血管造影对小肠平滑肌肿瘤的临床应用价值

目的：分析小肠平滑肌肿瘤的血管造影的Ｘ线表现,探讨血管造对小肠平滑肌肿瘤的临床应用价值。材料和方法：应用选择性肠系膜上动脉造影,回顾性分析了１１例小肠平滑肌肿瘤的血管造影征象。结果：血管造影主要表现为：（１）肿瘤的供血动脉增组;（２）动脉期显示一团病理血管;（３）可有血管池;（４）肿瘤染色;（５）可出现静脉早显。结论：（１）血管造影对小肠平滑肌肿瘤的诊断价值优于钡剂造影和内镜检查,可作为本病的首冼     

桃红消癥散对子宫肌瘤模型大鼠雌、孕激素受体表达的影响

目的:研究桃红消癓散对子宫肌瘤模型大鼠雌激素受体(ER)、孕激素受体(PR)及增殖细胞核抗原(PCNA)表达的影响。方法:采用雌孕激素负荷法建立大鼠子宫肌瘤动物模型,通过放免法检测血清雌孕激素水平,观察子宫组织病理改变,免疫组化法观察大鼠子宫平滑肌细胞ER,PR及PCNA的表达。结果:模型大鼠较正常大鼠子宫明显增大,血清性激素水平升高,子宫平滑肌细胞ER,PR及PCNA的表达明显高于正常大鼠。与模型对照组比较,桃红消癓散可降低血清性激素水平,改善子宫组织结构,抑制平滑肌细胞ER,PR及PCNA的表达。结论:桃红消癓散有治疗子宫肌瘤的作用,其机制可能与调节血中雌孕激素水平,抑制子宫平滑肌细胞ER,PR及PCNA的表达有关。     

Multiple cutaneous leiomyomas leading to discovery of novel splice mutation in the fumarate hydratase gene associated with HLRCC

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a rare autosomal dominant condition, which manifests as cutaneous leiomyomas (CL), uterine fibroids and renal cell cancer (RCC). We describe the case of a 53‐year‐old woman who presented with multiple CL with a novel heterozygous canonical splice site mutation in intron 9 of the fumarate hydratase (FH) gene IVS 9–1 G>C ( NM_000143.3 :c 1391–1 G>C) that was not detected on initial screening of a mutation hotspot but was picked up on sequencing the remaining exons and splice site junctions. This report highlights the importance of clinical suspicion in the diagnosis of HLRCC in the absence of a family or personal history of cancer and despite initial genetic testing being negative.     

1例遗传性平滑肌瘤病和肾细胞癌综合征PET/CT表现

<正>患者女,29岁,1周前体检发现左肾占位;1年前因“子宫肌瘤”接受“腹腔镜下子宫肌瘤剔除术”;其母曾因“子宫肌瘤”接受“子宫全切术”。查体及实验室检查均未见明显异常。¹⁸FFDG PET/CT：左肾及腹膜后见异常高代谢灶,子宫代谢增高(图1A);左肾上极2.1cm×2.1cm肿物(图1B),腹膜后多发肿大淋巴结、彼此融合(图1C),子宫多发结节(图1D);考虑左肾恶性病变伴腹膜后多发淋巴结转移,子宫多发肌瘤。行全麻下腹腔镜下左肾切除+腹膜后肿物切除术,术中见左肾肿物最大径约3cm,质硬;腹膜后球形肿物最大径约5cm,与腹主动脉关系密切。     

改良经腹子宫肌瘤剔除术(附30例临床分析)

目的:评价经腹改良子宫肌瘤剔除术的临床效果.方法:对30例诊断为子宫肌瘤,有保留子宫要求的患者采用改良经腹子宫肌瘤剔除术,即先解剖并永久性阻断(结扎)子宫动脉上行支,结扎卵巢固有韧带,之后剔除肌瘤.术后随访18个月.结果:术前和术后症状明显改善,复发率低.结论:改良经腹子宫肌瘤剔除术是一种有效的治疗子宫肌瘤的术式,在没有腹腔镜技术的基层医院有很好应用前景.     

Melatonin activates cell death programs for the suppression of uterine leiomyoma cell proliferation

The circadian nature of melatonin has a protective effect on the progression of female reproductive cancers, including breast and ovarian cancers. However, the effect of melatonin on the growth of uterine leiomyoma is still unclear. In this study, we found that the growth of uterine leiomyoma ELT3 cells was reduced by treatment with melatonin. Treatment with melatonin increased the distribution of sub-G1 phase and increased DNA condensation in ELT3 cells. Melatonin-induced apoptosis and autophagy cell death progression were observed in ELT3 cells. Melatonin exerts a highly selective effect on primary normal human uterine smooth muscle (UtSMC) cells. The UtSMC cell cycle was arrested by melatonin treatment through up-regulation of p21, p27, and PTEN protein expression, but melatonin did not further promote apoptosis program activation. Melatonin reduced cell proliferation in ELT3 cells underlying the activation of melatonin MT1 and MT2 receptors, which in turn down-regulated the Akt-ERK1/2-NFκB signaling pathway. Melatonin reduced ELT3 tumor growth in both xenograft and orthotopic uterine tumor mice models. The extracellular matrix of the tumor was also reduced by melatonin treatment. Taken together, these results suggest that melatonin potentially plays a role in suppression of uterine leiomyoma growth.     

Subungual leiomyoma in the left thumb of a 16‐year‐old female

Cutaneous leiomyomata, which are benign smooth muscle neoplasms, commonly present as dermal‐based nodules or papules with smooth borders and firm consistency. Digital, particularly subungual leiomyomata are quite rare. A 16‐year‐old female presented to nail clinic complaining of discoloration of the lunula of the left thumbnail for 2.5 months. On initial examination, a pink longitudinal band was present in the center of the nail plate, with yellow discoloration and distal onycholysis. The patient had only mild tenderness with firm palpation, and did not recall trauma of the area. A nail matrix biopsy was performed to determine the etiology of the lesion. Microscopic examination demonstrated a well‐demarcated dermal‐based spindle‐cell fascicular proliferation. Bland cells exhibited eosinophilic cytoplasm and elongate nuclei with blunt ends and minimal cytologic atypia. Prominent nucleoli, mitoses or necrosis were not appreciated. Immunohistochemical stains for smooth muscle actin and caldesmon highlighted the cells. Contrarily, S‐100, epithelial membrane antigen, p63, factor XIIIa, CD34, CD68 and p75 were all negative. Ki‐67 showed a low proliferative index. The immunoprofile combined with the morphologic features were interpreted as subungual leiomyoma. Subungual leiomyoma is a very rare diagnosis. We seek to bring awareness and expedite the diagnosis in patients with this lesion.     

彩色多普勒超声评价高强度聚焦超声治疗子宫肌瘤

目的 探讨高强度聚焦超声（HIFU）治疗子宫肌瘤的近期疗效及评价彩色多普勒血流显像（CDFI）在治疗前后的应用价值。方法 应用CDFI对经HIFU治疗的子宫肌瘤患者114例共175个肌瘤进行检测,观察治疗前后声像图的变化,并以治疗后瘤体的缩小程度为治疗有效指标对比分析,分析彩色多普勒血流信号变化与HIFU治疗效果的关系。结果 114例患者的175个肌瘤中,169个治疗后二维图像显示回声明显增强。158个治疗后3个月瘤体明显缩小,与治疗前相比差异有显著意义（P＜0．05）。143个治疗后血流信号消失,瘤体缩小;8个血流信号无明显变化,瘤体逐渐增大。24个血流信号明显减少,随着随访时间的延长,11例瘤体血流信号消失者中有9例血流信号重新变得丰富。结论 应用彩色多普勒超声技术能正确评价HIFU治疗子宫肌瘤的疗效,并在治疗后短期内指导临床治疗方案的修订及实施。     

子宫阔韧带肌瘤的CT诊断

目的　探讨子宫阔韧带肌瘤的CT诊断价值。方法　收集 2 1例子宫阔韧带肌瘤CT资料 ,进行回顾性分析 ,所有病例均经手术病理证实。结果　 2 1例均在盆腔内、子宫外显示肿块 ,CT表现 :实质性肿块 19例 ,边界清楚光整 16例 ,不甚清楚 3例 ,密度均匀 6例 ,平扫时与子宫肌密度相当 ,增强扫描呈明显强化 ,与子宫肌强化基本同步 ,不均匀 13例 ,其强化程度低于子宫肌 (约相差 10～ 2 0HU) ,瘤内变性、坏死或液化区不明显强化或不强化 ;囊实性 2例 ;肿块位置较固定 ,大多在宫旁匍匐生长 ,与子宫位置密切相关 ,其最大径层面与子宫体中心层面基本保持一致 ;形态各异 ,呈条块状、哑铃分叶状及扁圆烧饼状共 15例 ,呈圆形、椭圆形6例。结论　子宫旁呈条块、哑铃分叶状及扁圆烧饼状的实质性或实质性为主的肿块是本病较为可靠的CT征象 ,CT对诊断阔韧带肌瘤有实用价值