Clinical Characterization of Patients with Ovarian Mass Combined with Dysplasia of Secondary Sexual Characteristics / 中国医学科学院学报

Objective To investigate the clinical characteristics of preadolescent and adolescent female patients with ovarian mass combined with dysplasia of secondary sexual characteristics. Methods This study retrospectively analyzed 18 cases of ovarian mass combined with dysplasia of secondary sexual characteristics aged 0-19 years admitted to Peking Union Medical College Hospital from January 2012 to November 2019.By analyzing the clinical manifestations,surgical methods,postoperative pathology,therapies and prognosis of the cases,we summarized the diagnosis and treatment ideas. Results Among the 18 cases,7(7/18,38.9%)developed secondary sex signs before puberty,including 5 cases showing precocity(including 2 cases of juvenile granulosa cell tumor,1 case of gonadoblastoma,1 case of ovarian follicular cyst,and 1 case of 46,XY simple gonadal dysplasia combined with dysgerminoma)and 2 cases presenting masculine manifestations(1 case of steroid cell tumor and 1 case of sclerosing stromal tumor).The rest 11(11/18,61.1%)cases showed abnormal development of secondary sexual characteristics during puberty,including 8 cases with masculine manifestations or abnormal menstruation after menarche(7 cases with sex cord stromal cell tumor and 1 case with cystic granulosa cell tumor),2 cases with primary amenorrhea(1 case with androgen insensitivity syndrome combined with testicular sertoli cell tumor and 1 case with endometriosis cyst combined with reproductive tract malformation),and 1 case diagnosed as 46,XX gonadal dysplasia with serous cystadenoma and no secondary sexual development during puberty. Conclusions Sex hormone levels should be actively tested in the case of prepubertal secondary sexual characteristics appearing early,pubertal secondary sexual characteristics being abnormal(underdevelopment),and/or menstrual abnormalities.Imaging examination should be performed to exclude ovarian organic lesions,and chromosome karyotype analysis should be performed if necessary.The diagnosis of ovarian mass in preadolescent and adolescent females with related symptoms should first be alerted to cord stromal cell tumor.It is recommended to rule out the possibility of combined reproductive tract malformation in the adolescent patients with primary amenorrhea.Chromosome examination should be conducted to rule out the possibility of gonadal dysplasia in the adolescent patients with primary amenorrhea and/or no development of secondary sexual characteristics.

The complete chloroplast genome of the threatened Dipentodon sinicus (Dipentodontaceae)

Dipentodon is a monotypic genus of Dipentodontaceae and the only species, Dipentodon sinicus, is scattered in southwest China as well as adjacent Myanmar, northeast India and northern Vietnam. This species was evaluated as vulnerable in ‘China Species Red List’. Here, we assembled and characterized the complete chloroplast (cp) genome of D. sinicus using Illumina sequencing data for the first time. The complete cp genome was 158,795 bp in length, consisting of a pair of inverted repeats of 26,587 bp, a large single-copy region of 87,233 bp and a small single-copy region of 18,388 bp. The genome encoded 113 unique genes, including 79 protein-coding genes, 30 tRNA genes and four rRNA genes. Phylogenetic analysis based on 16 complete cp genome sequences indicated that D. sinicus is a member of Huerteales, consistent with its position in the latest classification of flowering plants (AGP IV).

Pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios do not predict survival in patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A few inflammatory markers were studied to evaluate their possible prognostic roles in various cancers. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are hypothesized to reflect the systemic inflammation. The objective of the present study was to investigate whether or not the pretreatment neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio can predict the survival of patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.</p><p><b>METHODS</b>We performed a retrospective study on cervical cancer patients (FIGO stage Ib2-IIb) who had undergone neoadjuvant chemotherapy and radical hysterectomy at Peking Union Medical College Hospital between January 1999 and December 2010. Data on demographics, clinical prognostic markers and histopathology were collected and analyzed. Univariate and multivariate analyses for prognostic factors were performed.</p><p><b>RESULTS</b>A total of 111 patients were identified. The median neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were 2.4 and 142.2, respectively. Overall survival and progression-free survival were neither significantly different between patients with high and low neutrophil-to-lymphocyte ratio (P = 0.149 and P = 0.108) nor in high and low platelet-to-lymphocyte ratio (P = 0.336 and P = 0.510). On multivariate analysis, lymph node status (P = 0.000 and P = 0.007) and lymphovascular space involvement (P = 0.001 and P = 0.001) were independent prognostic factors of progression-free survival and overall survival.</p><p><b>CONCLUSIONS</b>Lymph node status and lymphovascular space involvement were found to be independent prognostic factors for patients with cervical cancer who underwent neoadjuvant chemotherapy and radical hysterectomy. The pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios seemed not to predict the survival of patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.</p>

Identification of low-risk indicators of early stage cervical cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the low-risk indicators of early cervical cancer.</p><p><b>METHODS</b>The medical records of 201 patients undergoing radical surgery between March 2000 and April 2011 for staging Ia2,Ib1 (tumor diameter≤2cm) cervix cancer were retrospectively reviewed, with particular focus on the pathological findings [parametrial involvement, positive margin, positive pelvic lymph node, and lymph vascular space invasion (LVSI)], treatment, and outcomes.</p><p><b>RESULTS</b>The operation duration ranged 75-330min (mean:188.87 min) and the intra-operative blood loss was approximately 100-2500 ml (mean: 583.33 ml). Pathology showed the rate of parametrial spread, positive margins, lymph node metastasis, LVSI was 0, 6.97%, 12.44%, and 17.41%. Based on the pathologic findings, the patients were classified as two groups: group A had 147 patients(73.13%) with no neoplasm or tumor diameter ≤2 cm,while group B had 54 patients (26.87%) with tumor diameter > 2 cm. The incidence of ≥ 1/2 cervical stromal invasion, LVSI, positive lymph node, underlying section of uterus involvement, and low tumor differentiation in group A and B were 20.14% vs. 85.19% (p = 0.000), 13.61% vs. 27.78%(p = 0.019), 9.52% vs. 20.37% (p=0.039), 4.82% vs. 14.81% (p=0.008), and 35.37% vs. 44.44% (p=0.025), respectively, with significant differences. Among the 163 patients who were followed up for more than 3 months, 10(6.13%) developed recurrence whereas no patient died.</p><p><b>CONCLUSIONS</b>Pathologic parametrial involvement in clinical stage 1a2 and 1b1 cervical cancer is uncommon. Tumor size and cervical stromal invasion can be used to identify low-risk population that are worthy of consideration for studies of less radical surgery performed in conjunction with pelvic lymphadenectomy.</p>

Primary sarcoma of the ovary: clinicopathological characteristics, prognostic factors and evaluation of therapy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The primary ovarian sarcoma is a very rare malignancy. The objective of this study was to further investigate the clinicopathologic features and outcome in patients with primary sarcoma of the ovary.</p><p><b>METHODS</b>Between 1988 and 2007, 24 patients with primary ovarian sarcoma who underwent treatment at Peking Union Medical Hospital were reviewed retrospectively. Response to treatment, progression and overall survival were analyzed.</p><p><b>RESULTS</b>Patients with ovarian sarcoma had a mean age of (54.3 ± 10.3) years, and 16 of them were postmenopausal. The most common symptom was abdominal pain, present in 14 patients. Of the 24 patients, 16 patients were pathologically diagnosed as carcinosarcoma (known as malignant mixed mesodermal tumor (MMMT)), 2 as ovarian leiomyosarcoma (LS) and 6 patients as ovarian endometrial stromal sarcoma (ESS). The patients in optimal debulking group had a median survival period of 28 months and 1-year survival rate of 71%. The patients in suboptimal debulking group had a significantly lower median survival of 6 months (P = 0.02) and 1-year survival rate of 29%. Among the patients, 23 patients received chemotherapy and most of regimens were based on platinum, 3 patients received chemoradiation. The mean number of courses of combined chemotherapy was 6.6 ± 5.0, and the response was unsatisfactory. The median survival for the entire group was 18.7 months. The one-year survival rate was 58%, and two-year survival rate only 29%.</p><p><b>CONCLUSIONS</b>Ovarian primary sarcoma has a poor overall prognosis. Optimal debulking surgery appears to be of prognostic significance. There is a clear need for further study to explore the role and the regimen of platinum-based chemotherapy in primary ovarian sarcoma.</p>

Prognostic factors and fertility outcomes of borderline ovarian tumors after conservative surgery / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the prognostic factors and fertility outcomes of borderline ovarian tumors (BOT) after conservative surgery.</p><p><b>METHODS</b>The clinical data of 109 patients with BOT who were treated in Peking Union Medical College Hospital from January 1990 to December 2007 were retrospectively analyzed. According to the FIGO staging system,there were 34(31.2%) patients at Stage Ia and Ib, 66 (60.6%) at Stage Ic, 2 (1.8%) at Stage II and 7(6.4%) at stage III. No patient was at Stage 4.</p><p><b>RESULTS</b>Surgical treatment included comprehensive staging surgery (n=40, 36.7%), ovarian cystectomy (n=27,24.8%), and unilateral salpingo-ovariectomy (n=42, 38.5%). The average follow-up period was (60.3±42.5) months. Relapse occurred in 25 patients (22.9%), and the mean duration from therapy to recurrence was (36.1±31.9) months. Only one patient died of BOT. Multivariate analysis showed that surgery procedure and tumor stage were the independent prognostic factors affecting recurrence. Of 66 patients with the desire of fertility, 24 (36.4%) finally got pregnant.</p><p><b>CONCLUSIONS</b>Conservative surgery has comparatively good prognosis and should be the first choice for younger patients with the desire of fertility. The high-risk factors should be evaluated before the initiation of treatment.</p>

Treatment and prognosis of malignant ovarian neoplasms complicating pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the clinicopathological features and prognosis of malignant ovarian neoplasms complicating pregnancy and explore the rational treatment.</p><p><b>METHODS</b>The clinical data of 38 patients with malignant ovarian neoplasms complicating pregnancy were retrospectively analyzed,and the intra-surgical pathological sections were reviewed. International Federation of Gynecology and Obstetrics (FIGO) staging system (1988) was applied.</p><p><b>RESULTS</b>Of these 38 patients,the malignancies included epithelial ovarian cancer (n=9, 23.7%), epithelial borderline ovarian tumor (n=13, 34.2%),ovarian malignant germ cell tumors (n=11, 28.9%), sex cord stromal tumors (n=3, 7.9%), and metastatic tumor from gastrointestinal tracts (n=2, 5.3%). Twenty-seven patients (71.1%) were at stage I. The pregnancy outcomes included termination in the first trimester (n=8), full-term vaginal delivery (n=6), full-term Cesarean section (n=15), and therapeutical Cesarean section for premature birth (n=9). One newborn died,and the remaining 29 survived in a healthy status. All patients underwent surgical treatment,among whom two patients received surgeries during pregnancy. Patients were followed up for (40.5±38.5) months,during which one patient was lost to follow-up, 7 died, 1 survived with tumor, and 29 (76.3%) survived free of tumors.</p><p><b>CONCLUSIONS</b>The management of ovarian malignancies complicating pregnancy should be individualized. Both surgical treatment and chemotherapy are relatively safe in the second and third trimesters. Satisfactory prognosis can be expected after appropriate treatment.</p>

Differentially expressed proteins between normal ovaries and ovarian cancer tissues screened by the protein chips / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the differentially expressed proteins between normal ovaries and ovarian cancer tissues using the protein chips.</p><p><b>METHODS</b>Tissues of 11 epithelial ovarian cancer (EOC) and 11 matched normal ovaries were labeled with cy3 and cy5 fluorescent dyes and then were hybridized with 512 monoclonal protein antibody chips. The internally normalized ratio (INR) was calculated according to the intensity of fluorescence of each protein spots. The value of INR > 2.0 or < 0.7 was considered as the cut-value to filtrate the differentially expressed proteins between tissues of EOC and normal ovaries.</p><p><b>RESULTS</b>Thirty one differentially expressed proteins were found between tissues of EOC and normal ovaries, in which 17 up-regulated and 14 down-regulated proteins involved in the transcription, proliferation, signal conduction, and apoptosis of cells.</p><p><b>CONCLUSION</b>Antibody chips can effectively screen the differentially expressed proteins between normal ovaries and ovarian cancer tissues.</p>

Seven cases of epithelial ovarian carcinoma with brain metastasis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To summarize the clinical characteristics, treatment, and prognosis of brain metastasis in patients with epithelial ovarian carcinoma.</p><p><b>METHODS</b>Retrospective analysis was conducted in 7 cases of brain metastases of epithelial ovarian carcinoma from January 1986 to March 2007 in Peking Union Medical College Hospital for summarizing therapy results and prognosis-affecting factors.</p><p><b>RESULTS</b>Incidence of brain metastases of epithelial ovarian carcinoma was about 0.66% (7/1055). Serous adenocarcinoma was the predominant pathological type in 4 cases and the subsequent was adenocarcinoma in 3 cases. All the patients were diagnosed at late stage, 6 cases with the International Federation of Gynecology and Obstetrics (FIGO) stage IIIc and 1 with FIGO stage IV. The mean duration from diagnosis of ovarian carcinoma to brain metastasis was 32.7 +/- 20.0 months (range, 23-73 months). Single metastasis focus occurred in 43% of cases and multiple metastases in 57% of cases. Fifty-seven percent of patients presented extracranial metastasis. Serum CA125 played a role in monitoring reoccurrence and brain metastases. The average survival time was about 12 months. Better treatment with prolonged survival could be achieved by combination of operation and chemotherapy or combination of radiotherapy with chemotherapy.</p><p><b>CONCLUSIONS</b>As a rare condition, brain metastasis of epithelial ovarian carcinoma is rising in incidence with improved treatment of ovarian carcinoma and prolonged survival. However, brain metastasis indicates bad prognosis which can be improved by combined therapy.</p>

Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical impact of body diffusion weighted imaging (DWI) on the diagnosis and preoperative N staging of cervical cancer.</p><p><b>METHODS</b>Twenty-four patients (mean age 37.9 years old) with proved cervical cancer by cervical biopsy and 24 female patients with other suspected pelvic abnormalities received preoperative body DWI scan. Results of body DWI were compared with pathological findings. The apparent diffusion coefficient (ADC) values of normal cervix and different pathological types of cervical cancer were compared. ADC value of normal or inflammatory lymph nodes was also compared with that of metastatic ones. Student's t test was used for statistical analysis.</p><p><b>RESULTS</b>There were 5 adenocarcinomas and 19 epitheliomas showed with biopsy results, and DWI showed 21 cervical lesions out of them (87.5%). ADC values of the normal cervix (n = 24), epithelioma (n = 19), and adenocarcinoma (n = 5) were (1.73 +/- 0.31) x 10(-3), (0.88 +/- 0.22) x 10(-3), and (1.08 +/- 0.12) x 10(-3) mm2/s, respectively. Statistical analysis showed significant difference in ADC value between normal cervical tissue and either tumor tissues (both P < 0.01). In patients had lymphadenectomy (n = 24), totally 67 lymph nodes including 16 metastatic lymph nodes were pathologically analyzed, and DWI showed 66 (98.5%) out of them. ADC values of normal/inflammatory and metastatic lymph nodes were (1.07 +/- 0.16) x 10(-3) and (0.77 +/- 0.13) x 10(-3) mm2/s (P < 0.01). Receiver operating characteristic (ROC) curve of ADC value of metastatic lymph node showed that area under curve was 0.961.</p><p><b>CONCLUSIONS</b>ADC value in cervical carcinoma is lower than that in normal cervix, and ADC may have predictive value in subtype discrimination. ADC value may improve the preoperative characterization of lymph node metastasis. And at least abdominal and pelvic DWI scan is suggested for N staging evaluation in such patients.</p>

Phase II study of gemcitabine combined with platinum chemotherapy for recurrent epithelial ovarian cancer / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the anti-tumor effect and toxicity of gemcitabine combined with platinum chemotherapy on recurrent epithelial ovarian cancer.</p><p><b>METHODS</b>Phase II study of gemcitabine combined with platinum chemotherapy was carried out in 22 patients with recurrent epithelial ovarian cancer. Median age of patients was 50.5 years old. Seven patients were platinum-sensitive and 15 patients were platinum-resistant or -refractory. All patients received gemcitabine combined with carboplatin or oxaliplatin chemotherapy. Patients' response rate (RR) and toxicity of gemcitabine combined with platinum chemotherapy were evaluated.</p><p><b>RESULTS</b>A total of 98 gemcitabine-based chemotherapy cycles were performed. Total RR was 36.4%, RR of platinum-sensitive patients was 4/7 and platinum-resistant and -refractory patients was 4/15. The estimated median survival time was 10.0 months (95% CI: 7.0-13.0) after initiation of gemcitabine combined with platinum chemotherapy. There was no significant difference in survival time between platinum-resistant/refractory group and platinum-sensitive group (P = 0.061). Side effects of gemcitabine combined with platinum chemotherapy were observed in 81.8% of patients. Grade II/III anemia (54.5%) and grade III/IV neutropenia (54.5%) were most common toxicities. Ten (45.5%) patients had to delay their chemotherapy cycles or reduce the dose of chemotherapeutic drugs because of the severe side effects. Fourteen (63.6%) patients received granulocyte colony-stimulating factor to relieve neutropenia, and 8 (36.4%) patients received component blood transfusion to treat anemia or thrombocytopenia. There was no treat-ment-associated death.</p><p><b>CONCLUSION</b>Gemcitabine combined with platinum chemotherapy appears to be an effective and well-tolerant treatment for recurrent epithelial ovarian cancer, including platinum-resistant or -refractory diseases.</p>

Comparison of three subcategories of laparoscopic hysterectomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the clinical characteristics of three subcategories of laparoscopic hysterectomy: total laparoscopic hysterectomy (TLH) and two subcategories of laparoscopic-assisted vaginal hysterectomy (LAVH): LAVHs and LAVHb.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 393 patients underwent laparoscopic hysterectomy, including TLH (n=178), LAVHa (n=177), and LAVHb (n=38), in our hospital from September 2002 to September 2005.</p><p><b>RESULTS</b>Myoma and adenomyosis of uterus were the most common diseases in this study, accounting for 66.9%, 38.4%, and 52.6% in TLH group, LAVHa group, and LAVHb group, respectively. The mean surgery duration and blood loss were not significantly different between TLH group and LAVHa group (P > 0.05), but were significantly less in TLH group than in LAVHb group (P < 0.05). The bulk of uterus in TLH group was significantly bigger than in other two groups (P < 0.05). The incidence of major complications in the TLH group (9. 0%) was lower than in LAVHa group (14.1%) and in LAVHb group (18.4%), but without statistical significance. Conclusion Compared with LAVH, TLH is feasible to deal with bigger uterus with less blood loss and shorter surgery duration and without more frequent complications.</p>

Treatment options for patients with recurrent ovarian cancer: a review of 54 cases / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the efficacy of treatment options for patients with recurrent ovarian cancer.</p><p><b>METHODS</b>From 1990 to 2000, 54 patients with recurrent ovarian cancer primarily treated in Peking Union Medical College Hospital were selected and reviewed. All the clinical data related to the recurrent tumor were collected. Two-side P values for differences in survival were calculated by the Cox regression model.</p><p><b>RESULTS</b>The platinum-free interval > 6 months and the surgery followed by salvage chemotherapy prolonged survival time of the patients with recurrent ovarian cancer (95% CI = 0.153-0.987, P = 0.047; 95% CI = 1.611-10.914, P = 0.003, respectively). The increased number of chemotherapy cycles ( > 10 months) offered some benefit on the survival (95% CI = 0.110-1.090, P = 0.070). The initiation of treatment and chemotherapy regiments failed to demonstrate an improvement in survival.</p><p><b>CONCLUSION</b>The treatment options for patients with recurrent ovarian cancer depend on the platinum-free-interval of the patients. A strategy of secondary surgical cytoreduction followed by salvage chemotherapy is suggested for the patients with platinum-sensitive disease.</p>

Lymphadenectomy in the treatment of malignant ovarian germ cell tumor / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the impact of lymphadenectomy on the relapse and survival of malignant ovarian germ cell tumor (OGCT).</p><p><b>METHODS</b>The clinical data of 102 OGCT cases treated in Peking Union Medical College Hospital from June 1980 to June 2003 were analyzed retrospectively. All the data about lymphadenectomy during primary and secondary surgery were collected, and other factors related to prognosis were also collected at the same time. Chi-squared test was applied in the univariate analysis related to relapse of disease. Cox model was applied in multivariate analysis related to relapse and survival of disease.</p><p><b>RESULTS</b>Pelvic and paraaortic lymph node metastasis was not significantly related to prognosis in primary and secondary treated patients. Lymphadenectomy showed no significant impact on disease relapse and survival. In the primary treatment, International Federation of Gynecology and Obstetrics (FIGO) staging, chemotherapy regimen, residual tumor and lymphadenectomy were the significant factors related to the relapse. After being stratified for the chemotherapy regimen, lymphadenectomy was not significantly related to the relapse in bleomycin +etoposide +cisplatin or cisplatin +vincristine +bleomycin regimen group, and lymphadenectomy could prevent relapse in no chemotherapy or other chemotherapy regimen group. In relapsed patients, only residual tumor was significantly related to survival time after relapse.</p><p><b>CONCLUSIONS</b>Pelvic lymph node metastasis is not the significant risk factor related to prognosis. Lymphadenectomy may have a beneficial effect on survival, although such effect is not significant. Although lymphadenectomy provides important information for prognosis, they provide little benefit to those patients already requiring chemotherapy based on the original operative findings. Lymphadenectomy should be performed to primary or relapsed patients by an expert surgical team.</p>

Clinicopathological conference: an advanced ovarian carcinoma patient suddenly died of pulmonary embolism / 中国医学科学院学报

A 60 year-old female complained with abdominal distension for one month. Stage IIIc, grade 2 clear cell carcinoma of the ovary was diagnosed after laparotomy. Weekly paclitaxel combined with carboplatin as adjuvant chemotherapy was given after optimal cytoreductive surgery. An acute cerebral infarction after first chemotherapy cycle was developed. The patient presented with dyspnoea after the third chemotherapy cycle and the symptom could be relieved at rest. Such symptom worsened and relieved alternatively for 3 days. A sudden dyspnoea occurred to the patient again when she got up one night, and died of respiratory and circulatory failure on the way to the hospital. Autopsy revealed ovarian clear cell carcinoma with metastasis to the whole pelvic and abdominal cavity and massive pulmonary arterial embolism (the length of embolus is 20 cm) with cerebral infarction. A conclusive remarks was made during the conference that patients who underwent operation and chemotherapy were at high risk for venous thrombosis (VT) and pulmonary embolism (PE). It was important to analyze a patient's individual risk for VT and PE. Appropriate thrombosis prophylaxis ought to be considered highly for high risk patients.