Ovarian and omental ependymomas in peritoneal washings: cytologic and immunocytochemical features

The cytologic findings in peritoneal washings of two women, one of whom had an ovarian ependymoma and the other a primary omental ependymoma, are reported. The ependymomas were characterized by the presence of numerous, isolated, spindle and stellate cells as well as groups of cells forming true rosettes. The tumor cells displayed slightly pleomorphic, round-to-oval eccentric nuclei and abundant fibrillary cytoplasm with tapering cytoplasmic processes. In addition, one of the patients had numerous papillae and cell clusters with associated psammoma bodies indistinguishable from those found in low-grade serous carcinoma. The demonstration of glial fibrillary acidic protein (GFAP) in both cases by immunocytochemical procedures indicates the usefulness of this method in cytologic preparations to confirm the diagnosis of these uncommon neoplasms.     

戈舍瑞林对绝经前乳腺癌患者化疗期间卵巢功能的保护

目的评估戈舍瑞林对绝经前乳腺癌患者辅助化疗期间卵巢功能的保护作用。方法回顾性分析2年内收治的绝经前乳腺癌患者的临床资料,分成研究组(常规化疗+戈舍瑞林)和对照组(常规化疗),每组40例。观察两组患者月经情况及化疗期间与化疗结束后随访1年内的激素水平变化。结果 80例患者均完成化疗,化疗期间均出现月经周期紊乱。研究组和对照组月经恢复率分别为85%和55%,差异有统计学意义(P=0.007)。研究组在戈舍瑞林联合化疗期间,雌二醇(E2)水平减低到绝经后水平,促卵泡生成素(FSH)和促黄体生成素(LH)也明显降低;对照组在化疗期间E2水平逐渐降低,FSH和LH则明显增加。结论乳腺癌患者化疗期间应用戈舍瑞林,能有效地防止化疗引起的卵巢功能损伤,使大多数中青年患者维持正常月经及生育能力。     

Laparoscopic surgical management and clinical characteristics of ovarian fibromas

Objective:

This study aims to analyze the clinical characteristics and diagnostic features of ovarian fibromas and to evaluate the efficacy and safety of laparoscopic surgery for ovarian fibromas.

Methods:

We reviewed the records of 47 consecutive women who underwent laparoscopic or laparotomic surgeries and whose final histopathological diagnoses were ovarian fibroma, cellular fibroma, or fibrothecoma from January 1999 to August 2010.

Results:

During the study period, 49 tumors were removed from 47 women including 27 ovarian fibromas, 19 fibrothecomas, and 3 cellular fibromas. The preoperative diagnoses were ovarian fibroma in 25 women (53.2%) and uterine myoma in 16 women (34.0%). A high serum CA 125 level (>35U/mL) was observed in 15 women, and serum CA 125 level was significantly higher in women with ascites (P=<0.001). The tumors were removed surgically in all women, using the laparotomic approach in 16 women (34.0%) and the laparoscopic approach in 31 women (66.0%). The laparoscopic surgery had the advantages of shorter hospital stay and faster return of bowel activities compared to laparotomy.

Conclusions:

Ovarian fibromas are often misdiagnosed as uterine myomas, and sometimes mistaken for a malignant tumor of the ovary preoperatively. Laparoscopic surgery can be an effective and safe surgical approach for managing ovarian fibromas.     

An ovary as unusual contents of an incarcerated umbilical hernia

We present the unusual case of a woman presenting with an incarcerated umbilical hernia. Intraoperatively, the contents of the hernia were found to be an ovary. We outline the clinical presentation of our patient, investigations and management as well as a discussion on unusual contents of umbilical hernias. To our knowledge, this is the first case of a non-malignant ovary incarcerated in an umbilical hernia.     

卵巢囊性腺纤维瘤MR特征及病理分析

目的：探讨卵巢囊性腺纤维瘤的MRI表现特征及病理学基础,提高对该疾病的诊断准确性。方法收集并回顾性分析14例经手术病理证实的卵巢囊性腺纤维瘤患者MRI资料,所有患者术前均行MR平扫及增强扫描。重点对病变内部结构、信号特征及增强表现进行分析归纳,明确其具有诊断价值的图像特征。结果本组13例病灶为单侧发病,1例为双侧发病。病灶最大径为3．4-14．8cm,平均约8．15cm;8例呈囊性（多囊者6例,单囊者2例）,5例呈囊实性,1例呈实性。8例囊性病变于MRI-T2WI囊壁及分隔呈低信号;囊实性病灶实性成份主要表现为低信号,其中并见多发小囊样高信号灶,其中2例形成较典型的“黑色海绵征”。MR增强扫描所有病灶实性成份及囊壁均呈中度或明显强化效应。结论卵巢囊性腺纤维瘤多为单侧发病,主要呈多囊性表现;肿瘤中实性成份及囊壁T2WI呈低信号,增强扫描呈轻中度强化。“黑色海绵征”是其较典型的特征表现。     

参芪胶囊治疗多囊卵巢综合征临床观察

目的:探讨参芪胶囊治疗多囊卵巢综合征的临床疗效。方法:将91例患者随机分为两组,两组均采用克罗米芬促排卵,治疗组46例,于排卵后口服参芪胶囊治疗,对照组45例,于卵泡成熟时肌注HCG5000U,治疗前后测性激素、体重指数、腰臀比,计算多毛和痤疮评分,统计获得的排卵周期、子宫内膜厚度、黄体期天数和妊娠率。结果:治疗后组间比较,治疗组LH、LH/FSH、T、BMI、WHR及痤疮评分下降,差异有显著性意义(P<0.05),黄体期P升高,黄体期延长,子宫内膜厚度增加,差异有显著性意义(P<0.05)。治疗组排卵率83.33%,妊娠率52.17%,对照组排卵率80.28%,妊娠率37.78%,妊娠率的差异有显著性意义(P<0.05)。结论:在克罗米芬促排卵周期中应用参芪胶囊,通过降低患者BMI和WHR,改善肥胖、痤疮等临床特征,调整性轴功能,降低T和LH/FSH,能较好维持黄体功能,从而使患者成功妊娠,提高妊娠率。     

卵巢囊腺瘤的CT诊断

目的:提高对卵巢囊腺瘤CT诊断及鉴别诊断能力。方法:回顾性分析手术病理证实的27例卵巢囊腺瘤的CT表现。结果:浆液性囊腺瘤5例,单房4例,多房1例,密度均匀,囊壁可薄可厚或厚薄不均。粘液性囊腺瘤9例,单房3例,密度均匀,囊壁厚,多房6例,密度不均匀,内见多发大小不等子囊。交界性(6例)和恶性变(7例)13例,其中浆液性3例,粘液性10例,12例为多房改变,囊壁及分隔增厚且边缘模糊,部分呈囊实性及壁结节改变,2例恶性变者伴有大量腹水。结论:单房浆液性囊腺瘤及多房粘液性囊腺瘤具有较典型CT表现,CT易于诊断及鉴别诊断,当病变呈囊实性改变,出现壁结节,或囊壁分隔不规则增厚模糊时,提示交界性或恶性变。     

海藻糖在生育力保存中的应用

肿瘤诊疗技术的进步显著提高了患者的生存率,但放化疗可能造成人类生育力的下降乃至丧失。如何有效保存生育力已成为近年来研究的热点。海藻糖属于非渗透性冷冻保护剂,是一种具有特殊生物学性能的双糖,能够在干燥、脱水、冷冻等恶劣条件下有效保护蛋白质等大分子不变性失活。随着研究的逐步深入,海藻糖已被广泛应用于生育力保存等医学领域中,有学者将其用于保存精子、精原干细胞、卵母细胞、胚胎、卵巢组织和睾丸组织并取得了显著成果。综述海藻糖的生物学性质、作用机制假说以及在生育力保存中的应用研究现状和最新进展。     

卵巢囊腺癌的MRI和CT诊断价值

目的探讨MRI和CT对卵巢浆液性囊腺癌和黏液性囊腺癌的应用价值与选择。方法回顾性分析22例MRI诊断卵巢囊腺癌经手术和病理证实的资料,结合CT对照分析。结果MRI诊断14／22例为浆液性囊腺癌,8／22例为黏液性囊腺癌。病理13／14例为浆液性囊腺癌,1／14例为浆、黏液性囊腺瘤;5／8例为黏液性囊腺癌,3／8例为黏液性囊腺瘤。CT诊断10／20例为浆液性囊腺癌,10／20例为黏液性囊腺癌。病理9／10例为浆液性囊腺癌,1／10例为卵巢透明细胞癌;9／10例为黏液性囊腺癌,1／10例为浆液性囊腺癌伴出血。MRI及CT均可显示卵巢囊腺癌为囊实性病变,即敏感性差异不大,在特异性方面前者在平扫时显示更为优越,但在增强后的特异性则后者又超过前者,原因是MRI在增强扫描时采用T1WI,此时黏液改变亦为高信号与显示的对比剂相混杂导致增强失真的效果,而CT增强扫描则可明确显示局部的不规则囊壁以及壁结节的形成。因此CT所显示的特异性更强,亦即对诊断的正确性更高。结论浆液性囊腺癌MRI与CT应用价值相近,黏液性囊腺癌CT定性优于MRI。     

Methoxychlor inhibits growth of antral follicles by altering cell cycle regulators

Methoxychlor (MXC) reduces fertility in female rodents, decreases antral follicle numbers, and increases atresia through oxidative stress pathways. MXC also inhibits antral follicle growth in vitro. The mechanism by which MXC inhibits growth of follicles is unknown. The growth of follicles is controlled, in part, by cell cycle regulators. Thus, we tested the hypothesis that MXC inhibits follicle growth by reducing the levels of selected cell cycle regulators. Further, we tested whether co-treatment with an antioxidant, N-acetyl cysteine (NAC), prevents the MXC-induced reduction in cell cycle regulators. For in vivo studies, adult cycling CD-1 mice were dosed with MXC or vehicle for 20 days. Treated ovaries were subjected to immunohistochemistry for proliferating cell nuclear antigen (PCNA) staining. For in vitro studies, antral follicles isolated from adult cycling CD-1 mouse ovaries were cultured with vehicle, MXC, and/or NAC for 48, 72 and 96 h. Levels of cyclin D2 (Ccnd2) and cyclin dependent kinase 4 (Cdk4) were measured using in vivo and in vitro samples. The results indicate that MXC decreased PCNA staining, and Ccnd2 and Cdk4 levels compared to controls. NAC co-treatment restored follicle growth and expression of Ccnd2 and Cdk4. Collectively, these data indicate that MXC exposure reduces the levels of Ccnd2 and Cdk4 in follicles, and that protection from oxidative stress restores Ccnd2 and Cdk4 levels. Therefore, MXC-induced oxidative stress may decrease the levels of cell cycle regulators, which in turn, results in inhibition of the growth of antral follicles.