[Study on leuprorelin acetate in treatment of uterine adenomyosis with infertility].

OBJECTIVE: To study clinical efficacy of leuprorelin acetate in treatment of uterine adenomyosis with infertility. METHODS: From January 1,2011 to March 31,2012, 166 cycles in 166 infertile patients combined with uterine adenomyosis undergoing in vitro fertilization embryo transplant (IVF-ET) with long protocol ovum induction by leuprorelin acetate in centre of medical reproduction, ningbo women and children's hospital were studied retrospectively. In the mean time, 200 cycles in 200 infertile patients with tubal factors were enrolled as control group.The volume of uterus and outcome of IVF-ET were compared and studied between two groups. RESULTS: (1) Volume of uterus:in adenomyosis group, after 2-6 cycles of injecting leuprorelin acetate (3.75 mg/28 days), the mean uterine volume was shrinked from (180 ± 73) cm(3) to (86 ± 67) cm(3) (P < 0.05). (2) Outcome of IVF-ET:the rate of embryo implantation was 39.1% in adenomyosis group and 35.8% in control group. The rate of clinical pregnancy was 54.2% in adenomyosis group and 53.7% in control group. The rate of abortion was 4.7% in adenomyosis group and 4.2% in control group. They all did not show statistical differences (P > 0.05). (3) In adenomyosis group, the rate of fertilization, two pronuclear (2PN) and superior embryo were 67.2%(319/475), 60.8% (289/475) and 52.9% (162/306) in patients with failed pregnancy and 74.2% (423/570), 67.7% (386/570) and 62.1% (256/412) in patients with successful pregnancy after IVF-ET, which reached significant difference (P < 0.05). CONCLUSION: Leuprorelin acetate could improve volume of uterine adenomyosis and outcome of pregnancy in patients undergoing IVF-ET.

[Clinicopathologic study on 61 cases of uterine papillary serous carcinoma with or without adjuvant therapy].

OBJECTIVE: To study the clinicopathologic features of uterine papillary serous carcinoma (UPSC) and the roles of adjuvant therapy. METHODS: Sixty-one cases of UPSC with operation done and followed up for a period of 4 to 9 years were enrolled into the study. The histology of slides specimens were reviewed and immunohistochemical study was performed. The follow-up and survival data were analyzed. RESULTS: All of the 61 patients were post-menopausal, with a median age of 68 years. The clinical presentations included abnormal vaginal bleeding, abdominal symptoms and abnormal Pap smears. The median size of the tumors was 7.5 cm (range=1.2 to 14.8 cm). There were 27.9% cases in FIGO stage I (8.2% in stage IA, 14.8% in stage IB and 4.9% in stage IC), 9.8% in stage II, 32.8% in stage III and 29.5% in FIGO stage IV. The histologic features were similar to those of the ovarian counterpart, with tumor cells containing the high-grade nuclei and arranged in complex papillae. Psammoma bodies were identified in 24.6% of the cases. Immunohistochemical study showed that the tumor cells demonstrated diffuse and strong nuclear staining for p53 and Ki-67. They were negative for estrogen receptor and progesterone receptor. Fifteen of the 61 cases (24.6%) showed no evidence of myometrial invasion. However, ten of the 15 cases had extrauterine disease, with peritoneal (6/15) and nodal (9/15) involvement. Tumors with deep myometrial invasion, lymphovascular permeation and nodal metastasis were associated with worse prognosis by univariate analysis. Fifty-six patients received adjuvant therapy. The number of patients receiving adjuvant chemotherapy alone, adjuvant radiotherapy alone and combined adjuvant chemotherapy/radiotherapy were 42, 24 and 10, respectively. The median survivals of the chemotherapy group and non-chemotherapy group (with or without radiotherapy) were 66.4 months and 32.8 months, respectively. CONCLUSIONS: UPSC has distinctive clinical and pathologic features. The tumor stage, lymph node status, lymphovascular permeation and depth of myometrial invasion were important prognostic factors. Adjuvant chemotherapy for stage III/IV tumors or recurrent UPSC may have survival benefit.