Principales indicadores del Programa de Diagnóstico Precoz del Cáncer Cervicouterino en un hospital de Santiago de Cuba

Introducción: El cáncer cervicouterino ocupa el tercer lugar como causa de defunción por neoplasias malignas a nivel mundial, afectando principalmente a los países de ingresos bajos y medianos. Hacia el 2020 se estimó una incidencia de 604 000 nuevos casos. Objetivo: Caracterizar los principales indicadores hospitalarios del Programa de Diagnóstico Precoz del Cáncer Cervicouterino. Métodos: Se realizó un estudio observacional, descriptivo y transversal, que permitió caracterizar los principales indicadores hospitalarios del Programa en el Servicio de Patología de Cuello del Hospital General Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero del 2020 a diciembre del 2022. La población de estudio estuvo constituida por 443 mujeres. Los datos recopilados fueron analizados mediante técnicas de estadística descriptiva, expresándose en frecuencia y porcentajes. Resultados: De las mujeres estudiadas, 60,9 % presentaron lesión intraepitelial cervical de alto grado de malignidad, con 32,6 % positivo a cáncer cervicouterino. El porcentaje global de pruebas citológicas no útiles fue de 2,07 y sin células de la zona de transformación, de 4,01; ambos indicadores de calidad. Existió una alta significación en cuanto a la tasa de cobertura global de las mujeres en riesgo (K=0,615), demostrando que los resultados de la citología reflejan en gran medida los diagnósticos de la histología, con una buena concordancia. Conclusiones: La prueba citológica cérvico-vaginal sigue siendo el método diagnóstico de mayor valor para detectar neoplasia intraepitelial cervical y carcinoma en estadio precoz en grandes masas de población.

Introduction: Cervical cancer is the third leading cause of death from malignancies worldwide, affecting mainly low- and middle-income countries. By 2020 an incidence of 604,000 new cases was estimated. Objective: To characterize the main hospital indicators of the Cervical Cancer Early Diagnosis Program. Methods: An observational, descriptive and cross-sectional study was carried out to characterize the main hospital indicators of the Program in the Neck Pathology Service of the General Hospital Dr. Bruno Zayas Alfonso of Santiago de Cuba, from January 2020 to December 2022. The study population consisted of 443 women. The data collected were analyzed using descriptive statistic techniques, expressed in frequency and percentages. Results: Of the women studied, 60.9 %had cervical intraepithelial lesion of high degree of malignancy, with 32.6 % positive for cervical cancer. The overall percentage of useless cytological tests was 2.07 and no cells from the processing zone was 4.01, both quality indicators. There was a high significance in terms of the overall coverage rate of women at risk (K=0.615), showing that the results of the cytology largely reflect the diagnosis of histology, with a good agreement. Conclusions: Cervical-vaginal cytology remains the most valuable diagnostic method for detecting cervical intraepithelial neoplasm and early-stage carcinoma in large populations

Gestão e planejamento integrado em saúde no SUS: análise da capacidade governamental em região de saúde da Bahia / Integrated regional health management and planning in the SUS: analysis of government capacity in a health region in the state of Bahia

Resumo Este artigo objetivou analisar o grau de implantação do planejamento regional, considerando como condição traçadora os fluxos assistenciais para o câncer de colo de útero, em uma região de saúde do SUS baiano. Trata-se de um estudo avaliativo, do tipo avaliação da implantação do planejamento regionalizado em saúde, a partir de um estudo de caso da Região de Saúde de Vitória da Conquista (RSVC), Bahia. Realizaram-se 29 entrevistas com gestores e representantes da Comissão Intergestores Regional (CIR) e foram analisados 103 documentos. A matriz avaliativa subsidiou a mensuração do grau de implantação do planejamento pelos municípios, considerada incipiente, com três municípios apresentando grau intermediário (M1, M2 e M3); apenas M4 atingiu o grau avançado. Observou-se o caráter político nas tomadas de decisão persistente, preterindo-se a análise técnica e, consequentemente, não favorecendo as ações de monitoramento do acesso, que foram pontuais, e reduzindo a capacidade de controle e negociação junto aos prestadores de serviços privados. Os desafios da gestão, organização sistêmica e contexto político regional foram determinantes para a incipiente implantação do planejamento ante a incoerência entre instituições e características desfavoráveis à integração intermunicipal, sendo necessárias ações estratégicas para fortalecer a capacidade de planejamento integrado entre municípios.

Abstract This article aimed to analyze the degree of implementation of regional planning, considering care flows for cervical cancer as a defining condition, in a health region of the SUS in Bahia. This is an evaluative study, evaluating the implementation of regionalized health planning, based on a case study of the Vitória da Conquista Health Region (RSVC), state of Bahia. Twenty-nine interviews were carried out with managers and representatives of the Regional Intermanagers Commission (CIR) and 103 documents were analyzed. The evaluation matrix supported the measurement of the level of planning implementation by the municipalities, considered incipient, with three municipalities showing an intermediate level (M1, M2, and M3); only M4 reached an advanced grade. The political nature of persistent decision-making was observed, neglecting technical analysis and, consequently, not favoring access monitoring actions, which were punctual, and reducing the capacity for control and negotiation with private service providers. The challenges of management, systemic organization, and regional political context were decisive for the incipient implementation of planning given the incoherence between institutions and characteristics unfavorable to inter-municipal integration, making strategic actions necessary to strengthen the capacity for integrated planning between municipalities.

Autoeficacia para el tamizaje de cáncer cervical o de próstata: comparando mujeres y hombres colombianos / Self-efficacy in requesting cervical or prostate cancer screening: comparing Colombian females and males

Introducción: Los cánceres de cuello uterino y próstata tienen una importante carga de morbilidad en países en desarrollo. La autoeficacia para solicitar el tamizaje es un elemento clave en la prevención. Objetivo: Comparar la percepción de hombres y mujeres sobre autoeficacia para el tamizaje de cáncer cervical y de próstata. Métodos: Estudio mixto con 50 mujeres y 50 hombres. Se indagaron datos sociodemográficos. Se aplicó la escala de autoeficacia de detección del cáncer cervical, con una modificación de esta para medición de cáncer de próstata en hombres. La autoeficacia se clasificó por niveles y las variables asociadas a esta se identificaron con regresión robusta. Se realizaron entrevistas semiestructuradas a 27 individuos (18 hombres y 9 mujeres) con baja y alta autoeficacia, así como a individuos de "otra" religión, para conocer las diferencias en la intención del tamizaje. Se crearon tres categorías de análisis basadas en el modelo de creencias en salud. Resultados: Mujeres y hombres fueron similares, excepto en religión, ocupación y antecedentes de Papanicolaou o examen rectal. La autoeficacia fue mayor entre las mujeres (ß aj.:-15,29 IC del 95 %: -18,36 a -12,21) y los no creyentes (ß aj.: -5,38 IC del 95 %: -10,33 a -0,44). Ellas buscan más el tamizaje que los hombres, quienes necesitan tener síntomas para hacerlo, necesitan tener síntomas. La vergüenza e incomodidad son barreras expresadas por ambos sexos. En los hombres, el machismo es una fuerte barrera para solicitar el tamizaje. La religión asocia el sexo con impureza, siendo una barrera entre las mujeres. Los servicios de atención de la salud solo se centran en el cribado femenino. Conclusiones: Los roles de género y elementos de religión son expresiones culturales que determinan la intención de detección del cáncer en hombres y mujeres. Las intervenciones de los servicios de salud deben considerar estos elementos para mejorar la cobertura de detección temprana y reducir la morbimortalidad de estos dos tipos de cáncer.

Introduction: Cervical and prostate cancers have a significant burden of disease in developing countries. Self-efficacy to request screening is a key element in prevention. Objective: To compare the perception of men and women on self-efficacy for cervical and prostate cancer screening. Methods: Mixed study with 50 women and 50 men. Sociodemographic data was investigated. The cervical cancer detection self-efficacy scale was applied, with a modification for measuring prostate cancer in men. Self-efficacy was classified by levels and the variables associated with it were identified with robust regression. Semi-structured interviews were conducted with 27 individuals (18 men and 9 women) with low and high self-efficacy and of "other religion" to know the differences in the intention of the screening. Three categories of analysis were created based on the health belief model. Results: Women and men were similar except for religion, occupation, and history of Pap smear or rectal exam. Self-efficacy was higher among women (Adj. ß: -15.29, 95% CI: -18.36 to -12.21) and non-believers (Adj. ß: -5.38, 95% CI: -10.33 to -0.44). They seek screening more than men because they need to have symptoms. Shame and discomfort are barriers expressed by both genders. In men, machismo is a strong barrier to request screening. Religion associates sex with impurity, thus, acts as a barrier among women. Health care services only focus on female screening. Conclusions: gender roles and elements of religion are cultural expressions, which determine the intention of cancer detection in men and women. Health services interventions should consider these elements to improve the coverage of early detection and reduce the morbidity and mortality of these two types of cancer.

Tumor de colisión de útero. Reporte de caso y revisión de la literatura / Uterine collision tumor. Case report and review of he literature

Objetivos: Reportar el caso de una paciente con tumor de colisión del útero y realizar una revisión de la literatura respecto al diagnóstico histopatológico, tratamiento y pronóstico de esta condición. Materiales y métodos: Mujer de 76 años que consultó al centro nacional de referencia del cáncer en Bogotá (Colombia), donde se hizo el diagnóstico de tumor de colisión del útero, compuesto por un adenocarcinoma de endometrio tipo seroso y adenosarcoma de cérvix. Recibió tratamiento quirúrgico más quimioterapia y radioterapia complementaria, falleció a los 16 meses. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed y Embase, que incluía reportes y series de caso de mujeres con diagnóstico de tumor de colisión del útero, y se extrajo información sobre el diagnóstico, tratamiento y pronóstico. Se realizó un resumen narrativo de los hallazgos. Resultados: La búsqueda identificó 36 títulos, de los cuales se incluyeron 14 estudios que incluían 17 pacientes. El diagnóstico histopatológico más frecuente fue el adenocarcinoma endometrioide de endometrio y sarcoma endometrial de alto y bajo grado (47 %). El tratamiento básico fue quirúrgico. Cerca del 50 % recibió tratamiento adyuvante con quimioterapia y radioterapia (15 %). La sobrevida a un año fue del 75 %. Conclusiones: En la literatura no se identificaron casos de tumores de colisión de útero con la histopatología y en la ubicación del caso presentado. La mortalidad a dos años es cercana al 28 % si se toma en cuenta el caso reportado. Se necesitan más estudios que describan la inmunohistoquímica, el tratamiento y el pronóstico de esta condición.

Objectives: To report the case of a patient with a uterine collision tumor and to conduct a review of the literature. Material and methods: A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a serous-type endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made. Results: The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %. Conclusions: No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.

Variables asociadas al conocimiento y uso de citología cervicouterina en mujeres de una universidad de Cartagena, Colombia / Variables associated with the awareness and use of cervical cytology in women from a university in Cartagena (Colombia)

Introducción: Anualmente se diagnostican 500.000 casos nuevos de cáncer de cuello uterino, aproximadamente 80% ocurren en países en desarrollo. La baja incidencia de la enfermedad está relacionada con la presencia de programas de detección temprana. Objetivo: Determinar las variables sociodemográficas y familiares asociadas al conocimiento y uso adecuado de la citología cervicouterina (CCU) en mujeres de una Universidad de Cartagena. Materiales y métodos: Estudio analítico, con 259 mujeres, estudiantes y trabajadoras de una institución universitaria. Los datos fueron recolectados utilizando una encuesta sociodemográfica, una de tipología familiar y preguntas que evaluaban los conocimientos y uso de la CCU. Resultados: 42,3% (109) pertenecían a familias nucleares, seguido de 29,5% (76) a familias atípicas. El 85,3% (221) conoce la citología cervical, la principal fuente de información son las instituciones de salud 22,4% (57). El 54,12% (140) de las mujeres tenía una citología previa, y el 26,5% (67) la realiza anualmente. El Conocimiento estuvo asociado a la percepción de funcionalidad familiar, (OR 2,1245 (1,0338-4,3662). Conclusiones: La percepción de disfuncionalidad familiar es un elemento que reduce la práctica de la citología entre las mujeres estudiadas, siendo más importante esta reducción entre las mujeres de estratos más bajos y sin afiliación en salud.

Introduction: 500,000 new cases of cervical cancer are diagnosed yearly, 80% of which belong to developing countries. The low incidence of this disease is related to implementation of early detection programs. Objective: To determine the sociodemographic and family variables associated with the knowledge and proper use of cervical cytology (CC) in female students from a University in Cartagena. Materials and methods: An analytical study was performed on 259 female students and female employees of a university. The data was collected using sociodemographic and family typology surveys together with questions assessing knowledge and use of CC. Results: 42.3% (109) of participants belonged to nuclear families, followed by atypical families (29.5%; 67). 85.3% (221) have knowledge about cervical cytology and the main source of information being health institutions (22.4%; 57). 54.12% (140) of the female participants had a previous cytology, and 26.5% (67) did it annually. Their knowledge was associated with the perception of family functionality (OR 2.1245 (1.0338-4.3662). Conclusions: Perception of family dysfunction is an element that reduces the practice of cytology in the women studied, this decrease being more important among women from lower social strata and not being covered by health insurance.

Sarcoma del estroma endometrial de bajo grado

El sarcoma del estroma endometrial es una neoplasia maligna poco frecuente que se origina en el estroma endometrial. Puede tener varias formas de diferenciación, entre ellas del músculo liso y del cordón sexual. El sarcoma del estroma endometrial de bajo grado es un tipo de tumor endometrial raro, que constituye solo el 0,2% de todas las neoplasias uterinas. Su etiología es desconocida, pero algunos casos se asocian con obesidad, síndrome de ovario poliquístico, diabetes mellitus, menarquia temprana y terapia de sustitución de estrógenos o al tamoxifeno. La sintomatología es inespecífica, varía desde el dolor pélvico hasta el sangrado genital anormal progresivo y es difícil de reconocer por las imágenes radiológicas. En la mayoría de los casos, el diagnóstico se realiza mediante una evaluación anatomopatológica. La tinción inmunohistoquímica también puede ayudar a diferenciarlo de otras neoplasias. Por lo tanto, es importante tener un alto índice de sospecha para este tipo de neoplasia rara. Su tratamiento es quirúrgico y su seguimiento debe ser a largo plazo, debido al alto riesgo de recidivas tardías y metástasis. Se presenta un caso de sarcoma estromal endometrial de bajo grado.

Endometrial stromal sarcoma is a rare malignant neoplasm that originates in the endometrial stroma. It can have several forms of differentiation, including smooth muscle and sex cord. Low-grade endometrial stromal sarcoma is a rare type of endometrial tumor, constituting only 0.2% of all uterine neoplasms. Its etiology is unknown, but some cases are associated with obesity, polycystic ovary syndrome, diabetes mellitus, early menarche, and estrogen replacement therapy or tamoxifen. Symptomatology is nonspecific, ranging from pelvic pain to progressive abnormal genital bleeding, and is difficult to recognize by radiological imaging. In most cases, the diagnosis is made by pathological evaluation. Immunohistochemical staining can also help differentiate it from other neoplasms. Therefore, it is important to have a high index of suspicion for this type of rare neoplasm. Its treatment is surgical and its follow-up should be long term, due to the high risk of late recurrences and metastasis. A case of low-grade endometrial stromal sarcoma is presented.

Leiomioma disecante cotiledóneo del útero / Cotyledonoid dissecting leiomyoma of the uterus

RESUMEN Los tumores benignos de músculo liso son los tumores más frecuentes en el aparato genital femenino. El leiomioma disecante cotiledóneo del útero es una variante rara de leiomioma benigno, que presenta patrones de crecimiento inusuales y comparte algunas características con otras variantes de leiomioma disecante. Tiene un patrón de crecimiento inusual caracterizado por disección intramural dentro del miometrio y con apariencia similar de sus componentes extrauterinos a los cotiledones placentarios. Su aspecto sarcomatoide y carácter inusual dan la impresión de malignidad. El diagnóstico se realiza por los hallazgos histopatológicos característicos de la lesión. Se presenta un caso de leiomioma disecante cotiledóneo del útero.

ABSTRACT Benign smooth muscle tumors are the most common tumors in the female genital tract. Cotyledonoid dissecting leiomyoma of the uterus is a rare variant of benign leiomyoma, which presents unusual growth patterns and shares some features with other variants of dissecting leiomyoma. It has an unusual growth pattern characterized by intramural dissection within the myometrium and with similar appearance of its extrauterine components to placental cotyledons. Its sarcomatoid appearance and unusual character give the impression of malignancy. The diagnosis is made by the characteristic histopathologic findings of the lesion. A case of cotyledonoid dissecting leiomyoma of the uterus is presented.

Clinical analysis of 81 cases of intravenous leiomyomatosis confined to pelvic cavity / 中华妇产科杂志

Objective:To investigate the clinical features, treatment and recurrence factors of intravenous leiomyomatosis (IVL) confined to the pelvic cavity after the operation.Methods:The clinical data of 81 patients who underwent surgery and were pathologically diagnosed with IVL at Women′s Hospital, School of Medicine, Zhejiang University from January 2014 to March 2021, were analyzed retrospectively to explore the influencing factors of postoperative recurrence of IVL, including age, gravidity and parity, surgical methods, intraoperative conditions and so on.Results:(1) Clinical features: the age of 81 IVL patients was (43.9±8.1) years old; increased menstrual volume in 26 cases (32%, 26/81), prolonged menstrual period in 31 cases (38%, 31/81), frequency and urgency to urinate in 4 cases (5%, 4/81), abdominal pain and abdominal distension in 8 cases (10%, 8/81), and pelvic masses in 34 cases (42%, 34/81). IVL was diagnosed right in 4 of 72 patients (6%, 4/72) underwent preoperative ultrasound, right in 11 of 51 patients (22%, 11/51) underwent magnetic resonance imaging (MRI), and right in 4 of 19 patients (4/19) underwent CT. (2) Treatment: all patients with IVL underwent surgical treatment. Surgical procedure: myomectomy in 37 cases, total hysterectomy and bilateral salpingectomy in 19 cases, total hysterectomy and bilateral salpingo-ophorectomy in 25 cases. Surgical approach: hysteroscopic operation in 6 cases, transabdominal operation in 52 cases, laparoscopic operation in 23 cases. Fifty-three cases underwent rapid intraoperative pathological examination, 17 cases (32%, 17/53) of them were diagnosed right as IVL. (3) Influencing factors of IVL postoperative recurrence: among 81 patients with IVL, 3 cases were lost to follow-up, and 8 cases (10%, 8/78) had recurrence during follow-up. Age<35 years, number of pregnancies<2, number of births<2, number of fibroids ≥10, abnormal appearance of fibroids (long, vermicular, beadlike, cystic, etc.) and IVL invasion into adjacent vessels were all the risk factors influencing postoperative recurrence of IVL (all P<0.05). Methods of operation, ovariectomy or not, IVL invasion or not, maximum diameter of IVL, abundant blood vessels near uterine fibroids were not associated with postoperative recurrence of IVL (all P>0.05). Conclusions:The clinical manifestations and preoperative auxiliary examination of IVL are lack of specificity. Doctors need to pay attention to young patients with uterine fibroids, and choose the appropriate surgical scope when the characteristic manifestations of IVL be found during the operation, or the right diagnoses of IVL in the surgery′s rapid intraoperative pathology be examined, and should remove the IVL lesions to reduce the recurrence as far as possible.

Comparison of the long-term outcomes of focused ultrasound ablation surgery for uterine fibroids and myomectomy / 中华妇产科杂志

Objective:To compare the long-term outcomes after focused ultrasound ablation surgery (FUAS) versus myomectomy for uterine fibroids.Methods:A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015. Regular follow-up was conducted to evaluate the symptoms relief, symptoms recurrence, the need for re-interventions and complications of the two groups.Results:The effective rates were 95.7% (730/763) and 95.5% (1 151/1 205) in women who were treated by FUAS and myomectomy, no statistical difference was seen between the two groups ( χ2 =0.027, P=0.869). The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in FUAS group were 1.8%, 6.8%, 11.9%, 15.2% and 15.9%, respectively; and the cumulative re-intervention rates were 0.7%, 4.1%, 6.8%, 9.9% and 11.0%, respectively. The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in myomectomy group were 1.8%, 5.9%, 10.6%, 14.2% and 14.9%, respectively; and the cumulative re-intervention rates were 0.9%, 4.5%, 7.8%, 10.3% and 11.4%, respectively. No statistical differences were seen between the two groups (all P>0.05). There were no significant differences in the effective rate, symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids; but the effective rate of FUAS (95.9%, 235/245) was higher than that of myomectomy (89.1%, 115/129), the symptoms recurrence rate (11.9%, 28/235) was lower than that of myomectomy (27.8%, 32/115), and the re-intervention rate (7.7%, 18/235) was lower than that of myomectomy (17.4%, 20/115) in patients with submucosal fibroids, there were significant different (all P<0.05). The effective rate of FUAS (91.0%, 132/145) was lower than that of myomectomy (97.0%, 322/332), the symptoms recurrence rate (32.6%, 43/132) was higher than that of myomectomy (9.9%, 32/322), and the re-intervention rate (22.0%, 29/132) was higher than that of myomectomy group (6.2%, 20/132) in patients with subserosal fibroids, there were significant different (all P<0.01). The incidences of total [1.8% (14/763) vs 21.9% (264/1 205)], minor and moderate adverse events were lower in FUAS group than myomectomy group (all P<0.001). Conclusion:Satisfaction with long-term outcomes after FUAS treatment or myomectomy for uterine fibroids is comparable.

Multicenter retrospective study of 38 cases with fumarate hydratase deficiency uterine leiomyoma / 中华妇产科杂志

Objective:To investigate the clinicopathological features of fumarate hydratase (FH) deficiency uterine leiomyoma.Methods:The data of 38 patients with FH deficiency uterine leiomyoma were screened and analyzed. The expressions of FH, S-(2-succino)-cysteine (2SC), desmin, p16, p53, CD 10 and cell proliferation associated nuclear antigen (Ki-67) proteins were detected by immunohistochemistry, and their clinicopathological features were analyzed retrospectively. Results:(1) Clinical features: the median age of the patients was (42.5±7.4) years old. Twenty-one cases (55%) of them were myomas found in physical examination, and the median maximum diameter of the tumor was 6.0 cm (range: 5.0-7.5 cm); myomectomy was performed in 23 cases (61%), total hysterectomy with or without bilateral appendages in 15 cases (39%); laparoscopic surgery in 27 cases (71%), open surgery in 11 cases (29%); none of the patients had renal cell carcinoma. (2) Histological features: atypical nuclear cells were distributed locally or diffusely, eosinophilic nucleoli and intranuclear inclusion bodies could be seen, glass like globules could be seen in the cytoplasm, nuclear division was 0-4/10 high power field (HPF), and antler like blood vessels and pulmonary edema-like changes could be seen in the stroma. Among 38 patients with FH deficiency uterine leiomyoma, FH was negative in 37 cases (97%), and positive in 1 case (3%); 2SC, desmin, p16, p53, CD 10 and Ki-67 showed focal positive expression in 38 cases (100%), including 35 cases (92%) with Ki-67 index<10% and 3 cases (8%) with Ki-67 index ≥10%. (3) Follow-up: 4 cases (11%) recurred, and there was no death. There were significant differences in age, family history, distribution of atypical nuclei and mitosis number between recurrent group and non-recurrent group (all P<0.05). Conclusions:FH deficiency uterine leiomyoma is a rare tumor, which needs pathological examination,immunohistochemical examination and clinical history. Patients younger than 43 years old, with family history, histologically atypical diffuse nuclear distribution and mitotic number ≥3/10 HPF should be alert to the risk of recurrence.

Clinical study of hysteroscopical electroresection of FIGO type 3 myoma / 中华妇产科杂志

Objective:To analyze the clinical application and to evaluate the efficiency of hysteroscopical electroresection of International Federation of Gynecology and Obstetrics (FIGO) type 3 myoma.Methods:The clinical data of patients who underwent hysteroscopical electroresection single FIGO type 3 myoma in Obstetrics and Gynecology Hospital of Fudan University from January 2019 to October 2021 were collected retrospectively. The clinical symptoms, myoma size, location, operation time, intraoperative bleeding, surgical complications and postoperative follow-up were recorded, and the subsequent pregnancy outcomes were followed-up.Results:Totally 35 patients with FIGO type 3 myoma were included in this study. The average age was (36.6±4.7) years old, the diameter of myoma was (4.0±1.2) cm (range: 2.0-5.8 cm). The rate of complete resection of myoma in one operation was 86% (30/35), the average operation time was (41±15) minutes (range: 20-65 minutes), and the average intraoperative bleeding was (24±18) ml (range: 5-150 ml). No complications such as uterine perforation, massive hemorrhage, hyperhyderation syndrome and infection occurred in all patients perioperation. There were 20 cases with significant increase of menstruation before operation, the cure rate and effective rate of hysteroscopical electroresection of FIGO type 3 myoma were 75% (15/20) and 95% (19/20). There were 24 patients with fertility requirements, their average follow-up time was (14.5±6.8) months, the pregnancy rate within 1 year after operation was 79% (19/24), and the average postoperative pregnancy time was (5.8±3.4) months. There were 15 cases who had completed delivery after operation, including 10 cases of vaginal delivery and 5 cases of cesarean section, and none of them had uterine rupture.Conclusions:Hysteroscopy could effectively resect FIGO type 3 myoma. Hysteroscopical electroresection of FIGO type 3 myoma is minimally invasive with rapid postoperative recovery and could achieve pregnancy in a short time, which is not only helpful to reduce the amount of menstruation, but also beneficial for the prognosis of fertility. It should be carried out by the experienced hysteroscopists.

Safety analysis of cesarean myomectomy in twin pregnancies with intramural myomas / 中华妇产科杂志

Objective:To estimate the safety of myomectomy in twin pregnant women with intramural myomas during cesarean section.Methods:The clinical data of 145 cases of twin pregnancies with intramural myomas who were delivered by cesarean section in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2013 to December 2021 were collected. Maternal demographics, fibroids′ characteristics, maternal and fetal outcomes were compared between groups of cesarean section with myomectomy (myomectomy group, 49 cases) and cesarean section only (non-myomectomy group, 96 cases).Results:Compared with non-myomectomy group, myomectomy group had significantly prolonged operative time [50.0 minutes (37.5-57.5 minutes) vs 40.0 minutes (35.0-50.0 minutes), respectively; P=0.007] and significantly longer postoperative hospital stay [4.0 days (3.0-4.0 days) vs 3.0 days (3.0-4.0 days), respectively; P=0.047). Other maternal and fetal outcomes such as estimated blood loss, hemoglobin difference, postpartum hemorrhage, blood transfusion, B-Lynch structure, uterine artery ligation, postoperative fever and neonatal Apgar score showed no significant differences (all P>0.05). For intramural myomas <5 cm, there were no significant differences in maternal and fetal outcomes between myomectomy group and non-myomectomy group (all P>0.05). For intramural myomas ≥5 cm, operative time [55.0 minutes (40.0-60.0 minutes) vs 42.5 minutes (40.0-50.0 minutes), respectively; P=0.019] was significantly prolonged, postoperative hospital stay [4.0 days (4.0-5.0 days) vs 4.0 days (3.0-4.0 days), respectively; P=0.048] was significantly longer in myomectomy group than non-myomectomy group, but there were no significant differences in other maternal and fetal outcomes (all P>0.05). Conclusion:For twin pregnancies with intramural myomas, it is safe and feasible to remove intramural myomas during cesarean section by experienced obstetricians.

Postpartum pyomyoma: two cases report and literature review / 中华围产医学杂志

Objective:To investigate the clinical characteristics of postpartum pyomyoma.Methods:Clinical data of two patients with postpartum pyomyoma admitted to the Department of Obstetrics and Gynecology, Peking University First Hospital, between 2019 and 2020, were collected. Another 16 postpartum pyomyoma reported in China and foreign areas from 2000 to 2020 were reviewed.Results:Apart from three patients without reported gravidity and parity, 12 out of the remaining 15 patients were primiparous. The median maximum diameter of uterine fibroids in pregnancy was 10 cm (6-25 cm). Of the 18 patients, 12 had a history of intrauterine manipulation, 10 had anemia or severe postpartum hemorrhage, and four had other infections. All patients manifested as fever at first, and most were accompanied by abdominal pain. The onset time of 14 cases was within postpartum two weeks. CT, MRI, and ultrasound detection rate in diagnosing postpartum pyomyoma was 11/13, 3/6, and 1/8, respectively. Pus culture had the highest positive rate, with Escherichia coli as the most common pathogen. No death was reported, but 14 patients developed severe complications, including sepsis, septic shock, disseminated intravascular coagulation, rupture of pyomyoma, peritonitis, and incision infection. As failing in anti-infection medication, all patients received surgical treatment, which controlled infections. Three patients were conceived two years after the operation (16 months to two years). Conclusions:Pyomyoma should be considered once postpartum fever develops in patients complicated by uterine fibroids ≥10 cm in diameter during pregnancy, especially those with anemia, infection, or a history of intrauterine manipulation. Surgical treatment should be performed once pyomyoma is diagnosed.

Effect of miRNA-186-3p on the function of cervical cancer CaSki cells and its relationship with transforming growth factor β-Smad signaling pathway / 肿瘤研究与临床

Objective:To investigate the effect of miRNA-186-3p (miR-186-3p) on the apoptosis, immigration and invasion of cervical cancer CaSki cells and its relationship with transforming growth factor-β (TGF-β)-Smad signaling pathway.Methods:Plasmids containing miR-186-3p suppressor gene and miR-186-3p mimics were transfected into cervical cancer CaSki cells, namely miR-186-3p-I group and miR-186-3p-M group, respectively. In addition, CaSki cells transfected with empty plasmids were used as control (miR-186-3p-group C). Flow cytometry was used to detect the apoptosis rate of each group, and Transwell method was used to detect the migration and invasion ability of each group. Western blotting was used to detect the expression level of TGF-β-Smad signaling pathway related proteins. The target genes of miR-186-3p were predicted by using Starbase software and verified by using dual luciferase reporter gene assay.Results:The apoptosis rate of miR-186-3p-M group was lower than that of miR-186-3p-I group and miR-186-3p-C group [(7.5±3.2)% vs.(13.9±0.7)%, (12.7±0.6)%, all P < 0.05]. The number of migrating cells in miR-186-3p-M group [(218±25) vs. (168±13), (175±13), both P < 0.001] and the number of invasive cells in miR-186-3p-I group and miR-186-3p-C group were higher than those in miR-186-3p-I group and miR-186-3p-C group [(165±21) vs. (130±11), (142±12), all P < 0.001]. The relative expression levels of TGF-β, Smad2, Smad3, phosphorylated Smad2 (p-Smad2) and phosphorylated Smad3 (p-Smad3) in miR-186-3p-M group were the lowest, and the differences were statistically significant compared with the other two groups (all P < 0.001). Starbase software was used to predict the complementary binding of miR-186-3p to XIST RNA. Dual luciferase reporter assay showed that the relative luciferase activity of cells co-transfected with XIST wild-type vector and miR-186-3p mimic plasmid was lower than that of cells co-transfected with XIST wild-type vector and miR-186-3p empty plasmid ( P < 0.001). Conclusion:miR-186-3p may directly bind to XIST RNA and down-regulate the activity of TGF-β-Smad signaling pathway, thereby enhancing the immigration, apoptosis and invasion activities of cervical cancer CaSki cells.

Tumor mülleriano mixto maligno / Malignant mixed müllerian tumor

RESUMEN Introducción: El tumor mülleriano mixto maligno es una neoplasia uterina infrecuente, agresiva y se caracteriza por su histología por contener elementos malignos sarcomatosos y carcinomatosos. Objetivo: Describir un caso de tumor mülleriano mixto maligno y revisar la literatura sobre el tema. Caso clínico: Paciente femenina de 63 años de edad, color de la piel negra, obesa e hipertensa con tratamiento, antecedentes de mastectomía derecha seis meses atrás, acudió a consulta por presentar aumento de volumen abdominal, dolor en bajo vientre y sangramiento uterino. Con la administración de anestesia combinada (general orotraqueal y regional epidural continua) se resecó un fibroma uterino gigante y se confirmó el diagnóstico de un tumor mülleriano mixto maligno. Conclusiones: El tumor mülleriano mixto maligno se debe sospechar en mujeres de edad avanzada con sangrado genital acompañado de masa pélvica. El estudio anatomopatológico es de elección para el diagnóstico definitivo de esta neoplasia rara y muy agresiva. La cirugía, la radioterapia y la quimioterapia son las opciones terapéuticas más aceptadas, sin embargo, en mujeres con tumor en estadios avanzados, independiente del tratamiento proporcionado, la tasa de supervivencia es corta.

ABSTRACT Introduction: The malignant mixed müllerian tumor is an infrequent, aggressive uterine neoplasm and is histologically characterized by containing sarcomatous and carcinomatous malignant elements. Objective: To describe a case of a malignant mixed Müllerian tumor and to review the literature on the subject. Case report: A 63-year-old black female patient, obese and hypertensive under treatment, with a history of right mastectomy six months ago, who was consulted due to increased abdominal volume, lower abdominal pain and uterine bleeding. With the administration of combined anesthesia (general orotracheal and continuous epidural regional) a giant uterine fibroid was resected and the diagnosis of a malignant mixed Müllerian tumor was confirmed. Conclusions: Malignant mixed Müllerian tumor should be suspected in elderly women with genital bleeding accompanied by a pelvic mass. The pathological study is of choice for the definitive diagnosis of this rare and potentially aggressive neoplasm. Surgery, radiotherapy and chemotherapy are the most accepted therapeutic options, however, in women with advanced stage tumors, regardless of the treatment provided, the survival rate is short.

Clinicopathological study of cystic and atypical uterine leiomyoma: a rare entity / Estudo clinicopatológico de leiomioma uterino atípico e cístico: uma entidade rara

ABSTRACT A 43-years-old Brazilian woman, Caucasian, premenopausal, was attended with a history of lower abdominal pain, distension, and bleeding. Pelvic and transvaginal ultrasound revealed an enlarged uterus with a large, well-defined, uniformly hyperechoic lesion. The patient underwent total hysterectomy and the specimen was sent for anatomopathological evaluation. The histopathological analyses revealed a leiomyoma with extensive cystic degeneration and atypical characteristics, the immunohistochemical study confirmed the benignity of the case. The finding of atypical leiomyoma with cystic degeneration is rare and should be carefully evaluated to exclude malignant diseases.

RESUMEN Mujer brasileña de 43 años, caucásica, premenopáusica, fue atendida con antecedentes de dolor abdominal bajo, distensión y menorragias. La ecografía pélvica y transvaginal reveló un útero agrandado con una lesión grande, bien definida y uniformemente hiperecoica. La paciente fue sometida a histerectomía total y la pieza fue enviada para evaluación anatomo-patológica. Los análisis histopatológicos revelaron un leiomioma con degeneración quística extensa de características atípicas y la inmunohistoquímica confirmó la benignidad del caso. El hallazgo de un leiomioma atípico con degeneración quística es raro y debe evaluarse cuidadosamente para descartar enfermedades malignas.

RESUMO Mulher brasileira, 43 anos de idade, caucasiana, na pré-menopausa, foi atendida devido a história de dor em abdômen inferior, distensão e sangramento. A ultrassonografia pélvica e transvaginal revelou útero aumentado com grande lesão hiperecoica, bem definida e uniforme. A paciente foi submetida à histerectomia total, e a amostra foi enviada para avaliação anatomopatológica. A análise histopatológica revelou quadro de leiomioma com degeneração cística extensa e características atípicas; o estudo imuno-histoquímico confirmou a benignidade do caso. O achado de leiomioma atípico com degeneração cística é raro e deve ser cuidadosamente avaliado para excluir doenças malignas.

Two Cases of Uterine Tumors Resembling Ovarian Sex-cord Tumors: Rare Case of Uterine Tumor / 이화의대지

Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare tumors that occur mainly in the uterine fundus of women in reproductive age. These tumors can be classified into group 1 and group 2 by histological results. In group 1, epithelial-like differentiation is partially observed in the tumors. In group 2, sex-cord elements are predominant in uterine mural mass. We experienced UTROSCT group 1 in a 29-year-old woman who complained of severe abdominal pain that started one week after delivery and UTROSCT group 2 case in a 49-year-old woman who complained of dysfunctional uterine bleeding. We report two different types of UTROSCT cases that we experienced.

Association between the incidence and mortality rates for corpus uteri cancer and human development index (HDI): a global ecological study

OBJECTIVE: The aim of this study was to determine the association between the incidence of and mortality due to corpus uteri cancer (CUC) and the human development index (HDI) across the world.METHODS: This was an ecological study. The incidence and mortality rates of CUC along with HDI data were extracted from the Global Cancer Data in 2018. Subsequently, correlation coefficient and linear regression model were used to determine the association between the incidence and mortality rates of CUC and the HDI. STATA-14 was used for data analysis.RESULTS: There was a positive and significant correlation between the incidence (r=0.693; P<0.001) and mortality (r=0.284; P<0.001) rates of uterine cancer and the HDI. A positive and significant correlation was also observed between the incidence rate and the gross national income per 1,000 capita (r=0.440; P<0.001), mean years of schooling (MYS) (r=0.740; P<0.001), life expectancy at birth (LEB) (r=0.590; P<0.001), and expected years of schooling (r=0.650; P<0.001). The results of the linear regression model showed a significant statistical association between MYS and the incidence of CUC (β=1.10; 95% confidence interval [CI], 0.60–1.70) and LEB and mortality due to uteri cancer (β=0.40; 95% CI, 0.10–0.90).CONCLUSION: The results of this study suggest a significant statistical association between the incidence and mortality rates of CUC and the HDI.

Application progresses of photodynamic and sonodynamic therapy for malignant gynecologic neoplasms / 中国医学影像技术

The incidence of gynecological malignant tumors is increasing year by year, posing serious threatens to women's health. Photoacoustic dynamic therapy includes photodynamic therapy and sonodynamic therapy, killing tumor cells by photosensitizer and sonosensitizer activated by light or ultrasound, have the advantages of non-invasion, precise targeting, little side effects and widely used in diagnosis and treatment of gynecological tumors. The progress of photoacoustic dynamic therapy and its application in cervical cancer, ovarian cancer and endometrial cancer were reviewed in this article.