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BACKGROUND: The anatomical structure of cervical spine is complex, and the important structures of blood vessels, nerves, esophagus and trachea are adjacent to the tumor. The operation is difficult. OBJECTIVE: To explore the application of three-dimensional (3D) printing model in surgical resection and reconstruction of cervical tumor. METHODS: Eleven patients with cervical tumors, who were treated in the Gansu Provincial Hospital from September 2016 to December 2018, were selected, including 7 males and 4 females, at the age of 35-68 years. Eleven patients were scanned by cervical CT before operation. The image information obtained by CT was saved in DICOM format, and then the data were imported into Mimics 3D modeling software to reconstruct the 3D model. Finally, the reconstruction results were imported into the 3D printer in STL format, and the 1 ∶ 1 anatomical model was printed layer by layer according to the 3D model. According to the 3D printed model, the surgical resection and reconstruction plan of cervical tumor was made. After 6-12 months of follow-up, the visual analogue scale score and Oswestry dysfunction index were compared before and after surgery. This study was approved by the Ethics Committee of Gansu Provincial Hospital. RESULTS AND CONCLUSION: (1) Eleven cases were operated successfully, and no serious complications such as spinal cord, nerve root and vertebral artery injury occurred; postoperative X-ray reexamination showed that the lesion site was completely removed, and the implant was in a good position without loosening. (2) The visual analogue scale score and Oswestry dysfunction index of eleven patients were significantly improved in 1 week, 1 and 3 months after operation (P < 0.05). (3) The results showed that 3D printing model could make a complete resection and reconstruction plan before operation, including the specific resection scope, fixed segment, screw and steel plate size, familiar with the anatomical relationship between the focus and the surrounding tissue, avoid the injury of important nerves and blood vessels during operation, reduce the risk of operation and improve the clinical effect.
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Resumen ANTECEDENTES: Los quistes de Naboth son tumoraciones benignas del cuello uterino, casi siempre son asintomáticos, por excepción son gigantes y de localización intraabdominal. CASO CLÍNICO: Paciente de 44 años, acudió a consulta debido a sangrado uterino anormal de 7 años de evolución, flujo transvaginal hialino abundante y continuo, sensación de pesantez pélvica, aumento del tamaño abdominal y dificultad para orinar. En la exploración física el abdomen se encontró blando, depresible, el útero no delimitado, con el anexo derecho aumentado de tamaño. La tomografía abdominopélvica reportó una lesión compleja en el anexo derecho. Debido a la sospecha diagnóstica de tumoración del anexo, dependiente del ovario, se solicitaron los marcadores tumorales Ca 125 que se reportaron con valores en límites normales; la citología cervicovaginal fue negativa para displasia. En la laparoscopia se encontró integridad de los anexos y útero macroscópicamente normal, con un quiste en la cara anterior, adherido al espacio paravesical. De la cistectomía con punción del quiste se obtuvo material mucinoso, se observó comunicación entre el quiste y el canal vaginal de aproximadamente 6 cm. Con base en esos hallazgos se decidió la histerectomía total por vía abdominal. El reporte histopatológico fue de: quiste complejo de Naboth, profundo hasta la pared en el segmento y parametrios, sin evidencia de malignidad. CONCLUSIONES: Los quistes gigantes de Naboth son sintomáticos, de origen compresivo y abundante descarga vaginal. Debe sospecharse entre las tumoraciones anexiales; el diagnóstico definitivo se establece por histopatología.
Abstract BACKGROUND: Naboth cysts are benign tumors of the uterine cervix, usually asymptomatic, exceptionally present as giant cysts and rarely intra-abdominal location. CLINICAL CASE: A 44-year-old female who came to present with abnormal 7-year-old uterine bleeding, a feeling of pelvic heaviness, an increase in abdominal size, difficulty in urination and the presence of abundant and continuous transvaginal hyaline flow. On physical examination, a depressible soft abdomen, an unmarked uterus, with an enlarged right appendix was found. Abdominopélvica computed axial tomography reported a complex lesion in the right annex. An annex tumor was suspected, mainly ovarian-dependent, so tumor markers Ca 125 were requested with values within normal ranges, cervicovaginal cytology was negative for dysplasia. Laparoscopy was performed finding the integrity of the annexes and macroscopically normal uterus with presence of cyst in the anterior face adhered to the paravesical space, cystectomy was performed with puncture of the cyst obtaining mucinous material, communication was observed between the cyst and the vaginal canal of approximately 6 cm, So it was decided to perform total hysterectomy via abdominal. The histopathological report: complex cyst of deep Naboth to wall in the segment and parametria without evidence of malignancy. CONCLUSIONS: Naboth´s giant cysts usually cause symptoms especially of compressive origin and abundant vaginal discharge, it should be suspected among the adnexal tumors, the definitive diagnosis is made by histopathology.
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El tumor desmoides es un tumor benigno raro, de origen fibroblastico no inflamatorio, algunas veces referido como fibromatosis no agresiva. Su etiología aún no está completamente clara, sin embargo, se asocia habitualmente a trauma previo y/o procedimientos quirúrgicos. La ubicación más frecuente es abdominal, el cual posee características imagenologicas claras, al igual que su presentación musculo esquelética plantar. La presentación fuera de estos lugares es infrecuente y difícil de diagnosticar. Presentamos un caso de un tumor desmoides cervical que genero un gran desafío diagnóstico, identificando sus claves diagnósticas y realizando una revisión de la bibliografía al respecto para esta ubicación.
Desmoid tumours are a rare benign tumour of fibroblastic non inflammatory origin, sometimes referred as non aggressive fibromatosis.The etiology is not yet completely clear, however, it is usually associated with previous trauma and / or surgical procedures. The most frequent location is in the abdomen, which has typical images characteristics, as well as its skeletal muscle presentation at the plantar level. The presentation outside these places is infrequent and difficult to diagnose. We present a case of a cervical desmoid tumour that generated a great diagnostic challenge, identifying its key imaging characteristics and performing a literature review of the bibliography regarding this location.
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Humans , Male , Adult , Fibroma/surgery , Fibroma/diagnostic imaging , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Fibroma/pathology , Head and Neck Neoplasms/pathologyABSTRACT
OBJECTIVE: To analyze the distribution and pathogenicity of 27 HPV(Human papillomavirus)subtypes in cervical lesions.METHODS: A retrospective analysis was carried out in 5735 patients with cervical lesions admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2015 to July 2017,including 997 cases of cervicitis,1568 cases of LSIL(low-grade squamous intraepithelial lesion),2576 cases of HSIL(high-grade squamous intraepithelial lesion)and 594 cases of cervical cancer. The HPV subtypes,histopathological results and ages were obtained for analysis.RESULTS: The positive rates of HPV in cervicitis group,LSIL,HSIL group and cervical cancer group were 57.0%,78.3%,90.5%,and 93.9%(P<0.05)respectively. The five most prevalent HPV types in cervicitis and LSIL group were 52,53,16,58 and 18;in HSIL and cervical cancer they were 16,52,58,33 and 18. The cumulative attribution rates of HPV16,18,58,52,33,31 and 45 in cervicitis,LSIL,HSIL and cervical cancer were 22.2%,38.4%,68.4% and 80.1%,respectively. The incidence of cervical cancer after HPV16,31 and 45 infection was 27.7,14.3 and8.2 times higher than that of cervicitis. Among the 36 cervical cancer tissue samples with negative HPV,8 cases were detected positive by HPV E6/E7 DNA detection.CONCLUSION: HPV16,18,58,52,33,31 and 45 have a high prevalence,cumulative attribution rates and risk values in patients with squamous intraepithelial lesions and cervical cancer. The above-mentioned subtypes of HPV should be included in the prevention and screening of cervical cancer.HPV E6/E7 DNA detection may be a reliable assay for HPV-based screening for prevention of cervical cancer.
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The choice of treatment in locally advanced cervical carcinoma is a hot topic in the controversy of treatment for gynecology tumor.The three primary therapies for locally advanced cervical carcinoma are concurrent chemotherapy and radiotherapy,direct radical hysterectomy and operation after radiotherapy.This article mainly discusses several types of treatment and advises personalized treatment for locally advanced cervical carcinoma.
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Radical hysterectomy(RH)with bilateral pelvic lymph node dissection is recommended as the standard treatment for early-stage cervical cancer(FIGO stageⅠB1 or ⅡA1 disease).Minimally invasive surgery(MIS)has been adopted as an optimal treatment for early cervical cancer since 20th century for its advantages in perioperative outcomes and comparable oncological outcomes.Not until 2018 were two articles from MD Anderson Center published in The New England Journal of Medicine reversed the situation.Their results suggested that patients who underwent MIS for RH had higher recurrence rates and worse overall survival compared to patients that underwent open surgery.Since then,controversy about open surgery and MIS has continued.This article will discuss the current controversy and stragegies of laparoscopic surgery for cervical cancer.
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With the standardization and popularization of cervical cancer screening techniques,more and more young patients with cervical cancer are being detected at an early stage,and most patients with cervical cancer at reproductive age have a strong intention to preserve fertility.This article will summarize the operation indication,operation methods,safety,oncologic outcomes and related controversies of fertility preservation surgery in patients with cervical cancer.
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As the treatment methods develop,the prognosis of cervical cancer has been significantly improved.Surgery and radiotherapy are still the main treatments for cervical cancer,accompanied by chemotherapy.For young patients with cervical cancer,radiotherapy can result in the ovarian failure and lead to a series of menopausal symptoms.Radiotherapy can also cause a lot of other complications and affect the quality of life.Chemotherapy,especially adjuvant chemotherapy before and after surgery,is drawing more and more attention recently.Therefore we made a summary of the latest progress in the strategies for postoperative adjuvant chemotherapy and preoperative neoadjuvant chemotherapy for cervical cancer.
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Cervical cancer is one of the most common gynecological malignancies during pregnancy.The management of cervical cancer during pregnancy depends on the following factors:tumor stage,histological type,gestational age,state of lymph nodes and desire regarding fertility.The treatment for patients who want to preserve pregnancy needs to be individualized and requires a multidisciplinary team.This article reviews the researches about management of cervical cancer during pregnancy.
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Abdominal radical trachelectomy was usually utilized in ⅠB1 cervical cancer patients whose tumor ≥2 cm since the procedure removed more parametrial tissue than the vaginal approach.We raised selection criteria for ART in such patients in 2011. In this article,we will further discuss issues regarding fertility-sparing surgery in ⅠB1 cervical cancer with tumor ≥2 cm.
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A case of seminoma metastasis to neck 2 years after operation is reported and the reference for clinical diagnosis of neck masses of the tumor is provided.
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Chordomas are rare low to intermediate grade malignant tumours derived from the notochordal remnants. Their location in the cervical spine is exceptional. The clinic radiologic features, anatomopathologic aspects, diagnostic difficulties, therapeutic methods and prognostic factors are discussed through a case report of a cervical spine chordoma with a literature review.
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Objective To compare theshort-term efficacy and safety between TP and PVB scheme chemoradiation for advanced cervical cancer. Methods Between January 2012 and January 2014, 187 Xinjiang uygur patients with advanced cervical cancer (stageⅡb to Ⅳa) who received concurrent chemoradiotherapy in Xinjiang medical university affiliated tumor hospital were analyzed. A1l cases were divided into two groups receiving radiotherapy concomitant (n = 104), PVB group (n = 83). Theshort-term efficacy and toxicity was evaluated four weeks aftertreatment. Results For squamous cell carcinomas, the response rates were 85.9% and 73.5% in TP and PVB group respectively (P > 0.05). For Non-squamous cell carcinomas (adenocarcinoma and adenosquamous), the response rates were 75.7% and 40% in TP and PVB group respectively (P 0.05). Conclusions For cervical squamous cell carcinomas, theshort-term efficacy of two chemotherapy regimens is similar while forNon-squamous cell carcinomas, TP regimengroup is superior toBone marrow suppression and neurotoxicity in TP regimengroup is significantly higher than PVB group (P < 0.05), while gastrointestinal adverse reaction lower than PVBgroup.
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We report a case of 29-year-old man diagnosed as a primary eosinophilic granuloma (EG) lesion of the seventh cervical vertebra. He had paresthesia on both arms, and grasping weakness for 10 days. Cervical magnetic resonance image (MRI) showed an enhancing mass with ventral epidural bulging and cord compression on the seventh cervical vertebra. Additionally, we performed spine series MRI, bone scan and positive emission tomography for confirmation of other bone lesions. These studies showed no other pathological lesions. He underwent anterior cervical corpectomy of the seventh cervical vertebra and plate fixation with iliac bone graft. After surgical management, neurological symptoms were much improved. Histopathologic evaluation confirmed the diagnosis of EG. There was no evidence of tumor recurrence at 12 months postoperative cervical MRI follow-up. We reported symptomatic primary EG of cervical spine successfully treated with surgical resection.
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Adult , Humans , Arm , Eosinophilic Granuloma , Follow-Up Studies , Hand Strength , Magnetic Resonance Imaging , Paresthesia , Spine , TransplantsABSTRACT
Objective To evaluate the values of visual inspection with acetic acid( VIA) and human papillomavirus( HPV) and thinprep cytology test( TCT) in the screening of cervical cancer.Methods VIA,HPV test and TCT in 946 women was conducted.Cervical biopsy or endocenical curettage( ECC) was performed in VIA positive women or HPV positive women or TCT positive women. The pathologic outcome was as the gold standard,and the out come more and equal to cervical intraepithelial neoplasia( CIN) Ⅱ were identified as positive.Results There was no significant difference among three groups in sensitivity rate( 73.l％,96.2,88.5％ ) and negative predictive value ( 99. 1％ ,99.9％ ,99.7％ ) ( all P ＞ 0.05 ).The specificity rate (97.5％ ) and positive predictive value ( 50.O％ ) of TCT was better than those of HPV ( 93.5％,29.4％ ),and HPV was better than those of VIA( 87.0％,13.7％ ),and the difference had statistifical significance among three groups ( x2 =71.34,26.00,22.17,8.28,all P ＜ 0.05 ).Conclusion Although the rate of missed diagnosis and misdiagnosis rate was higher than that of HPV and TCT,but VIA seems to be appropriate methods in the screening of cervical cancer owing to its low price.
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We report a 60 years old male presenting with a history of repeating syncopal episodes lasting seven days. The patient had a history of an intestinal lymphoma treated four years ago. Imaging studies showed a macro nodule in the left thyroid lobe. The pathological study disclosed a type B non Hodgkin lymphoma. The patient was treated with chemotherapy with a favorable outcome. The association of syncope and cervical tumors has been described previously.
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Humans , Male , Aged , Goiter, Nodular/etiology , Lymphoma, B-Cell/complications , Lymphoma, Non-Hodgkin/complications , Head and Neck Neoplasms/complications , Syncope, Vasovagal/etiology , Goiter, Nodular , Head and Neck Neoplasms , Mediastinal Neoplasms/complications , Mediastinal Neoplasms , Syncope/etiologyABSTRACT
Objective:To investigate the curative effect of electroacupuncture on urine retention following cervical cancer operation. Methods: A treatment group was treated with electroacupuncture according to classification based on syndrome differentiation and a control group, by a conventional method. One course of treatment consisted of 5 days. Results: The curative rate and cure rate were 96.67% and 76.67%, respectively, in the treatment group and 70% and 36.67%, respectively, in the control group. There were significant differences in curative rate and cure rate between the two groups (P＜0.01). Conclusion:Electroacupuncture is a good method for treating urine retention subsequent to cervical cancer operation.
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Objective:To construct a short hairpin RNA(shRNA) eukaryotic expression vector of the survivin gene,and investigate its inhibitory effect on the survivin expression in human cervical cancer cells.Methods:We designed and synthesized 2 pairs of survivin-specific small interfering RNA primers(s1 and s2),cloned them into the eukaryotic expression vector pSilencer 2.1-U6 neo by DNA recombined techniques after annealing connection reaction,and transfected them respectively into human cervical cancer cell line HeLa using LipofectAMINE2000 after identificationby restrict endonuclease digestion and DNA sequencing.Then we selected the positive clones by G418 and detected the expression of survivin mRNA by semi-quantitative RT-PCR and that of the survivin protein by Western blot.Results:The survivin shRNA eukaryotic expression vectors pSilencer2.1-s1 and pSilencer2.1-s2 were successfully constructed.Positive clones were obtained by screening with G418 for 24 days,the survivin expression in HeLa cells decreased in different degrees after transfected with pSilencer2.1-s1 and pSilencer2.1-s2,and the latter showed a better interference efficiency.Conclusion:The shRNA eukaryotic expression vector of the survivin gene we constructed,with its improved interfering efficiency,has paved the way for further research on its role in regulating the biological behavior of cervical cancer cells.
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OBJECTIVE: The objective of this study is to evaluate the expressions, microvessel counts and angiogenic pathway of VEGF and PD-ECGF and proliferative activity of Ki-67 according to clinicopathologic feature of cervical tumor. METHODS: Two hundred three cervical specimens were evaluated; among these 20 were designated normal epithelium, 36 mild dysplasia, 28 moderate dysplasia, 36 severe dysplasia, 28 carcinoma in situ, 17 microinvasive carcinoma and 38 invasive cervical carcinoma (21 squamous cell carcinoma and 17 adenocarcinoma). Microvessel count was determined by immunohistochemical staining using anti-factor VIII-related monoclonal antibody. The expression of VEGF (vascular endothelial growth factor) and PD-ECGF (platelet-derived endothelial cell growth factor) were evaluated by immunohistochemical staining with anti-human VEGF monoclonal antibody and anti-dThdPase monoclonal antibody. The proliferative activity was examined using a Ki-67 equivalent monoclonal antibody (MIBl). RESULT: There was no statistical significance on microvessel count except invasive cancer comparing with mild dysplasia including normal tissue, but there was a little increase in microvessel counts according to severity of tumor. The intensity of VEGF and PD-ECGF expression was significantly correlated with severity of cervical tumor. And the microvessel density was significantly higher in the positive expression of VEGF and PD-ECGF than in the negative expression. The intensity of PD-ECGF expression in invasive adenocarcinoma was significantly lower in comparison with VEGF expression. The intensity of Ki-67 expression had no correlation with severity of cervical tumor and was significantly higher in moderate and severe dysplasia than in microinvasive and invasive carcinoma. Ki-67 expression had no statistical correlation with VEGF and PD-ECGF. CONCLUSION: The VEGF and PD-ECGF are important angiogenic factors and associated with progression of cervical tumor. The VEGF may be involved in the progressions of squamous cell carcinoma and adenocarcinoma, but the PD-ECGF may not be involved or be minimally involved in the progression of adenocareinoma. There seems to be a different angiogenic pathway pertaining to the histologic difference of cervical cancer. There was no difference of Ki-67 expression according to severity of cervical tumor.