BACKGROUND & AIMS: :Intravenous leiomyomatosis imitates an invasive malignant tumour both clinically and pathologically although it represents a perfectly benign disease with a favourable outcome. The knowledge of this very rare disease is necessary not to omit the indicated operation on the patient, because of an erroneous assumption of incurability. Therefore, we present the clinical and pathological appearance of this disease from two typical cases of our own.

背景与目标： : 静脉内平滑肌瘤病在临床和病理上都模仿了侵袭性恶性肿瘤，尽管它代表了一种完全良性的疾病，具有良好的疗效。对这种非常罕见的疾病的了解是必要的，不要忽略对患者的指示操作，因为错误的假设是不可治愈的。因此，我们从我们自己的两个典型病例中介绍了这种疾病的临床和病理表现。

BACKGROUND & AIMS: :Benign metastasizing leiomyoma is a rare lesion characterized by benign-appearing smooth muscle tumor most frequently involving the lung and usually associated with a benign leiomyoma or intravenous leiomyomatosis of the uterus. The pathogenetic mechanism of the tumor has not been clarified, but the possibilities including hormone-sensitive in situ proliferations of smooth muscle bundles, mechanical displacement or intravascular spread of preexisting benign uterine tumor tissue, and metastasized very low-grade uterine leiomyosarcoma have been proposed. We described a case of pulmonary benign metastasizing leiomyoma associated with a uterine intravenous leiomyomatosis in a 46-year-old woman with a result of comparative genomic hybridization study. The 2 lesions showed significantly overlapping, if not identical, complex genomic changes in the comparative genomic hybridization, suggesting that the 2 lesions are closely related to each other. Unresected pulmonary nodules were left untreated for 13 months after the hysterectomy and wedge biopsy of 3 pulmonary nodules to show no further growth, suggesting clinical behavior of nonmalignant tumor in our case. Benign metastasizing leiomyomas may comprise a heterogeneous group of tumors in terms of their malignant potential and pathogenetic mechanism.

背景与目标： : 良性转移性平滑肌瘤是一种罕见的病变，其特征是良性出现的平滑肌肿瘤最常累及肺部，通常与良性平滑肌瘤或子宫静脉内平滑肌瘤病有关。肿瘤的发病机制尚未阐明，但已提出了可能的可能性，包括激素敏感的平滑肌束原位增殖，先前存在的良性子宫肿瘤组织的机械移位或血管内扩散以及转移性极低级别子宫平滑肌肉瘤。我们描述了一名46岁女性的肺良性转移性平滑肌瘤与子宫静脉内平滑肌瘤病相关的病例，并进行了比较基因组杂交研究。在比较基因组杂交中，这2个病变显示出明显重叠的复杂基因组变化，即使不相同，也表明这2个病变彼此密切相关。未切除的肺结节在子宫切除术和3个肺结节的楔形活检后未治疗13个月，未显示出进一步的生长，这表明我们的病例是非恶性肿瘤的临床行为。就其恶性潜能和致病机制而言，良性转移性平滑肌瘤可能包含一组异质性肿瘤。

BACKGROUND & AIMS: :Smooth muscle tumours of the uterus are common and the majority are benign leiomyomas. However, there are some tumours which exhibit unusual morphological features or growth patterns that cause difficulty in their distinction from malignant neoplasms and those with endometrial stromal differentiation. Such lesions are reviewed in this article with detailed descriptions of their morphology, differential diagnosis and correlation with biological behaviour.

背景与目标： : 子宫平滑肌肿瘤很常见，大多数是良性平滑肌瘤。然而，有些肿瘤表现出异常的形态特征或生长方式，难以与恶性肿瘤和子宫内膜间质分化的肿瘤区分开来。本文对此类病变进行了综述，并详细描述了其形态，鉴别诊断疾病以及与生物学行为的相关性。

BACKGROUND & AIMS: :We have previously shown that NK lineage cells migrate to the murine decidua of pregnancy; but with advancing gestation, they are progressively inactivated in situ by prostaglandins of the E series (PGE2) secreted by decidual cells and decidual macrophages. We have also shown that the same mechanism inactivates all killer lineage cells in the human decidua, and that this inactivation is at least in part due to a down-regulation of IL-2 receptors and an inhibition of IL-2 production in situ. We examined whether chronic indomethacin therapy (to block prostaglandin synthesis), or a systemic administration of a high dose of IL-2, or a combination of both agents administered to pregnant mice could activate killer cells in situ and interfere with the progress of pregnancy; and if so, whether there was a causal relationship between the two events. Pregnant CD1 mice (Day 5 of gestation) were subjected to chronic indomethacin therapy (14 micrograms/ml in drinking water up to Day 15, or 50 micrograms twice daily sc or ip up to Day 10), high dose IL-2 therapy (25,000 Cetus U of human recombinant IL-2, ip every 8 or 12 hr for 3-5 days), or a combination of the two. These treatments led to pregnancy loss in 89-100% of mice, in contrast to 1% loss in control, vehicle-treated mice. Uterine mononuclear cells isolated from the embryo resorption sites exhibited high killer activity against YAC-1 lymphoma as well as murine trophoblast targets, with NK-like phenotype (Asialo GM-1+, Thy-1-) after indomethacin therapy and LAK-like phenotype (AGM-1+, Thy-1+) after IL-2 or indomethacin + IL-2 therapy. That AGM-1+ killer cells resulted in the pregnancy loss was suggested by the findings that in two of three separate experiments, iv injections of AGM-1 ab into pregnant indomethacin + IL-2-treated mice nearly completely prevented the fetoplacental demise (reducing it to 7.7% from 100%). These results reveal that PGE2-mediated inactivation of killer lineage cells in the decidua in situ is conducive to the survival of the conceptus.

背景与目标： : 我们以前已经证明NK谱系细胞迁移到妊娠的鼠蜕膜; 但是随着妊娠的推进，它们逐渐被蜕膜细胞和蜕膜巨噬细胞分泌的e系列前列腺素 (PGE2) 原位灭活。我们还表明，相同的机制使人蜕膜中的所有杀伤谱系细胞失活，并且这种失活至少部分是由于IL-2受体的下调和原位IL-2产生的抑制。我们检查了慢性吲哚美辛疗法 (阻止前列腺素合成)，或全身施用高剂量的IL-2，或两种药物的组合施用给怀孕小鼠是否可以原位激活杀伤细胞并干扰妊娠进程; 如果是这样，这两个事件之间是否存在因果关系。怀孕的CD1小鼠 (妊娠第5天) 接受慢性吲哚美辛治疗 (14微克/毫升饮用水至第15天，或50微克每日两次sc或ip至第10天)，高剂量IL-2治疗 (25,000人重组IL-2的鲸鱼座U，ip每8或12小时3-5天)，或两者的组合。这些处理导致89-100% 小鼠的妊娠损失，与对照、赋形剂处理的小鼠的1% 损失相反。从胚胎吸收部位分离的子宫单核细胞对YAC-1淋巴瘤和鼠滋养层靶标表现出高杀伤活性，吲哚美辛治疗后具有NK样表型 (Asialo GM-1 +，Thy-1-) 和LAK样表型 (AGM-1 +，thy-1 +) IL-2或吲哚美辛 + IL-2治疗后。AGM-1 + 杀伤细胞导致妊娠损失的研究结果表明，在三个独立实验中的两个实验中，向怀孕的吲哚美辛 + IL-2-treated小鼠静脉注射AGM-1 ab几乎完全阻止了胎儿胎盘的死亡 (将其从100% 减少到7.7%)。这些结果表明，原位蜕膜中杀伤谱系细胞的PGE2-mediated失活有利于概念的存活。

BACKGROUND & AIMS: :Cytogenetic analysis of a uterine leiomyoma from a 56-year-old woman revealed an interstitial deletion of chromosome 10, del(10)(q22q24), as the only chromosomal abnormality. Band 10q22 was also rearranged in a previously reported leiomyosarcoma of the uterus showing a t(10;17)(q22.1;p13) as the only change. These findings provide an additional example in soft tissue tumors for involvement of the same chromosomal regions in benign and malignant proliferation of cells from the same lineage.

背景与目标： : 来自56岁女性的子宫平滑肌瘤的细胞遗传学分析显示，唯一的染色体异常是10号染色体del(10)(q22q24) 的间质缺失。带10q22也在先前报道的子宫平滑肌肉瘤中重新排列，显示t(10;17)(q22.1;p13) 是唯一的变化。这些发现为软组织肿瘤提供了另一个例子，该例子涉及相同谱系细胞的良性和恶性增殖中的相同染色体区域。

BACKGROUND & AIMS: PURPOSE:To evaluate the impact of systemic cyclophosphamide treatment on the rat uterus and investigate the potential therapeutic effects of natural antioxidant preparations curcumin and capsaicin against cyclophosphamide side effects. METHODS:A 40 healthy adult female Wistar albino rats were used in this study. Rats were randomly divided into four groups to determine the effects of curcumin and capsaicin against Cyclophosphamide side effects on the uterus (n=10 in each group); Group 1 was the control group (sham-operated), Group 2 was the cyclophosphamide group, Group 3 was the cyclophosphamide + curcumin (100mg/kg) group, and Group 4 was the cyclophosphamide + capsaicin (0.5 mg/kg) group. RESULTS:Increased tissue oxidative stress and histological damage in the rat uterus were demonstrated due to the treatment of systemic cyclophosphamide chemotherapy alone. The level of tissue oxidant and antioxidant markers and histopathological changes were improved by the treatment of curcumin and capsaicin. CONCLUSION:Cytotoxic effects of natural alkylating chemotherapeutic agents like cyclophosphamide on the uterus can be prevented by curcumin and capsaicin.

背景与目标：

BACKGROUND & AIMS: :Inflammatory myofibroblastic tumor (IMT) is a spindle cell neoplasm with low malignant potential, which may appear in different parts of the body. Uterine localization is rare, especially among children. Etiology is unclear, although some authors suggest underlying trauma or distress. A 3.5-year-old girl was treated at our institute for recurring vaginal bleeding without injury or known pathology. Physical examination and laboratory analysis revealed no specific findings, contrast-enhanced MRI found a 25 × 28 × 30 mm-sized inhomogeneous soft tissue mass in the uterus wall, which was excised in toto. Histological examination identified a spindle cell pattern, and the FISH test revealed ALK gene rearrangement, the lesion was defined as an IMT. Six cases were published to date, and their diagnostic methods are not equivocal, CT, and PET CT were preferred instead of MRI. Aggressive therapy seems to be exaggerated according to low recurrence and metastasis occurrence, and crizotinib is proved as good therapeutic agent in those cases. Biopsy and histology has important role in order to distinguish IMT from malignancies completed with FISH examination because ALK positivity strengthens the diagnosis. No lethal outcome was published among children, as our patient is also symptom-free after 3 years.

背景与目标： : 炎症性肌纤维母细胞瘤 (IMT) 是一种具有低恶性潜能的梭形细胞肿瘤，可能出现在身体的不同部位。子宫定位很少见，尤其是在儿童中。病因尚不清楚，尽管一些作者建议潜在的创伤或困扰。一名3.5岁的女孩在我们研究所接受了复发性阴道出血的治疗，没有受伤或已知的病理。体格检查和实验室检查未发现具体发现，增强MRI在子宫壁中发现25 × 28 × 30毫米大小的不均匀软组织肿块，并在toto中切除。组织学检查确定了梭形细胞模式，FISH测试显示ALK基因重排，病变被定义为IMT。迄今为止已发表了6例病例，其诊断方法并不模棱两可，首选CT和PET CT而不是MRI。根据低复发和转移发生率，积极的治疗似乎被夸大了，在这些情况下，克唑替尼被证明是良好的治疗剂。活检和组织学对于区分IMT和FISH检查完成的恶性肿瘤具有重要作用，因为ALK阳性可增强诊断。在儿童中没有发表致命的结果，因为我们的患者在3年后也没有症状。

BACKGROUND & AIMS: OBJECTIVE:To investigate if an asymmetry exists in the lateral distribution of obstructed hemivagina and renal agenesis in women with uterus didelphys. DESIGN:All English-language medical papers on uterus didelphys, obstructed hemivagina, and associated renal agenesis published from 1980 to 2005 and identified by Embase, Medline, and Pubmed database searches were retrieved. In addition, 41 institutional cases are described. We considered articles in which the presence of a uterus didelphys, obstructed hemivagina, and renal agenesis was assessed as well as the affected side. Data were stratified based on surgical confirmation or imaging evidence of the specific müllerian anomaly. Two authors abstracted data independently on standardized forms, and the combined frequency of right- and left-side malformation subtype was computed. RESULT(S):Thirty-six reports including 138 subjects were selected. Unilateral hemato- or pyocolpos was on the right side in 91 patients (66%). Among the 125 cases with surgical demonstration of the müllerian malformation subtype, 81 (65%) had the anomaly on the right side. In the institutional series, lesions were on the right side in 25 cases (61%). Combining the above figures, the observed proportion of right-sided anomalies (116/179) was 65% (95% CI 57% to 72%). CONCLUSION(S):Left-right asymmetry may be induced before organogenesis, establishing differences in morphogenesis on the left and right sides of the embryo.

背景与目标：

BACKGROUND & AIMS: :The mesenchymal to epithelial transition (MET) is thought to be involved in the maintenance, repair, and carcinogenesis of the fallopian tube (oviduct) and uterine epithelium. However, conclusive evidence for the conversion of mesenchymal cells to epithelial cells in these organs is lacking. Using embryonal cell lineage tracing with reporters driven by mesenchymal cell marker genes of the female reproductive tract (AMHR2, CSPG4, and PDGFRβ), we show that these reporters are also expressed by some oviductal and uterine epithelial cells at birth. These mesenchymal reporter-positive epithelial cells are maintained in adult mice across multiple pregnancies, respond to ovarian hormones, and form organoids. However, no labeled epithelial cells are present in any oviductal or uterine epithelia when mesenchymal cell labeling was induced in adult mice. Organoids developed from mice labeled in adulthood were also negative for mesenchymal reporters. Collectively, our work found no definitive evidence of MET in the adult fallopian tube and uterine epithelium.

背景与目标： : 间充质到上皮的转变 (MET) 被认为与输卵管 (输卵管) 和子宫上皮的维持，修复和癌变有关。然而，缺乏关于这些器官中间充质细胞转化为上皮细胞的确凿证据。使用由女性生殖道的间充质细胞标记基因 (AMHR2，CSPG4和pdgfr β) 驱动的报告子的胚胎细胞谱系追踪，我们显示这些报告子在出生时也被某些输卵管和子宫上皮细胞表达。这些间充质报告阳性上皮细胞在多次妊娠的成年小鼠中维持，对卵巢激素有反应，并形成类器官。然而，当在成年小鼠中诱导间充质细胞标记时，任何输卵管或子宫上皮中都没有标记的上皮细胞。从成年标记的小鼠开发的类器官对间充质报告基因也呈阴性。总的来说，我们的工作没有在成人输卵管和子宫上皮中发现MET的确切证据。

BACKGROUND & AIMS: Exposure of goat uterine nuclei to estradiol in vitro results in an immediate exit of ribonucleoproteins (RNP) from the nuclei to the medium. This RNP exit appears to be mediated by an estrogen receptor localized in small nuclear ribonucleoproteins containing U1 and U2 snRNA. Available evidence indicates that the estrogen receptor involved is not the ERalpha, but an alternative form, which is also a 66 kDa protein. This is the nuclear estrogen receptor II (nER-II) that has no DNA-binding capacity. The transport is estrogen-specific since non-estrogenic steroids do not stimulate the transport of the RNP where the receptor is localized.

背景与目标： 山羊子宫核在体外暴露于雌二醇会导致核糖核蛋白 (RNP) 立即从细胞核退出到培养基。这种RNP退出似乎是由位于含有U1和U2 snRNA的小核糖核蛋白中的雌激素受体介导的。现有证据表明，涉及的雌激素受体不是ERalpha，而是一种替代形式，也是66 kDa的蛋白质。这是没有DNA结合能力的核雌激素受体II (nER-II)。转运是雌激素特异性的，因为非雌激素类固醇不会刺激受体定位的RNP的转运。

BACKGROUND & AIMS: OBJECTIVE:We investigated how progesterone and salmeterol modify the effect of nifedipine in an in vivo preterm birth model in rats, and how terbutaline and nifedipine modify the contractions of the isolated human myometrium. DESIGN:Experimental animal and human myometrial studies. SAMPLE:Twenty-four female Sprague-Dawley rats and 13 human uterine tissues sampled from cesarean section. METHODS:Preterm birth was induced in Sprague-Dawley rats with a combination of mifepristone and prostaglandin-E(2). The animals were treated with nifedipine or its combination with salmeterol and progesterone. Additionally, isolated human myometrial strips from cesarean sections were stimulated with oxytocin, and the inhibitory effects of nifedipine and terbutaline were studied. RESULTS:Nifedipine delayed the preterm delivery in the rats, but its effect was tripled by the addition of β(2)-mimetics, or abolished after progesterone pretreatment. Synergism was observed in the relaxing effects of nifedipine and terbutaline on the isolated human myometrium. CONCLUSION:The action of nifedipine in delaying labor is impeded by progesterone. A combination of nifedipine and β(2)-agonists should be considered for the treatment or prevention of preterm birth.

背景与目标：

BACKGROUND & AIMS: :The role of adjuvant therapy for malignant mixed müllerian tumors of the uterus has not been established. Our aim was to review our experience with sequential adjuvant therapy using cisplatin and ifosfamide chemotherapy and radiotherapy after surgical staging. A retrospective study of 43 patients from 1995 to 2004 was undertaken. Survival was calculated using the Kaplan-Meier method and compared by the log-rank test. The Cox proportional hazard regression model was used to assess the effect of treatment on survival after adjustment for age and stage. Twenty-eight patients received adjuvant chemotherapy and 28 patients had adjuvant radiotherapy. Twenty-one patients underwent sequential adjuvant chemotherapy and radiotherapy. Tumor recurrence occurred in 14 patients at a median duration of 10 months. The overall 2- and 5-year survival was 64% and 60%, respectively. The 2- and 5-year survival for stage I and II diseases was both 95%, while the 2-year survival for stage III and IV diseases was 25%. Patients who underwent sequential adjuvant therapy had an improved survival compared with patients who did not follow the protocol (P= 0.024). Our results with sequential adjuvant therapy are encouraging and justify future randomized trials.

背景与目标： : 辅助治疗子宫恶性苗勒氏混合瘤的作用尚未确定。我们的目的是回顾我们在手术分期后使用顺铂和异环磷酰胺化疗和放疗进行序贯辅助治疗的经验。对43名1995年2004年的患者进行了回顾性研究。使用Kaplan-Meier方法计算生存率，并通过log-rank检验进行比较。Cox比例风险回归模型用于评估调整年龄和分期后治疗对生存率的影响。28例患者接受了辅助化疗，28例患者接受了辅助放疗。21例患者接受了序贯辅助化疗和放疗。14例患者发生肿瘤复发，中位持续时间为10个月。总2年和5年生存率分别为64% 和60%。I和II期疾病的2年和5年生存率均为95%，而III和IV期疾病的2年生存率为25%。与未遵循方案的患者相比，接受序贯辅助治疗的患者的生存率提高 (P = 0.024)。我们的序贯辅助治疗结果令人鼓舞，并证明了未来的随机试验是合理的。

BACKGROUND & AIMS: :We report the case of a young girl with uterus didelphys, obstructed vagina and ipsilateral renal agenesis treated by diagnostic laparoscopy and resection of the vaginal septum by a vaginal approach in order to drain the distended uterus. Despite classic surgery, the myometrium on the treated side never recovered its normal function, with subsequent persistence of recurrent hematometra. Laparoscopic subtotal hemihysterectomy had to be performed to avoid retention of hematometra and secondary pelvic inflammatory disease.

背景与目标： : 我们报告了一名年轻女孩的情况，该女孩患有子宫内膜异位，阴道阻塞和同侧肾发育不全，通过诊断性腹腔镜检查治疗，并通过阴道入路切除阴道中隔以引流扩张的子宫。尽管进行了经典的手术，但治疗侧的子宫肌层从未恢复其正常功能，随后持续出现复发性血常规。必须进行腹腔镜半全子宫切除术，以避免保留血常规和继发性盆腔炎。

BACKGROUND & AIMS: BACKGROUND:Incarceration of the gravid uterus is a rare obstetric disorder that contributes to pregnancy-related complications. To understand its clinical characteristics and managements, we have reviewed the etiology, risk factors, clinical characteristics and current treatments of an incarcerated gravid uterus based on 162 cases reported in the English language literature, including our patient. CASE PRESENTATION:A 25-year-old primigravida, with a history of lymphatic tuberculosis, infertility due to blocked fallopian tubes and received in vitro fertilization. The patient presented with urine retention and lower abdominal pain in the early second trimester. Uterine incarceration was diagnosed based on pelvic examination and abdominal ultrasound. A Foley catheter was placed and manual reposition was successful. No episode of retention was experienced after the further enlargement of the uterus and its ascent. A healthy infant was delivered vaginally on 38th week of pregnancy. CONCLUSIONS:Uterine incarceration due to pelvic adhesions is rare and, because of it non-specific clinical presentations, is often misdiagnosed. Abdominal ultrasound is instrumental for the diagnosis because it can directly image the disturbed uterine and pelvic anatomy. There are limited treatment options for uterine incarceration, but definitive diagnosis allows procedures to treat and to reduce severe complications of uterine incarceration.

背景与目标：

BACKGROUND & AIMS: AIM:To confirm the difference in the expression of endothelial nitric oxide synthase in the normal endometrium and myometrium of women who have leiomyoma or adenomyosis compared with controls, and its correlation with the pathogenesis of menorrhagia or dysmenorrhea in patients with uterine leiomyoma. METHODS:Fifty-one hysterectomized patients were divided into three groups: (i) patients with leiomyoma (n=24); (ii) those with adenomyosis (n = 19); and (iii) the control group (n=8). The expression of endothelial nitric oxide synthase was confirmed on immunohistochemistry and analyzed using an evaluation nomogram. RESULTS:The expression of endothelial nitric oxide synthase was significantly higher in the leiomyoma group and the adenomyosis group as compared with the control group. In the subgroup analysis of leiomyoma depending on symptoms (menorrhagia or dysmenorrhea or both), the expression of endothelial nitric oxide synthase was significantly higher in the symptomatic subgroup than the asymptomatic subgroup (endometrium P=0.0029, myometrium P=0.0276). CONCLUSIONS:Based on the findings that the expression of endothelial nitric oxide synthase was significantly higher in the uterus with leiomyoma or adenomyosis, it can therefore be inferred that nitric oxide might have a pathological effect on the uterus with the above diseases. In particular, it is also presumed that endothelial nitric oxide synthase is closely associated with menorrhagia and dysmenorrhea.

背景与目标：