宫颈上皮内瘤样病变及宫颈癌中细胞周期素D1、Ki67的表达

目的探讨细胞周期素D1和Ki67在宫颈上皮内瘤样病变中表达及其意义。方法采用免疫组化法检测慢性宫颈炎组织11例、宫颈上皮内瘤样病变不同分级组织53例和宫颈鳞癌15例组织中细胞周期素D1和Ki67表达。结果宫颈鳞癌和CIN组织中细胞周期素D1表达明显高于子宫颈慢性炎症组织;细胞周期素D1表达与CIN分级程度成正相关。Ki67阳性表达与CIN分级程度成正相关,在宫颈鳞癌中有显著性(P<0.01);Ki67在细胞周期D1阳性表达组的标记指数高于阴性组(P<0.05)。结论细胞周期素D1蛋白过度表达可能在宫颈CIN及宫颈鳞癌发生、发展中发挥作用,Ki67与CIN及宫颈鳞癌发生有关,细胞周期素D1及Ki67与CIN分级有关。     

阴道镜检查在宫颈疾病诊断中的应用价值

目的 探讨电子阴道镜在宫颈疾病诊断中的应用价值.方法 对2007-2008年岳阳市三人民医院妇产科180例宫颈疾病患者进行阴道镜检查并行宫颈细胞学检查,进行回顾性分析和比较.结果 ①阴道镜在诊断宫颈病变中的诊断符合率为83.0%,灵敏度为80.4%,特异度为87.7%,漏诊率为5.1%;②阴道镜图像与组织学结果相比:二联征符合率为77.8%,三联征符合率为100%,可疑宫颈癌符合率为100%.醋白上皮符合66.7%;③宫颈疾病中30～40岁年龄段发病所占比例最大46.5%,50～60岁为宫颈癌发病高峰.结论 阴道镜检查诊断宫颈疾病结果准确可靠,减少漏诊,尤其对CIN的早期诊断、治疗及降低宫颈癌的发生率有重要意义.     

阴道镜检查宫颈病变156例临床分析

目的：了解阴道镜在子宫颈病变中的诊断价值,以便早期发现和治疗宫颈疾病。方法：对2007年5月～2008年7月,156例宫颈病变患者的阴道镜检查进行回顾性分析。结果：阴道镜检查156例宫颈病变中,全部进行病理学检查,病理检查确诊为CIN 43例（包括CINⅠ～Ⅱ级）,原位癌19例（包括CINⅢ级）,宫颈浸润癌9例,慢性宫颈炎85例。结论：阴道镜检查对宫颈癌前病变、宫颈癌的早期诊断具有重要价值。     

宫颈癌组织Bcl-2基因的表达与HPV感染的关系

目的研究宫颈癌组织Bcl-2基因的表达与人乳头瘤病毒（HPV）感染的关系。方法应用免疫组化PV-9000法对正常宫颈组织38例、各级宫颈上皮内瘤样变（CIN）组织106例、宫颈癌组织66例中Bcl-2基因的表达水平进行检测。应用PCR方法对66例宫颈癌组织中HPV表达进行检测及分型。结果Bcl-2在各宫颈组织中均有表达,宫颈癌组Bcl-2阳性表达率（57．6％）,显著高于正常宫颈组（15．8％）和CINI组（19．4％）,P均〈0．01;高于CINⅡ组（28．6％）,P〈0．05;与CINlI组（60．0％）比较差异无统计学意义,P〉0．05。宫颈癌组织中Bcl-2蛋白表达与HPV感染具有相关性,P〈0．05。Bcl-2蛋白在HPVl6／18阳性宫颈癌组织和HPV其他型别阳性宫颈癌组织中表达差异无统计学意义,P〉0．05。结论Bcl-2蛋白的高表达可能在宫颈癌的发生发展中起重要作用。Bcl-2蛋白的高表达与宫颈癌HPV感染相关,但与HPV型别关系不大。Bcl-2蛋白可能成为宫颈癌诊断和治疗的指标。     

Novel intronic germline FLCN gene mutation in a patient with multiple ipsilateral renal neoplasms

Multiple renal tumors of diverse morphology are rare and typically seen in Birt-Hogg-Dubé syndrome. Birt-Hogg-Dubé syndrome is a rare inherited cancer syndrome caused by a germline mutation in the folliculin (FLCN) gene, but the genetic causes for histologic diversity of renal tumors in Birt-Hogg-Dubé syndrome have not been elucidated. We describe here a 64-year-old man with a novel germline mutation in the FLCN gene who presented with 3 phenotypically distinct renal tumors in the same kidney, which were histologically classified as oncocytoma (1.4 cm), oncocytic papillary carcinoma (0.5 cm), and clear cell renal carcinoma (0.8 cm). Genetic analysis of normal kidney tissue revealed a heterozygous germline FLCN mutation (intron 9, IVS9+6 C>T). Additional molecular genetic testing revealed somatic mutations and epigenetic events in genes typically associated with these specific histologic tumor types: oncocytoma harbored a second FLCN mutation (intron 12, IVS12+4 C>T), oncocytic papillary carcinoma harbored promoter methylation of FLCN, and a missense mutation in the MET gene (P246L), whereas clear cell carcinoma harbored inactivating VHL mutation (5–base pair deletion in exon 2) and VHL gene promoter methylation. In addition, chromosomal analysis of peripheral blood lymphocytes showed low level chromosome instability, not previously associated with germline mutations in the FLCN gene.     

High Grade Cervical Intraepithelial Neoplasia and Viral Load of High-Risk Human Papillomavirus: Significant Correlations in Patients of 22 Years Old or Younger

High-risk human papillomavirus (HR-HPV) is recognized as the primary cause for the development of cervical cancers and their precursor lesions. We investigated whether high-grade cervical dysplasia correlates with high viral load of HR-HPV in an age-dependent manner. Cases were retrospectively selected to include patients with a prior cytological diagnosis of ASCUS or higher grade squamous intraepithelial lesions, and a positive Digene Hybrid Capture II (HC-II) HR-HPV testing within 2 months before or after cervical biopsy. The quantitative viral load data was classified as negative, low, moderate and high according to the manufacturer’s instruction. Cases were then stratified into 4 age groups: ≤22 years, 23-30 years, 31-40 years and >40 years. Chi-Square analysis and logistic regression were performed where appropriate. A total of 995 patients were identified. Age categories were significantly associated with HPV loads (p=0.046). Moderate to high viral loads of HPV were significantly related to the histological grade of dysplasia (p=0.029). Logistic regression analysis further confirmed the association of HPV with histological grades, even after adjusting for age factor. In particular, high-grade dysplasia (p=0.011) but not low grade dysplasia (p=0.140) was significantly associated with moderate to high HPV loads. Patients of 22 years old or younger were the only group found significantly correlated with high viral loads of HPV (p=0.015). In conclusion, high-grade squamous intraepithelial lesions and patients’ age of 22 years old or younger are significantly associated with a moderate to high viral load of HR-HPV.     

宫颈锥切术后HPV检测的临床意义

目的:探讨人乳头瘤病毒(HPV)在宫颈上皮内瘤样病变(CIN)行LEEP、冷刀锥切(CKC)术后的随访价值。方法:回顾分析180例行LEEP锥切、119例行冷刀锥切的CIN患者术前、术后HPV感染情况,观察锥切术后CIN的消失情况。结果:二者手术前后HPV感染率分别为:LEEP组78.3%和7.8%,CKC组64.7%和6.7%,无统计学差异,术后HPV感染率明显降低,术后HPV持续感染者宫颈病变进展率高于HPV转阴者,二者有统计学差异。结论:HPV检测在LE EP、CKC术后可作为随访有效手段。     

宫颈锥切术后HPV检测的临床意义

目的：探讨人乳头瘤病毒（HPV）在宫颈上皮内瘤样病变（CIN）行LEEP、冷刀锥切（CKC）术后的随访价值。方法：回顾分析180例行LEEP锥切、119例行冷刀锥切的CIN患者术前、术后HPV感染情况,观察锥切术后CIN的消失情况。结果：二者手术前后HPV感染率分别为：LEEP组78.3%和7.8%,CKC组64.7%和6.7%,无统计学差异,术后HPV感染率明显降低,术后HPV持续感染者宫颈病变进展率高于HPV转阴者,二者有统计学差异。结论：HPV检测在LE EP、CKC术后可作为随访有效手段。     

150例LEEP刀手术围术期的护理体会

目的：探讨Leep刀手术治疗宫颈上皮内瘤变患者围术期护理方法。方法：自2007年3月-2010年10月,对150例宫颈上皮内瘤变患者行Leep刀手术,术前给予心理护理与术前准备、术中及术后各期均给予精心护理,做好并发症的预防与处理。结果：本组患者手术顺利进行,无一例发生并发症,一次性治愈率达96%。结论：将人文关怀融入Leep刀手术的护理工作,可使患者在接受手术时充满信心,为手术的顺利进行创造良好的条件,提高手术成功率,预防并发症发生。     

宫颈病变组织中p16蛋白表达及其与人乳头瘤病毒感染的关系

目的探讨宫颈癌（cervicalcancer）及其癌前病变组织中p16蛋白表达及其与人乳头瘤病毒（humanpapillomavirus,HPV）感染的关系。方法采用免疫组化（immunohistochemistry,IHC）SP法检测40例宫颈浸润癌（invasivecarcinomaofcervix,ICC）标本（ICC组）、20例低度宫颈上皮内瘤样病变（cervicalintraepithelialneoplasiaI,CINI）标本（CINI组）、30例高度宫颈上皮内瘤样病变（CINⅡ～Ⅲ）（CINⅡ～Ⅲ组）标本和20例正常宫颈组织标本（对照组）的p16蛋白表达;用导流杂交基因芯片技术（HybriMax）测定上述标本的人乳头瘤病毒分型。结果P16蛋白在正常宫颈上皮（对照组）无表达,在宫颈癌及癌前病变组织呈现过表达（ICC组,CINI组,CINⅡ～Ⅲ组）;在CINI,CINII～HI,ICC组过表达率分别为35．0％,83．3％和100．0％。P16蛋白表达随宫颈病变级别进展而增加（P〈O．001）。高危人乳头状瘤病毒在正常宫颈上皮（对照组）的感染率为0,CINI,CINⅡ～Ⅲ,ICC组分别为55．0％,80．0％和92．5％。HPV一16和（或）一18亚型是宫颈癌及癌前病变最常见感染亚型。P16蛋白过表达在高危型人乳头瘤病毒（highriskhumanpapillomavirus,HR—HPV）感染宫颈组织明显高于HPV呈阴性或低危型人乳头瘤病毒（low—risk human papillomavirus,LRHPV）感染宫颈组织（P〈0．05）。结论P16蛋白过表达,可用于区分正常宫颈和宫颈癌前病变及宫颈浸润癌组织。P16蛋白过表达与高危型人乳头瘤病毒感染有关。