A recently observed case of deep infiltrating endometriosis with its vaginal invasion diagnosed by vaginal cytology is reported. A 28-year-old Japanese woman complained of a severe dysmenorrhea. Left ovarian endometri...A recently observed case of deep infiltrating endometriosis with its vaginal invasion diagnosed by vaginal cytology is reported. A 28-year-old Japanese woman complained of a severe dysmenorrhea. Left ovarian endometriotic cyst and deep infiltrating endometriosis were suspected. Two red-spots were also present in the posterior fornix of vagina. Vaginal cytology with?cytokeratin (CK) 7-immunocytochemistry suggested the presence of infiltrating endometriosis. She underwent left ovarian cystectomy and resection of thickened uterosacral ligaments with vaginal endometriotic spots, under a laparoscope, based on the diagnosis of endometriotic cyst. Histopathology revealed DIE with vaginal invasion. Immunostaining for CK7 was positive for endometriotic cyst, while CK20 was negative. The stromal cells in endometriosis were immunohistochemically positive for CD10. The vaginal fornix was well-healed one month later the surgery. Postoperatively, she got pregnant with her natural intercourse and delivered a healthy 2138 g girl at 36 weeks of gestation.展开更多
Young patients with the endometrial cancer IA who desire to preserve fertility, can select the conservative therapy with progestin. However, the therapy involves risks of progression and relapse. We examined immunohis...Young patients with the endometrial cancer IA who desire to preserve fertility, can select the conservative therapy with progestin. However, the therapy involves risks of progression and relapse. We examined immunohistochemical analyses of phosphatase and tension homolog (PTEN) and p53 expressions to predict the early relapse, and pregnancy and delivery. Twenty women with endometrial cancer, FIGO IA (1988) (FIGO staging was essentially defined post-surgically), instead of the pathogical specimen before surgery without myometrial invasion were estimated by MRI under 40 years at Gifu University Hospital, Japan from 1988 to 2009. Patients were treated with medroxyprogesterone acetate (MPA, 400 - 600 mg/day) for 4 - 10 months, with whole wall endometrial curettage performed every four weeks. Response to the therapy, pregnancy, delivery and relapse of disease during follow-up over a 72-month period. Immunohistochemical expression of PTEN and p53 was also evaluated with pregnancy, delivery and relapse rate. All patients had pathological complete remissions within 4 - 10 months. Relapse rate was high (60%) in more than 72 months. Immunohistochemical PTEN retain in tumor cells before MPA treatment (8/10) was significant better correlation with pregnancy and delivery rate than of lost cases (1/5) in non-obese women (P < 0.05). Conservative therapy is feasible in carefully selected young women with endometrial cancer without myometrial invasion. However, the relapse rate was high. In cases who desire to be a pregnant, an earlier infertility treatment may be considered especially for PTEN loss especially in nonobese cases.展开更多
文摘A recently observed case of deep infiltrating endometriosis with its vaginal invasion diagnosed by vaginal cytology is reported. A 28-year-old Japanese woman complained of a severe dysmenorrhea. Left ovarian endometriotic cyst and deep infiltrating endometriosis were suspected. Two red-spots were also present in the posterior fornix of vagina. Vaginal cytology with?cytokeratin (CK) 7-immunocytochemistry suggested the presence of infiltrating endometriosis. She underwent left ovarian cystectomy and resection of thickened uterosacral ligaments with vaginal endometriotic spots, under a laparoscope, based on the diagnosis of endometriotic cyst. Histopathology revealed DIE with vaginal invasion. Immunostaining for CK7 was positive for endometriotic cyst, while CK20 was negative. The stromal cells in endometriosis were immunohistochemically positive for CD10. The vaginal fornix was well-healed one month later the surgery. Postoperatively, she got pregnant with her natural intercourse and delivered a healthy 2138 g girl at 36 weeks of gestation.
文摘Young patients with the endometrial cancer IA who desire to preserve fertility, can select the conservative therapy with progestin. However, the therapy involves risks of progression and relapse. We examined immunohistochemical analyses of phosphatase and tension homolog (PTEN) and p53 expressions to predict the early relapse, and pregnancy and delivery. Twenty women with endometrial cancer, FIGO IA (1988) (FIGO staging was essentially defined post-surgically), instead of the pathogical specimen before surgery without myometrial invasion were estimated by MRI under 40 years at Gifu University Hospital, Japan from 1988 to 2009. Patients were treated with medroxyprogesterone acetate (MPA, 400 - 600 mg/day) for 4 - 10 months, with whole wall endometrial curettage performed every four weeks. Response to the therapy, pregnancy, delivery and relapse of disease during follow-up over a 72-month period. Immunohistochemical expression of PTEN and p53 was also evaluated with pregnancy, delivery and relapse rate. All patients had pathological complete remissions within 4 - 10 months. Relapse rate was high (60%) in more than 72 months. Immunohistochemical PTEN retain in tumor cells before MPA treatment (8/10) was significant better correlation with pregnancy and delivery rate than of lost cases (1/5) in non-obese women (P < 0.05). Conservative therapy is feasible in carefully selected young women with endometrial cancer without myometrial invasion. However, the relapse rate was high. In cases who desire to be a pregnant, an earlier infertility treatment may be considered especially for PTEN loss especially in nonobese cases.
