外阴白色病变、鳞状上皮内瘤样变及外阴鳞状细胞癌中CD44v6的表达

目的　探讨CD44v6与外阴鳞状细胞癌发生、发展和侵袭转移的关系。方法　采用免疫组化SP法对外阴正常皮肤、外阴白色病变、鳞状上皮内瘤样变及外阴鳞状细胞癌中CD44v6进行检测。结果　正常皮肤无CD44v6表达 ;在外阴白色病变中其阳性率为 2 6.7%;鳞状上皮内瘤样变中为 5 3 .3 %;外阴鳞状细胞癌中为 73 .3 %。在外阴鳞状细胞癌中CD44v6阳性率与临床分期呈正相关 ;有淋巴结转移者阳性率为 92 .3 %,明显高于无淋巴结转移者 (P <0 .0 5 )。结论　CD44v6与外阴鳞状细胞癌淋巴结转移密切相关。     

Anal intraepithelial neoplasia in HIV infection

Human papillomavirus (HPV) infections belong to the most common sexually transmitted infections worldwide. While the immune system eliminates most HPV infections over time in immunocompetent individuals, HPV infections tend to persist in immunodeficient individuals. In HIV‐infected men who have sex with men (MSM), anal HPV prevalence is more than 90% and infections with multiple HPV types are common. Consequently, HPV‐associated anogenital malignancies occur with high frequency in patients with HIV infection. Anal intraepithelial neoplasia (AIN) is a potential precursor lesion of squamous cell carcinoma of the anus. Like its cervical counterpart, cervical intraepithelial neoplasia (CIN), AIN is causally linked to persistent infections with high‐risk HPV types such as HPV16 or HPV18. As AIN and CIN share distinct biological similar‐ities, AIN screenings analogous to Pap smear programs for CIN have been recommended in high‐risk populations to reduce the incidence of anal carcinoma. These screenings include cytological analysis followed by high resolution anoscopy in case of anal dysplasia. Treatment guidelines for AIN are not yet available. Therapeutic strategies can be divided into topical (e.g. trichloroacetic acid, podophyllotoxin, imiquimod, photodynamic therapy) and ablative (e. g. surgical excision, laser ablation, infrared coagulation, electrocautery) measures. However, controlled studies on AIN treatment have not been performed. The impact of HPV vaccination on AIN development will also need to be assessed. Long‐term follow‐up of these patients is essential to gain more insight into the natural history of anogenital HPV infection in HIV‐positive MSM.     

Photodynamic therapy using meta-tetrahydroxyphenylchlorin (Foscan) for the treatment of vulval intraepithelial neoplasia

BACKGROUND: Photodynamic therapy (PDT) has unique properties which make it suitable for the local treatment of superficial epithelial disorders; it has been suggested as a useful treatment for carcinoma in situ of the vulva. OBJECTIVES: To evaluate the effect of the systemic photosensitizing agent meta-tetrahydroxyphenylchlorin (mTHPC or temoporfin; Foscan, Biolitec, Edinburgh, U.K.) in vulval intraepithelial neoplasia type III (VIN III). METHODS: PDT using mTHPC was performed in six patients with VIN III. A dose of 0.1 mg kg(-1) body weight mTHPC was injected intravenously and the area of VIN irradiated 96 h later with 652-nm light from a diode laser. Patients were reviewed 1 week, 6 months and 2 years following treatment. RESULTS: Patients experienced only minimal pain from the initial treatment but two patients subsequently developed severe pain at the treated site for up to 2 weeks following PDT. All patients developed oedema and slough formation at the treated site and one patient developed cellulitis. At 6 months two patients had developed small recurrences of VIN at the original site and one patient had an area of VIN at a new site. These were treated either with further PDT or with a small excision. At 2 years there was no recurrence of VIN at the original site in all patients reviewed. CONCLUSIONS: This small case series demonstrates that mTHPC-PDT is a useful initial treatment for VIN III. It is relatively selective, shows good cosmesis and conserves form and function. This is a major advantage over surgery. Repeat treatments are also possible, which is important in a condition such as VIN, which tends to be multifocal. Systemic mTHPC-PDT appears to have an advantage over topical 5-aminolaevulinic acid-PDT as the photosensitizer is distributed widely in areas of disease and consequently identifies foci which may not be apparent clinically but become evident when illuminated.     

醋酸白溶液在宫颈上皮内瘤变Ⅱ级及以上病变中应用研究

目的探讨采用叶酸受体介导的宫颈特殊染色法(Flolate receptor mediated cervical special staining,FRD)上皮组织特殊染色液对宫颈病变检查的临床价值,为早期及时发现宫颈癌前病变及宫颈癌提供参考依据。方法选取2015年7月~2017年7月本院妇科门诊年龄常规进行宫颈癌筛查的20~60岁女性患者10 000例。分别行FRD宫颈特殊染色和液基细胞检查(Thinprep cytologic test,TCT),筛查出399例行阴道镜检查及病理活检,以病检为金标准,比较两者的诊断结果。结果以组织病理宫颈上皮内瘤变Ⅱ级(CINⅡ)及以上病变为阳性标准,TCT组、FRD组分别与病理检查结果比较,均无统计学差异(χ~2=1.88,1.52,P=0.17,0.52)。FRD组阳性预测值、阴性预测值、灵敏度、特异度、误诊率、漏诊率与TCT组无统计学差异(χ~2=2.384,P=0.794),但前者阳性活检率高于后者(χ~2=12.25,P=0.00)。结论 FRD宫颈特殊染色在宫颈癌前病变及宫颈癌筛查中较传统方法简便、经济、快速,可以作为一种新方法推广。     

LEEP锥切术对宫颈癌前期病变宫颈上皮内瘤变治疗观察

目的探讨在宫颈癌前期病变宫颈上皮内瘤变的治疗上LEEP锥切术的应用价值。方法回顾性分析于2016年7月~2017年10月在我院接受诊疗的70例宫颈癌前期病变宫颈上皮内瘤变患者的临床资料,并依据数字表法将其随机分成两组(对照组与实验组),每组35例。对照组和实验组分别利用冷刀锥切术和LEEP锥切术给予治疗,对两组患者的手术成果进行对比。结果对照组的总痊愈率(77.19%)显著低于实验组(总痊愈率为94.28%)(P0.05);对照组的宫颈恢复时间、手术时间均明显长于实验组,术中出血量明显多于实验组,差异有统计学的意义(P0.05)。结论在宫颈癌前期病变宫颈上皮内瘤变的治疗上,LEEP锥切术能够对患者的手术时间进行显著缩短,加快患者宫颈的恢复,其具有优异的治愈效果。     

Gene Expression Profiling Reveals Clear Differences Between EBV‐Positive and EBV‐Negative Posttransplant Lymphoproliferative Disorders

Posttransplant patients are at risk of developing a potentially life‐threatening posttransplantation lymphoproliferative disorder (PTLD), most often of diffuse large B cell lymphoma (DLBCL) morphology and associated with Epstein–Barr Virus (EBV) infection. The aim of this study was to characterize the clinicopathological and molecular‐genetic characteristics of posttransplant DLBCL and to elucidate whether EBV(+) and EBV(?) posttransplant DLBCL are biologically different. We performed gene expression profiling studies on 48 DLBCL of which 33 arose posttransplantation (PT‐DLBCL; 72% EBV+) and 15 in immunocompetent hosts (IC‐DLBCL; none EBV+). Unsupervised hierarchical analysis showed clustering of samples related to EBV‐status rather than immune status. Except for decreased T cell signaling these cases were inseparable from EBV(?) IC‐DLBCL. In contrast, a viral response signature clearly segregated EBV(+) PT‐DLBCL from EBV(?) PT‐DLBCL and IC‐DLBCL cases that were intermixed. The broad EBV latency profile (LMP1+/EBNA2+) was expressed in 59% of EBV(+) PT‐DLBCL and associated with a more elaborate inflammatory response compared to intermediate latency (LMP1+/EBNA2?). Inference analysis revealed a role for innate and tolerogenic immune responses (including VSIG4 and IDO1) in EBV(+) PT‐DLBCL. In conclusion we can state that the EBV signature is the most determining factor in the pathogenesis of EBV(+) PT‐DLBCL.     

家族性多发性内分泌腺瘤2A型的基因诊断

目的：提高对多发性内分泌腺瘤2型（multiple endocrine neoplasia 2, MEN2）的诊断和预测诊断水平。方法对临床已诊断首发症状为嗜铬细胞瘤的一个家族内两姐妹患者进行RET（外显子10～16）、VHL（外显子1～3）、SDHD（外显子1～4）、SDHB（外显子1～8）及SDHC（外显子1～6）基因测序。发现两患者均有RET基因634号核酸发生突变,并对其家族其他成员的RET基因进行测序。结果其家族内共有5例患者均有RET基因634号突变（ TGC突变为CGC）,导致其氨基酸编码由半胱氨酸变为精氨酸。其中2例先为临床诊断然后基因诊断,1例先由基因诊断然后临床诊断,2例（均为儿童,分别为6岁及7岁）为基因诊断,目前尚未发病。其中3例行腹腔镜双侧肾上腺肿瘤切除术,病理确诊为双侧嗜铬细胞瘤;1例行甲状腺切除术,病理诊断为甲状腺髓样癌。结论对于多发性内分泌多发肿瘤2A型患者及其家族成员行基因检查不仅可以作为确诊手段,更可以作为无症状者的预测诊断途径。     

高危型人乳头瘤病毒与女性下生殖道感染联合检测专家共识

女性下生殖道感染是妇科常见疾病,包括阴道炎和子宫颈炎。常见的下生殖道感染包括：细菌性阴道病、需氧菌性阴道炎、外阴阴道假丝酵母菌病、阴道毛滴虫病以及由淋病奈瑟菌、衣原体、支原体等引起的子宫颈炎等。     

Staging and classification of gestational trophoblastic disease

Many staging, classification and prognostic systems have been applied to persistent trophoblastic disease. Also terminology has differed across the world, together with criteria for treatment. Consequently it has been difficult to compare results from different centres and it is likely that some patients have been either under or over treated, resulting in increased chemoresistance or treatment toxicity, respectively. There is a need for globally agreed guidelines. This chapter addresses developments leading up to the recent publication of an internationally agreed staging/prognostic scoring system.