Ａ、Ｂ、Ｃ组宫腔微生物检出率分别为３０．０％,２９．２％,２０．８％,与Ｄ组（７０．０％）差异有显著性（Ｐ＜０．０５）。结论：使用ＩＵＤ５－１４年未增加子宫内膜癌、癌前病变及慢性子宫内膜炎发生率。Ｉ     

妊高征患者血浆肾上腺髓质素含量的初步探讨

目的探讨肾上腺髓质素（ＡＤＭ）与妊高征之间的关系。方法应用特异性放射免疫法测定１２例正常妊娠妇女（正常妊娠组）及２６例妊高征患者（妊高征组）的血浆ＡＤＭ水平。结果（１）妊高征组血浆ＡＤＭ水平为（２４．６７±１．２７）ｎｇ／Ｌ,高于正常妊娠组（１９．１６±１．１７）ｎｇ／Ｌ,两组间比较,差异有显著性（Ｐ＜０．０５）;（２）妊高征组血浆ＡＤＭ水平：重度妊高征为（３０．００±１．１７）ｎｇ／Ｌ＞中度妊高征为（２４．８０±０．７０）ｎｇ／Ｌ＞轻度妊高征（１９．３８±２．６５）ｎｇ／Ｌ,３者间比较,差异有显著性（Ｐ＜０．００１）;（３）妊高征ＡＤＭ水平升高与平均动脉压呈明显正相关（ｒ＝０．７７５,Ｐ＜０．００１）。结论ＡＤＭ与妊高征关系密切,可能在妊高征发病和防治中具有重要的生理及病理学意义。     

卵泡发育不良的临床分析

目的探讨卵泡发育不良（ＦＭ）的表现及其结局。方法对２９６例不孕患者中的ＦＭ患者８０例（ＦＭ组）及２０例正常排卵者（对照组）进行连续宫颈评分、Ｂ超监测卵泡发育、放射免疫法测定血雌二醇（Ｅ２）值等检查,并行腹腔镜和子宫内膜活体组织检查。结果（１）在不孕妇女中ＦＭ发生率为２７０％;（２）ＦＭ组宫颈评分最高分为７３±１８分（ｘ±ｓ,下同）,对照组为１３２±１８分;月经中期血Ｅ２水平,ＦＭ组为３００±１００ｐｍｏｌ／Ｌ,对照组为９００±４００ｐｍｏｌ／Ｌ,两组比较,差异有显著性（Ｐ＜０．０１）;（３）Ｂ超检查显示,ＦＭ组卵泡模糊,常为多个小卵泡;（４）腹腔镜检查ＦＭ组约２／３以上病例卵巢上可见黄体,但无排卵裂孔,约１／３病例无黄体;（５）ＦＭ组子宫内膜呈分泌改变者占５６７％,呈增生期改变者占３３３％左右。结论（１）ＦＭ是不孕的一个重要原因;（２）ＦＭ结局有二,一为卵泡闭锁,另一为未成熟卵泡黄素化。     

放射诱导细胞凋亡与子宫颈癌放射敏感性的关系

目的 研究细胞凋亡及放射诱导细胞调亡与子宫颈癌放射敏感性的关系,寻找预测放射敏感性的新指标。方法 采用原位末端标记法（ＴＵＮＥＬ）检测宫颈癌活检标本中凋亡的细胞数,并观察细胞凋亡及放射诱导细胞凋亡与３次后肿瘤体积缩小、肿瘤细胞放射敏感性级别以及放射治疗（放疗）结束后肿瘤局部控制率的关系。结果 放疗前凋亡细胞数与放疗后宫颈肿瘤体积缩小无关（Ｐ〉０．０５）;放射诱导凋亡细胞数与宫颈肿瘤体积缩小有明显相     

宫颈鳞癌与腺癌生物学行为的回顾性对比分析

目的探讨宫颈鳞癌(SCC)和宫颈腺癌(AC)在生物学行为方面存在的差异,为宫颈癌的合理诊治提供更多的临床依据。方法回顾分析山东大学齐鲁医院妇产科1997年1月至2006年3月收治的273例宫颈癌初治患者的临床资料,对比分析SCC和AC在发病相关因素、临床病理特征、5年生存率等生物学行为方面的不同。结果SCC和AC两组病例中有吸烟史者分别占22%和10%、宫颈涂片阳性率分别为80%和46%,体重指数(body mass index,BMI)≥24kg/m2者分别占15%和34%,确诊时FIGOⅠ期、Ⅱ期、Ⅲ期、Ⅳ期患者分别占SCC患者的42%、46%、11%、1%和AC患者的31%、47%、12%、10%,卵巢转移率分别为0.5%和6.7%,5年生存率分别为69.9%和50.6%,以上差异均有统计学意义(P<0.05)。结论SCC和AC在发病相关因素、临床病理特征和预后等方面均有统计学差异,SCC组有吸烟史者的比例及宫颈涂片阳性率更高,AC患者中则体重超重或肥胖者占较高比例,AC患者确诊时晚期患者较多而且更容易发生卵巢转移,预后较SCC差。     

Does adenocarcinoma of uterine cervix have a worse prognosis than squamous carcinoma?

OBJECTIVE: The objective of this study was to examine the influence of histology on the outcome of patients with cervix carcinoma, treated with radiotherapy and radical surgery. PATIENTS AND METHODS: Clinical, histological, therapeutical and outcome data of 360 patients with stage IB-II cervix carcinoma patients (45 adenocarcinomas and 315 squamous cell carcinoma) managed between 1985 and 1998 were collected from the database of the Institut Gustave-Roussy. RESULTS: The incidence of adenocarcinomas slightly increased during the study period (P =0.07). Histological grade was higher for squamous cell carcinoma than for adenocarcinoma (P =0.08). Adenocarcinomas were smaller than squamous cell carcinoma (P =0.06). With only 38% of sterilized hysterectomy specimen vs 52% for squamous cell carcinomas (P =0.07), adenocarcinoma seemed to be less radiosensitive. With a median follow-up of 67 months, histological type did not influence survival. DISCUSSION AND CONCLUSIONS: Our study demonstrates that radiosensitivity is different between adenocarcinoma and squamous cell carcinoma of the cervix and that surgery may compensate the low radiosensitivity of adenocarcinoma.     

Assessment of cervical cancer radioresponse by serum squamous cell carcinoma antigen and magnetic resonance imaging

OBJECTIVE: To investigate the possibility of objective clinical assessment of the radioresponse of cervical cancer via determination of serum squamous cell carcinoma antigen levels and magnetic resonance imaging (MRI)-based estimation of tumor shrinkage. METHODS:The cases of 60 patients undergoing definitive radiotherapy for cervical squamous cell carcinoma (stage I-II: n = 20; stage III-IV: n = 40) were reviewed. Measurements of serum squamous cell carcinoma antigen levels (n = 60), estimated tumor volume on preradiotherapy MRIs (n = 60), and evaluated tumor shrinkage on postradiotherapy MRIs available (n = 30) were taken. The relation between postradiotherapy squamous cell carcinoma antigen level 2 months after the start of radiotherapy and disease recurrence was investigated. Regression analysis of tumor volume measured on MRIs was used to estimate the extent of tumor shrinkage 2 months after the start of radiotherapy. RESULTS: Preradiotherapy squamous cell carcinoma antigen levels correlated significantly with preradiotherapy tumor volumes. Recurrence was identified in 27 patients as distant (n = 19), distant and local (n = 1), local (n = 5), or regional (n = 2). Of 51 patients with elevated preradiotherapy squamous cell carcinoma antigen levels, 33 achieved normalized levels after radiotherapy. Squamous cell carcinoma antigen normalization was associated with a higher recurrence-free survival rate at 2 years (74.3%) than that associated with nonnormalization of squamous cell carcinoma antigen (5.6%, P <.001). The extent of shrinkage ranged from 61% to 100%, and there was no local recurrence. CONCLUSION: Postradiotherapy squamous cell carcinoma antigen status is a useful indicator of clinical outcome, particularly about tumor recurrence. It is not, however, useful for assessing response to radiotherapy. Magnetic resonance imaging is useful for obtaining an objective assessment of radioresponse.     

Influence of histologic type and age on survival rates for invasive cervical carcinoma in Taiwan.

OBJECTIVE: The aim of this study was to assess survival rates and to evaluate histologic type and age as prognostic factors for cervical carcinoma in an ethnically homogenous population in Taiwan. METHODS: A retrospective analysis was conducted of 3678 cases of squamous cell carcinoma and adenocarcinoma that were diagnosed and treated for invasive cervical carcinoma between 1977 and 1994. Observed survival rates were estimated using the Kaplan-Meier method, and prognostic factors were assessed using Cox's proportional hazards regression analysis. RESULTS: Correlating both FIGO stage and age with histologic type revealed a higher proportion of cases with adenocarcinoma in the lower FIGO stages (P = 0.0417). Further, we found that the younger the age group the higher the proportion of cases of cervical adenocarcinoma (P = 0.0006). The 5-year survival rate was lower for patients with adenocarcinoma than for patients with squamous cell carcinoma (66.5 vs 74.0%, P = 0.0009). The 5-year survival rates for FIGO stages I, II, III, and IV squamous cell carcinoma were 81.3, 75.2, 42.7, and 26.1%, respectively, while for adenocarcinoma they were 75.9, 62.9, 29.2, and 0%, respectively. The difference in survival rates between squamous cell carcinoma and adenocarcinoma was found mainly in stage I (P = 0.0039) and stage II (P = 0.0103), where radiotherapy was used as the primary treatment. Age also affected the overall Kaplan-Meier estimate of survival. The younger the age group, the better the survival rate (P < 0.0001). Multivariate analysis confirmed a highly significant association between survival rate and both histologic type (P < 0.0001) and age (P = 0.0037). CONCLUSIONS: Early stage cervical cancer (stages I and II) with a glandular component had a lower 5-year survival rate than squamous cell carcinoma in cases where radiotherapy was the primary treatment. We speculate that this difference in survival rates between cervical adenocarcinoma and squamous cell carcinoma was due to the relative ineffectiveness of radiotherapy as a primary treatment in cases of adenocarcinoma.     

The curative role of radiotherapy in patients with isolated para-aortic node recurrence from cervical cancer and value of squamous cell carcinoma antigen for early detection

The objective of this study was to examine the clinical benefits of routine squamous cell carcinoma antigen (SCC-ag) monitoring of patients with locally advanced cervical cancer. Recurrent disease occurred in 99 uterine cervical cancer patients with elevated pretreatment SCC-ag before primary radiotherapy. Elevated SCC-ag levels persisted in 23 patients after primary radiotherapy (group 1), and SCC-ag was normalized in 76 patients after primary radiotherapy (group 2). The overall survival (OS) rate was higher for patients with SCC-ag elevation as the first sign than for patients with recurrence predicted by other modalities for group 2 patients (P = 0.033). The prediction of isolated para-aortic node recurrence significantly correlated with SCC-ag elevation as an initial sign (P = 0.001). The SCC-ag level before primary radiotherapy (> or = 10.8 ng/mL) significantly affected recurrence predicted by SCC-ag elevation as an initial sign (P = 0.002). For multivariate analysis, the presence of para-aortic node recurrence was statistically significant in OS (P < 0.0001). Routine SCC-ag monitoring of patients with carcinoma of the uterine cervix can lead to the early diagnosis of isolated para-aortic lymph node recurrence, and prolonged survival can be achieved by applying radiation therapy to the para-aortic region. To reduce the number of patients monitored for SCC-ag, we recommend monitoring group 2 patients with pretreatment SCC-ag level before primary radiotherapy > or = 10.8 ng/mL.     

A comparison of prognoses of FIGO stage IB adenocarcinoma and squamous cell carcinoma

OBJECTIVES: The objective of this study was to compare clinical and pathologic variables and prognosis of FIGO stage IB adenocarcinoma and squamous cell carcinoma of uterine cervix. METHODS: A retrospective review was performed of 521 patients with stage IB squamous cell carcinoma and adenocarcinoma of cervix who treated primarily by type 3 hysterectomy and pelvic and/or para-aortic lymphadenectomy at Hacettepe University Hospitals between 1980 and 1997. RESULTS: Age, tumor size, grade, depth of invasion, lymph node metastasis, parametrial, vaginal, and lymphvascular space involvement (LVSI) were not different between two cell types except number of the lymph nodes involved. Metastasis to three or more lymph nodes was significantly higher in adenocarcinoma. Overall and disease-free survival were 87.7%, 84.0% versus 86.4%, 83.1% for squamous cell carcinoma and adenocarcinoma, respectively (P > 0.05). The rate and site of recurrence were not different between two cell types. Multivariate analysis of disease-free and overall survival revealed independent prognostic factors as tumor size, LVSI, number of involved lymph node, and vaginal involvement. CONCLUSION: Prognosis of FIGO stage IB cervical cancer patients who were treated by primarily radical surgery was found to be same for those with adenocarcinoma and squamous cell carcinoma.     

Primary signet ring cell carcinoma of the uterine cervix: A clinicopathologic study of two cases with review of the literature

Haswani P, Arseneau J, Ferenczy A. Primary signet ring cell carcinoma of the uterine cervix: A clinicopathologic study of two cases with review of the literature. Int J Gynecol Cancer 1998; 8 : 374–379.
Signet ring cell carcinoma of the endocervix is most commonly considered to be metastatic in origin. We describe two cases of apparently primary cervical signet ring cell adenocarcinoma occurring in patients aged 33 and 38 years, respectively. Both patients had been treated previously for cervical "condylomas". The lesions, occupying the posterior lip of the cervix, were formed predominantly of malignant neoplastic signet ring cells. One case was positive for HPV type 18 and coexisted with adenocarcinoma in situ and a high grade squamous intraepithelial lesion (HSIL). One patient died 18 months after the diagnosis of carcinoma with massive intra-abdominal metastasis; autopsy was not performed. The second patient is alive and well nine months postsurgery and undergoing pelvic radiotherapy for FIGO stage IB1 adenocarcinoma with one of the pelvic nodes containing a metastasis. Although in neither of the two cases was absolute proof obtained of the absence of a gastrointestinal tract tumor, the clinical presentation of the tumors, the history of previous HPV infection of the cervix, the coexistent in situ adenocarcinoma and HSIL and the detection of HPV type 18 in one case lent support for a primary cervical origin of this rare form of adenocarcinoma.     

The study of ovarian metastasis in uterine cancer]

The correlation between histological ovarian metastasis and histologic cell type, clinical stage, depth of invasion, lymph node metastasis, and menstrual activity were analyzed in 566 patients who underwent surgery for uterine cancer at the hospital of Niigata University between January, 1971 and May, 1990. Ovarian metastasis was studied in 456 patients with stage Ib or more advanced cervical cancer and 110 patients with stage Ia or more advanced endometrial cancer. The following results were obtained: 1. The incidence of ovarian metastasis of cervical cancer by histologic cell type was 18.6% (8/43) for adenocarcinoma, 6.7% (1/15) for mixed type adenocarcinoma and squamous cell carcinoma, and 0% (0/398) for squamous cell carcinoma. The metastasis rate in patients with endometrial carcinoma was 10.8% (10/93) for adenocarcinoma, but there was no metastasis of 2 squamous cell carcinoma, 13 mixed type of adenocarcinoma and squamous cell carcinoma or 2 undifferentiated carcinoma. 2. The incidence of metastasis of cervical adenocarcinoma by stage was 5.3% (1/19) for stage Ib and 29.2% (7/24) for stage II. The metastasis rate of mixed type of adenocarcinoma and squamous cell carcinoma was 0% (0/6) for stage Ib and 11.1% (1/9) for stage II. The incidence of metastasis of endometrial carcinoma was 2.1% (1/47) for stage Ia, 15.0% (3/20) for stage Ib, 15.0% (6/40) for stage II and 0% (0/3) for stage III. 3. All the patients with ovarian metastases of uterine cervical cancer had invasion to a depth of more than 2/3 of the uterine cervix, while the incidence of ovarian metastasis of endometrial carcinoma was increased with deep invasion of the uterine muscular layer, and metastasis was present even in shallow invasion.(ABSTRACT TRUNCATED AT 250 WORDS)     

宫颈鳞癌和腺癌中微血管密度和基质金属蛋白酶-2 、9及其抑制剂-1、2表达的研究

目的通过观察肿瘤微血管密度(MVD)及MMP-2、MMP-9和TIMP-1、TIMP-2在宫颈鳞癌与腺癌组织中的表达情况,在蛋白水平探讨宫颈腺癌较鳞癌恶性程度高的可能原因.方法采用免疫组织化学方法(SP) 检测40例宫颈鳞癌和20例宫颈腺癌组织的MVD和MMP-2、MMP-9、TIMP-1、TIMP-2蛋白的表达情况.结果MVD在宫颈腺癌中较鳞癌高.MMP-2在宫颈鳞癌的阳性表达强度较腺癌高(P=0.006);MMP-9、TIMP-1在腺癌的阳性表达较鳞癌高(P=0.078,P=0.000);TIMP-2在两组间比差异无显著性(P＞0.05).在宫颈癌的临床病理特征中,MMP-2和MMP-9在鳞癌和腺癌中的表达不一,而TIMP-1始终是在腺癌中的表达较鳞癌高.结论宫颈腺癌较鳞癌恶性程度高的原因,可能与较高的MVD和TIMP-1的高表达有关.