Pap smear screening history of women with squamous cell carcinoma and adenocarcinoma of the cervix

BACKGROUND: Since the introduction of the Pap smear screening, the incidence of squamous cell carcinoma (SCC) has decreased significantly, but the incidence of adenocarcinoma (AC) relative to SCC has increased. AIM: To compare the Pap smear history of patients with AC and SCC of the cervix. METHODS: Patients for the study were identified from the database of Queensland Centre for Gynaecological Cancer. Patients with AC and SCC were matched for age at diagnosis and International Federation of Gynecology and Obstetrics stage. The final population included 188 matched pairs, being 376 patients in total. Data were collected upon the histological type of cancer, result of the most recent Pap smear, date and result of the Pap smear prior to the most recent Pap smear and symptoms. Chi-squared tests and Fisher's exact test were used to compare the two patient groups for several variables. RESULTS: Patients with AC had significantly more false-negative results on their most recent Pap smear (P<0.0001) than patients with SCC. The incidence of symptoms such as bleeding and/or vaginal discharge was comparable in patients with AC and SCC. The time between the most recent Pap smear and the diagnosis of cervical cancer was significantly shorter for patients with AC (P=0.01). CONCLUSIONS: Patients with AC had Pap smears more regularly than those with SCC, and their most recent Pap smear was significantly more likely to be normal. Thus, Pap smear prior to a diagnosis of AC is more likely than SCC false-negative and therefore not indicative of cervical cancer.     

Neoadjuvant chemotherapy plus radical surgery in locally advanced cervical cancer during pregnancy: a case report

Management of cervicocarcinoma during pregnancy is influenced by gestational age, stage of disease, and patient's desire to maintain her pregnancy. We report a case of a pregnant patient with locally advanced cervicocarcinoma successfully treated by neoadjuvant chemotherapy, followed by caesarean section and radical surgery.     

4-Methylumbelliferone inhibits hyaluronate synthesis in human uterine cervical fibroblasts

AIM: Hyaluronate plays an important role in the regulation of cervical function during parturition. In our previous study we showed that 4-methylumbelliferone (MU) suppresses hyaluronate synthesis by cultured human skin fibroblasts. The present study investigated the effects of MU on fibroblasts obtained from the human uterine cervix and assessed the possibility of controlling cervical ripening with MU. METHODS: Human uterine cervical fibroblasts were collected from uterine cervices obtained from the uteri of three patients who had a total hysterectomy for uterine myoma at Hirosaki University Hospital. The fibroblasts were cultured in Dulbecco's modified Eagle's medium until confluence. They were then cultured in medium containing [3H]glucosamine (0.074 MBq/mL) with various MU doses. Hyaluronate synthesis was evaluated by assessing the incorporation of [3H]glucosamine into the soluble fraction of hyaluronate. Three independent studies were carried out on each specimen to clarify whether MU causes compositional changes or promotes hyaluronate degradation, whether the inhibitory effects of MU on hyaluronate synthesis are dose-dependent, and whether the effects of MU are reversible. RESULTS: MU added to the medium of the cultured cells reduced the synthesis of hyaluronate in a dose-dependent manner. After MU was removed from the medium, hyaluronate synthesis recommenced, and the amount of [3H]hyaluronate synthesized was similar to the control level. CONCLUSIONS: MU inhibits the synthesis of hyaluronate in human uterine cervical fibroblasts.     

Angiographic uterine artery embolization followed by immediate curettage: an efficient treatment for controlling heavy bleeding and avoiding recurrent bleeding in cervical pregnancy

Two cases of cervical pregnancy with heavy bleeding successfully treated by uterine artery embolization (UAE) followed by immediate curettage are described in this report. Case 1 demonstrated intermittent bleeding after serious bleeding was successfully controlled by UAE. Serum beta human chorionic gonadotropin (beta-hCG) level rose remarkably after a short time decline. Transvaginal sonography consistently revealed a heterogeneous mass in the cervix. Repeated UAE followed by immediate curettage was performed and complete resolution was achieved. Case 2 was also successfully managed by UAE followed by immediate curettage after failure of medical treatment. This report suggests that UAE followed by immediate curettage is a safe and efficient procedure for controlling heavy bleeding and avoiding recurrent bleeding when fertility capacity is desired in cases of cervical pregnancy with fetal cardiac activity and high beta-hCG concentration.     

宫颈癌筛查采用Cervista与HC2法比较的研究进展

宫颈癌在女性生殖系统恶性肿瘤中发病率最高,且近年来其发病率和死亡率有明显增长趋势,尤其是在中青年女性中.全世界浸润性宫颈癌的HPV检出率99.3％,而部分HPV感染可以随着免疫力的增强逐渐被机体所清除;且早期病变演变为宫颈癌其潜伏期长达10年左右;再者,局部治疗即可阻止其进一步发生恶变,所以,通过筛查不但可早期发现宫颈的癌前病变,而且可早治疗、提高疗效、挽救生命.最新的Cervista酶切免疫放大技术特异性更高、假阳性更少,检测效率高、不确定率更低,本文通过与HC2对比,对该方法予以综述.     

后路椎间融合器结合新型椎弓根钉系统治疗腰椎滑脱症

目的 探讨纯钛多孔涂层后路椎间融合器结合新型椎弓根钉系统对腰椎滑脱症的治疗效果。方法 33例腰椎滑脱症病人,采用后路全椎板切除减压、纯钛多孔涂层后路椎间融合器行椎间融合、新型椎弓根钉系统内固定治疗。结果 33例术后均随访,时间6~36个月,平均18.6个月。本组患者术后无神经损伤和切口感染,动态摄片观察无融合器移位、椎弓根螺钉松脱、断裂等并发症。按Brantigan评价标准评定结果:优21例、良10例、可2例、差0例。结论 纯钛多孔涂层后路椎间融合器结合新型椎弓根钉系统治疗腰椎滑脱症,具有椎管减压充分、椎体复位好、术后能立即改善疼痛症状、立即稳定椎体、病人可早期下床等优点,是一种治疗腰椎滑脱症较理想的方法。     

大菜花型宫颈癌的放疗效果及预后分析

目的 回顾性分析大菜花型宫颈癌的放疗效果及预后因素。方法 64例经病理证实的大菜花型宫颈癌,肿瘤最大直径5~8 cm(平均6.5cm),按FIGO新分期标准放疗前临床分期:IIA期9例,IIB期19例,IIIA期5例,IIIB期31例。采用外照射、肿瘤组织间插植及腔内照射综合手段进行根治性放疗。根据放疗第4周妇检记录进行“放疗中再分期”。采用Kaplan-Meier法计算生存率,并将年龄、病理类型与分化程度、肿瘤最大径、放疗前分期和“放疗中再分期”等因素纳入Cox模型进行预后的多因素分析。结果 放疗中再分期结果:I期9例,IIA期28例,IIB期13例,IIIA期5例,IIIB期9例。全组累计5年生存率和无瘤生存率分别为81%和75.8%。一系列因素中,只有“放疗中再分期”是影响生存率的重要和独立的预后因素(P<0.01)。结论 大菜花型宫颈癌根治性放疗效果较好;放疗前分期不准确,对估计预后无价值;“放疗中再分期”是影响预后的主要因素。     

鳞状上皮细胞癌抗原在子宫颈癌患者血清中的诊断价值

目的: 探讨肿瘤标志物鳞状上皮细胞癌抗原(squamous cell carcinoma antigen,SCCAg)在子宫颈鳞癌中的诊断价值,验证化学发光法检测SCCAg的灵敏度和特异性。方法: 对经临床验证的140例子宫颈癌患者(病例组)进行血清学SCCAg检测,以150名健康女性作对照。结果: 病例组和正常女性对照组的SCC值分别为(21.54±39.95) ng/ml和(0.69±0.42) ng/ml,2组差异有统计学意义(P < 0.01)。若以>正常组的x+3s即> 1.9 ng/ml为阳性值,则病例组的SCCAg阳性率为86.4%。结论: SCCAg可作为诊断子宫颈癌的特异性指标物,它不仅是有效检测子宫颈癌的方法学之一,并且快速、简便、准确、特异,患者易接受,对患者的疗效观察及预后评价具有重要意义。