Primary endodermal sinus tumor originating from the sacral ligament: a case report and review of the literature.

BACKGROUND: Endodermal sinus tumor (EST) is a malignant tumor originating from the ovary or testis. In most case, ultrasound examination shows ovarian mass. But there is a special kind of extra-gonadal endodermal sinus tumor, which occur in organs other than gonads with insidious onset. Here we reported a case of endodermal sinus tumor, which originated from the sacral ligament presenting as an acute lower abdominal pain. CASE PRESENTATION: A 14-year-old girl was admitted to the hospital because of acute lower abdominal pain. The ultrasound showed a mass with 72 mm × 64 mm × 50 mm in Douglas, and there was no abnormality in bilateral ovaries and fallopian tubes. Laparoscopic exploration showed a large amount of blood clots in the pelvic cavity. After removal of the blood, we found rotten fish-like tissue in the left sacral ligament, rapid pathology suggested endodermal sinus tumor. After the operation, we retrospectively examined the value of alpha-fetoprotein (AFP), which was found to be elevated, and post-operative paraffin pathology confirmed the diagnosis. After four cycles of BEP chemotherapy, exploratory laparotomy was performed to remove the visible lesion, but postoperative pathology showed no abnormality. At the one-year follow-up, the patient remained recurrence-free. CONCLUSION: Extra-gonadal germ cell tumors are rarely reported. When young teenagers complain of acute lower abdominal pain with elevated AFP, but there was no lesion in bilateral ovaries and fallopian tubes, we must think about the possibility of endodermal sinus tumors. Accurate diagnosis facilitates complete resection of lesions and improves patient's outcomes.

Manganese Deficiency Promotes the Progression of Invasive Adenocarcinoma of the Cervix by Enhancing the Inflammatory Response.

OBJECTIVE: We aimed to explore the association between manganese (Mn) and the progression of invasive adenocarcinoma of the cervix (IAC), together with the corresponding mechanisms. MATERIALS: Venous blood was collected from 65 IAC patients and 65 normal controls (female, participated in physical examination) in the fasting state. The levels of Mn and of inflammatory factors in the venous blood were measured using graphite furnace atomic absorption spectrometry (GAS) and enzyme-linked immunosorbent assay (ELISA), respectively. To investigate the relationships between Mn/inflammatory reactions and tumor progression, IAC patients were divided into two groups (I/II and III/IV) according to tumor grade. In vitro studies were also performed using human cervical cancer (CC) cell lines that were HPV-16 positive (Caski) or negative (C-33A). Following treatment with Mn, cell proliferation was detected by CCK-8, cell apoptosis was examined with flow cytometry, and the level of inflammatory factors was measured using qRT-PCR. RESULTS: The levels of Mn and of the anti-inflammatory factor interleukin-10 (IL-10) in the blood of IAC patients were lower than in normal controls, whereas levels of the pro-inflammatory factors interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were higher. Additionally, the serum electrolyte concentrations of Ca, Mg and K were lower in most IAC patients. The blood Mn level was positively correlated with IL-10, but negatively correlated with IL-6 and TNF-α. Higher Mn level and mild inflammatory response were associated with lower tumor grade. Human CC cells treated in vitro with Mn showed reduced cell proliferation ability, increased apoptosis abilities, and reduced inflammatory reaction. CONCLUSION: Mn deficiency may enhance the inflammatory reaction that could in turn promote the progression of IAC.

Comparison Of Three Different Treatment Methods For Cesarean Scar Pregnancy.

BACKGROUND/AIM: Cesarean scar pregnancy is a long term complication of cesarean section. There is a lot of controversy about the best treatment methods. We retrospectively summarized the clinical characteristics of patients with cesarean scar pregnancy and explored the advantages and disadvantages of fertility-preservation treatment method. METHODS: From January 2008 to September 2017, a total of 204 cases of cesarean scar pregnancy were retrospectively reviewed. 145 patients underwent transvaginal clearance, 33 patients underwent endoscopic surgery, and 26 patients underwent uterine artery embolism. The clinical characteristics, diagnosis, various treatment methods, and clinical outcomes were analyzed. RESULTS: There were no significant differences among the three groups in terms of patient age, number of previous cesarean sections, serum human chorionic gonadotropin, and clinical symptoms. The difference in mean gestational sac diameter (23.5±2.1mm vs 31.3±2.4mm vs 30.8± 1.9mm), surgical time (31.4±2.5min vs. 45.8±2.2min vs. 51.4±1.9min), blood loss (53.3± 5.5mL vs. 105.2±3.2mL vs. 75.6 ±3.5mL), blood transfusion (1/145 case vs.3/33 case vs. 0/26 case), discomfort (1/145 case vs.9/33 case vs. 16/26 case), hospital stay (6.1±1.1 day vs. 7.4±0.9 day vs.18.6±1.5 day), fever duration (1.0±0.5 day vs. 2.1±2.8 day vs. 5.7±3.5 day), and hospital expense (¥ 7825.9±234.9 vs. ¥ 10248.3± 312.9 vs. ¥ 18774.9±243.6) in transvaginal pregnancy tissue clearance, endoscopic surgery, and uterine artery embolism groups were significantly different. CONCLUSION: Transvaginal clearance is an effective and relatively safe treatment option for patients with cesarean scar pregnancy.

MicroRNA-320a acts as a tumor suppressor in endometrial carcinoma by targeting IGF-1R.

Dysregulation of microRNAs (miRs) is implicated in the carcinogenesis of various types of malignant tumor by manipulating cell growth and apoptosis. Abnormal expression of miR­320a is involved in tumorigenesis of many types of cancer. The potential association of miR­320a and the possible regulatory mechanisms in endometrial carcinoma is rarely elucidated. In the present study, it was demonstrated that miR­320a expression was decreased in endometrial carcinoma tissues and cell lines. The present results also indicated that overexpression of miR­320a suppressed cell proliferation through inducing G2/M phrase arrest and apoptosis. Insulin­like growth factor receptror­1 (IGF­1R) was verified to be the potential target of miR­320a by computational analysis and luciferase reporter assays. In addition, overexpression of miR­320a reduced endogenous IGF­1R expression in cells. Furthermore, it was demonstrated that upregulation of miR­320a inhibited phosphorylated (p)­protein kinase B and p­mechanistic target of rapamycin activation and promoted B cell lymphoma­2­associated death promoter expression. Reintroduction of IGF­1R into miR­320a­overexpressed cells antagonized the impact of miR­320a on its downstream protein, which demonstrated that the tumor suppressive role of miR­320a in endometrial carcinoma is exerted by the signal pathway mediated by IGF­1R. It was therefore concluded that miR­320a served an anti­tumor role on endometrial carcinoma through the regulation of IGF­1R, and miR­320a may be used as the target for the gene therapy of endometrial carcinoma.

MicroRNA-424 regulates epithelial-mesenchymal transition of endometrial carcinoma by directly targeting insulin-like growth factor 1 receptor.

Although numerous miRNAs are reported to contribute to the carcinogenesis of malignant tumor, the specific role of miR-424 in endometrial carcinoma is seldom reported. To explore the effect of miR-424 on epithelial-mesenchymal transition and its underlying mechanism, we detected miR-424 expression in endometrial carcinoma tissue and cells. We found that miR-424 was significantly downregulated in endometrial carcinoma tissues and cells, especially in HEC-1B cells. To perform the functional analysis, we transfected HEC-1B with miR-424-mi, miR-424-inh, mi-control, and inh-control, respectively. We found that overexpression of miR-424 significantly decreases cell proliferation and migration, accompanied with the increased E-cadherin/Vimentin expression and the transition of mesenchymal to epithelial cell phenotype. We identified that insulin-like growth factor-1 receptor (IGF-1R) was a potential target of miR-424 by computational analysis followed by luciferase reporter assays. Of note, we found that the downregulation of miR-424 in HEC-1B cells enhanced endogenous IGF-1R expression. Further mechanistic analysis revealed that forced expression of IGF-1R in miR-424-mim transfected cells remedied the weakened migration resulting from overexpression of IGF-1R. Taken together, the results of the current study demonstrated that miR-424 was a tumor suppressor for endometrial carcinoma and a favorable factor against tumor progression through targeting IGF-1R, thus providing a target for the treatment of endometrial carcinoma.

Functional FGFR4 Gly388Arg polymorphism contributes to cancer susceptibility: Evidence from meta-analysis.

Fibroblast growth factor receptor 4 (FGFR4) is a member of receptor tyrosine kinase family. A functional Gly388Arg (rs351855 G>A) polymorphism in FGFR4 gene causes a glycine-to-arginine change at codon 388 within the transmembrane domain of the receptor. Although the FGFR4 rs351855 G>A polymorphism has been implicated in cancer development, its association with cancer risk remains controversial. Here, we have systematically analyzed the association between the rs351855 G>A polymorphism and cancer risk by performing a meta-analysis of 27 studies consisting of 8,682 cases and 9,731 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to measure the strength of the association. The rs351855 G>A polymorphism was associated with an increased cancer risk under the recessive model (OR=1.19, 95% CI=1.01-1.41). Stratified analysis by cancer type indicated the rs351855 G>A polymorphism was associated with an increased risk of breast and prostate cancer, but a decreased risk of lung cancer. This meta-analysis demonstrates the FGFR rs351855 G>A polymorphism is associated with increased cancer risk and suggests it could potentially serve as a chemotherapeutic target or biomarker to screen high-risk individuals.

Fifteen cases clinical analysis of wedge-shaped resection of uterus treating adenomyosis-CONSORT.

To investigate the improvement of dysmenorrhea and menorrhagia after wedge-shaped resection of uterus. The clinical data of 15 patients who experienced wedge-shaped resection of uterus for adenomyosis were retrospectively analyzed from September 2012 to October 2013. We use the amount of the completed soaked napkins to measure the menstrual blood volume, and the visual analog scale to evaluate the degree of dysmenorrhea. We used the 2 index to evaluate the improvement of dysmenorrhea and menorrhagia after operation. All operations were successful, no serious complication occurred. Before the operation, all 15 patients used more than 25 pieces of completed soaked napkins, after the operation, 13 patients had significantly decreased menstrual flow, the average amount of completed soaked napkins was 3.6. Meanwhile, 2 patients had no menstrual after surgery. Before the operation, among the 10 patients with severe dysmenorrhea, 9 patients had significant relief on pain, they only experienced slight pain after surgery, only 1 patient still experienced moderate pain. Two patients with slight pain had no pain after operation. Among the 3 patients with moderate pain, 2 patients experienced slight pain and 1 patient felt no pain after operation. The wedge-shaped resection of uterus is a safe and effective procedure to significantly reduce menorrhagia and alleviate the extent of dysmenorrhea, which is a promising alternative for patient who suffered from dysmenorrhea and menorrhagia for adenomyosis.

The Research of Feasibility and Efficacy of Radiofrequency Ablation in Treating Uterine Fibroids.

To explore the feasibility and efficacy of radiofrequency ablation in treating uterine fibroids.Ninety patients with multiple uterine fibroids, who had undergone hysterectomy were included in the study. After the uterus was resected, the temperature of 60, 80, 100°C were adopted to ablate the in vitro fibroid with each temperature dealing with 30 patients. Simultaneously, 5 patients were included, whose in vivo fibroid were ablated with the temperature of 100°C before the fibroids were removed after laparotomy. After the fibroids were ablated, the smooth muscle in the ablated center (group A), the ablated edge (group B) and 1 cm away from the ablated edge (group C) were taken. Then, the samples were stained with hematoxylin and eosin (HE) to examine the histopathological changes, and immunohistochemistry was performed to detect the expression of estrogen receptor (ER) and progesterone receptor (PR).After radiofrequency ablation, the ablated lesions were round, toast tan, and dry on gross appearance. There were no obvious tissue carbonization and there were distinct boundary from periphery tissue. In vitro: On automated analysis, the average optical density of ER and PR in group A, B, and C was lower than the control group (P < 0.05), and which were gradually raised with the increased distance to electrode. In the same treatment group, ER optical density was gradually decreased with the increased temperature among 3 different groups. The PR optical density was decreased with the increased temperature under different temperatures in group A and group B, there was significant difference among groups (P < 0.05). But in group C, there was no difference in PR expression among the temperature of 60, 80, and 100°C (P > 0.05). In vivo: Compared with the control group, the average optical density of ER and PR were significantly different among group A, B, and C (P < 0.05), what's more, it was gradually raised with the increased distance to electrode.After radiofrequency ablation, the tissues displayed coagulative necrosis, and decreased ER and PR expression. Radiofrequency ablation may be considered a minimally invasive alternative for those women who wish to retain their reproductive potential. Eighty degree Celsius was expected to be the optimum temperature in radiofrequency ablation treatment of uterine fibroid.

Ultra-structure changes and survivin expression in uterine fibroids after radiofrequency ablation.

PURPOSE: To explore the reliability and validity of radiofrequency (RF) ablation in treating uterine fibroids. MATERIALS AND METHODS: We evaluated 63 patients who underwent hysterectomy to treat multiple fibroids. Thirty patients immediately underwent abdominal hysterectomy after the fibroids were ablated under direct vision. Thirty-three patients first experienced trans-vaginal ablation with the guidance of a baseline ultrasound. We performed abdominal or trans-vaginal hysterectomy 72 h later. The tissues in the centre of the ablated lesion (group A), at the edge of the ablated lesion (group B), 1 cm away from the ablated edge (group C) and the control group were sampled. We observed ultra-structure changes by transmission electron microscopy and detected survivin expression with Western blot analysis. RESULTS: According to transmission electron microscopy, the ultra-structure of fibroid cells in groups A and B was damaged. However, in group C, the ultra-structure was normal. Compared with the control group, survivin expression was significantly decreased. Meanwhile survivin expression was significantly increased with the distance to the ablated centre (p < 0.05). CONCLUSIONS: Radiofrequency ablation caused permanent and irreversible damage to fibroid cells and decreased survivin expression, which provided reliable clinical evidence for the success of radiofrequency ablation treating uterine fibroids.

Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy.

Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient.

Down-regulation of IGF-1R expression inhibits growth and enhances chemosensitivity of endometrial carcinoma in vitro.

The type-1 insulin-like growth factor receptor (IGF-1R) is over-expressed by endometrial carcinoma, level of IGF-1R has been correlated with tumor progression, and high IGF-1R expression has been found to be an important prognostic factor. In the study, we used lentivirus-mediated shRNA targeting IGF-1R to silence its expression, then assessed the effect of down-regulation of this receptor on cell growth and chemosensitivity to cisplatin. Lentivirus-mediate shRNA was designed and transfected to the endometrial carcinoma HEC-1B cell. The IGF-1R mRNA and related protein expression, cell proliferation ability, cell apoptosis, and cell cycle change were detected. Cell proliferation inhibition rates, cell apoptosis, and level of cleaved caspase-9 were measured in various concentrations of cisplatin. The mRNA and protein level of IGF-1R, and the phosphorylated protein p-Akt, p-Erk were all suppressed after transfection. Cell proliferation was inhibited in successive five days after transfection, the highest inhibition rate was 43.28 ± 3.55% on day 5. After transfection, 24.96 ± 1.05% cells were in G(2)/M phase, and cell apoptotic rate increased from 10.66 ± 0.08 to 19.92 ± 1.34%. In various concentrations of cisplatin, transfected cells proliferation was significantly inhibited which made the IC50 value drop from 21.85 uM to 10.58 uM. Incubation with different concentrations of cisplatin for 48 h, cells apoptotic rate increased to 41.92 ± 2.5, 31.13 ± 2.76, 22.21 ± 4.63%, respectively, which was accompanied with increased cleaved caspase-9 expression. Lentivirus-mediated shRNA targeting IGF-1R has the potential to develop as a clinical treatment method in advanced and chemoresistant endometrial carcinoma.

Inhibitory effect of siRNA targeting IGF-1R on endometrial carcinoma.

The type-1 insulin-like growth factor receptor (IGF-1R) is one member of tyrosine protein kinase receptor family. It is a causal factor for tumor initiation, development and frequently overactivated in a variety of human malignancies, including endometrial carcinoma. To investigate its possibility as a therapeutic target for endometrial carcinoma, we adopted RNA interference technology to down-regulate IGF-1R expression in endometrial carcinoma and analyzed its apoptosis inductive effect and tumorigenicity in vivo. Results showed that RNAi mediated down-regulation of IGF-1R expression in endometrial carcinoma significantly induced apoptosis, reduced downstream protein phosphorylation and decreased tumorigenicity in vivo accompanied with lower proliferation index in tumor tissue, Which implied the therapeutic potential of RNAi in the treatment of endometrial carcinoma by targeting IGF-1R and IGF-1R may be a potential therapeutic target for human endometrial carcinoma.