p53 Arg72Pro多态性与新疆维吾尔族和汉族妇女宫颈癌发生的相关性

目的探讨p53 Arg72Pro多态性与新疆维吾尔族、汉族妇女宫颈癌发生及与HPV感染宫颈癌的相关性。方法采用聚合酶链反应-限制性片段长度多态性分析（PCR—RFLP）方法检测152例维吾尔族妇女宫颈癌组织及110例非癌宫颈组织、120例汉族妇女宫颈癌组织及122例非癌宫颈组织中p53 Arg／Arg、Pro／Pro、Arg／Pro三种基因型的分布。结果比较维吾尔族妇女宫颈癌和非癌对照组中p53基因型总构成比,差异有统计学意义（χ^2=7．196,P〈0．05）,Arg／Arg所占比例在维吾尔族妇女宫颈癌组高于非癌对照组。比较汉族妇女宫颈癌和非癌对照组中p53基因型总构成比,差异有统计学意义（χ^2=8．231,P〈0．025）,Pro／Pro所占比例在汉族妇女宫颈癌组高于对照组。比较维吾尔族妇女宫颈癌中HPV16阳性组和阴性组p53基因型构成比,差异有统计学意义（χ^2=7．177,P〈0．05）,Arg／Arg所占比例在HPV16阳性组高于阴性组。结论p53 Arg／Arg基因型可能是新疆维吾尔族妇女宫颈癌发生的遗传易感因素,且与维吾尔族妇女HPV相关宫颈癌的发生有关。p53 Pro／Pro基因型可能是新疆汉族妇女宫颈癌发生的遗传易感因素。新疆维吾尔族妇女与汉族妇女宫颈癌的发生可能存在遗传易感性方面的差异。     

宫颈淋巴瘤样病变与宫颈淋巴瘤的鉴别

目的探讨宫颈淋巴瘤样病变和宫颈淋巴瘤的临床病理特点及免疫球蛋白重链（IgH）基因重排在两者鉴别诊断上的价值。方法对10例宫颈淋巴瘤样病变和16例宫颈淋巴瘤进行临床资料分析和组织病理学观察,以免疫组织化学（EnVision法）检测B、T淋巴细胞标记物和免疫球蛋白轻链（κ,λ）的表达,并应用半套式聚合酶链反应方法检测了4例淋巴瘤样病变和4例淋巴瘤中IgH基因重排的情况。结果宫颈淋巴瘤样病变患者年龄24—54岁（中位年龄43岁）,临床多表现为宫颈糜烂或息肉,镜下观察可见表浅分布的、局灶或弥漫性免疫母细胞样大细胞浸润,伴淋巴细胞转化成熟现象和多型性炎性细胞浸润（多量成熟浆细胞、嗜酸性粒细胞、中性粒细胞）。宫颈淋巴瘤患者年龄28—78岁（中位年龄58岁）,临床表现为宫颈肿块或弥漫性宫颈肥大,镜下观察示12例弥漫性大B细胞淋巴瘤和4例滤泡性淋巴瘤,二者组织学形态分别以弥漫分布、形态单一的肿瘤性大淋巴细胞浸润和肿瘤性滤泡形成为特点,病灶中少有多型性炎性细胞浸润,也不出现淋巴细胞转化成熟现象。宫颈淋巴瘤样病变中,免疫母细胞样大细胞κ和λ染色结果欠满意。4例宫颈淋巴瘤病例和2例宫颈淋巴瘤样病变中检出单克隆性IgH基因重排。结论宫颈淋巴瘤样病变和淋巴瘤主要依据不同的临床和病理形态特点相互区分。IgH基因重排检测对于二者鉴别有帮助,但需注意部分良性病变也有单克隆性淋巴细胞增生。     

Immunohistochemistry as a diagnostic aid in cervical pathology

As with biopsies from other sites in the female genital tract, immunohistochemistry is now being increasingly used in cervical pathology as an aid to diagnosis. In this review, I discuss applications of immunohistochemistry in diagnostic cervical pathology with a particular focus on recent developments. It is emphasised that immunohistochemistry is to be used as an adjunct to routine morphological examination and that no marker is totally specific or sensitive for a given lesion. Although much of this review focuses on glandular lesions, the value of markers, such as MIB1 and p16, in the assessment of pre-invasive cervical squamous lesions is discussed. In the broad field of cervical glandular lesions, topics covered include: the value of markers such as MIB1, p16 and bcl-2 in distinguishing adenocarcinoma in situ and glandular dysplasia from benign mimics; markers of mesonephric lesions, including CD10; markers of value in the diagnosis of minimal deviation adenocarcinoma, such as HIK1083; markers of value in distinguishing metastatic cervical adenocarcinoma in the ovary from primary ovarian endometrioid or mucinous adenocarcinoma. Rarely ectopic prostatic tissue occurs in the cervix, which can be confirmed by positive staining with prostatic markers. A panel of markers, comprising oestrogen receptor, vimentin, monoclonal carcinoembryonic antigen and p16, is of value in distinguishing between a cervical adenocarcinoma and an endometrial adenocarcinoma of endometrioid type. Markers of use in the diagnosis of cervical neuroendocrine neoplasms, including small cell and large cell neuroendocrine carcinoma, are discussed. It is stressed that small cell neuroendocrine carcinomas may be negative with most of the commonly used neuroendocrine markers and this does not preclude the diagnosis. p63, a useful marker of squamous neoplasms within the cervix, is of value in distinguishing small cell neuroendocrine carcinoma (p63 negative) from small cell squamous carcinoma (p63 positive) and in confirming that a poorly differentiated carcinoma is squamous in type.     

阴道镜对宫颈上皮内瘤样病变的临床价值

目的:评价阴道镜图像对宫颈疾病尤其对宫颈上皮内瘤样病变(CIN)的诊断价值。方法:回顾分析1512例中277例CIN的阴道镜检结果。结果:CIN的发病例数呈上升趋势,发病年龄也日趋年轻化,1512例中宫颈活检1206例,CIN 277例。CIN的异常阴道镜图像主要为醋酸白色上皮,对CIN诊断的敏感性和阳性预测值高,其与点状区和或镶嵌同时存在时,对CIN诊断的敏感性下降,特异性升高。结论:阴道镜是辅助诊断CIN的重要方法,发现阴道镜可疑时应进行常规活检。     

宫颈浆液性乳头状癌1例

患者女,32岁.因白带增多半年,接触性出血3个月入院.妇科检查:阴道通畅;宫颈前唇隆起,前穹隆、左右穹隆消失,肿物向直肠方向突起;子宫界限不清,双附件增大.实验室检查:肿瘤相关抗原(CA125)73 U/mL.     

人正常子宫颈移行上皮重症联合免疫缺陷小鼠模型的建立

目的探讨人正常子宫颈移行上皮重症联合免疫缺陷小鼠(SCID鼠)模型建立的可行性及其生物学特性。方法获取正常子宫颈组织的移行带标本,接种于12只SCID鼠皮下,随机分成3组,分别在2、4、6周取出其皮下移植物行HE染色、免疫组化及人乳头瘤病毒(HPV)DNA的检测。结果所有小鼠的移植物均存活,病理证实存在宫颈鳞柱状上皮并具有基底膜结构,上皮细胞免疫组织化学染色ki-67阳性,HPV DNA检测为阴性。结论初步建立了人正常子宫颈移行上皮SCID鼠模型,为进一步研究子宫颈上皮HPV感染致癌变过程提供了理想的动物模型。     

100例正常成年妇女的膀胱颈—尿道上段声像图

本文报告100例正常成年妇女膀胱颈-尿道上段的声像图表现:纵切面上呈前上-后下斜行的低回声带。上端的前、后缘分别与膀胱的前后壁相延续;横切面上为位于膀胱无回声区与阴道前壁之间的圆形或椭圆形低回声区。比较了不同年龄组膀胱颈-尿道上端的前后径、左右径、横截面积和周长,40岁以上组的四项测值均略高于18～39岁组,但均无统计学意义。膀胱颈-尿道上段声像图是对女性膀胱超声显像的完善和补充,对该部病变(如结石、肿瘤、膀胱颈梗阻等)的诊断有一定价值。     

中老年患者无明确诊断意义的鳞状上皮细胞病变以上宫颈病变临床处理方法研究

目的 探讨中老年患者性质不明不典型鳞状上皮细胞（ASCUS）及ASCUS以上宫颈病变的临床处理方法.方法 根据临床对中老年患者ASCUS宫颈病变不同处理方法分组,观察1组（348例）行阴道镜检查;观察2组（316例）行高危型人乳头瘤病毒（HPV）检测,HPV阳性行阴道镜检查;观察3组（129例）定期宫颈细胞学复检,鳞状上皮内病变行阴道镜检查,比较三组临床处理情况.结果 三组574例患者同时行液基薄层细胞学检查（TCT）及阴道镜宫颈活检病理检查,结果上皮内瘤变（CIN）以上宫颈病变223例（38.9%）,其中CIN Ⅰ 136例（23.7%）、CINⅡ64例（11.2%）、CINⅢ20例（3.5%）、原位癌3例（0.5%）;观察1组348例中,行阴道镜检查348例（100.0%）,活检CINⅡ以上的患者36例（10.3%）;观察2组转阴道镜检查213例（67.4%）,活检CINⅡ以上的患者38例（12.0%）;观察3组转阴道镜检查13例（10.1%）,活检CINⅡ以上的患者3例（2.3%）.活检CINⅡ以上检出率,观察1组、观察2组差异无统计学意义（P＞0.05）,与观察3组比较差异均有统计学意义（x2 =7.014、9.156,均P＜0.05）.结论 高危型HPV检测分流ASCUS,可减少宫颈病变处理过程中误诊、漏诊及过度治疗的问题.     

四种常用避孕措施对妇女宫颈细胞学检查结果的影响分析

目的对官内节育器、避孕套、口服避孕药、绝育术4种常用避孕措施的已婚妇女进行宫颈细胞学检查,探讨较理想的避孕方法,提高避孕效果,减少宫颈炎的发生率。方法选择2011年江苏省已婚妇女宫颈癌筛查项目中健康育龄妇女1941例,根据避孕方法分为4组,宫内节育器避孕组、屏障法避孕组、口服避孕药避孕组和绝育术避孕组;采用巴氏涂片染色方法和TBS行宫颈细胞学诊断。结果宫颈细胞学检查≥ASC．US病变的发生率从高到低依次为绝育术避孕组、口服避孕药避孕组、宫内节育器避孕组和屏障法避孕组,分别为7．3％、6．3％、5．4％和2．2％,但差异无统计学意义。结论口服避孕药和绝育术与宫颈细胞学阳性改变有一定相关性;使用宫内节育器和避孕套避孕组炎性反应性改变率略高。     

Comparison of interventions for pain control with tenaculum placement: a randomized clinical trial

Objective

Although previous studies have demonstrated that a variety of local anesthetics are effective to decrease pain associated with tenaculum placement, no studies directly compare an injection with a topical anesthetic. The objective of this study was therefore to compare mean pain scores with tenaculum placement after an intracervical lidocaine injection or topical lidocaine gel.

Study Design

A randomized, single-blinded trial of women presenting for office gynecologic procedures that required a tenaculum. Women aged 18 years or older were randomized to receive either a 1% lidocaine intracervical injection or topical application of 2% lidocaine gel to the cervix immediately prior to tenaculum placement. The primary outcome was pain at the time of tenaculum placement, measured on a 100 mm Visual Analog Scale. Secondary outcomes included pain with the intervention and satisfaction with tenaculum placement.

Results

Seventy-four women were enrolled and randomized; 35 subjects in each group met criteria for analysis. The two groups had similar socio-demographic characteristics. Women who received the injection had lower mean pain levels at tenaculum placement [12.3 mm (S.D. 17.4 mm) versus 36.6 mm (S.D. 23.0 mm), p<.001] but higher mean pain levels with study drug application [20.4 mm (S.D. 19.4 mm) versus 5.9 mm (S.D. 8.6 mm), p<.001]. Satisfaction with tenaculum placement was similar for the two groups.

Conclusion

Mean pain with tenaculum placement is lower after receiving a lidocaine injection than after receiving a topical lidocaine gel. Satisfaction with tenaculum placement is similar with both interventions.