左炔诺孕酮宫内缓释系统联合宫腔镜治疗子宫内膜息肉临床分析

目的以子宫内膜息肉(EMP)为基础病,探究宫腔镜子宫内膜切除手术后安置左炔诺孕酮宫内缓释系统在治疗该病中的应用。方法选取2011年1月～2012年1月在我院治疗的子宫内膜息肉患者113例,进行回顾性研究,研究组患者68例采用宫腔镜手术联合左炔诺孕酮宫内缓释系统治疗,对照组45例采用宫腔镜治疗。比较两组患者6个月、12个月、24个月后月经量以及子宫内膜等指标。结果研究组与对照组的总有效率分别为88.23%、68.89%,两组差异有统计学意义(P<0.05);两组患者治疗12个月、24个月后月经量以及内膜厚度指标存在明显差异(P<0.05);研究组患者EMP复发6例,复发率为8.82%,对照组患者EMP复发9例,复发率为20.00%,两组差异有统计学意义(P<0.05)。结论宫腔镜联合左炔诺孕酮宫内缓释系统是治疗子宫内膜息肉患者较好的选择,适宜临床推广。     

Endometrial thermal balloon ablation by a simple technique using Foley’s catheter with or without pre ablation endometrial curettage to treat cases with intractable menorrhagia

ObjectivesTo assess the efficacy and safety of endometrial thermal ablation by a technique using Foley’s catheter to treat cases with intractable menorrhagia and to compare between results with and without pre procedure curettage.Study designProspective randomized controlled study.Patients and methodsForty eight patients aged from 39 to 52 years complaining of menorrhagia not responding to treatment for at least 6 months were included in the study, pre ablation endometrial curettage was done for 24 randomly selected cases (group 1) and ablation without curettage for the other 24 cases (group 2). A latex silicon coated Foley’s catheter with 30–50 ml capacity was tested and inserted into uterine cavity then inflated by a variable volume of boiling saline as the uterine cavity permits under moderate pressure and replaced every 2 min with a new boiling saline, for 8 min duration. Then follow up for 6 months and hysteroscopic examination were done to detect endometrial scarring.Outcome measuresPatients satisfaction, menstrual outcome, hysteroscopic diagnosed scarred endometrium.ResultsThis study showed a satisfaction rate of 83.3%, improvement in menstrual bleeding (79.2%) and hysteroscopic diagnosed scarring of the endometrium (75%). Cases in group 1 had a significantly higher satisfaction rate (95.8%) than in group 2 (70.8%) and significantly lower incidence of persistent menorrhagia after ablation than cases in group 2 (4.2% versus 37.5%, respectively). Hysteroscopic diagnosed endometrial scarring was significantly higher in group 1 (91.7%) versus (53.8%) for group 2.ConclusionEndometrial thermal balloon ablation by a technique using Foley’s catheter is a safe, simple, cheap and effective procedure as an alternative to hysterectomy for treatment of menorrhagia in properly selected cases. Pre ablation endometrial curettage increases the satisfaction rate and improves menstrual outcome.     

A novel case of endometrial dedifferentiated adenocarcinoma associated with MLH1 promotor hypermethylation and microsatellite instability

Endometrial dedifferentiated carcinoma is a rare, malignant tumor whose molecular alterations have not been clarified yet. We report a novel case of a 61-year old woman who presented with irregular vaginal bleeding after menopause and a 3?cm uterus mass. Histology revealed endometrial dedifferentiated adenocarcinoma, a rare subtype comprised of undifferentiated adenocarcinoma. The patient still survived 1?year after surgery without chemotherapy and radiotherapy. Immunohistochemistry revealed loss of MLH1/PMS2 expression and retained MSH2/MSH6 expression. Consistently, microsatellite instability was detected indicative of high microsatellite instability (MSI-H). No BRAF V600E, KRAS and POLE mutations were identified. Remarkably, the promoter regions of mutL homolog 1(MLH1) were methylated. Furthermore, several tumor cells were PD-L1 positive in this case with a concentration at the infiltrating tumor edge indicating MSI-H in endometrial dedifferentiated adenocarcinoma is a potential predictive factor for response to immunotherapy targeting the PD-1 or its ligand PD-L1.     

探讨认知护理干预对子宫内膜癌化疗患者的焦虑及自尊的影响

目的探讨认知护理干预用于治疗子宫内膜癌化疗患者焦虑的治疗情况。方法选取50例子宫内膜癌化疗患者进行分组,随机分为观察组和对照组各25例,对照组给予常规护理,观察组在此基础上给予适当的认知护理干预。结果 子宫内膜癌化疗患者在认知护理干预下明显减少了焦虑症状,自尊感明显提高,与对照组相比,差异显著P0.05。结论 应用认知护理干预能够有效缓解子宫内膜癌化疗患者的焦虑状况。     

Impact of external beam pelvic radiotherapy of endometrial carcinoma: A focus on chronic digestive toxicity

PurposeThe standard treatment for endometrial cancer is surgery, although depending on the risk factors, adjuvant radiation therapy may also be given. It is proposed for high-risk carcinomas for which an improvement in progression-free survival though not overall survival has been shown. However, despite the development of radiotherapy treatments with intensity modulation and image guidance, adjuvant radiation therapy remains toxic to the digestive system. We aimed to investigate the incidence of digestive toxicity and the presence of any predictive factors.Materials and methodsData were retrospectively collected from patients treated with adjuvant radiotherapy for endometrial carcinoma at the Institut de cancérologie de Lorraine and centre hospitalier Émile-Durkheim between January 2010 and October 2016 and analyzed to identify factors associated with chronic digestive toxicity.ResultsOne hundred and thirty-nine patients received a total dose of 50 Gy fractionated into 25 sessions, five per week for five weeks. The median follow-up after irradiation completion was 38 months. The incidence of gastrointestinal and rectal toxicity in all patients treated with pelvic irradiation for endometrial carcinoma was 11.1% (95% confidence interval [95%CI]: 5.4–19%) for grade 3–4 and 25.6% (95%CI: 17.0–34.9%) for grade 2–4. No factor was found to be significantly predictive of chronic digestive toxicity. At five years, the overall survival was 74.3%, (95%CI: 65.3–81.4%), progression-free survival was 69.6% (95%CI: 60.1–77.3%) and incidence of pelvic recurrence was 7.9% (95%CI: 3.8–13.9%).ConclusionOur results confirmed that pelvic radiotherapy can induce a relatively high rate of digestive toxicity but failed to identify relevant factors able to predict it.     

Ultrastructural markers of tissue endometrial receptivity in patients with recurrent implantation failure

Abstract

The scanning electron microscopy of the endometrial surface epithelium during the ‘implantation window’ was performed in 119 patients with uterine factor of infertility or recurrent miscarriage due to endometrial hypoplasia. Ultramorphological picture of the surface endometrial epithelium was characterized by aplasia and hypoplasia of pinopodes (67.39%), dense cell – cell contacts (69.53%), heteromorphy of secretory cells (15.22%) in combination with atypia of microenvironment cells (50%) in patients with infertility. The asynchronous development of pinopodes (46.67%) and the absence of intercellular contacts separation during the ‘implantation window’ (84.44%) was observed in patients with recurrent miscarriage. The revealed disturbance determines the mechanisms of the blastocyst adhesion violation and trophoblast invasion in the different stages of implantation in patients with uterine factor of infertility and recurrent miscarriage.     

Disparate genomic characteristics of concurrent endometrial adenocarcinoma and ovarian granulosa cell tumor,revealed by targeted next-generation sequencing

Concurrence of both endometrial adenocarcinoma and ovarian adult granulosa cell tumor (aGCT) is believed to be related to high estrogen milieu, but genomic alterations of the concurrent endometrial adenocarcinoma and aGCT are not known. For this, we analyzed an uterine endometrial adenocarcinoma and an ovarian aGCT in a same patient by a targeted next generation sequencing (NGS). We found a germline mutation in STK11 (p.L113fs). The endometrial adenocarcinoma harbored FGFR2 and TP53 mutations and the aGCT harbored a FOXL2 (p.C134?W) mutation. These germline and somatic mutations have been reported in non-concurrent tumors. These two tumors harbored 20 CNAs but only one CNA was exactly overlapped in the tumors. Our findings indicate that the concurrent endometrial adenocarcinoma and aGCT in this patient might not be genetically related to each other at germline or somatic level and suggest that such concurrence might be originated from non-genetic backgrounds including stimulated estrogen milieu.     

Dedifferentiated endometrial cancer: an atypical case diagnosed from cerebellar and adrenal metastasis: case presentation and review of literature

Dedifferentiated endometrial cancer (DEC) is microscopically characterized by the presence of high-grade areas emerging from low-grade tumour. DEC is an aggressive tumour even when the dedifferentiated component represents only 20% of the entire neoplasm. A proper histological diagnosis is essential to define the most appropriate therapeutic approach for these tumors, since they are characterized by a particularly aggressive trend and by an extremely poor prognosis. We report a single case of DEC associated with dedifferentiated and adrenal metastasis, for which the patient underwent both abdominal-pelvic and cerebellar surgery. Dedifferentiated carcinoma of the endometrium is a poorly recognized neoplasm since they have not been clearly defined the histological features discriminating this neoplasm from high-grade endometrioid adenocarcinoma. Revising existing literature we found 79 described cases of central nervous system secondary involvement and 13 cases where the onset of the disease was characterized by neurological signs and symptoms. We could only find two reported cases of adrenal metastases originating from endometrial neoplasia but in no case of dedifferentiated endometrial carcinoma previously described has been reported the concomitant adrenal-cerebellar involvement.     

系统干预对子宫内膜息肉TCRP术后复发结局影响分析

目的探讨系统护理干预措施对子宫内膜息肉TCRP术后复发结局的影响。方法选择在我院就诊治疗的132例子宫内膜息肉患者,随机分为观察组和对照组,每组66例,两组均采用宫腔镜手术联合3个周期妈富隆治疗,对照组给予常规护理措施,观察组在术前、术后、出院后采取一对一系统护理干预措施,了解妈富隆服药依从性(按时、按量、无间断)、患者术后月经改善(经量、经期、周期恢复)、子宫内膜息肉复发情况。结果两组出院后10d、第二周期、第三周期不同时间段妈富隆服药依从性比较,观察组显著高于对照组,差异有统计学意义(P0.01);术后子宫内膜息肉复发观察组5例(7.50%),对照组15例(22.72%),对照组复发率显著高于观察组,差异有统计学意义(P0.05)。结论服药不规律或随意终止孕激素周期治疗影响EP术后复发结局,采取系统干预措施可提高患者对妈富隆周期治疗依从性,减少复发率。