BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature.Breast metastases are associated with poor prognosis.The following case highlights the dia...BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature.Breast metastases are associated with poor prognosis.The following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized treatment.CASE SUMMARY A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina,parametria and lymph node metastases.Cervical biopsies confirmed high grade adenocarcinoma with mucinous features.A positron emission tomography/computed tomography(PET/CT)did not show evidence of metastatic disease.She received concurrent cisplatin with external beam radiation therapy.Follow up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic disease.Patient was lost to follow up for six months.She was re-imaged on re-presentation and found to have widely metastatic disease including breast disease.Breast biopsy confirmed programmed death-ligand 1 positive metastatic cervical cancer.The patient received six cycles of carboplatin and paclitaxel with pembrolizumab.Restaging imaging demonstrated response.Patient continued on pembrolizumab with disease control.CONCLUSION Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis challenging.Clinical history and immunohistochemical evaluation of breast lesion,and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the breast.Overall,the prognosis is poor,but immunotherapy can be considered in select patients and may result in good disease response.展开更多
Background:LncRNA DLX6-AS1 has been uncovered to exert effects on various cancers.Nevertheless,the impacts of DLX6-AS1 on endometrial cancer(EC)development remained obscure.The study explored the influence of DLX6-AS1...Background:LncRNA DLX6-AS1 has been uncovered to exert effects on various cancers.Nevertheless,the impacts of DLX6-AS1 on endometrial cancer(EC)development remained obscure.The study explored the influence of DLX6-AS1 on EC progression via the microRNA(miR)-374a-3p/zinc-finger protein(ZFX)axis.Methods:EC cell lines were collected and DLX6-AS1,miR-374a-3p,and ZFX levels in EC cell lines were detected.The EC cells were transfected with DLX6-AS1,miR-374a-3p,and ZFX constructs to examine the biological functions of EC cells.The xenograft model was established for detecting tumor growth.Rescue experiments were conducted to verify the interaction of DLX6-AS1,miR-374a-3p,and ZFX in EC cells.Results:DLX6-AS1 and ZFX levels were elevated,while miR-374a-3p exhibited a reduced level in EC cells.Silencing DLX6-AS1 and elevated miR-374a-3p expressions repressed the biological activities of EC cells.Reduced DLX6-AS1 repressed tumor development.MiR-374a-3p silencing reversed the impacts of DLX6-AS1 silencing,while ZFX overexpression abrogated the impacts of miR-374a-3p elevation on EC cell growth.Mechanically,DLX6-AS1 was found to bind to miR-374a-3p,and miR-374a-3p targeted ZFX.Conclusion:DLX6-AS1 depletion restricts the malignant phenotype of EC cells.The study might provide novel therapeutic biomarkers for EC treatment.展开更多
BACKGROUND Epithelioid trophoblastic tumor(ETT) is the rarest type of gestational trophoblastic tumor(GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Her...BACKGROUND Epithelioid trophoblastic tumor(ETT) is the rarest type of gestational trophoblastic tumor(GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a case of ETT within the lower uterine segment and cervical canal and discuss its manifestations,possible causes, and related influencing factors.CASE SUMMARY A 35-year-old woman(gravida 7, miscarriage 3, induction 2 with 1 being twins,para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made.Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue.Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%.CONCLUSION A search of the PubMed database using the search terms "cesarean section" and "epithelioid trophoblastic tumor" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present case is the 14th reported case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.展开更多
Ovarian cancer(OC)poses a significant challenge in modern gynecologic oncology,both diagnostically and therapeutically.According to the American Cancer Society,an estimated 21,000 new cases of OC were reported in the ...Ovarian cancer(OC)poses a significant challenge in modern gynecologic oncology,both diagnostically and therapeutically.According to the American Cancer Society,an estimated 21,000 new cases of OC were reported in the United States alone in 20211.The most prevalent subtype of OC87,highgrade serous(HGS),is characterized by heightened genomic instability and defects in DNA damage response(DDR)pathways,which contribute to disease development and progression2.Notably,approximately 50%of HGS ovarian cancer(HGSOC)patients exhibit homologous recombination repair(HRR)defects(HRDs)3.展开更多
Lactobacillus crispatus is a commonly found species in the urogenital tract(UGT)of healthy females and can also colonize other niches,such as the gastrointestinal tract(GIT).Although its potential protective role in c...Lactobacillus crispatus is a commonly found species in the urogenital tract(UGT)of healthy females and can also colonize other niches,such as the gastrointestinal tract(GIT).Although its potential protective role in cervical cancer has been reported,the anticancer mechanisms involved are still unclear.In this study,we sequenced and characterized the complete genomes of two L.crispatus strains(Lc31 and Lc83)isolated from the UGT of healthy women of reproductive age.Phylogenetic and phylogenomic analyses of these two strains and 15 other L.crispatus strains with complete genome sequences revealed that strains from the UGT and GIT clustered separately.UGT strains had a larger genome size,higher GC contents,and more protein-coding sequences and insertion sequence(Is)elements,indicating the likelihood of active horizontal gene transfer in this niche.We found a universal presence of genes encoding bacteriocins and the absence of virulence factors and antibiotic resistance genes in UGT strains,suggesting the potential of L.crispatus as a urogenital probiotic.Comparative genomic analysis identified an ula gene cluster responsible for L-ascorbate catabolism exclusively in UGT strains,and carbohydrate fermentation experiments confirmed that this substrate supported the growth of L.crispatus Lc31 and Lc83.Our findings improve the understanding of how the genome determines niche adaptation by L.crispatus,providing a foundation for investigating the mechanisms by which urogenital-derived L.crispatus promotes female health.展开更多
Objective: The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer.Methods: The clinical-pathological data of ...Objective: The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer.Methods: The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics(FIGO) Ib–IIa cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed.The median follow-up was 70 months.Results: Of all the patients,61.6% of the cases received adjuvant therapy,with 5-year disease-free survival(DFS)of 92.1% and 5-year overall survival(OS) of 95.0%.In multivariate analysis,differentiation of G3(P<0.05),lymph node metastasis(LNM,P<0.05) and lymphovascular space invasion(LVSI,P<0.05) were independent predictors for OS,while LNM(P<0.05),deep stroma invasion(DSI,P<0.05) and LVSI(P<0.05) were independent factors for DFS.The samples were stratified by histologic type,and cervical squamous cell carcinoma(SCC) was found to share the same independent factors except for differentiation of OS.As to patients with cervical adenocarcinoma/adenosquamous carcinoma(AC/ASC),differentiation was the independent predictor of OS(P<0.05); and LVSI of DFS(P<0.05).Of 236 patients with high-risk factors,there was no significant difference in survival between concurrent chemoradiotherapy(CCRT,n=195),radiotherapy(RT,n=24),and chemotherapy(CT,n=17).Among the 190 patients with LNM who underwent CCRT,124 cases showed improved DFS after sequential CT(P=0.118),with a recurrence rate decrease of 14%,though the difference was not statistically significant.Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy,but the difference was not statistically significant.Conclusions: LNM,LVSI,DSI and differentiation were found to be independent prognostic factors for operable cervical cancer.Aggressive postoperative adjuvant therapy based on single risk factors in Chinese National Cancer Center could benefit survival.CCRT+CT outperformed CCRT in high-risk patients.For patients with single non-high-risk factor,the role of adjuvant therapy needs to be further discussed.展开更多
Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; so...Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the "gold standard" procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical(MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.展开更多
High-risk human papillomavirus (hrHPV) infection plays an important role in the development of cervical intraepithelial neoplasia and cervical cancer.A total of 11 549 women were enrolled from the Maternal and Child H...High-risk human papillomavirus (hrHPV) infection plays an important role in the development of cervical intraepithelial neoplasia and cervical cancer.A total of 11 549 women were enrolled from the Maternal and Child Health Hospital of Hubei Province.Each participant accepted hrHPV testing and completed a self^administered questionnaire about basic information and potential risk factors.The univariable and multivariable logistic regression model was used to explore the associations between variants and hrHPV infection.Our results showed that hrHPV prevalence was 16.09% in Hubei Province,among which,hrHPV was more likely to be positive in women aged 51 years or above (OR=1.65,95% CI:1.28-2.14),and in women who had symptoms of bleeding after intercourse (OR=1.32,95% CI:1.17-1.50),had first sexual intercourse at the age of 18 years or below (OR=1.33,95% CI:1.07-1.64),had at least three male sexual partners (OR=2.50,95% CI:2.07-3.03),and who had been diagnosed with sexually transmitted infections (OR=1.50,95% CI:1.12-2.03).Married women (OR=0.66,95% CI:0.55-0.78) and women who frequently used condoms (OR=0.75,95% CI:0.67-0.84) had a relatively lower hrHPV prevalence.This study confirms that hrHPV infection was associated with age,marital status,symptoms of intercourse bleeding,history of sexually transmitted infections,and sex-related behaviors.Above all,this study provides a baseline database prior to obtaining vaccinations for dynamic tracking of the changes in hrHPV prevalence.展开更多
Metastasis is the main cause of cancer mortality. One of the initiating events of cancer metastasis of epithelial tumors is epithelial-to-mesenchymal transition(EMT), during which cells dedifferentiate from a relative...Metastasis is the main cause of cancer mortality. One of the initiating events of cancer metastasis of epithelial tumors is epithelial-to-mesenchymal transition(EMT), during which cells dedifferentiate from a relatively rigid cell structure/morphology to a flexible and changeable structure/morphology often associated with mesenchymal cells. The presence of EMT in human epithelial tumors is reflected by the increased expression of genes and levels of proteins that are preferentially present in mesenchymal cells. The combined presence of these genes forms the basis of mesenchymal gene signatures, which are the foundation for classifying a mesenchymal subtype of tumors. Indeed, tumor classification schemes that use clustering analysis of large genomic characterizations, like The Cancer Genome Atlas(TCGA), have defined mesenchymal subtype in a number of cancer types, such as high-grade serous ovarian cancer and glioblastoma. However, recent analyses have shown that gene expression-based classifications of mesenchymal subtypes often do not associate with poor survival. This "paradox" can be ameliorated using integrated analysis that combines multiple data types. We recently found that integrating m RNA and micro RNA(mi RNA) data revealed an integrated mesenchymal subtype that is consistently associated with poor survival in multiple cohorts of patients with serous ovarian cancer. This network consists of 8 major mi RNAs and 214 m RNAs. Among the 8 mi RNAs, 4 are known to be regulators of EMT. This review provides a summary of these 8 mi RNAs, which were associated with the integrated mesenchymal subtype of serous ovarian cancer.展开更多
Objective:To investigate the clinic values of combining test of serum matrix metalloproteinase 9(MMP-9),acetyl heparinase(Hpa) and Cathepsin L(CL) in diagnosis of ovarian cancer.Methods:Serum levels of MMP-9,Hpa and C...Objective:To investigate the clinic values of combining test of serum matrix metalloproteinase 9(MMP-9),acetyl heparinase(Hpa) and Cathepsin L(CL) in diagnosis of ovarian cancer.Methods:Serum levels of MMP-9,Hpa and CL were detected in a total of 418 cases,including 217 cases with ovarian malignant tumor,100 cases with ovarian benign tumor and 101 healthy controls,by using enzyme-linked immunosorbent assay(ELISA).Their correlation with clinicopathologic feature of ovarian malignant tumor was analyzed and their diagnosis performance was evaluated by receiver operating characteristic(ROC).The combined diagnosis model was established by logistic regression analysis.Results:The serum levels of MMP-9,Hpa and CL were significantly higher in patients with ovarian malignant tumor than in benign tumor and healthy control,the serum levels of CL and Hpa were higher in epithelial cancer than in non-epithelial tumor,and MMP-9,Hpa and CL were elevated in low grade and advanced stage compared to high grade and early stage.The sensitivity for diagnosis of ovarian malignant tumor from high to low was CL,Hpa and MMP-9,and the specificity was MMP-9,CL and Hpa.The united diagnosis model was established and showed the sensitivity and specificity of combined detection were 84.6% and 82.1%,respectively,which were significantly higher than a single tumor marker.Conclusion: Serum MMP‐9, Hpa and CL were correlated with ovarian malignant tumor and the combined detection of which may be valuable for clinical diagnosis of ovarian malignant tumor.展开更多
OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatme...OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatment in our hospital during a periodfrom January 2000 to December 2007, were collected andretrospectively analyzed. The prognostic factors were studiedusing univariate analysis. Analytical evaluation of the independentprognostic factors was performed using COX proportionalhazardsregression model.RESULTS The 1-, 3- and 5-year survival rates of the 60 patientswere 95%, 78% and 68%, respectively, with a median survivaltime of 32 months. Univariate survival analysis showed thatthese independent prognostic factors included positive pelviclymph nodes (P = 0.001), lymphovascular tumor embolus (P =0.001), and adjuvant chemotherapy (P = 0.011). In the 60 cases,postoperative local recurrence in the pelvic cavity occurred in1 and distant metastasis in 3. Related complications, such asradiocystitis, recto-vaginal fistula and vesico-vaginal fistula werefound in 6 of the total cases (10%). The serum levels of squamousepithelium antigen detected before and after treatment weresignificantly different (P = 0.000). The incidence of CCS is low;however, the disease is difficult to cure due to the high incidenceof complications and to the frequency of distant metastasis.Therefore, individualized treatment is needed. Complications fromsubtotal hysterectomy (STH) should be treated and controlledaggressively. Careful follow-up as well as close monitoring andobservation for significant symptoms in the postoperative coursewill enhance clinical outcome.CONCLUSION Cancer of the cervical stump has a lowmorbidity and severe complications, and most recurrences aredistant metastases. Because it is difficult to cure, there is a needto design a treatment regimen for each individual patient basedon the factors deemed as high risk. The surgical indications forsubtotal uterine resection should be followed and close follow-upafter surgery should be maintained.展开更多
Cervical cancer is a form of malignant tumor that seriously threatens women’s health. In China,according to the cancer statistics, 98,900 new cervical cancer cases and 30,500 deaths due to cervical cancer were estima...Cervical cancer is a form of malignant tumor that seriously threatens women’s health. In China,according to the cancer statistics, 98,900 new cervical cancer cases and 30,500 deaths due to cervical cancer were estimated to have occurred in2015, and the incidence and mortality rates still exhibited an upward trend[1].展开更多
Background:Protein tyrosine kinase 6(PTK6) is overexpressed in many epithelial tumors and predicts poor prognosis.However,PTK6 expression status and its role in cervical squamous cell cancer are unknown.This study aim...Background:Protein tyrosine kinase 6(PTK6) is overexpressed in many epithelial tumors and predicts poor prognosis.However,PTK6 expression status and its role in cervical squamous cell cancer are unknown.This study aimed to investigate the expression level and clinical significance of PTK6 in early-stage cervical squamous cell cancer.Methods:Quantitative reverse transcription-polymerase chain reaction(qRT-PCR) and western blotting analysis were performed to detect PTK6 mRNA and protein expression levels in 10 freshly frozen,early-stage cervical squamous cell cancer specimens and adjacent non-tumorous cervical tissues.The expression of PTK6 was detected using immunohistochemical staining in 150 formalin-fixed,paraffin-embedded,early-stage cervical squamous cell cancer sections and 10 normal cervical tissue sections.Results:The mRNA and protein levels of PTK6 in cancer tissues were higher than those in adjacent non-tumorous cervical tissues.Immunohistochemical analysis showed that PTK6 was not expressed in normal cervical tissues but was overexpressed in the cytoplasm of cervical squamous cell cancer cells.The level of PTK6 expression was significantly associated with tumor grade(P = 0.020).The 5-year overall survival rate of patients with high PTK6 expression was lower than that of patients with low PTK6 expression(81.3%vs.96.2%,P = 0.008).Multivariate Cox regression analysis showed that the expression level of PTK6 in cervical squamous cell cancer was an independent prognostic factor for patient survival(hazard ratio = 5.999,95%confidence interval 1.622-22.191,P< 0.05).Conclusions:PTK6 is overexpressed in cervical squamous ceil cancer.Increased PTK6 expression is associated with reduced 5-year overall survival.PTK6 expression is an independent prognostic predictor for cervical cancer.展开更多
Long noncoding RNA(lncRNA) HOTAIR and MALAT1 are implicated in the development of multiple cancers. Genetic variants within HOTAIR and MALAT1 may affect the gene expression, thereby modifying genetic susceptibility to...Long noncoding RNA(lncRNA) HOTAIR and MALAT1 are implicated in the development of multiple cancers. Genetic variants within HOTAIR and MALAT1 may affect the gene expression, thereby modifying genetic susceptibility to cervical cancer. A case-control study was designed, including 1 486 cervical cancer patients and 1 536 healthy controls. Based on RegulomeDB database, 11 SNPs were selected and genotyped by using Sequenom’s Mass ARRAY. Univariate and multivariate logistic regression models were used to calculate the odds ratio(OR) and 95% confidence interval(CI). We found that the A allele of rs35643724 in HOTAIR was associated with increased risk of cervical cancer, while the C allele of rs1787666 in MALAT1 was associated with decreased risk. Compared to individuals with 0–1 unfavorable allele, those with 3–4 unfavorable alleles showed18% increased odds of having cervical cancer. Our findings suggest that HOTAIR rs35643724 and MALAT1 rs1787666 might represent potential biomarkers for cervical cancer susceptibility.展开更多
Summary:With delayed childbearing in women,preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma(EOC).Fertility-sparing surgery(FSS)can be considered in patien...Summary:With delayed childbearing in women,preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma(EOC).Fertility-sparing surgery(FSS)can be considered in patients with early-stage disease in order to preserve fertility and improve quality of life.In order to evaluate oncological safety,attitudes toward childbearing and reproductive outcomes in women with EOC who underwent FSS,this multicenter retrospective study was conducted.Between January 2005 and December 2014,total of 87 young women with FIGO stage I EOC were included,with their clinicopathologic parameters in relation to disease-free survival(DFS)and overall survival(OS)assessed.Attitudes toward childbearing,ovarian function and fertility were studied in women undergoing FSS(n=36).As a result,in contrast to radical sur ery,FSS did not affect prognosis by Kaplan-Meier curves(log-rank test;DFS:P=0.484;OS:P=0.125).However,two of the three recurrence cases and both death cases were in FSS group stage IC.All women undergoing FSS resumed regular menstrual periods after chemotherapy.Only 16(44.44%)had tried to conceive,and 17 pregnancies occurred in 15(93.75%)women.Among 20 women who did not attempt conception,the most common reason was not being married(70%),followed by already having children(15%).In summary,FSS is considered safe in young women with stage IA EOC.Regular menstruation and good obstetric outcomes can be achieved.This study also provides some insight into the attitudes and social factors regarding fertility in EOC patients.展开更多
Objective To investigate the clinicopathological characteristics and clinical treatment outcomes of patients with papillary serous carcinoma of the uterine cervix(PSCC).Methods In this study, 4 patients with histologi...Objective To investigate the clinicopathological characteristics and clinical treatment outcomes of patients with papillary serous carcinoma of the uterine cervix(PSCC).Methods In this study, 4 patients with histologically confirmed papillary serous carcinoma of the uterine cervix were retrospectively investigated. Pap smears, human papillomavirus(HPV) screening, tumor marker status, biopsy analysis, and relevant imaging examinations were conducted for the confirmation of primary diagnosis and recurrence. Patients underwent surgery, chemotherapy, or radiotherapy, and survival were the main endpoint.Results The 4 patients were diagnosed with IB1, IB1, IIA, or IIIB disease. Two patients(2/4) presented with recurrence within 18 months after primary therapy. Compared with chemotherapy alone(progressionfree survival(PFS): 11 months), radiotherapy combined with adjuvant chemotherapy showed favorable PFS rates(PFS: 20, 36, 13 months in 3 cases), although valid statistical analysis was not feasible because of the small sample size. The 5-year survival rate was 0%, and the 3-year survival rate was 75%. Our data, in agreement with the literature evidence, showed that the number of moderate-risk and high-risk factors in patients diagnosed with PSCC at an early stage was higher than that in patients diagnosed with common adenocarcinoma/squamous carcinoma of the uterine cervix.Conclusion PSCC has a poor clinical prognosis, and compared with chemotherapy alone, radiotherapy combined with adjuvant chemotherapy may lead to improved PFS.展开更多
BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scruti...BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.展开更多
BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are rare.The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established.Here we report a case of a large 10...BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are rare.The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established.Here we report a case of a large 10-kg multi-locular ovarian mass,which was successfully laparoscopically removed:Our aim was to innovate the surgical practice in this field by providing a safe,effective,and minimally invasive management method for such complex and rare cases.CASE SUMMARY A 49-year-old nulliparous woman presented with abdominal distension,lasting from six Mo prior to admission;she reported worsening abdominal pain,abdominal swelling,and mild dyspnea.Imaging showed a presumed benign multi-locular(>10 locules)left ovarian cyst that measured about 30 cm in diameter.Based on the IOTA-ADNEX model the mass had a 27.5%risk of being a borderline or malignant tumor.The patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy,followed by the external drainage of the cyst.Tumor spillage was successfully avoided during this procedure.The final volume of the drained mucinous content was 8950 L;the cyst wall,extracted through the minilaparotomy,weighed about 1200 g.The pathologic gross examination revealed a 24 cm×15 cm×10 cm mass;the histologic examination diagnosed a mucinous cystoadenoma.To our knowledge,this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external decompression.CONCLUSION Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.展开更多
文摘BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature.Breast metastases are associated with poor prognosis.The following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized treatment.CASE SUMMARY A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina,parametria and lymph node metastases.Cervical biopsies confirmed high grade adenocarcinoma with mucinous features.A positron emission tomography/computed tomography(PET/CT)did not show evidence of metastatic disease.She received concurrent cisplatin with external beam radiation therapy.Follow up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic disease.Patient was lost to follow up for six months.She was re-imaged on re-presentation and found to have widely metastatic disease including breast disease.Breast biopsy confirmed programmed death-ligand 1 positive metastatic cervical cancer.The patient received six cycles of carboplatin and paclitaxel with pembrolizumab.Restaging imaging demonstrated response.Patient continued on pembrolizumab with disease control.CONCLUSION Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis challenging.Clinical history and immunohistochemical evaluation of breast lesion,and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the breast.Overall,the prognosis is poor,but immunotherapy can be considered in select patients and may result in good disease response.
基金supported by Shanghai Municipal Health Commission(Grant/Award No.20194Y0050).
文摘Background:LncRNA DLX6-AS1 has been uncovered to exert effects on various cancers.Nevertheless,the impacts of DLX6-AS1 on endometrial cancer(EC)development remained obscure.The study explored the influence of DLX6-AS1 on EC progression via the microRNA(miR)-374a-3p/zinc-finger protein(ZFX)axis.Methods:EC cell lines were collected and DLX6-AS1,miR-374a-3p,and ZFX levels in EC cell lines were detected.The EC cells were transfected with DLX6-AS1,miR-374a-3p,and ZFX constructs to examine the biological functions of EC cells.The xenograft model was established for detecting tumor growth.Rescue experiments were conducted to verify the interaction of DLX6-AS1,miR-374a-3p,and ZFX in EC cells.Results:DLX6-AS1 and ZFX levels were elevated,while miR-374a-3p exhibited a reduced level in EC cells.Silencing DLX6-AS1 and elevated miR-374a-3p expressions repressed the biological activities of EC cells.Reduced DLX6-AS1 repressed tumor development.MiR-374a-3p silencing reversed the impacts of DLX6-AS1 silencing,while ZFX overexpression abrogated the impacts of miR-374a-3p elevation on EC cell growth.Mechanically,DLX6-AS1 was found to bind to miR-374a-3p,and miR-374a-3p targeted ZFX.Conclusion:DLX6-AS1 depletion restricts the malignant phenotype of EC cells.The study might provide novel therapeutic biomarkers for EC treatment.
文摘BACKGROUND Epithelioid trophoblastic tumor(ETT) is the rarest type of gestational trophoblastic tumor(GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a case of ETT within the lower uterine segment and cervical canal and discuss its manifestations,possible causes, and related influencing factors.CASE SUMMARY A 35-year-old woman(gravida 7, miscarriage 3, induction 2 with 1 being twins,para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made.Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue.Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%.CONCLUSION A search of the PubMed database using the search terms "cesarean section" and "epithelioid trophoblastic tumor" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present case is the 14th reported case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.
基金funded by the National Natural Science Foundation of China(Grant No.82073129)the Ningxia Key Research and Development Program(Grant No.2023BEG02037)+3 种基金the Chongqing Science and Technology Bureau(Grant Nos.CSTB2023NSCQ-MSX1030,cstc-2021jxjl130032,and cstc2022jxjl20039)the Chongqing Health Commission(Grant Nos.2023ZDXM029 and 2023MSXM043)the Project for Enhancing Scientific Research Capabilities of Chongqing University Cancer Hospital(Grant No.2023nlts009)the Beijing Kangmeng Charity Foundation(Grant No.BJHA-CRP-089)。
文摘Ovarian cancer(OC)poses a significant challenge in modern gynecologic oncology,both diagnostically and therapeutically.According to the American Cancer Society,an estimated 21,000 new cases of OC were reported in the United States alone in 20211.The most prevalent subtype of OC87,highgrade serous(HGS),is characterized by heightened genomic instability and defects in DNA damage response(DDR)pathways,which contribute to disease development and progression2.Notably,approximately 50%of HGS ovarian cancer(HGSOC)patients exhibit homologous recombination repair(HRR)defects(HRDs)3.
基金supported by grants from the Natural Science Foundation of Anhui Province(grant number 2208085MH253)the National Natural Science Foundation(grant number 81702560)the Fundamental Research Funds for the Central Universities(grant number WK9110000110),People's Republic of China.
文摘Lactobacillus crispatus is a commonly found species in the urogenital tract(UGT)of healthy females and can also colonize other niches,such as the gastrointestinal tract(GIT).Although its potential protective role in cervical cancer has been reported,the anticancer mechanisms involved are still unclear.In this study,we sequenced and characterized the complete genomes of two L.crispatus strains(Lc31 and Lc83)isolated from the UGT of healthy women of reproductive age.Phylogenetic and phylogenomic analyses of these two strains and 15 other L.crispatus strains with complete genome sequences revealed that strains from the UGT and GIT clustered separately.UGT strains had a larger genome size,higher GC contents,and more protein-coding sequences and insertion sequence(Is)elements,indicating the likelihood of active horizontal gene transfer in this niche.We found a universal presence of genes encoding bacteriocins and the absence of virulence factors and antibiotic resistance genes in UGT strains,suggesting the potential of L.crispatus as a urogenital probiotic.Comparative genomic analysis identified an ula gene cluster responsible for L-ascorbate catabolism exclusively in UGT strains,and carbohydrate fermentation experiments confirmed that this substrate supported the growth of L.crispatus Lc31 and Lc83.Our findings improve the understanding of how the genome determines niche adaptation by L.crispatus,providing a foundation for investigating the mechanisms by which urogenital-derived L.crispatus promotes female health.
文摘Objective: The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer.Methods: The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics(FIGO) Ib–IIa cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed.The median follow-up was 70 months.Results: Of all the patients,61.6% of the cases received adjuvant therapy,with 5-year disease-free survival(DFS)of 92.1% and 5-year overall survival(OS) of 95.0%.In multivariate analysis,differentiation of G3(P<0.05),lymph node metastasis(LNM,P<0.05) and lymphovascular space invasion(LVSI,P<0.05) were independent predictors for OS,while LNM(P<0.05),deep stroma invasion(DSI,P<0.05) and LVSI(P<0.05) were independent factors for DFS.The samples were stratified by histologic type,and cervical squamous cell carcinoma(SCC) was found to share the same independent factors except for differentiation of OS.As to patients with cervical adenocarcinoma/adenosquamous carcinoma(AC/ASC),differentiation was the independent predictor of OS(P<0.05); and LVSI of DFS(P<0.05).Of 236 patients with high-risk factors,there was no significant difference in survival between concurrent chemoradiotherapy(CCRT,n=195),radiotherapy(RT,n=24),and chemotherapy(CT,n=17).Among the 190 patients with LNM who underwent CCRT,124 cases showed improved DFS after sequential CT(P=0.118),with a recurrence rate decrease of 14%,though the difference was not statistically significant.Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy,but the difference was not statistically significant.Conclusions: LNM,LVSI,DSI and differentiation were found to be independent prognostic factors for operable cervical cancer.Aggressive postoperative adjuvant therapy based on single risk factors in Chinese National Cancer Center could benefit survival.CCRT+CT outperformed CCRT in high-risk patients.For patients with single non-high-risk factor,the role of adjuvant therapy needs to be further discussed.
文摘Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the "gold standard" procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical(MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.
基金This work was supported by the Natural Science Foundation of Hubei Province, China (No.2017CKC891).
文摘High-risk human papillomavirus (hrHPV) infection plays an important role in the development of cervical intraepithelial neoplasia and cervical cancer.A total of 11 549 women were enrolled from the Maternal and Child Health Hospital of Hubei Province.Each participant accepted hrHPV testing and completed a self^administered questionnaire about basic information and potential risk factors.The univariable and multivariable logistic regression model was used to explore the associations between variants and hrHPV infection.Our results showed that hrHPV prevalence was 16.09% in Hubei Province,among which,hrHPV was more likely to be positive in women aged 51 years or above (OR=1.65,95% CI:1.28-2.14),and in women who had symptoms of bleeding after intercourse (OR=1.32,95% CI:1.17-1.50),had first sexual intercourse at the age of 18 years or below (OR=1.33,95% CI:1.07-1.64),had at least three male sexual partners (OR=2.50,95% CI:2.07-3.03),and who had been diagnosed with sexually transmitted infections (OR=1.50,95% CI:1.12-2.03).Married women (OR=0.66,95% CI:0.55-0.78) and women who frequently used condoms (OR=0.75,95% CI:0.67-0.84) had a relatively lower hrHPV prevalence.This study confirms that hrHPV infection was associated with age,marital status,symptoms of intercourse bleeding,history of sexually transmitted infections,and sex-related behaviors.Above all,this study provides a baseline database prior to obtaining vaccinations for dynamic tracking of the changes in hrHPV prevalence.
基金supported by the U.S. National Institutes of Health grants (U24 CA143835 to IS and WZ, P50 CA083639 and P50 CA098258 to AKS)MD Anderson support grant (CA016672) to WZ+6 种基金a grant from the Blanton-Davis Ovarian Cancer Research Program to WZgrants from the Program for Changjiang Scholars, Innovative Research Team in University (PCSIRT) in Chinathe National Key Scientifi c and Technological Project (2011ZX0 9307-001-04)Tianjin Science and Technology Committee Foundation (09ZCZDSF04700) to KCa grant from National Nature Science Foundation of China (#81201651) to YSa grant from Fondazione CARIPLO (2013-0865) to DMthe A. Lavoy Moore Endowment Fund to YS and DY
文摘Metastasis is the main cause of cancer mortality. One of the initiating events of cancer metastasis of epithelial tumors is epithelial-to-mesenchymal transition(EMT), during which cells dedifferentiate from a relatively rigid cell structure/morphology to a flexible and changeable structure/morphology often associated with mesenchymal cells. The presence of EMT in human epithelial tumors is reflected by the increased expression of genes and levels of proteins that are preferentially present in mesenchymal cells. The combined presence of these genes forms the basis of mesenchymal gene signatures, which are the foundation for classifying a mesenchymal subtype of tumors. Indeed, tumor classification schemes that use clustering analysis of large genomic characterizations, like The Cancer Genome Atlas(TCGA), have defined mesenchymal subtype in a number of cancer types, such as high-grade serous ovarian cancer and glioblastoma. However, recent analyses have shown that gene expression-based classifications of mesenchymal subtypes often do not associate with poor survival. This "paradox" can be ameliorated using integrated analysis that combines multiple data types. We recently found that integrating m RNA and micro RNA(mi RNA) data revealed an integrated mesenchymal subtype that is consistently associated with poor survival in multiple cohorts of patients with serous ovarian cancer. This network consists of 8 major mi RNAs and 214 m RNAs. Among the 8 mi RNAs, 4 are known to be regulators of EMT. This review provides a summary of these 8 mi RNAs, which were associated with the integrated mesenchymal subtype of serous ovarian cancer.
基金supported by a grant from the Provincial Research Project Funding of Guangxi,China (No. GSR 9817101)
文摘Objective:To investigate the clinic values of combining test of serum matrix metalloproteinase 9(MMP-9),acetyl heparinase(Hpa) and Cathepsin L(CL) in diagnosis of ovarian cancer.Methods:Serum levels of MMP-9,Hpa and CL were detected in a total of 418 cases,including 217 cases with ovarian malignant tumor,100 cases with ovarian benign tumor and 101 healthy controls,by using enzyme-linked immunosorbent assay(ELISA).Their correlation with clinicopathologic feature of ovarian malignant tumor was analyzed and their diagnosis performance was evaluated by receiver operating characteristic(ROC).The combined diagnosis model was established by logistic regression analysis.Results:The serum levels of MMP-9,Hpa and CL were significantly higher in patients with ovarian malignant tumor than in benign tumor and healthy control,the serum levels of CL and Hpa were higher in epithelial cancer than in non-epithelial tumor,and MMP-9,Hpa and CL were elevated in low grade and advanced stage compared to high grade and early stage.The sensitivity for diagnosis of ovarian malignant tumor from high to low was CL,Hpa and MMP-9,and the specificity was MMP-9,CL and Hpa.The united diagnosis model was established and showed the sensitivity and specificity of combined detection were 84.6% and 82.1%,respectively,which were significantly higher than a single tumor marker.Conclusion: Serum MMP‐9, Hpa and CL were correlated with ovarian malignant tumor and the combined detection of which may be valuable for clinical diagnosis of ovarian malignant tumor.
文摘OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatment in our hospital during a periodfrom January 2000 to December 2007, were collected andretrospectively analyzed. The prognostic factors were studiedusing univariate analysis. Analytical evaluation of the independentprognostic factors was performed using COX proportionalhazardsregression model.RESULTS The 1-, 3- and 5-year survival rates of the 60 patientswere 95%, 78% and 68%, respectively, with a median survivaltime of 32 months. Univariate survival analysis showed thatthese independent prognostic factors included positive pelviclymph nodes (P = 0.001), lymphovascular tumor embolus (P =0.001), and adjuvant chemotherapy (P = 0.011). In the 60 cases,postoperative local recurrence in the pelvic cavity occurred in1 and distant metastasis in 3. Related complications, such asradiocystitis, recto-vaginal fistula and vesico-vaginal fistula werefound in 6 of the total cases (10%). The serum levels of squamousepithelium antigen detected before and after treatment weresignificantly different (P = 0.000). The incidence of CCS is low;however, the disease is difficult to cure due to the high incidenceof complications and to the frequency of distant metastasis.Therefore, individualized treatment is needed. Complications fromsubtotal hysterectomy (STH) should be treated and controlledaggressively. Careful follow-up as well as close monitoring andobservation for significant symptoms in the postoperative coursewill enhance clinical outcome.CONCLUSION Cancer of the cervical stump has a lowmorbidity and severe complications, and most recurrences aredistant metastases. Because it is difficult to cure, there is a needto design a treatment regimen for each individual patient basedon the factors deemed as high risk. The surgical indications forsubtotal uterine resection should be followed and close follow-upafter surgery should be maintained.
基金supported by the Natural Science Foundation of Hubei Province,China [Grant No.2017CKC891]the Health Commission Of Hubei Province,China [Grant No.WJ2019H286]
文摘Cervical cancer is a form of malignant tumor that seriously threatens women’s health. In China,according to the cancer statistics, 98,900 new cervical cancer cases and 30,500 deaths due to cervical cancer were estimated to have occurred in2015, and the incidence and mortality rates still exhibited an upward trend[1].
文摘Background:Protein tyrosine kinase 6(PTK6) is overexpressed in many epithelial tumors and predicts poor prognosis.However,PTK6 expression status and its role in cervical squamous cell cancer are unknown.This study aimed to investigate the expression level and clinical significance of PTK6 in early-stage cervical squamous cell cancer.Methods:Quantitative reverse transcription-polymerase chain reaction(qRT-PCR) and western blotting analysis were performed to detect PTK6 mRNA and protein expression levels in 10 freshly frozen,early-stage cervical squamous cell cancer specimens and adjacent non-tumorous cervical tissues.The expression of PTK6 was detected using immunohistochemical staining in 150 formalin-fixed,paraffin-embedded,early-stage cervical squamous cell cancer sections and 10 normal cervical tissue sections.Results:The mRNA and protein levels of PTK6 in cancer tissues were higher than those in adjacent non-tumorous cervical tissues.Immunohistochemical analysis showed that PTK6 was not expressed in normal cervical tissues but was overexpressed in the cytoplasm of cervical squamous cell cancer cells.The level of PTK6 expression was significantly associated with tumor grade(P = 0.020).The 5-year overall survival rate of patients with high PTK6 expression was lower than that of patients with low PTK6 expression(81.3%vs.96.2%,P = 0.008).Multivariate Cox regression analysis showed that the expression level of PTK6 in cervical squamous cell cancer was an independent prognostic factor for patient survival(hazard ratio = 5.999,95%confidence interval 1.622-22.191,P< 0.05).Conclusions:PTK6 is overexpressed in cervical squamous ceil cancer.Increased PTK6 expression is associated with reduced 5-year overall survival.PTK6 expression is an independent prognostic predictor for cervical cancer.
基金supported by National Natural Science Foundation of China(81502873)the Natural Science Foundation of Jiangsu Province(BK20150997)+3 种基金Priority Academic Program for the Development of Jiangsu Higher Education Institutions(Public Health and Preventive Medicine)Innovation Fund of State key Laboratory of Reproductive Medicine(SKLRMGC201802)Clinical Medicine Research Fund of the Chinese Medical Association(17020420711)Top-notch Academic Programs Project of Jiangsu Higher Education Institutions(PPZY2015A067)
文摘Long noncoding RNA(lncRNA) HOTAIR and MALAT1 are implicated in the development of multiple cancers. Genetic variants within HOTAIR and MALAT1 may affect the gene expression, thereby modifying genetic susceptibility to cervical cancer. A case-control study was designed, including 1 486 cervical cancer patients and 1 536 healthy controls. Based on RegulomeDB database, 11 SNPs were selected and genotyped by using Sequenom’s Mass ARRAY. Univariate and multivariate logistic regression models were used to calculate the odds ratio(OR) and 95% confidence interval(CI). We found that the A allele of rs35643724 in HOTAIR was associated with increased risk of cervical cancer, while the C allele of rs1787666 in MALAT1 was associated with decreased risk. Compared to individuals with 0–1 unfavorable allele, those with 3–4 unfavorable alleles showed18% increased odds of having cervical cancer. Our findings suggest that HOTAIR rs35643724 and MALAT1 rs1787666 might represent potential biomarkers for cervical cancer susceptibility.
基金This work was supported by National Key Technology Research and Development Program of China(No.2019YFC1005200,No.2019YFC1005202 and No.2018YFC1002103)National Natural Science Foundation of China(No.81802896)Hubei Province Health and Family Planning Scientific Research Project(No.WJ2019M127).
文摘Summary:With delayed childbearing in women,preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma(EOC).Fertility-sparing surgery(FSS)can be considered in patients with early-stage disease in order to preserve fertility and improve quality of life.In order to evaluate oncological safety,attitudes toward childbearing and reproductive outcomes in women with EOC who underwent FSS,this multicenter retrospective study was conducted.Between January 2005 and December 2014,total of 87 young women with FIGO stage I EOC were included,with their clinicopathologic parameters in relation to disease-free survival(DFS)and overall survival(OS)assessed.Attitudes toward childbearing,ovarian function and fertility were studied in women undergoing FSS(n=36).As a result,in contrast to radical sur ery,FSS did not affect prognosis by Kaplan-Meier curves(log-rank test;DFS:P=0.484;OS:P=0.125).However,two of the three recurrence cases and both death cases were in FSS group stage IC.All women undergoing FSS resumed regular menstrual periods after chemotherapy.Only 16(44.44%)had tried to conceive,and 17 pregnancies occurred in 15(93.75%)women.Among 20 women who did not attempt conception,the most common reason was not being married(70%),followed by already having children(15%).In summary,FSS is considered safe in young women with stage IA EOC.Regular menstruation and good obstetric outcomes can be achieved.This study also provides some insight into the attitudes and social factors regarding fertility in EOC patients.
文摘Objective To investigate the clinicopathological characteristics and clinical treatment outcomes of patients with papillary serous carcinoma of the uterine cervix(PSCC).Methods In this study, 4 patients with histologically confirmed papillary serous carcinoma of the uterine cervix were retrospectively investigated. Pap smears, human papillomavirus(HPV) screening, tumor marker status, biopsy analysis, and relevant imaging examinations were conducted for the confirmation of primary diagnosis and recurrence. Patients underwent surgery, chemotherapy, or radiotherapy, and survival were the main endpoint.Results The 4 patients were diagnosed with IB1, IB1, IIA, or IIIB disease. Two patients(2/4) presented with recurrence within 18 months after primary therapy. Compared with chemotherapy alone(progressionfree survival(PFS): 11 months), radiotherapy combined with adjuvant chemotherapy showed favorable PFS rates(PFS: 20, 36, 13 months in 3 cases), although valid statistical analysis was not feasible because of the small sample size. The 5-year survival rate was 0%, and the 3-year survival rate was 75%. Our data, in agreement with the literature evidence, showed that the number of moderate-risk and high-risk factors in patients diagnosed with PSCC at an early stage was higher than that in patients diagnosed with common adenocarcinoma/squamous carcinoma of the uterine cervix.Conclusion PSCC has a poor clinical prognosis, and compared with chemotherapy alone, radiotherapy combined with adjuvant chemotherapy may lead to improved PFS.
文摘BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.
文摘BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are rare.The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established.Here we report a case of a large 10-kg multi-locular ovarian mass,which was successfully laparoscopically removed:Our aim was to innovate the surgical practice in this field by providing a safe,effective,and minimally invasive management method for such complex and rare cases.CASE SUMMARY A 49-year-old nulliparous woman presented with abdominal distension,lasting from six Mo prior to admission;she reported worsening abdominal pain,abdominal swelling,and mild dyspnea.Imaging showed a presumed benign multi-locular(>10 locules)left ovarian cyst that measured about 30 cm in diameter.Based on the IOTA-ADNEX model the mass had a 27.5%risk of being a borderline or malignant tumor.The patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy,followed by the external drainage of the cyst.Tumor spillage was successfully avoided during this procedure.The final volume of the drained mucinous content was 8950 L;the cyst wall,extracted through the minilaparotomy,weighed about 1200 g.The pathologic gross examination revealed a 24 cm×15 cm×10 cm mass;the histologic examination diagnosed a mucinous cystoadenoma.To our knowledge,this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external decompression.CONCLUSION Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.
