Hysteroscopic removal of a heterotopic cervical pregnancy to preserve a patient's intrauterine sac.

OBJECTIVE: To introduce a case of removing heterotopic cervical pregnancy while preserving the normal gestational sac in the uterine cavity by hysteroscopic surgery under ultrasound guidance. DESIGN: Video description of the case and surgical procedure. SETTING: Hospital affiliated to a university. PATIENT: A 35-year-old woman with G7P1A5L1 was admitted with a heterotopic cervical pregnancy 21 days after in vitro fertilization and embryo transfer (the corrected gestational age was 5+2 weeks). The serum ß-human chorionic gonadotropin level was 24,530 mIU/mL at the corrected gestational age of 5+3 weeks. Ultrasound examination on the day of admission showed that there was a gestational sac in the cervical canal (1.5 × 0.8 × 0.5 cm, yolk sac visible) and another in the intrauterine cavity (1.2 × 1.2 × 1.1 cm, yolk sac visible). The pregnant woman and her partner strongly urged to remove the cervical gestational sac and continue the intrauterine pregnancy to term. INTERVENTION: After the Institutional Review Board approval was obtained, hysteroscopic surgery with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the heterotopic cervical pregnancy while preserving the intrauterine gestational sac. MAIN OUTCOME MEASURES: The heterotopic cervical pregnancy was completely resected by hysteroscopy, and the normal gestational sac in the uterine cavity was successfully preserved. RESULTS: Ultrasound-guided hysteroscopic surgery allowed us to successfully preserve the intrauterine pregnancy while removing the cervical pregnancy completely. During the operation, the dilation pressure and the flow rate of the dilation fluid was kept as low as possible to avoid excessive intrauterine pressure and excessive dilation fluid entering the intrauterine cavity, which could have had adverse effects on the intrauterine pregnancy sac. No surgical- or anesthesia-related complications occurred. The pathological results confirmed placental villi and decidual tissue. The one-month follow-up ultrasonography showed a live single intrauterine pregnancy with cardiac activity. CONCLUSION(S): Hysteroscopic removal of a heterotopic cervical pregnancy under ultrasound guidance can be safely performed while successfully preserving an ongoing intrauterine pregnancy.

Antitumor Therapy Targeting the Tumor Microenvironment.

The development and progression of tumors in human tissues extensively rely on its surrounding environment, that is, tumor microenvironment which includes a variety of cells, molecules, and blood vessels. These components are modified, organized, and integrated to support and facilitate the growth, invasion, and metabolism of tumor cells, suggesting them as potential therapeutic targets in anticancer treatment. An increasing number of pharmacological agents have been developed and clinically applied to target the oncogenic components in the tumor microenvironment, and in this review, we will summarize these pharmacological agents that directly or indirectly target the cellular or molecular components in the tumor microenvironment. However, difficulties and challenges still exist in this field, which will also be reported in this literature.

Treatment of heterotopic cervical pregnancy by ultrasound-guided hysteroscopy: A case report and literature review.

BACKGROUND: Heterotopic cervical pregnancy is a rare event of ectopic pregnancy with an incidence rate of < 1%. Herein, we report a rare case of successful treatment of heterotopic pregnancy following an in vitro fertilization-embryo transfer using ultrasound-guided hysteroscopy. In order to choose the best treatment option, we reviewed the clinical treatments and discussion of heterotopic cervical pregnancy over the last 15 years. METHODS: The heterotopic pregnancy was terminated using ultrasound-guided hysteroscopy; however, the intrauterine pregnancy was maintained. We searched for the keywords "cervical pregnancy combined with intrauterine pregnancy," "compound pregnancy," "assisted reproductive technology," "cervical pregnancy," and "ectopic pregnancy" on PubMed to include articles published in the last 15 years. RESULTS: The patient underwent an emergency cervical cerclage at 22 weeks' gestation for cervical insufficiency and delivered a healthy newborn at 38 weeks' gestation by transvaginal compliance. Twenty-one relevant case reports were selected. After analysis and discussion, we found that assisted reproductive technology is more likely to lead to heterotopic pregnancy than unassisted reproduction. Most women requesting the preservation of intrauterine embryos opted for surgical termination of cervical pregnancy and achieved the ideal outcomes. CONCLUSION: More attention should be paid to the diagnosis and treatment of heterotopic pregnancies to obtain the most optimal pregnancy outcome and long-term prognosis. Hysteroscopic surgery is a completely feasible cervical pregnancy treatment option with less postoperative impact on the mother and the intrauterine fetus.

Follicle-Stimulating Hormone Promotes the Development of Endometrial Cancer In Vitro and In Vivo.

Endocrine disruptors as risk factors for endometrial cancer (EC) are positively correlated with serum follicle-stimulating hormone (FSH) levels. Additionally, increased FSH is associated with EC. However, its exact mechanism is not yet clear. Therefore, this study investigated how FSH affects the occurrence of EC. Using immunohistochemistry (IHC), immunofluorescence (IF), and Western blot (WB), we found that FSH receptor (FSHR) was expressed in both EC tissues and cell lines. To explore the effect of FSH on EC in vitro, Ishikawa (ISK) cells were cultured in different doses of FSH, and it was found that FSH could promote the proliferation and migration of ISK cells. Furthermore, the detection of key molecules of migration and apoptosis by WB showed that FSH promoted cell migration and inhibited apoptosis. Additionally, FSH decreased AMPK activation. To clarify the effect of FSH on EC in vivo, we subcutaneously planted ISK cells into ovariectomized mice and then gave two of the groups oestradiol (E2). In comparison with the OE (ovariectomy plus E2) and sham groups, the growth rates and weights of the tumors in the OE plus FSH group were significantly higher. The findings above suggest that FSH promotes the proliferation and metastasis of EC, providing a new strategy for the treatment of EC.