Atypical epithelioid trophoblastic lesions after a cesarean section with cyst and fistula formation:a clinicopathological analysis of 4 cases / 中华病理学杂志

Objective@#To elucidate the clinicopathologic characteristics of atypical epithelioid trophoblastic lesions with cyst and fistula formation after cesarean section.@*Methods@#The clinical and pathological data of 4 cases of post-cesarean atypical epithelioid trophoblastic lesions with cyst and fistula formation diagnosed at Women′s Hospital, School of Medicine, Zhejiang University during April 2007 to June 2018 were evaluated by hematoxylin and eosin stain and EnVision two-step immunohistochemical staining technique.@*Results@#The age of the 4 patients ranged from 32 to 41 years, with a mean age of 36.5 years. Three patients recieved cystectomy and one underwent subtotal hysterectomy. Histologically, the lesions were well circumscribed and consisted of uniform cells of medium size, irregularly enlarged with hyperchromatic nuclei and 1 to 2 inconspicuous nucleoli embedded in abundant hyalinized matrix with fibrinoid material in the center. The cells exhibited immunohistochemical feature of chorionic-type intermediate trophoblastic cells (CK18+, p63+ and CD146-). All patients were alive without recurrence during follow-up of 1 to 40 months (mean=22 months).@*Conclusion@#Atypical epithelioid trophoblastic lesion with cyst and fistula formation after cesarean section has unique histological features, and its biological behavior and prognosis are still unclear, which need further exploration.

Vaginal tubulo-squamous polyp: a clinicopathological analysis of four cases / 中华病理学杂志

Objective@#To investigate clinicopathological characteristics of vaginal tubulo-squamous polyp (TSP).@*Methods@#Clinical and pathological data of 4 cases of vaginal TSP diagnosed at Women′s Hospital, School of Medicine, Zhejiang University from 2007 to 2018 were analyzed by hematoxylin-eosin and EnVision two-step immunohistochemical staining technique.@*Results@#The age of the 4 patients ranged from 62 to 71 years, with a mean of 66 years. Histologically, the polyps consisted of an admixture of squamous epithelium and tubules within a fibrous stroma. Immunohistochemically, the cells lining the tubules showed positive staining of prostatic acid phosphatase (PSAP) and/or prostate-specific antigen (PSA) in all 4 cases. Available follow-up in 3 patients for 4 to 6 months (mean of 5.3 months) showed no tumor recurrence.@*Conclusion@#TSP is an under-recognized benign vaginal polypoid disease that may develop from paraurethral Skene glands.

Effects of pathological assessment of endometrial tissue in fertility-sparing treatment with progestin for endometrial carcinoma of stage Ⅰ a and complex atypical hyperplasia / 中华妇产科杂志

Objective To assess the efficacy and pathological change of fertility-sparing treatment with progestin for endometrial carcinoma (EC) of stage Ⅰ a and complex atypical hyperplasia (CAH) and to observe the prognosis of the treatment.Methods Nine EC patients of stage Ⅰ a and 21 CAH patients aged under 40 years who desired childbearing and retaining their fertility were enrolled into this study.All patients were given a daily oral high-dose of progestin with duration of treatment ranging from 6 to 9 months.Diagnostic curettage was performed every 3 months as a modality for seeing the histologic change of neoplastic tissues and endometrial tissue.A careful and long-term follow-up is necessary for patients with complete response (CR).Results During the first period of fertility-sparing management,according to histologic change,5 EC patients and 18 CAH patients showed CR with no evidence of endometrial adenocarcinoma or hyperplasia,2 EC patients and 2 CAH patients showed partial response with a regression to complex or simple hyperplasia without atypia,2 EC patients and 1 CAH patient showed stable disease or progressive disease.Accordingly,a total of 26 patients showed CR (26 of 30 patients).The median time to CR was 6 months (range,3 to 21 months) of progestin treatment.The median follow-up time was 55.5 months (range,24 to 104 months) and all patients were alive.During follow-up,among the 26 patients with CR,3 of 6 EC patients achieved CR recurred disease after a median time interval of 10 months (range,6 to 51 months),7 of 20 CAH patients achieved CR had recurrent disease after a median time interval of 12 months (range,6 to 55 months).Four of 7 CAH with recurrent disease achieved CR to progestin retreatment.Eight of 26 patients achieved CR continued a further 3 or 6 months of consolidation therapy,3 of them had recurrent disease,the remaining 18 stopped progesterone treatment after CR and 7 patients had recurrent disease; there was no significant statistical difference between the two groups (P=1.000).EC patients succeeded in 4 pregnancies,CAH patients succeeded in 10 pregnancies,they gave birth to 16 healthy babies in all.Conclusions EC of stage Ⅰ a and CAH had slow progression of symptoms.Progestin treatment in EC of stage Ⅰ a and CAH patients was effective.A careful and long-term follow-up is required because of the substantial high rate of recurrence.Progestin re-treatment in most patients with recurrent endometrial cancer is effective and safe.

Recurrent Müllerian adenofibroma of uterus: a clinicopathologic study of 7 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and differential diagnosis of recurrent Müllerian adenofibroma (MAF) of the uterus.</p><p><b>METHODS</b>Clinicopathologic information of 7 cases of recurrent MAF of uterus was retrieved from January 1992 to April 2006 and compared with 12 cases of MAF without recurrence and 14 cases of low-grade Müllerian adenosarcoma (MAS). EnVision immunohistochemistry of estrogen receptor (ER), progesterone receptor (PR), smooth muscle actin (SMA), CD10, Ki-67 and p53 were performed in all cases.</p><p><b>RESULTS</b>All cases of recurrent MAF of the uterus were polypoid, lobulated, and broad based mass arising from the corpus or cervix. Microscopically, the tumor consisted of benign epithelial and mesenchymal components with low mitotic activity ( ≤ 1/10 HPF). The clinical and pathologic features of 3 recurrent tumors were similar to their primary tumors, while 4 cases of recurrent tumor presented with focally higher cellularity and mitotic activity, meeting the diagnostic criteria of adenosarcoma. The stromal expression patterns of ER, PR, SMA and p53 in recurrent MAF were similar to those of clinically benign MAF and low-grade MAS. Negative or focally positive stromal cell expression of CD10 was seen infrequently in recurrent MAF (1/7) and clinically benign MAF (1/12). In contrast, a moderate to strong CD10 staining was frequently seen in MAS (9/14, P < 0.05). The difference of Ki-67-labeling index between MAF and MAS did not reach a statistical significance (P > 0.05). Ki-67-labeling index increased in areas of periglandular stromal cuffing as compared with interglandular areas in all MAS cases, but it was not observed in either recurrent MAF or clinically benign MAF cases.</p><p><b>CONCLUSIONS</b>Recurrent MAF may be associated with aggressive behavior. It is difficult to distinguish MAF from low-grade MAS. CD10 and Ki-67 staining pattern in stromal cells may be helpful for the differential diagnosis.</p>

Preliminary study on the relationship between tubal intraepithelial carcinoma of the fimbria and pelvic high-grade serous carcinoma / 中华妇产科杂志

Objective To explore the relationship between tubal intraepithelial carcinoma (TIC) of the fimbria and pelvic high-grade serous carcinoma.Methods All 34 cases of pelvic high-grade serous carcinoma with clear fimbria were evaluated from January 2009 to June 2010,including ovarian carcinoma (n=26),tubal carcinoma (n=7) and peritoneal carcinoma (n=1).Among of these ovarian carcinomas,12 cases were surface deposits and the other 14 cases within ovarian parenchyma.All 42 cases of non highgrade serous carcinoma in this period including 13 endometrioid ovary carcinomas,11 clear cell ovary carcinomas,11 mucinous ovary carcinomas,6 low-grade serous ovary carcinomas,1 low-grade serous tubal carcinoma,were also collected as a reference.The presence of tubal intraepithelial carcinomas was assessed.Based on the presence of TIC,high-grade serous ovary carcinomas were divided into TIC positive (+) and TIC negative (-) groups,and the clinical and pathological features of them were also evaluated.Results Fifteen cases (44％) were identified TIC in 34 high-grade pelvic serous carcinomas,and all of them were in the fimbria only,while none of TIC was found in control cases.There were significant difference between the two groups (x2=23.086,P=0.000).Eleven cases(42％) were identified TIC in all 26 high-grade ovarian serous carcinomas,in which 8 cases with unilateral ovary carcinomas were associated with ipsilateral TIC,2 cases with bilateral ovary carcinomas associated with unilateral TIC and one case with bilateral ovary carcinoma was associated with bilateral TIC.Four TIC (4/7) were identified in 7 cases with high-grade tubal serous carcinomas,and there was no presence of TIC in the 1 high-grade serous peritoneal carcinoma.Of all 26 high-grade ovarian serous carcinomas,6/11 cases were surface deposits,and 5/11 were parenchyma tumors in TIC (+) group while 6/15 cases were surface deposits and 9/15 were parenchyma tumors in TIC (-) group,in which there were correlated in distribution of TIC between the two groups( P＞0.05 ).The average diameter of ovarian cancer were 6.9 and 6.5 cm between the two groups with no significant differences ( t=0.409,P=0.690).Conclusion TIC is specific to high-grade serous carcinomas and maybe have something to do with the pathogenesis of pelvic serous carcinomas.

Morphological observation of cone biopsy and hysterectomy specimens of high-grade cervical intraepithelial neoplasia / 中华妇产科杂志

Objective To study the histopathologieal features,growth pattern and distribution on the uterine cervix of high-grade cervical intraepithelial neoplasia(CIN).Methods Cone biopsy and hysterectomy specimens of 592 women with hish.grade CIN(CIN Ⅱ or Ⅲ)were reviewed morphologically.Of all cases.the gross appearance of the external os was recorded,and the frequency of eervical quadrants involved in hish-grade CIN was assessed.Two hundred specimens were selected randomly to observe micrographieal changes,including the extent,depth,growth pattern and cell types of hish-grade CIN and the alteration of stroma surrounding CIN.Results Of 592 specimens,external os showed smoothness in 46 cases(7.8%),mild erosion in 151 cases(25.5%),moderate or severe erosion in 395 cases(66.7%),hypertrophy in 48 cases(8.1%),and neoplasm in 4 cases(0.7%).Higll-grade CIN involvement was equally frequent on each quadrant of cervix(P>0.05).Of 200 cases of hish-grade CIN reviewed micrographically,the depth of the deepest involred crypt was le88 than 3 mm in 188 specimens (94.O%).between 3 to 5 nnn in 12 specimens(6.O%),and more than 5 mm in none.High-grade CIN with isolated endocervieal crypt involvement was detected in 77 cases(38.5%),multiple crypt involvement in 143 cases(71.5%).and confluent crypt involvement in 73 cases(36.5%).Hish-grade CIN showed explanate in 81.0%(162/200)of cases,endophytie in 49.0%(98/200)of cages,and exophytic in 6.5%(13/200)of cases.Abrupt transition between CIN and normal epithelia were found in 167 specimens (83.5%),whereas gradual transition in 66 specimens(33.0%).A variety of cell types,but basaloid type predominantly.were observed in hiSh-grade CIN.In 28.5%-45.0%of ca8es,the stroma surroundin CIN displayed oedema,desmoplastic and lymphocytic responses.Conclusions Our data suggest that gross examination is of little importance for diagnoses of CIN.CIN trend to spread horizontally and Mong the endocervical crypts,and are mainly distributed to a depth less than 3 nLrn.These data also suggest that there are a variety of cell types of CIN,and stroma responses to CIN may exist in part of high-grade CIN.

Case report and literature review of epithelioid trophoblastic tumor / 中华妇产科杂志

Objective To evaluate the clinical characteristics of epithelioid trophoblastic tumor (ETT).Methods Six cases of ETT treated in Women's Hospital,School of Medicine,Zhejiang University from 2005 to 2007 were retrospectively analyzed,together with a literature review.Results Six cases of ETT were diagnosed pathologically after surgery.The age of patients ranged from 27 to 46 years.The most common presentation was abnormal vaginal bleeding(5/6).The preceding gestational events were hydatidiform mole in 1 case,abortion in 2 cases,and term delivery in 3 cases.The interval between the preceding gestation and the diagnosis of ETT ranged from 15-48 months.The serum human chorionic gonadotropin(hCG)level was 46-121 147 IU/L.Four cases presented with metastasis,including lung metastasis in all of the 4 cases,liver metastasis in 1 case,and pancreas metastasis in another 1 case.The main therapies were surgery combined with chemotherapy.All of the 6 cases received total abdominal hysterectomy.and 1 case also had lung lobectomy.One ease had a recurrence but refused any treatment again,and was lost to follow up;the therapy of 1 case unfinished;another 4 cases were without evidence of disease 9 to 19 months after surgery.Condusions The confirmation of ETF diagnosis is difficult before surgery.Surgical management is mostly recommended in ETT. The role of chemotherapy in ETT is not clear yet.

Fas and Fas-L expression in human adenocarcinoma of uterine cervix / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the significance of Fas and Fas-L expression in adenocarcinoma of uterine cervix.</p><p><b>METHODS</b>Both carcinoma tissue and their surrounding tissues from 36 patients with adenocarcinoma of uterine cervix, previously untreated either by radiation or chemotherapy, were studied for the expression of Fas and Fas-L by immunohistochemical stain with DNA apoptosis fragment detected by TUNEL.</p><p><b>RESULTS</b>The TUNEL labeling index was negatively correlated with differentiation of adenocarcinoma of cervix. Compared to highly differentiated and moderately differentiated tumor, the TUNEL labeling index was reduced obviously in poorly differentiated adenocarcinoma (P < 0.01). Fas expression was detected in 31 cases (86%) while there were only 3 weakly stained in the normal endocervical glands around the carcinoma. The 5 unstained carcinomas were 3 highly differentiated and 2 moderately differentiated. The positively stained Fas was associated with differentiation; the stronger the stain, the less differentiation there was. The Fas-L expression was detected in all adenocarcinomas while there was only 1 weakly stained in the normal ones. No significant difference was found in the expression of Fas-L in carcinomas with different degrees of differentiation. No correlation was observed between Fas and Fas-L expression.</p><p><b>CONCLUSIONS</b>The Fas expression is positively correlated with the different degrees of differentiation and Fas-L expression may be associated with the escape from of immunal surveillance.</p>

Placental expression of epidermal growth factor receptor in pregnancy induced hypertension / 中华妇产科杂志

0 1, for both). Conclusion Decreased expression of placental EGFR was found in women with PIH, and that may play a role in the pathogenesis of PIH.