Epithelioid trophoblastic tumor that requires fertility preservation: A case report and review of literature.

OBJECTIVE: Epithelioid trophoblastic tumor (ETT) is very rare and few cases have been published in the English literature. Hysterectomy is the recommended treatment, due to the high rate of recurrence and mortality. The objective of this article is to present a rare case of ETT with fertility-preserving treatment and review published similar cases. CASE REPORT: We report the case of ETT in a 19-year-old Chinese woman, who had a strong desire of fertility preservation. She presented with vaginal spotting and hysteroscopy showed an isolated solid mass (2.0 × 1.5 × 1.5 cm) at the right corner of the uterine cavity. Serum ß-human chorionic gonadotropin (ß-HCG) persisted at low level elevation about 100 IU/L. We treated her with a lesionectomy and 3 cycles EP-EMA (etoposide, cisplatin/etoposide, methotrexate and actinomycin) chemotherapy regimen. The patient is now in stable condition, without any signs of recurrence during 20 months of follow-up. CONCLUSION: Fertility-preserving surgery would probably be a feasible and safe strategy for the patients whose lesions can be completely removed.

Notch1 Affects Chemo-resistance Through Regulating Epithelial-Mesenchymal Transition (EMT) in Epithelial Ovarian cancer cells.

Background: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, chemo-resistance is the main cause for treatment failure. Our previous studies have found that SKOV3 could promote immune escape and tumor progression via Notch1 pathway. Therefore, Notch1 is suspected to be involved in chemo-resistance. The current study is to investigate the possible mechanisms of platinum-resistance in epithelial ovarian cancer mediated by Notch1. Methods: The expressions of Notch1, Snail, MMP-2, N-cadherin, Vimentin and E-cadherin were detected by Western-blot. A stable high expression or low expression of Notch1 in ovarian cancer cells was established by using lentiviral gene engineering. The cell migration and invasion ability were observed by scratch test and transwell test. Cell apoptosis rate and cell cycle were analyzed by flow cytometry. Results: The expression levels of Notch1, Snail, MMP-2, N-cadherin and Vimentin in ovarian cancer were high, while the expression levels of E-cadherin were low.Notch1 promoted the expression of Snail, vimentin, N-cadherin and MMP2 protein, but inhibiting the expression of E-cadherin, promoting cell migration and invasion. Notch1 affected apoptosis of cells through Epithelial-Mesenchymal Transition (EMT), increasing the proportion of cells in S phase and G2 phase, thus affecting drug resistance. Conclusion: Notch1 affects EOC cells chemo-resistance by regulating EMT. This may provide a new target for the treatment of ovarian cancer.

Synchronous occurrence of benign mesothelioma and adenomatoid tumor of uterus: A case report and review of literature.

INTRODUCTION: Synchronous occurrence of benign cystic mesothelioma and adenomatoid tumor of uterus (UAT) are very rare and few cases have been published in the English literature. They are easily misdiagnosed as malignant by clinicians, due to the lack of reports. PATIENT CONCERNS: A case of benign mesothelial combined with uterus adenomatoid tumor (UAT) in a 48-year-old Chinese woman was reported. Our patient presented with abdominal pain and surgery showed a large subserous mass (12.0 × 11.4 × 9.8 cm) combined with a small intramural solid nodule (2.0 × 1.0 × 1.0 cm), and multiple minute neoplastic growth on the ovary. DIAGNOSIS: Due to the patient's symptoms, pathological findings, she was diagnosed with synchronous occurrence of benign mesothelioma and UAT. INTERVENTIONS: We treated her with a total hysterectomy and bilateral adnexectomy. OUTCOMES: The patient is now in stable condition, without any signs of recurrence during 1 year of follow-up. LESSONS: Most mesotheliomas are malignant, synchronous occurrence of benign mesothelioma and UAT are extremely rare. And they are often misdiagnosed as malignancy by clinicians. Our case report can improve the awareness of the disease and avoid excessive treatment.

The inhibition of UBC13 expression and blockage of the DNMT1-CHFR-Aurora A pathway contribute to paclitaxel resistance in ovarian cancer.

Paclitaxel is widely used as a first-line chemotherapeutic drug for patients with ovarian cancer and other solid cancers, but drug resistance occurs frequently, resulting in ovarian cancer still presenting as the highest lethality among all gynecological tumors. Here, using DIGE quantitative proteomics, we identified UBC13 as down-regulated in paclitaxel-resistant ovarian cancer cells, and it was further revealed by immunohistochemical staining that UBC13 low-expression was associated with poorer prognosis and shorter survival of the patients. Through gene function experiments, we found that paclitaxel exposure induced UBC13 down-regulation, and the enforced change in UBC13 expression altered the sensitivity to paclitaxel. Meanwhile, the reduction of UBC13 increased DNMT1 levels by attenuating its ubiquitination, and the up-regulated DNMT1 enhanced the CHFR promoter DNA methylation levels, leading to a reduction of CHFR expression, and an increased in the levels of Aurora A. Our findings revealed a novel function for UBC13 in regulating paclitaxel sensitivity through a DNMT1-CHFR-Aurora A pathway in ovarian cancer cells. UBC13 could potentially be employed as a therapeutic molecular drug for reversing paclitaxel resistance in ovarian cancer patients.

Clinical Predictors of Recurrence and Prognostic Value of Lymph Node Involvement in the Serous Borderline Ovarian Tumor.

AIM: This study was aimed to evaluate the risk factors of recurrence and the value of nodal involvement in patients with serous borderline ovarian tumors (SBOT). METHODS: Two hundred twenty-five patients who underwent surgery and were diagnosed with SBOT were retrospectively studied. Univariate and multivariate analyses were used to assess the risk factors for recurrence. Patients' clinical pathologic characteristics were compared between the patients who presented lymph node involvement and those who did not. The significant values of lymph condition influencing 5-year disease-free survival were also evaluated by statistical analysis. RESULTS: Both univariate and multivariate analyses showed that risk factors for recurrence were micropapillary (P = 0.021), fertility-preserving surgery (P = 0.014), and laparoscopic approach (P = 0.009). Of these 112 patients on whom lymphadenectomy was performed, 17 cases showed lymph node positive, whereas the remaining 95 patients did not. Significant differences in terms of lymph node numbers (P < 0.0001), invasive implant (P = 0.022), and International Federation of Gynecology and Obstetrics staging (P < 0.0001) were observed between the 2 groups of lymphatic node involved or not. Kaplan-Meier curves of 5-year disease-free survival revealed that there were no significant differences either between groups of lymphatic node involved or not (P = 0.778) and groups of removed nodes whether more than 10 or not (P = 0.549). CONCLUSIONS: Micropapillary, fertility-preserving, and laparoscopic approach were factors significantly affecting the recurrence of SBOT by both univariate and multivariate analysis. Lymph node metastasis did not seem to be correlated to a worse prognosis of SBOT.

[Ultrasonic diagnosis and prognosis of fetal multicystic kidney dysplasia].

OBJECTIVE: To explore the diagnosis, clinical course and prognosis of fetal multicystic kidney dysplasia (MCDK). METHODS: 24 858 pregnant women detected by prenatal ultrasound, here were 41 cases with fetal multicystic kidney dysplasia, these fetuses were diagnosed at average 29.8 weeks of gestation, Carried on an observation to fetuses with multicystic kidney dysplasia and postnatal follow-up study. RESULTS: T17 cases were induced abortion. Of 13 infants, 1 case involute, 3 cases decrease, 9 cases no change. CONCLUSION: Prenatal ultrasonography can actual diagnosis for fetal multicystic kidney dysplasia, the key of management of multicystic kidney dysplasia is assessment of fetal prognosis, the natural history of unilateral MCDK is usually benign, the affected kidneys tend to show involution after birth. But bilateral MCDK often associated with impairement of renal function, abnormal chromosome or other anomalies, which indicates a poor prognosis.

[The accuracy of diagnosing cervical intraepithelial neoplasia with colposcopically directed biopsy].

OBJECTIVE: To evaluate the accuracy of colposcopically directed biopsy in the diagnosis of cervical intraepithelial neoplasia (CIN). METHODS: The clinical data of 153 patients with CIN diagnosed by colposcopically directed biopsy and treated with cervical loop electrosurgical procedure (LEEP) shortly after were retrospectively studied. The consistency of pathological examination between colposcopically directed biopsy and LEEP was evaluated. The factors of missed diagnosis of cervical invasive carcinoma were analyzed. RESULTS: The diagnosis of 106 out of the 153 patients by colposcopically directed biopsy was consistent with that by LEEP as confirmed by pathologic diagnosis with a consistence rate of 69.3%, however, the diagnoses of 47 of the 153 patients by colposcopically directed biopsy were not consistent with those by LEEP, with an inconsistent rate of 30.7%, including 22 cases of overdiagnosis (14.4%, 22/153) and 25 cases of underdiagnosis (16.3%, 25/153). Eighteen patients were confirmed as with cervical invasive carcinoma by LEEP/hysterectomy at last with a missed diagnosis rate of 11.8%. The missed diagnosis rate of invasive carcinoma by colposcopically directed biopsy was significantly higher in the patients with cytologic diagnosis of with > or = HSIL than in the patients cytologically diagnosed as with < HSIL (chi(2) = 8.208, P < 0.05). CONCLUSION: The accuracy of diagnosing CIN with colposcopically directed biopsy is still unsatisfying. Attention should be paid on the patients with cytological diagnosis of > or = HSIL so as to avoid missed diagnosis of cervical carcinoma.

[Effects of primary chemotherapy with single methotrexate on low-risk gestational trophoblastic neoplasia and influencing factors thereof].

OBJECTIVE: To evaluate the effects of primary chemotherapy with single-agent methotrexate (MTX) on low-risk gestational trophoblastic neoplasia (GTN) and the influencing factors thereof. METHODS: Sixty-one GTN patients with the score of < or = 6 according to the new International Federation of Gynecology and Obstetrics (FIGO) scoring system (2000) were divided into 2 groups: 51 patients were treated with single MTX 0.4 mg/kg daily for 5 days (MTX 5 d group), and 10 patients were treated with MTX on the days 1, 3, 5, and 7, and with folinic acid (FA) 0.1 mg/kg on the days 2, 4, 6, and 8 (MTX + FA group), both group with an interval of treatment course of 2 weeks. The serum level of human chorionic gonadotropin (hCG) was detected every week. If a plateau or increase of serum hCG appeared between 2 examination results, meaning tolerance to MTX, the patients concerned had to undergo different regimens of salvage chemotherapy, all with MTX as one of their components. Univariate and multivariate methods were used to analyze the relationships of different factors to the outcomes of chemotherapy. RESULTS: Thirty-five of the 51 patients of the MTX 5d group (68.6%) achieved complete primary remission, 3 of the 10 patients of the MTX + FA group achieved complete primary remission, and all patients achieved complete remission after salvage chemotherapy. Univariate analysis showed that the mean pretreatment serum level of hCG, duration between antecedent pregnancy and start of treatment, size of tumor, FIGO score, specific regimen of MTX were significantly associated with outcome of chemotherapy (P = 0.004, 0.022, 0.017, 0.005, 0.021 respectively). Logistic regression analysis showed that only three independent factors predictive for the outcome of chemotherapy: MTX regimen (OR = 2.476), FIGO score (OR = 1.431), and pretreatment hCG titer (OR = 1.001). CONCLUSION: Primary chemotherapy with single MTX regimen may still be one of the options for patients with low-risk GTN according to the new FIGO scoring system, though the rate of complete primary remission appears to be lower. All patients with low-risk GTN achieve complete remission after salvage chemotherapy. MTX regimen, FIGO score, and pretreatment hCG are independent risk factors of outcome of single MTX chemotherapy.