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Objective:To investigate the progress and prognosis of cervical high-grade squamous epithelial lesion (HSIL) in pregnancy and its effects on pregnancy outcome.Methods:Eighty-five pregnant women who were complicated by cervical HSIL and accepted prenatal care and delivered in Shanghai First Maternity and Infant Hospital from January 2013 to December 2017 were retrospectively recruited as case group. Another 85 pregnant women without cervical lesions were recruited as control. The progress and outcome of cervical HSIL in the case group and the association with delivery mode were analyzed. The pregnancy outcomes were compared between the two groups by two independent sample t-test, Chi-square test or Fisher's exact test. Results:In the case group, the regression rate of cervical HSIL was 29% (25/85) with 10 cases regressing to low-grade squamous epithelial lesion or atypical squamous epithelial cells of undetermined significance and 15 to chronic cervical inflammation; the persistence rate was 64%(54/85); and the progression rate was 7%(6/85). All six progressed patients gave birth to alive babies and one case progressed to invasive cervical cancer and five to HSIL with micro-invasive cervical cancer after delivery. There was no significant difference in the progression rate [7%(4/60) vs 8%(2/25)], regression rate [32%(19/60) vs 24%(6/25)] or persistence rate [62%(37/60) vs 68%(17/25)] between vaginal delivery and cesarean delivery women ( χ2=0.509, P=0.775). The incidence of premature birth of the HSIL group was higher than that of the control group [9%(8/85) vs 1%(1/85), Fisher's exact test, P=0.017], while there were no significant differences in the incidence of other complications or adverse pregnancy outcomes such as intrauterine fetal death, preterm premature rupture of membranes, low-lying placenta, amniotic fluid contamination of Ⅱ-Ⅲ degree, placental abruption, oligohydramnios and fetal distress between the two groups (all P>0.05). Conclusions:The progression rate of HSIL during pregnancy is low. Thus, a close follow-up could be conducted if invasive carcinoma is ruled out and the postpartum treatment should base on pathological results. HSIL during pregnancy could increase the risk of preterm labor, but is not an indication of cesarean section.
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Objective@#To investigate the sorting effect of p16INK4a/Ki-67 double immunostaining method in patients with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) cytology results.@*Methods@#Four-hundred and twenty cases collected during April 2014 to February 2015 of cervical cytology of ASCUS (n=318) and LSIL (n=102) were selected, and residual liquid-based cytology specimens were used for p16INK4a/Ki-67 double immunostaining. The sensitivity and specificity of the detection of cervical precancerous lesions and cervical cancer were calculated, and the results were compared with high risk HPV. Taking histological follow-up as the gold standard, the test was considered positive when at least one cell exhibited p16INK4a/Ki-67 co-staining, without requirement of adjunct morphologic interpretation of positive cells.@*Results@#Further screening CIN2+ in cytology ASCUS and LSIL group , the sensitivity of p16INK4a/Ki-67 double immunostaining was slightly lower than high risk HPV (84.2% vs. 94.7%), while the specificity was higher (84.0% vs. 53.9%). For ASCUS patients, the sensitivity of p16INK4a/Ki-67 double immunostaining and high risk HPV was 82.6% and 91.3%, and the specificity was 88.8% and 63.7%, respectively. For LSIL patients, the sensitivity of p16INK4a/Ki-67 double immunostaining and high risk HPV was 86.7% and 100.0%, and the specificity was 67.8% and 20.7%, respectively. For patients younger and older than 30 years, specificity of p16INK4a/Ki-67 double immunostaining was both higher than that of high risk HPV (80.8% vs. 42.3%; 84.6% vs. 56.9%).@*Conclusions@#p16INK4a/Ki-67 double immunostaining can effectively identify the high risk population in ASCUS or LSIL, with higher specificity than high risk HPV test. p16INK4a/Ki-67 double immunostaining may benefit patients younger than 30 years of age as a preliminary or potential cytology-combining screening tool.
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Objective To investigate the clinical effect of treating melasma by catgut embedding combined with thunder-fire moxibustion and acupuncture.Methods Between September 2011 to December 2012,82 cases of melasma patients in Acupuncture Department of Tongren Hospital were randomly recruited into test group (42 cases) and control group (40 cases).Test group was treated by catgut embedding combined with thunder-fire moxibustion and other 40 cases of control group were treated by common acupuncture.Then therapy effects were observed 8 weeks after treatments.Results In test group,general efficient rate of 42 cases was 97.6％,cure rate was 23.8％;in control group,general efficient rate of 40 cases was 72.5％,and cure rate was 15％.By statistical analysis,the effect of the test group was obviously higher than that of the control group (P＜0.05).Conclusions The treatment of melasma by catgut embedding combined with thunder fire moxibustion achieves more effective outcomes than common acupuncture.
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Purpose To improve the early correct diagnosis and avoid misdiagnosis of cervical mucinous adenocarcinoma.Methods Twenty-one cases of cervical mucinous adenocarcinoma were reviewed and analyzed retrospectively.The expression of CEA and Ki-67 was detected in the tumor by immunohistochemical staining (LABC method).Results Of the twenty-one cases, three cases (14.3%) were missed out, in which one was missed out by TCT and the others by biopsy; four cases (19.0%) were diagnosed by biopsy as adenocarcinoma in situ with invasion not be excluded, and then further confirmed as invasive adenocarcinoma by LEEP; one case (4.8%) was diagnosed as cervicitis at first and was further detected as adenocarcinoma by LEEP; twelve cases (57.1%) were directly diagnosed as adenocarcinoma by biopsy; one case (4.8%) was diagnosed as adenocarcinoma with unknown origin, and then as cervical adenocarcinoma after hysterectomy. Immunohistochemically, ten cases were CEA positive (47.6%) and the expression of Ki-67 was increased (>20%).Conclusions Understanding of the cytologic and histologic features of adenocarcinoma in cervix might improve its early detection and correct diagnosis, so that timely treatment is guaranteed for patients.
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Objective To clarify the features of malignant ovarian neoplasms arising from ovarian endometriosis Methods A total of 26 women with malignant ovarian neoplasms arising from ovarian endometriosis were analyzed retrospectively Results Dysmenorrhea and pelvic mass were the most common clinical features Among 18 cases who underwent B ultrasound or color doppler ultrasound examination, solid foci in the pelvic masses were found in 10 cases The main histologic types of ovarian malignancy were endometrioid adenocarcinoma and clear cell carcinoma Microscopically atypical endometriosis with the tumors were found in 15 cases International Federation of Gynecology and Obstetrics stage:stage Ⅰ 21(81%)cases,stage Ⅱ 3(12%)cases,stage Ⅲ 2 (8%)cases Conclusions Clinical diagnosis of malignant ovarian neoplasms arising from ovarian endometriosis in early stage is difficult, and B ultrasound examination is more valuable for diagnosis It is suggested that close serutiny of endometrial hyperplasia, cellular atypia and malignancy in ovarian endometriosis be essential to understand the origin and development of malignant neoplasms arising from ovarian endometriosis