The discriminatory diagnostic value of multimodal ultrasound combined with blood cell analysis for granulomatous lobular mastitis and invasive ductal carcinoma of the breast.

OBJECTIVE: To explore the discriminatory diagnostic value of multimodal ultrasound(US) combined with blood cell analysis(BCA) for Granulomatous Lobular Mastitis (GLM) and Invasive Ductal Carcinoma(IDC) of the breast. METHODS: A total of 157 breast disease patients were collected and divided into two groups based on postoperative pathological results: the GLM group(57 cases with 57 lesions) and the IDC group(100 cases with 100 lesions). Differences in multimodal ultrasound features and the presence of BCA were compared between the two groups. The receiver operating characteristic(ROC) curve was used to calculate the optimal cutoff values, sensitivity, specificity, 95% confidence interval(CI), and the area under the curve(AUC) for patient age, lesion size, lesion resistive index(RI), and white blood cell(WBC) count in BCA. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and AUC were calculated for different diagnostic methods. RESULTS: There were statistically significant differences(P <  0.05) observed between GLM and IDC patients in terms of age, breast pain, the factors in Conventional US(lesion size, RI, nipple delineation, solitary/multiple lesions, margin, liquefaction area, growth direction, microcalcifications, posterior echogenicity and abnormal axillary lymph nodes), the factors in CEUS(contrast agent enhancement intensity, enhancement pattern, enhancement range, and crab-like enhancement) and the factors in BCA(white blood cells, neutrophils, lymphocytes and monocytes). ROC curve analysis results showed that the optimal cutoff values for distinguishing GLM from IDC were 40.5 years for age, 7.15 cm for lesion size, 0.655 for lesion RI, and 10.525*109/L for white blood cells. The diagnostic accuracy of conventional US combined with CEUS(US-CEUS) was the highest(97.45%). The diagnostic performance AUCs for US-CEUS, CEUS, and US were 0.965, 0.921 and 0.832, respectively. CONCLUSION: Multifactorial analysis of multimodal ultrasound features and BCA had high clinical application value in the differential diagnosis of GLM and IDC.

Three new methylated Δ8-pregnene steroids from the Polyalthia laui-derived fungus Stemphylium sp. AZGP4-2.

Three new methylated Δ8-pregnene steroids, stemphylisteroids A-C (1-3) were isolated from the medicinal plant Polyalthia laui-derived fungus Stemphylium sp. AZGP4-2. Their structures were elucidated by the detailed analysis of comprehensive spectroscopic data. The absolute configuration of 1 was determined by X-ray crystallographic analysis. Compound 1 show antibacterial activity against Escherichia coli with the MIC value of 6.25 µg/mL, and 2 exhibited a broad spectrum of antibacterial activities against six pathogenic bacteria with the MIC values ranging from 12.5 to 50 µg/mL. The discovery of three methylated Δ8-pregnene steroids 1-3 are a further addition to diverse and complex array of methylated steroids.

3,4- seco-Norclerodane Diterpenoids from the Roots of Polyalthia laui.

Ten new clerodane diterpenoids, polylauioids A-J (1-10), and five known analogues (11-15) were isolated from the roots of Polyalthia laui. Among the new compounds, 3 and 8 are artifacts. The structures were elucidated using spectroscopic methods and by comparison with published NMR spectroscopic data. The absolute configurations of 4, 5, and 7 were defined based on single-crystal X-ray diffraction and electronic circular dichroism data. Compounds 1 and 2 represent the first examples of rearranged 3,4- seco-norclerodane diterpenoids, and a putative biosynthesis pathway for these compounds is proposed. Compounds 1, 4, 6, 7, 9, and 10 showed anti-HIV activities with EC50 values ranging from 12.2 to 35.2 µM.

[Primary pelvic retroperitoneal tumors: clinical analysis of 36 cases].

OBJECTIVE: To explorer the diagnostic rationales for primary pelvic retroperitoneal tumors and summarize their clinical characteristics and treatments. METHODS: The clinicopathological data of total of 36 patients with primary pelvic retroperitoneal tumor, who visited Peking Union Medical Collage Hospital, Chinese Academy of Medical Sciences because of pelvic mass from January 1986 and September 2013 were analysed retrospectively. And their clinical manifestations, accessory examination, surgical findings, postoperative pathological results and prognosis were summarized. RESULTS: Among the 36 patients, twenty-nine cases were treated by gynecology department firstly, 7 cases were treated by surgical department firstly. Only 7 cases complained abdominal expanding while others had no uncomfortable complains before the discovery of the tumor. Among 27 cases who took color Doppler ultrasonography examination, only 3 cases reminded that the tumors might come from the pelvic retroperitoneal space. CT and MRI results were respectively 6/16 and 3/6, that the tumor might come from the pelvic retroperitoneal space. The level of CA125 of 18 cases were tested before the surgery: 17 out of 18 cases were normal or elevated lightly. The tumors of 8 cases were excised incompletely because of the blood vessels around the tumors and the close relationship between the tumors and the pelvic wall, while other's were excised completely. Among the 25 cases that had operation at the gynecological department, ten cases underwent operations collaboratively with surgical department; two cases had complications of urinary system injures. Postoperative pathological examinations revealed there were 28 cases (78%, 28/36)with benign lesions including 11 schwannoma, 6 leiomyoma, 3 teratoma, 1 lymphangioleiomyoma, 1 neurofibroma, 1 paraganglioma, 2 fibromatosis, 1 aggressive angiomyxoma, 1 mucinous cystadenoma and 1 solitary fibrous tumor; and 8 cases(22% , 8/36)with malignant lesions including 3 leiomyosarcoma, 2 liposarcoma, 2 adenocarcinoma and 1 squamous carcinoma. During the follow-up period, 28 cases whose tumors were excised completely had no recurrence. While, 3 out of 8 cases excised incompletely recurred. CONCLUSIONS: Primary pelvic retroperitoneal tumors have no typical manifestations, CT and MRI are more accurate. Surgery is a key for retroperitoneal tumors. Considering the complexity of the anatomy of the pelvic retroperitoneal space and the resulted difficulties of the surgeries, multidisiciplinary cooperation is needed and important.

[Clinical analysis of prognostic factors for stage III ovarian epithelial carcinoma].

OBJECTIVE: To evaluate the prognostic factors for stage III ovarian epithelial carcinoma so as to provide scientific basis for further reasonable therapy. METHODS: The clinical records of 369 patients with stage III ovarian epithelial carcinoma, aged 53 +/- 9 (22-77), were reviewed retrospectively. SPSS 10.0 was utilized to analyze the possible prognostic factors statistically. RESULTS: All patients received cytoreductive surgery, 289 cases (71.8%) of which achieved optimal cytoreduction. During the operation, 150 cases (41.8%) and 265 cases (71.8%) were found with intestinal and diaphragmatic involvement respectively. Pathologic results showed that serous type was the most common histological type (48.9%) and mucinous type was the least one (2.2%). The grades G1, G2, and G3 accounted for 1.7%, 42.7%, and 55.6% respectively. 290 cases with effective response to surgery underwent chemotherapy for 3-22 (10 +/- 4) courses. Recurrence was recorded in 190 cases (51.5%) and death was recorded in 152 cases (41.2%). Multivariate analysis revealed that intestinal involvement, diaphragmatic invasion, tumor residuals, and course number of chemotherapy were significantly correlated with prognosis (P < 0.01, < 0.05, < 0.01, and < 0.01 respectively). CONCLUSION: Cytoreduction for the tumor in peritoneal cavity and positive chemotherapy should be emphasized sufficiently and may be helpful for the prognosis of stage III ovarian epithelial carcinoma.

[Clinical aspects of mature ovarian teratoma: result of 695 cases].

OBJECTIVE: To evaluate the clinical aspects of mature ovarian teratoma. METHOD: We retrospectively studied 695 patients operated in PUMC Hospital between January 1990 and December 2000. RESULTS: Laparoscopy surgery had shorter hospitalization day, less blood loss during surgery, shorter operation time compared with laparotomy (P < 0.001). Routine contralateral wedge resection was done in 601 cases, among which 459 had normal inspection and palpatation. Only one (0.22%) was pathologically confirmed bilateral tumor. Torsion was the major complication (7.5%). Average tumor size of torsion was (10.2 +/- 4.5) cm. Probability of torsion increased as the tumor enlarged, which was less than 4.4% when the tumor size was less than 6 cm and greater than 10% if size greater than 8 cm. Rupture, infection, and malignant transformation were rare. CONCLUSIONS: Laparoscopy is superior to laparotomy in the treatment of mature ovarian teratoma. If the contralateral ovarian is within normal configuration, contralateral wedge resection is unnecessary. When the tumor size is greater than 8 cm in diameter, it will have more chance to twist.

[Congenital vaginal atresia: report of 16 cases].

OBJECTIVE: To analyze the clinical features of congenital vaginal atresia (CVA) with normal uterine corpus and investigate the relationship between the subtypes and management. METHODS: Sixteen cases, partical atresia (type I) 10 and complete atresia (type II) 6, treated in Peking Union Medical College Hospital, during the past 16 years, were analysed retrospectively. RESULTS: Patients with type I CVA had an earlier onset of symptoms [(13.0 +/- 1.1) years of age], duration of [(3.5 +/- 2.4) months], greater pelvic masses [(7.7 +/- 3.0) cm in diameter] with lower location as compared with type II CVA [(15.5 +/- 3.4) years of age, 24.0 months, (5.3 +/- 1.0) cm in diameter, P < 0.01]. Distal colpoplasty was performed on 10 type I cases and vaginal mold was placed postoperatively. Dysmenorrhea relieved in all cases during median 21 month follow-up. Vaginal dilatation was done in 4 cases due to readhesion and constriction. One out of the 2 married patients delivered viable neonate by cesarean section. Three out of 6 type II patients were complicated with either endometriosis or hematosalpinx or double uterus. Hysterectomy with or without colpoplasty was done. While the other 3 underwent colpoplasty and cervical canalization. Only 2 had menses after operation, but 1 of the developed dysmenorrhea, ovarian endometrioma and was treated surgically again, the other 1 had hypomenorrhea. CONCLUSION: Patients with type I CVA had better outcomes after colpoplasty if they persist on placing vaginal mold. While for type II CVA, hysterectomy usually needed in most cases.

[Clinical analysis of 11 cases with perineal endometriosis].

OBJECTIVE: To report the diagnosis and treatment of 11 cases with perineal endometriosis (PE). METHODS: Eleven patients with PE treated in our department from 1983 - 2000 years were analyzed retrospectively and were followed for 0.5 - 7.0 years. RESULTS: The incidence of PE is 0.37% of total endometriosis cases operated in our department or 0.087 per thousand of total episiotomy undergone in our delivery room during the 18 year period. Their diagnosis were confirmed clinical manifestations and pathological evidences. All except one had history of perineal tear and episiotomy. The latent period of patient who was less than 30 years old is within one year. The latent period of patient who was more than 30 years old is more than one years (P < 0.05). Complete surgical excision with a cure rate of 91% (10/11). CONCLUSIONS: PE is mainly diagnosed by clinical manifestations. Surgical excision is the first choice of treatment.

[Transitional cell carcinoma of the ovary: one kind of uncommon type of ovarian epithelial carcinoma].

OBJECTIVE: To evaluated clinico-biologic behavior, prognosis and relative prognostic factors of transitional cell carcinoma of the ovary. METHODS: The clinical records of 58 patients with transitional cell carcinoma of the ovary, who received treatment in the department of Obstetrics and Gynecology, Peking Union Medical College Hospital in 20 years, were reviewed retrospectively. The data were analyzed statistically by SPSS 10.0. RESULTS: Among 58 cases, the median age was 55 +/- 10 (35 - 75) years old. 31% of them had bilateral ovary involvement, and the median level of CA(125) was (687 +/- 365) U/L. All patients received cytoreductive surgery in our hospital, 69% of them got optimal cytoreduction. Pathologic results showed that G(1), G(2), G(3) were 7%, 45% and 48% respectively, 40% were demonstrated lymph node metastasis. Nearly 80% of patients were classified to International Federation of Gynecology and Obstetrics (FIGO) stage III and IV. Different courses of chemotherapy were given to all patients. The recurrence occurred in 45% of cases and the death rate was 53%. The Cox hazards regression model was used to analyze the possible prognostic factors and revealed that tumor residuals (P < 0.01), preoperative level of CA(125) (P < 0.01), bilateral ovary involvement (P < 0.05) and lymph node metastasis (P < 0.05) were the most important prognostic factors. CONCLUSIONS: Transitional cell carcinoma of ovary is an uncommon type of ovarian cancer. It usually behaves better prognosis when compared with papillary serous cystadenocarcinoma of the ovary.