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Objective To investigate clinicopathological features of abdominal wall endometriosis(AWE).Methods A retrospective study was conducted on 151 consecutive AWE patients undergoing treatment in Affiliated Obstetrics and Gynecology Hospital,Fudan University from January 2003 to December 2010.The period of following up was at range of 16 to 97 months.Results(1)The incidence of AWE was 1.96％(166/8469).All 151 AWE cases followed up had previous cesarean sections.The period between the previous cesarean section(CS)and the onset of symptoms of AWE was 24 months(3-192 months).However,the latency was not associated with the age at CS,incision site,gestational week at CS,duration of lactation,postpartum menstruation recovery,the choice of contraceptives and size of AWE(P ＞ 0.05).The duration of disease,defined to be the time interval between the onset of symptoms and surgery,was 26 months(2-168 months),which was negatively correlated with the latent period(r =-0.267,P ＜ 0.05)and was positively with size of AWE(patients with large-scar endometrioma with diameter of lesions ≥ 3 cm had longer disease duration than those with small-scar endometriomas ＜ 3 cm,r =0.326,P ＜ 0.05).(2)The rate of pre-operational ultrasonography detection was 97.4％(147/151).The lesion size detected by pre-operative ultrasonography was significantly smaller than that measured intraoperatively by palpation (20 mm versus 35 mm,P ＜ 0.05).Moreover,only 26.5％(40/151)of AWE patients were found to have deep infiltration by pre-operative ultrasonography.(3)All patients were managed by surgical treatment to completely excise lesions on the abdominal wall.Of all 34 patients(22.5％,34/151)took medicine preoperatively while 57 patients(37.7％,57/151)taking medicine post-operatively.The rate of recurrence was 3.1％(3/96)of cases with lesions ≥3 cm,which was significantly lower than 17.8％(8/45)in cases with lesion ＜ 3 cm(P ＜ 0.05).(4)After surgery,the symptoms were found to be relieved in 93.4％(141/ 151)of patients.The recurrence rate was 7.8％(11/141)while the average recurrent time was(20 ± 16)months.Conclusion Surgery is the main management on AWE.The risk factors associated with recurrence were size of lesion and postoperative medication.
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Objective To evaluate the short-term effect of leuprorelin acetate microspheres in preventing recurrence of ovarian endometrioma after conservative surgery.Methods From January 2011 to September 2011,190 ovarian endometrioma patients undergoing conservative laparoscopic surgery at Affiliated Obstetrics and Gynecology Hospital Affiliated to Fudan University were enrolled in this retrospective study.Among 184 patients were followed up,the range of following up were 12 to 21 months.116 cases presented dysmenorrheal.Based on postoperative treatment,they were classified into 124 cases treated by domestic gonadotropin releasing hormone agonist (GnRH-a) post-operatively for 3-6 months and 60 cases without postoperative treatment.Among all,63 patients were treated with,that was leuprorelin acetate microspheres for injection (Beiyi,3.75 mg,q28 d),61 patients were treated with imported GnRH-a post-operatively for 3-6 months,that were either Zoladex (3.6 mg,q28 d),Dophereline (3.75 mg,q28 d) or Enatone (3.75 mg,q28 d).The recurrence and pain improvement were compared among those groups.Results (1) The total rate of cyst recurrence was 12.5％ (23/184) while the average recurrent time was (13.7 ±2.6) months (2-21 months).The cyst recurrence rate was significantly lower in patients treated with GnRH-a post-operatively than those who didn't take medications [21.7％ (13/60) versus 8.1％ (10/24),P ＜ 0.05].However,there was no significant difference between domestic GnRH-a group and the imported one [7.9％ (5/63) versus 8.2％ (5/61),P ＞ 0.05].(2) After conservative surgery,symptoms were found to be relieved in 87.1％ (101/116) patients among 116 patients complaining of dysmenorrheal preoperatively and the pain recurrence rate was 12.9％ (13/101).However,there was no significant difference in either symptom relief rate or pain recurrence rate among different groups.The symptom relief rate were 87％ (33/38),86％ (37/43) and 89％ (31/35) while the pain recurrence rate were 12％ (4/33),14％ (5/37) and 13％ (4/31) respectively in none,imported GnRH-a group and domestic GnRH-a group.Conclusions Leuprorelin acetate microspheres could be effective in preventing recurrence of ovarian endometrioma,but not in symptom relieving after conservative surgery in short term.The effect of domestic and imported GnRH-a was similar.
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Objective To profile methylation alterations of cytosine-phosphate-guanosine islands (CGI)in epithelial ovarian cancer and investigate its applications for finding new candidate tumor markers.Methods Cancer cells were obtained by lager microdissection from 20 tissues of frozen-preserved epithelial ovarian tumors.Primary cultured epithelial cells were isolated from 5 tissues of normal ovaries.Differential methylation hybridization(DMH)based on microarray assay Was conducted using DNA to construct the aberrant DNA methylation pattern of epithelial ovarian cancer.MethyLight was conducted to verify the methylation status of 7 hypomethylated promoter CGI detected by DMH in tumor tissues of 87 patients with epithelial ovarian cancer and 42 patients with benigh ovarian diseases.Results The aberrant DNA methylation pattem of epithelial ovarian cancer were included 182 hypermethylated loci and 64 hypomethylated loci,of which the positive loci located more than 25%arrays were 18 and 31,respectively.The methylation ratio of gene LSM2,EGFLAM and CDKN2A in tissue DNA of patients with epithelial ovarian cancer and benign ovarian diseases Was 11%(10/87)versus 33%(14/42),8%(7/87)versus 21%(9/42),9%(8/87)versus 31%(13/42),respectively,which Was significantly decreased in tissues DNA of ovarian cancer than that from benigh ovarian diseases(P＜0.05).Conclusions The aberrant DNA methylation pattern of epithelial ovarian cancer is important for finding new cancer related genes.The promoter CGI of gene ISM2,EGFIAM and CDKN2A may be Hovel candidate for ovarian cancerspecific hypomethylated tumor markers.
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Objective To investigate clinicopathological features of endometriosis-associated epithelial ovarian carcinoma.Methods Retrospective follow-up study,clinicopathological data from patients with ovarian epithelial carcinoma were retrieved,analyzed and compared.Among the 727 cases,34 were found to originate from endometriosis (group A),33 were found to have co-existing ovarian endometriosis (group B),and the remaining 660 had no ovarian endometriosis at all (group C).Result Seven hundred and twenty-seven epithelial ovarian carcinoma patients were identified and their ehnicopathological data retrieved.Sixty-seven (9.2%) of these cases were found to have coexisting endometriosis.The frequency of malignant tumors arising from ovarian endometriosis in this case series was estimated to be 0.87% (34/3890).The mean (standard deviation) age in groups A,B,and C were(47.2±1.3),(47.8±1.2),(51.2±0.4) years,respectively,with patients in group C being significantly older (P = 0.013).Patients with coexisting ovarian endometriosis were mostly diagnosed at stage Ⅰ (P = 0.000)and having subtype of clear-cell (P =0.000),while other patients were mostly diagnosed at stage Ⅲ (P =0.001),and having subtype of serous carcinoma (P =0.000).The estrogen receptor (ER) positivity was significantly lower in groups A and B than that in group C (22.2%,31.6% vs 43.9%;P =0.018),but the difference in positivity of progestogen receptor among the three groups did not reach statistical significance (22.2%,15.8% vs 35.5%;P =0.082).While the five-year overall survival rate for all patients was 55.6%,significant difference in overall survival among the three groups was found 78.9%,92.8%,51.9%,respectively,for groups A,B and C (P =0.000).Conclusion Patients of endometriosis-associated epithelial ovarian carcinoma,especially patients with tumors arising from endometriosis,were found to be younger,having a significant lower stage and a better survival,and were mostly diagnosed with the subtype of clear-cell.
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Objective: To evaluate the frequency of MSI in epithelial ovarian tumors and its relationship with clinicopathologic features. Methods: Ninety fresh specimens of epithelial ovarian tumors, including 74 primary and 16 secondary tumors, were collected. Microsatellite analysis was carried out using 5 mono- and dinucleotide markers from the National Cancer Institute Consensus Panel by fluorescence-labeled polymerase chain reaction. Results: Of 90 epithelial ovarian tumors analyzed, 18 demonstrated a high level of microsatellite instability (MSI-H), 30 demonstrated a low level of microsatellite instability (MSI-L), and the remaining 42 exhibited microsatellite stability (MSS). Frequency of microsatellite instability (MSI) at loci BAT-25 was higher than that at any other loci. No correlation was found between MSI level and patient age, tumor type, tumor differentiation (P>0.05). But the microsatellite instability-high phenotype correlates with clinical stage.It tended to occur more frequently in early-stage tumors (P=0.03). Conclusion: The frequent MSI in epithelial ovarian tumors suggests that it is an early event to involve in the development of epithelial ovarian tumors.
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Objective:This study investigated the prognostic significance of age at diagnosis, stage, tumor subtype, pelvic lymph node metastasis (PLNM), lymph-vascular space involvement (LVSI), presence or absence of deep cervical stromal invasion (DCSI) in stage ⅠB-ⅡA cervical cancer patients. It also investigated the inter-relationship among these factors. Methods: 152 patients treated with radical hysterectomy plus pelvic lymphadenectomy were followed up for a median of 49 months and were evaluated retrospectively. Results: The 5-year overall survival rate was 84.8%. The distribution of age at diagnosis is of bimodal shape, peaking at 42 and 68 years, respectively. Tumor subtype, PLNM, DCSI, and LVSI were found to be significant prognostic factors individually. After multivariate analysis, only tumor subtype and PLNM were found to be independent, significant prognostic factors for survival. The prognostic importance of LVSI appeared to be eclipsed by the presence of PLNM. DCSI was statistically related with FIGO stage, LVSI and PLNM. Conclusion: Tumor subtype and PLNM are the two most important independent prognostic factors for stages ⅠB-ⅡA cervical cancer. Some prognostic factors are inter-related and may reflect different facets of tumor progression.
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Objective To compare the efficacy of transcervical resection(TCRC)and loop electrosurgical excision procedure(LEEP)for the treatment of cervical intraepithelial neoplasia grade I(CINⅠ).Methods A total of 231 CIN I patients were divided into two groups according to their patient number to receive TCRC or LEEP.The resected specimens were sent for pathological diagnosis and human papilloma virus(HPV)-16/18 test.Results No significant difference was found in the operation time[(14.1?2.2)min vs.(13.8?2.1)min],rates of wound infection and cervical stricture[1.7%(2/115)vs.1.7%(2/116)and 0.9%(1/115)vs.1.7%(2/116)],and rates of cure and recurrence [99.1%(107/108)vs.99.1%(108/109)and 0.9%(1/108)vs.0.9%(1/109)] between the TCRC and LEEP groups(t=1.060,P=0.290;?2=0.000,P=1.000;?2=0.000,P=1.000;?2=0.000,P=1.000;?2=0.000,P=1.000).In the TCRC group,the surgical wound was healed in(5.0?0.6)weeks,which was significantly shorter than that in the LEEP group[(5.2?0.7)weeks,t=-2.331,P=0.021].The patients who had severe endocervicitis in both the groups had similar rate of residual endocervicitis[16.7%(2/12)vs.53.8%(7/13),Fisher's test:P=0.097].In both the groups,one patient respectively showed residual lesion after the procedure,in whom HPV-16 and/or HPV-18 were detected.Conclusions Both TCRC and LEEP are effective for CINI.LEEP is easier to master than TCRC.Closed follow-up is essential of the with patients positive HPV-16 or-18.
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Objective: Analyzing the protein expression of biomarkers CK7, Vim, and P53 to investigate their possible pathogenic roles in the development of variant subtypes of endometrial carcinoma. Methods:Biomarkers CK7, Vim, and P53 were immunohistochemistry-stained among 131 endometrial carcinoma specimens including 93 endometroid, 8 adenoacanthoma, and 32 rare subtypes of adenosquamas carcinoma, clean cell carcinoma, and papillary carcinoma, which had been confirmed clinically and pathologically, and studied statistically with Fisher test and Cochran-Mantel-Haenszel (CMH) Test. Results: Positive correlation was demonstrated among CK7, Vim, and P53 expression levels. The CK7 protein expression is increased, while the Vim and P53 are decreased in the subtype of endometrioid carcinoma. The clinical staging of endometriroid carcinoma is positively correlated with the expression of Vim. The positive rate of Vim and P53 is correlated with cytological differentiation of the carcinoma cells. Conclusion:Biomarkers CK7, Vim, and P53 are playing pathogenic roles, assuming as a mutual transcriptional modulator, and Vim but not P53 is likely the favorable prognostic factor, in the development of variant subtypes of endometrial carcinoma in addition to a evaluating the treatment.
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Objective To investigate the efficiency of antitumor immune responses induced by a controlled live dendritic cell(DC)vaccine Methods DC precursors were isolated from Fischer 344 rat bone marrow and cultured with granulocyte macrophage colony stimulating factor and interleukin 4 The rat ovarian tumor cell line NuTu 19 was genetically modified by retroviral mediated suicide gene(HSV 1 TK), and the positive clones were selected using G418 Live DC vaccine was then fused with DC and NuTu 19/TK cell by polyethylene glycol The characteristics of live DC vaccine were assayed with flow cytometry and confocal laser scanning microscopy The specific expression of HSV 1 TK gene in live DC vaccine was evaluated by RT PCR and western blot The sensitivity of live DC vaccine to ganciclovir (GCV) was evaluated by methylthiazoletetrazolium assay In vivo, rats vaccinated twice with live DC vaccine were compared to those vaccinated with killed DC vaccine, unfused DC and NuTu 19/TK cell or phosphate buffered saline Seven days following the last immunization, the rats were sacrificed to test the specific cytotoxic T lymphocyte (CTL) activity by lactate dehydrogenase release assay, or challenged with NuTu 19 and tumor incidence was observed Results The fusion efficiency was approximately (23?14) Live DC vaccine displayed an up regulated expression of major histocompatibility complex (MHC) IIOX6 (87 6?3 4)%, costimulatory molecule B 1 2 (71 1?9 3)%, integrin OX 62 (68 0?7 4)%, and adhesion ICAM 1 (77 1?2 0)%, and specifically expressed HSV 1 TK gene. Our data showed that spleen T lymphocytes from rats vaccinated with live vaccine displayed enhanced CTL aetivity (61 8?8 3)% contrast to that of rats vaccinated with killed vaccines (26 0?3 8)% ( P
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0 05). The correct diagnosis before operation was 0 percent, 63 6% of the patients was diagnosed during operation ( P