Endometrioid carcinoma of the endometrium with choriocarcinomatous differentiation: a case report and review of the literature

OBJECTIVE: An endometrioid adenocarcinoma (EAC) with true trophoblastic differentiation is a rare event with a highly aggressive clinical course. CASE: We report an endometrioid adenocarcinoma of the endometrium in which there was a morphologically conventional-appearing EAC component admixed with multinucleated giant cells and large pleomorphic tumor cells that resembled a choriocarcinoma without an elevated serum level of human chorionic gonadotropin (hCG) in a 42-year-old unmarried woman with a history of abnormal uterine bleeding. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Histopathologic study of the specimen showed endometrioid adenocarcinoma extended to the deep myometrium with a focus of hemorrhagic and necrotic tumor composed of multinucleated giant cells, large pleomorphic tumor cells, suggesting choriocarcinomatous differentiation (CD). Immunohistochemical studies demonstrated intense reactivity of tumor cells for human chorionic gonadotropin (hCG) confirming the diagnosis. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. The patient was alive with no evidence of disease 6 months later. CONCLUSION: Although endometrioid adenocarcinoma with choriocarcinomatous differentiation is known to behave in a more aggressive course, this disease may have a good prognosis with a clinically indolent course when it is small, and without elevated serum hCG levels.     

Kidney Function in Heart Failure

Objective. The purpose of this investigation was to improve a rankit ordinal model for evaluating and validating dichotomized tests in a prospective Nordic project. Material and methods. The model is based on the assumption that the S‐shaped curve of fractions of positive for increasing concentrations can be de‐convoluted to a histogram and thereby used to calculate the parameters for a ln‐Gaussian distribution. In a Nordic survey, four urine samples with known concentrations of hCG (human chorionic gonadotrophin) and nitrites were distributed to more than 2500 practitioners' offices. Results. The results are presented as parameters (geometric mean and CV) for the components urine‐hCG and urine‐nitrites, together with fractions of positive for clinical critical values (5 and 40?IU/L for hCG), for which fractions should be below 0.01 and above 0.99, respectively, and 7?µmol/L for nitrites. Furthermore, the concentration intervals of varying fractions of positive from 0.01 to 0.99 are estimated as grey zones. The parameters and grey zones for different kits are compared. No urine‐hCG kit fulfilled the low clinical criterion, whereas all fulfilled the high criterion. Seven of the eight nitrites kits had fractions of positive above 0.9 for the company confirmation limit, but varying fractions for the clinically important limit of 7?µmol/L (fractions from 0.06 to 0.83). Conclusions. The present model makes it easy to estimate parameters for the kits, and also to estimate the fractions of measured positives for specified concentrations. It is thus suited for external quality assessment as well as for manufacturers' method validation.     

血绒毛膜促性腺激素β在异位妊娠病情监测中的应用

目的探讨监测绒毛膜促性腺激素-β（human chorionic gonadotropin,β-hCG）在异位妊娠（ectopic pregnancy,EP）病情监测中的应用。方法对123例具有相同保守治疗指征的EP患者,保守治疗前均常规监测β-hCG,间隔48h复测一次。按50mg/m2计算给药,采用甲氨蝶呤（methotrexate,MTX）单次肌肉注射,用药后第4d（96h）再次监测β-hCG下降情况,每周一次,至β-hCG降到正常（β-hCG〈100U/L）。EP保守治疗成功组93例根据β-hCG上升或下降分为A组37例、B组56例,EP保守治疗失败的30例为C组（保守后改手术治疗）。结果三组在年龄、孕龄、EP包块直径大小间比较,无统计学意义（P〉0.05）;第一次测定血的β-hCG值结果A与B组比较无统计学意义（P〉0.05）。间隔48h测定,A组β-hCG有所下降,B组升高,A与B组比较有统计学意义（P〈0.01）。应用MTX治疗后A组β-hCG下降幅度〉15%,B组β-hCG有不同程度的升高,与A组比较差异有统计学意义（P〈0.01）。C组因在观察中改行手术治疗,保守治疗失败未做比较。三组β-hCG降至正常的时间B组较A组长,C组最短,差异有统计学意义（P〈0.01）。结论EP保守治疗前后监测β-hCG值的高低有助于判断治疗效果和时间。     

Cessation of Gonadotropin-Releasing Hormone Antagonist on Triggering Day: An Alternative Method for Flexible Multiple-Dose Protocol

This study was performed to analyze retrospectively outcomes of stimulated in vitro fertilization (IVF) cycles where the gonadotropin-releasing hormone (GnRH) antagonist was omitted on ovulation triggering day. A total of 92 consecutive IVF cycles were included in 65 women who are undergoing ovarian stimulation with recombinant FSH. A GnRH antagonist, cetrorelix 0.25 mg/day, was started when leading follicle reached 14 mm in diameter until the day of hCG administration (Group A, 66 cycles) or until the day before hCG administration (Group B, 26 cycles). The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and the number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in Group B compared to Group A (2.7±0.8 vs. 3.2±0.9 ampoules). There was no premature luteinization in the subjects. The proportion of mature oocytes (71.4% vs. 61.7%) and fertilization rate of mature (86.3±19.7% vs. 71.8±31.7%) was significantly higher in Group B. There were no significant differences in embryo quality and clinical pregnancy rates. Our results suggest that cessation of the GnRH antagonist on the day of hCG administration during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising IVF results.     

Ovarian Prorenin

We review here recent evidence that the ovaries synthesize and secrete prorenin and we explore the possible reasons why prorenin, and not active renin, is formed almost exclusively i n this extra-renal site. Very high concentrations of prorenin are present in the human ovary in the fluid inside mature follicles. This ovarian prorenin appears to be secreted into the circulation since plasma prorenin increases in normal women for two to three days at mid-menstrual cycle, at the time of ovulation. No change in plasma active renin occurs at this time. Plasma prorenin increases much more at mid-cycle in women whose ovaries have been hyperstimulated with gonadotropins. Their mid-cycle increment in plasma prorenin (after hCG) is directly related to the number of ovarian follicles. Plasma prorenin also increases markedly (10-fold) in pregnant women within two weeks after conception, in parallel with the rise in endogenous hCG. The ovaries are the apparent source of the increase in plasma prorenin during pregnancy since no such increase occurred in a woman with ovarian failure who conceived after receiving a donor egg. These results suggest that the ovaries synthesize and secrete prorenin in response to stimulation by gonadotropic hormones. Future studies will investigate the potential role of ovarian prorenin in human reproductive function. W e postulate the existence of a prorenin receptor which activates prorenin and, in consequence, activates a local renin-angiotensin system. The functioning of this system may be regulated by changes in prorenin and its receptor.     

冷应激对人绒毛膜促性腺激素诱导大鼠黄体与颗粒细胞功能的影响

目的为探讨冷应激对大鼠卵巢功能的影响。方法采用体外细胞培养法分离培养大鼠卵巢黄体、颗粒与卵母细胞,设37℃对照组与0、-5、-10、-15、-20、-25℃冷应激组,观察人绒毛膜促性腺激素(hCG)诱导黄体与颗粒细胞分泌孕酮与cAMP的变化,采用放免分析方法测定孕酮与cAMP生成含量,采用四甲基偶氮唑蓝(MTT)法检测细胞存活率。结果-5～-25℃冷应激组黄体细胞和颗粒细胞孕酮含量均低于对照组(均P<0.05),与对照组比较,冷应激组黄体细胞基础cAMP生成量增加,除-20℃组外,差异均有统计学意义(均P<0.05);与对照组比较,除-10℃冷应激组颗粒细胞基础cAMP生成量下降外,其余各组均升高,且差异有统计学意义(P<0.05)。0～-25℃冷应激组细胞存活抑制率呈上升趋势。结论冷应激抑制hCG诱导黄体与颗粒细胞孕酮分泌,协同cAMP生成,使卵母细胞存活率下降,其作用机制有待深入研究。     

Differential effect of human chorionic gonadotrophin on lymphocyte proliferation induced by mitogens

Human chorionic gonadotrophin (hCG) inhibits the lymphoproliferative responses of human peripheral blood mononuclear cells (PBM) to phytohaemagglutinin (PHA) and concanavalin A (Con A) at 10-50 IU of hCG/ml (P less than 0.05). hCG inhibited poorly the response of PBM to pokeweed mitogen (PWM) at concentration up to 100 IU/ml. When monocytes were removed from the PBM population with columns of Sephadex G10 the inhibitory effect of hCG on PHA- and Con A-induced lymphoproliferation was reduced, with inhibition occurring only at a level of 100 IU of hCG/ml. These results suggest that hCG does not inhibit equally the proliferative response of all lymphocyte subsets and further that cells of the monocyte/macrophage series may play a role in its action on lymphocyte proliferation.