• 【腺癌合并宫颈小细胞神经内分泌癌的细胞学特征。】 复制标题 收藏 收藏
    DOI:10.4103/1742-6413.207139 复制DOI
    作者列表:Shimojo N,Hirokawa YS,Kanayama K,Yoneda M,Hashizume R,Hayashi A,Uchida K,Imai H,Kozuka Y,Shiraishi T
    BACKGROUND & AIMS: :Adenocarcinoma admixed with neuroendocrine carcinoma of the uterine cervix is a rare malignancy with a poor prognosis, and few reports have described the cytological features of this carcinoma. To characterize the cytological features of this malignancy in cervical smears, we report a case of a 52-year-old Japanese woman with cervical adenocarcinoma admixed with small cell neuroendocrine carcinoma (SCNEC). Cytologically, there were two types of cells with different sizes. The smaller cells formed clusters, which showed a partially Indian file pattern, a high nuclear/cytoplasmic ratio, and hyperchromatic nuclei. In contrast, the larger cells showed cytological features of adenocarcinoma, indicating a glandular-like pattern. Histological examination of biopsy specimens revealed that the tumors were composed of almost equal areas of SCNEC and adenocarcinoma. Neuroendocrine differentiation was confirmed by immunohistochemistry for synaptophysin and CD56. Thus, when adenocarcinoma cells are detected in smears, attempts to search for SCNEC cells should be made by combined cytological and histological analyses in order to reach an accurate diagnosis of the carcinoma in the uterine cervix.
    背景与目标: : 腺癌与子宫颈神经内分泌癌混合是一种罕见的恶性肿瘤,预后较差,很少有报道描述该癌的细胞学特征。为了表征这种恶性肿瘤在宫颈涂片中的细胞学特征,我们报告了一例52岁的日本妇女,该妇女患有宫颈腺癌并伴有小细胞神经内分泌癌 (SCNEC)。在细胞学上,有两种大小不同的细胞。较小的细胞形成簇,显示出部分印度文件模式,高核/细胞质比和深染核。相反,较大的细胞显示出腺癌的细胞学特征,表明腺样模式。活检标本的组织学检查显示,肿瘤由SCNEC和腺癌几乎相等的区域组成。突触素和cd56的免疫组织化学证实了神经内分泌分化。因此,当在涂片中检测到腺癌细胞时,应通过结合细胞学和组织学分析来尝试寻找SCNEC细胞,以便对子宫颈癌进行准确诊断。
  • 【雌二醇和孕酮对未怀孕绵羊子宫颈前列腺素酶系统的调节。】 复制标题 收藏 收藏
    DOI:10.1530/REP-06-0328 复制DOI
    作者列表:Zhang Q,Collins V,Chakrabarty K,Rose JC,Wu WX
    BACKGROUND & AIMS: :In the present study, we examined the in vivo effects of estradiol (E(2)) and progesterone on cyclooxygenase (COX) 2, prostaglandin F synthase (PTGFS, also known as PGFS), and membrane-associated prostaglandin E synthase 1 (mPTGES1) expression at both mRNA and protein levels using a nonpregnant ovariectomized (OVX) sheep model. Sixteen ewes were OVX shortly after ovulation. After 40 days, ewes were treated with saline (Cont, n=5), or E(2) infused intravenously for 2 days (50 microg/day, n=5) or intravaginal progesterone (P) sponges for 10 days (0.3 g P, n=6). Cervical COX2, PTGFS, and mPTGES1 mRNA and protein were quantified by northern and western blot analyses respectively. In situ hybridization and/or immunocytochemistry were used to localize the cellular distribution of COX2, PTGFS, and mPTGES1 mRNAs and proteins. COX2 mRNA abundance increased significantly in the cervix after E(2) treatment (P<0.05). However, progesterone was a more potent stimulator than E(2) of COX2 mRNA and protein abundance in the cervix (P<0.01). In contrast, PTGFS and mPTGES1 mRNA and protein concentrations did not change after E(2) or progesterone treatment (P>0.05). COX2, PTGFS, and mPTGES1 mRNA and protein were only localized in cervical glandular epithelial cells. This study shows that increased cervical COX2 mRNA and protein, but not PTGFS and mPTGES1 mRNA and protein, were associated with E(2) and progesterone treatment in nonpregnant sheep. More strikingly, progesterone was a more potent stimulator of cervical COX2 expression than E(2). The expression of COX2, PTGFS, and mPTGES1 mRNA and/or protein was confined in the cervical glandular epithelial cells of nonpregnant sheep.
    背景与目标: : 在本研究中,我们检查了雌二醇 (E(2)) 和孕酮对环氧合酶 (COX) 2,前列腺素F合酶 (PTGFS,也称为PGFS) 的体内作用,使用非妊娠卵巢切除 (OVX) 绵羊模型在mRNA和蛋白质水平上的膜相关前列腺素E合酶1 (mPTGES1) 表达。排卵后不久,有16只母羊出现OVX。40天后,用盐水 (Cont,n = 5) 或E(2) 静脉内输注2天 (50微克/天,n = 5) 或阴道内孕酮 (P) 海绵治疗10天 (0.3g P,n = 6)。分别通过northern和western印迹分析定量子宫颈COX2,PTGFS和mPTGES1 mRNA和蛋白。原位杂交和/或免疫细胞化学用于定位COX2,ptgf和mPTGES1 mrna和蛋白质的细胞分布。E(2) 处理后子宫颈COX2 mRNA丰度显著增加 (P<0.05)。然而,孕酮是子宫颈中COX2 mRNA和蛋白质丰度的比E(2) 更有效的刺激因子 (P<0.01)。相反,在E(2) 或孕酮处理后,PTGFS和mPTGES1 mRNA和蛋白浓度没有变化 (P>0.05)。COX2,PTGFS和mPTGES1 mRNA和蛋白仅位于宫颈腺上皮细胞中。这项研究表明,在未怀孕的绵羊中,子宫颈COX2 mRNA和蛋白的增加,而PTGFS和mPTGES1 mRNA和蛋白的增加与E(2) 和孕酮治疗有关。更引人注目的是,孕酮比E(2) 更有效地刺激子宫颈COX2表达。COX2,PTGFS和mPTGES1 mRNA和/或蛋白的表达仅限于未怀孕绵羊的宫颈腺上皮细胞。
  • 【[宫颈癌照射后下尿路的功能变化]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Behr J,Winkler M,Willgeroth F
    BACKGROUND & AIMS: :104 patients submitted to primary irradiation for cervix carcinoma were examined by means of urodynamic methods of diagnosis in order to investigate the functional changes of the lower urinary tract induced by therapy. 34 patients could be examined prior to therapy, 19 and 12 patients, respectively, were examined six and 18 months on an average after the treatment. Another group of 70 patients had retrospective check-up examinations with average intervals of five and ten years. Hydronephrosis occurred only as a late result after more than six years in 12% of the irradiated women. The incidence of residual urine, significant bacteriuria, and disturbed sensory function of the bladder was not important. All patients were incontinent two years after the irradiation; 60% of the cases of incontinence were due to the bladder and 40% to the urethra. The increase of urgency incontinence is possibly caused by a radiofibrotic reaction of the bladder, as is shown by correspondent cystometric alterations: the bladder tonicity increased, whereas the bladder capacity decreased. These alterations were only partially reversible. The stress incontinence, however, was found already before the treatment. The maximum urethral closing pressure, which often indicates incontinence due to the urethra, was not modified by the irradiation. An increased stress incontinence, probably caused by advanced age, was found only after six years or later. The problems resulting from functional changes should be taken into consideration in the course of post-therapeutic care, i.e. the patients concerned should be given instructions for a regular bladder training.
    背景与目标: : 通过尿动力学诊断方法检查了104例接受宫颈癌初次照射的患者,以研究治疗引起的下尿路功能变化。治疗前可检查34例患者,治疗后平均6个月和18个月分别检查19例和12例患者。另一组70例患者进行了回顾性检查,平均间隔为5年和10年。在12% 受辐照的妇女中,肾积水仅在超过六年后才发生。残余尿液,明显的细菌尿和膀胱感觉功能紊乱的发生率并不重要。所有患者在照射后两年均失禁; 60% 的失禁病例是由于膀胱和尿道40% 引起的。尿急性尿失禁的增加可能是由膀胱的放射性纤维化反应引起的,如相应的膀胱测压改变所示: 膀胱张力增加,而膀胱容量减少。这些变化只是部分可逆的。然而,在治疗之前就已经发现了压力性尿失禁。最大尿道关闭压力 (通常表示由于尿道引起的尿失禁) 并未通过照射而改变。仅在六年后或更晚才发现可能是由高龄引起的压力性尿失禁增加。在治疗后护理过程中应考虑功能变化引起的问题,即应向有关患者提供定期膀胱训练的指导。
  • 【[外阴Bowen病与宫颈浸润性癌并存的病例]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Popiela A,Cisło M,Blok K,Rabczyński J
    BACKGROUND & AIMS: :The Bowen disease is rare, especially when the focus is located on the vulva. In each case of diagnosis of+ the disease, one should also examine the patient with respect of the coexistence of an additional neoplastic focus in the skin or other internal organs. In their teaching hospital the authors observed a patient in whom the Bowen disease coexisted with preinvasive cervical carcinoma.
    背景与目标: : Bowen病很少见,尤其是当焦点位于外阴时。在诊断疾病的每种情况下,还应检查患者是否存在皮肤或其他内部器官中的其他肿瘤灶。在他们的教学医院中,作者观察到一名Bowen病与浸润性宫颈癌并存的患者。
  • 【IIb期宫颈癌的手术治疗结果]。】 复制标题 收藏 收藏
    DOI:10.1055/s-2008-1036085 复制DOI
    作者列表:Friedberg V,Beck T
    BACKGROUND & AIMS: :A total of 506 cases of cervix cancer, Stage Ib and IIb, operated according to Wertheim-Meigs were retrospectively (1972-1986) evaluated with their clinical and morphological aspects. After 1978 a more intensive histological evaluation of the specimen was performed, resulting in the examination of a large number of pelvic lymph nodes. The amount of lymph nodes infiltrated depends on tumour stage, invasion depth, regional lymphovascular invasion of the tumour edge and parametria, and on haemangiosis carcinomatosa. Stage pT2b cervical cancers survived five years in 81% of cases, when lymph nodes were not involved--in 69% (1-3 infiltrated l.n.) and 64% (3 infiltrated l.n.) of cases with positive lymph nodes. The five-year survival rates were further determined by the parametrial infiltration and the number of positive pelvic lymph nodes. If neither the parametria nor the lymph nodes are infiltrated by the tumor the survival rate is 96% whereas in cases of lymphovascular invasion of the parametria without infiltrated lymph nodes the rate decreases to 79%; in cases in tumor infiltration of both lymph nodes and parametria the cure rates are worst (62%). The operation of cervical cancer of Stages Ib and IIb with a thorough histological evaluation of the excised tissue therefore has a high prognostic value, but it also probably has better cure rates than is the case with radiological treatment.
    背景与目标: : 回顾性 (1972-1986) 评估了根据Wertheim-Meigs手术的总共506例Ib期和IIb期宫颈癌的临床和形态学方面。1978后,对标本进行了更深入的组织学评估,从而检查了大量的盆腔淋巴结。浸润的淋巴结数量取决于肿瘤分期,浸润深度,肿瘤边缘和参数的区域淋巴管浸润以及癌性血管病。pT2b期宫颈癌在81% 例未累及淋巴结的情况下存活了五年-69% 例 (1-3例浸润的l.n.) 和64% 例 (3例浸润的l.n.) 淋巴结阳性。通过宫旁浸润和盆腔淋巴结阳性数目进一步确定了五年生存率。如果肿瘤和淋巴结都没有浸润,则生存率96%,而在没有浸润淋巴结的情况下,脉管的淋巴血管浸润的情况下,生存率降低到79%; 在淋巴结和淋巴结均浸润的情况下,治愈率最差 (62%)。因此,对切除的组织进行彻底的组织学评估的Ib和IIb期宫颈癌的手术具有很高的预后价值,但与放射治疗相比,治愈率也可能更高。
  • 【紫杉醇和卡铂治疗子宫颈大细胞神经内分泌癌。】 复制标题 收藏 收藏
    DOI:10.1111/j.1447-0756.2007.00509.x 复制DOI
    作者列表:Tangjitgamol S,Manusirivithaya S,Choomchuay N,Leelahakorn S,Thawaramara T,Pataradool K,Suekwatana P
    BACKGROUND & AIMS: :The prognosis of large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is generally poor despite multimodality of treatments. We report a case of advanced stage cervical LCNEC that showed definite response to paclitaxel/carboplatin, resulting in years of survival. The patient was referred to our institution after undergoing a simple hysterectomy with bilateral salpingo-oophorectomy in her local hospital because of a ruptured metastatic ovarian mass. She declined pelvic radiation treatment, so adjuvant chemotherapy (six cycles of paclitaxel/carboplatin) was given for the residual pelvic nodal diseases. Clinical complete remission was obtained, with a disease-free period of 19 months. Systemic recurrent diseases also showed partial response to the same drug regimen for months with only minimal toxicity. However, she subsequently had progressive diseases in the liver and brain and finally died at 44 months after primary diagnosis and 19 months after recurrent diseases.
    背景与目标: : 尽管有多种治疗方法,但子宫颈大细胞神经内分泌癌 (LCNEC) 的预后通常较差。我们报告了一例晚期宫颈LCNEC病例,该病例对紫杉醇/卡铂表现出明确的反应,导致多年的生存。由于转移性卵巢肿块破裂,该患者在当地医院接受了简单的子宫切除术和双侧输卵管卵巢切除术后被转诊至我们的机构。她拒绝接受盆腔放射治疗,因此对残留的盆腔淋巴结疾病进行了辅助化疗 (紫杉醇/卡铂六个周期)。临床完全缓解,无病期为19个月。系统性复发性疾病也显示出对相同药物方案的部分反应数月,毒性很小。然而,她随后在肝脏和大脑中患有进行性疾病,最终在初次诊断后44个月和复发后19个月死亡。
  • 【经阴道超声检查对子宫颈的 “快照” 矢状视图可以预测积极的早产吗?】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9378(96)70338-1 复制DOI
    作者列表:Timor-Tritsch IE,Boozarjomehri F,Masakowski Y,Monteagudo A,Chao CR
    BACKGROUND & AIMS: OBJECTIVE:Our purpose was to test the hypothesis that wedging of the cervical internal os determined by transvaginal ultrasonography is associated with premature labor and delivery. STUDY DESIGN:Seventy patients admitted to the hospital for threatened preterm labor were evaluated by transvaginal ultrasonography before institution of therapy. Bivariate and logistic regression analyses were performed to determine the variables that made a significant contribution to the prediction of preterm delivery. RESULTS:Preterm delivery was significantly associated with the presence of cervical wedging, as noted on cervical scan, and with short cervical length. A history of previous preterm delivery was of marginal significance as a predictor of preterm delivery (p=0.09). Preterm delivery was not significantly correlated with age, previous voluntary termination of pregnancy, gestational age at the time of study, previous normal spontaneous vaginal delivery, or tocolytic therapy. Use of wedging as a diagnostic test for the prediction of preterm delivery yielded a sensitivity of 100% a specificity of 74.5%, a positive predictive value of 59.4%, and a negative predictive value of 100%. CONCLUSION:The presence of wedging and shorter cervical length was suggestive of true preterm labor requiring aggressive management. A transvaginal ultrasonographic "snapshot" view of the cervix seems to be a more reliable method to evaluate the cervix in patients with threatened premature labor than are uterine contractions alone.
    背景与目标:
  • 【宫颈上皮修复: 形态学特征的评估以及与细胞学诊断的相关性。】 复制标题 收藏 收藏
    DOI:10.1097/00004347-199610000-00006 复制DOI
    作者列表:Yelverton CL,Bentley RC,Olenick S,Krigman HR,Johnston WW,Robboy SJ
    BACKGROUND & AIMS: This study evaluates the morphologic features of squamous epithelial repair of the uterine cervix, a condition describing a state of regeneration, and compares them with the features of its two histologic mimics, squamous metaplasia and mild dysplasia. The materials examined were from 20 patients with a histologic diagnosis of repair, 42 with cervical biopsy specimens of acceptable quality obtained within 3 weeks of a cervical smear showing repair, and 20 each with squamous metaplasia or mild dysplasia. Specimens with repair disclosed distinctive morphologic characteristics. On low-power magnification, the stroma was chronically inflamed (100%), often floridly (55%). The nuclei were uniform with absent or minimal pleomorphism (90%). The chromatin was bland and evenly distributed (70%). Nucleoli of a bull's eye or macronucleolar appearance (45%) were easily found. Mildly dysplastic epithelium, unlike reparative epithelium, was infrequently associated with an intensely inflamed stroma (20%); its nuclei were pleomorphic (100%) and commonly displayed coarse chromatin (75%) and mitoses (60%). Metaplastic epithelium ws also infrequently associated with an intensely inflamed stroma (10%). Nuclear pleomorphism (10%) and mitotic figures were infrequent (10%), never atypical (0%), and always basally located. Most nuclei had nucleoli, but the majority were small (80%). This study indicates that most cases of repair, mild dysplasia, and metaplasia can be readily distinguished, although due to overlapping features, some cases are difficult to classify as shown by interobserver variability.

    背景与目标: 这项研究评估了子宫颈鳞状上皮修复的形态学特征,这是一种描述再生状态的状况,并将其与两种组织学模拟物 (鳞状化生和轻度不典型增生) 的特征进行了比较。检查的材料来自20例组织学诊断为修复的患者,42例在宫颈涂片显示修复后3周内获得质量可接受的宫颈活检标本,以及20例鳞状上皮化生或轻度不典型增生。修复标本显示出独特的形态学特征。在低倍率放大时,基质长期发炎 (100%),通常是花哨的 (55%)。核是均匀的,不存在或极小的多形性 (90%)。染色质平淡且均匀分布 (70%)。很容易发现牛眼的核仁或大核仁外观 (45%)。与修复性上皮不同,轻度发育不良的上皮很少与强烈发炎的基质相关 (20%); 它的核是多形的 (100%),通常显示粗染色质 (75%) 和有丝分裂 (60%)。化生上皮也很少与强烈发炎的基质相关 (10%)。核多形性 (10%) 和有丝分裂图很少 (10%),从不非典型 (0%),并且始终位于基部。大多数核具有核仁,但大多数是小的 (80%)。这项研究表明,大多数修复,轻度不典型增生和化生的情况都可以很容易地区分,尽管由于重叠的特征,某些情况很难像观察者间变异性所显示的那样进行分类。
  • 【宫颈浸润性分层粘液癌 (iSMC) 通常具有高危特征,是不良预后的决定因素: 一项国际多中心研究。】 复制标题 收藏 收藏
    DOI:10.1097/PAS.0000000000001485 复制DOI
    作者列表:Stolnicu S,Boros M,Segura S,Horn LC,Parra-Herran C,Oliva E,Abu-Rustum N,Soslow RA,Park KJ
    BACKGROUND & AIMS: :Invasive stratified mucinous carcinoma (iSMC) has been suggested to represent an aggressive subtype of endocervical adenocarcinoma. We sought to investigate the outcomes of iSMC and determine which clinical and pathologic parameters may influence the prognosis. Slides from 52 cases of iSMC were collected and classified as follows: pure iSMC (>90% of the entire tumor) and iSMC mixed with other human papillomavirus-associated adenocarcinoma components (miSMC) (>10%, but <90% of the entire tumor). Clinical and pathologic parameters were evaluated and compared with overall survival (OS) and recurrence-free survival (RFS). One third of patients with iSMC presented with lymph node metastases (LNM) and 25% developed local recurrences, whereas 4 (7.7%) developed distant recurrences. 29 cases (55.8%) were pure iSMC, whereas 23 cases (44.23%) were miSMC. OS was 74.7% in pure iSMC versus 85.2% in miSMC (P=0.287). RFS was 56.5% in pure iSMC and 72.9% in miSMC (P=0.185). At 5 years, OS in stage I was 88.9% versus stage II to IV 30% (P=0.004), whereas RFS in stage I was 73.9% versus stage II to IV 38.1% (P=0.02). OS was influenced by International Federation of Gynecology and Obstetrics (FIGO) stage (P=0.013), tumor size (P=0.02), LNM (P=0.015), and local recurrence (P=0.022), whereas RFS was influenced by FIGO stage (P=0.031), tumor size (P=0.001), local recurrence (P=0.009), LNM (P=0.008), and type of surgical treatment (P=0.044). iSMC is an aggressive cervical tumor biologically different from other human papillomavirus-associated adenocarcinomas due to the propensity for LNM, local/distant recurrence. FIGO stage, tumor size, LNM, and presence of local/pelvic recurrences are determinants of outcome in iSMCs.
    背景与目标: : 浸润性分层粘液癌 (iSMC) 已被认为是一种侵袭性子宫颈癌。我们试图调查iSMC的结果,并确定哪些临床和病理参数可能影响预后。收集了52例iSMC的载玻片并将其分类如下: 纯iSMC (> 整个肿瘤的90%) 和与其他人乳头瘤病毒相关的腺癌成分 (miSMC) 混合的iSMC (>10%,但 <整个肿瘤的90%)。评估临床和病理参数,并与总生存期 (OS) 和无复发生存期 (RFS) 进行比较。三分之一的iSMC患者出现淋巴结转移 (LNM),25% 出现局部复发,而4 (7.7%) 出现远处复发。29例 (55.8%) 为纯iSMC,23例 (44.23%) 为miSMC。OS在纯iSMC中74.7%,而在miSMC中85.2% (P = 0.287)。RFS在纯iSMC中56.5%,在miSMC中72.9% (P = 0.185)。在5年时,阶段I的OS与阶段II至IV 30% 88.9% (P = 0.004),而阶段I的RFS与阶段II至IV 38.1% 73.9% (P = 0.02)。OS受国际妇产科联合会 (FIGO) 分期 (P = 0.013),肿瘤大小 (P = 0.02),LNM (P = 0.015) 和局部复发 (P = 0.022) 的影响,而RFS受FIGO分期 (P = 0.031) 的影响,肿瘤大小 (P = 0.001),局部复发 (P = 0.009),LNM (P = 0.008) 和手术治疗类型 (P = 0.044)。由于LNM,局部/远处复发的倾向,iSMC是一种侵袭性宫颈肿瘤,在生物学上与其他人乳头瘤病毒相关的腺癌不同。FIGO分期,肿瘤大小,LNM和局部/盆腔复发是ismc预后的决定因素。
  • 【cyclooxygenase-2抑制剂塞来昔布在宫颈癌患者中的前瞻性i-ii期试验,并对肿瘤微环境进行生物标志物评估。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijrobp.2006.08.024 复制DOI
    作者列表:Herrera FG,Chan P,Doll C,Milosevic M,Oza A,Syed A,Pintilie M,Levin W,Manchul L,Fyles A
    BACKGROUND & AIMS: PURPOSE:To evaluate the toxicity and effectiveness of celecoxib in combination with definitive chemoradiotherapy (CRT) in women with locally advanced cervical cancer. METHODS AND MATERIALS:Thirty-one patients were accrued to a phase I-II trial of celecoxib 400 mg by mouth twice per day for 2 weeks before and during CRT. Tumor oxygenation (HP(5)) and interstitial fluid pressure (IFP) were measured before and 2 weeks after celecoxib administration alone. The median follow-up time was 2.7 years (range, 1.1-4.4 years). RESULTS:The most common acute G3/4 toxicities were hematologic (4/31, 12.9%) and gastrointestinal (5/31, 16.1%) largely attributed to chemotherapy. Late G3/4 toxicity was seen in 4 of 31 patients (13.7% actuarial risk at 2 yr), including fistulas in 3 patients (9.7%). Within the first year of follow-up, 25 of 31 patients (81%) achieved complete response (CR), of whom 20 remained in CR at last follow-up. After 2 weeks of celecoxib administration before CRT, the median IFP decreased slightly (median absolute, -4.6 mm Hg; p = 0.09; relative, -21%; p = 0.07), whereas HP(5) did not change significantly (absolute increase, 3.6%; p = 0.51; median relative increase, 11%; p = 0.27). No significant associations were seen between changes in HP(5) or IFP and response to treatment (p = 0.2, relative HP(5) change and p = 0.14, relative IFP change). CONCLUSIONS:Celecoxib in combination with definitive CRT is associated with acceptable acute toxicity, but higher than expected late complications. Celecoxib is associated with a modest reduction in the angiogenic biomarker IFP, but this does not correspond with tumor response.
    背景与目标:
  • 【HIV-1-infected妇女子宫颈的T淋巴细胞分布以及总免疫球蛋白和病毒特异性免疫球蛋白浓度。】 复制标题 收藏 收藏
    DOI:10.1097/QAI.0b013e31802c5b3a 复制DOI
    作者列表:Quayle AJ,Kourtis AP,Cu-Uvin S,Politch JA,Yang H,Bowman FP,Shah M,Anderson DJ,Crowley-Nowick P,Duerr A
    BACKGROUND & AIMS: BACKGROUND:The mucosal lymphocyte population is the largest in the body, and the gastrointestinal compartment has been well characterized in HIV infection. Much less is known about the effects of HIV on the genital tract. OBJECTIVE:: To examine the T-lymphocyte phenotype and receptor repertoire as well as total and virus-specific immunoglobulin concentrations in the endocervix of HIV-infected women at different stages of infection as compared with uninfected women. PATIENTS AND METHODS:Participants were 12 seronegative women, 10 HIV-infected "slow progressors" not taking antiretroviral therapy, and 9 HIV-infected women whose antiretroviral therapy was failing. We used multiparameter flow cytometry to enumerate T-cell populations on cytobrush-obtained cervical specimens, the immunoscope technique to determine the T-cell receptor (TCR) repertoire, and quantitative enzyme-linked immunosorbent assays for antibody determinations on cervical secretions absorbed onto ophthalmic sponges. Nonparametric statistical analyses were performed. RESULTS:We found marked depletion of leukocytes and CD4 T lymphocytes in the endocervix of HIV-infected women as compared with uninfected women; this was significant at more advanced disease stages. Naive T cells were rare in the endocervix of all groups. Activation marker expression was higher in endocervical T lymphocytes than in peripheral blood among control and slow-progressing HIV-infected women but not in women failing therapy. Endocervical T lymphocytes showed highly restricted utilization of Vbeta TCR families. Unlike other mucosal sites, the cervix contained IgG as the predominant immunoglobulin isotype. HIV-IgG was detected in the cervix of most HIV-infected women and in blood of all infected women. CONCLUSIONS:HIV infection induces substantial changes in the immune profile of the female genital tract. Further study of the implications of these findings for HIV acquisition and transmission is needed.
    背景与目标:
  • 【宫颈癌早期浸润性癌的根治性子宫切除术和盆腔淋巴结切除术-14年经验。】 复制标题 收藏 收藏
    DOI:10.1046/j.1525-1438.1993.03040231.x 复制DOI
    作者列表:Sivanesaratnam V,Sen DK,Jayalakshmi P,Ong G
    BACKGROUND & AIMS: :During a 14-year period, 397 radical hysterectomies and pelvic lymphadenectomies were performed for early invasive carcinoma of the cervix. Twenty-one patients were in stage IA2 with lymphatic/vascular channel permeation (5.2%), 340 in stage IB (85.6%) and 34 in early stage 2A disease (8.5%). Eighteen patients (4.5%) were pregnant. Adenocarcinoma comprised 26.9% of cases. The mean operative time was 4.14 h; the intraoperative blood loss was less than 1.51 in 77.3% patients. There was no operative mortality; one patient died 3 weeks after surgery from clostridium difficile enterocilitis. Eleven patients (2.7%) developed venous thrombosis; severe lymphedema occurred in four (1%). The incidence of uretero-vaginal fistula was 0.2% and that of vesico-vaginal fistula 0.5%. Ovarian metastases were noted in 4.3% of cases with adenocarcinoma. Sixty-six patients had positive nodes (16.6%). Five-year survival in patients with more than 2 positive nodes was 68%. The use of adjuvant chemotherapy in patients with 'high risk' factors resulted in survival rates approaching those without risk factors. Neo-adjuvant chemotherapy was used in 10 patients with large bulky tumors; the results were favorable. Recurrences occurred in 47 patients (11.8%); 36 patients have died (9.1%). Age did not appear to influence survival. The overall 5-year survival was 92.2%.
    背景与目标: : 在14年的时间里,对宫颈早期浸润性癌进行了397次根治性子宫切除术和盆腔淋巴结切除术。21例患者处于IA2期,淋巴/血管通道渗透 (5.2%),340例处于IB期 (85.6%),34例处于2A期早期 (8.5%)。18例患者 (4.5%) 怀孕。腺癌包括26.9% 例。平均手术时间为4.14 h; 77.3% 例患者术中出血量少于1.51。没有手术死亡; 一名患者在手术后3周死于艰难梭菌肠系炎。11例患者 (2.7%) 出现静脉血栓形成; 4例 (1% 例) 发生严重淋巴水肿。输尿管-阴道瘘的发生率0.2%,膀胱阴道瘘的发生率0.5%。在4.3% 腺癌病例中发现卵巢转移。66例患者淋巴结阳性 (16.6%)。超过2个阳性淋巴结的患者的5年生存率为68%。在具有 “高风险” 因素的患者中使用辅助化疗会导致生存率接近没有危险因素的患者。10例大体积肿瘤患者使用了新辅助化疗; 结果是有利的。47例患者 (11.8% 例) 复发; 36例患者死亡 (9.1% 例)。年龄似乎没有影响生存率。总体5年生存率为92.2%。
  • 【一项I/II期研究,将根治性放疗与同期顺铂相结合,用于治疗晚期子宫颈鳞状细胞癌。】 复制标题 收藏 收藏
    DOI:10.1046/j.1525-1438.1992.02040215.x 复制DOI
    作者列表:Pearcey RG,MacLean GD
    BACKGROUND & AIMS: :Sixteen patients with advanced cervix cancer have been treated in a phase I/II study of concurrent radiotherapy and cisplatin chemotherapy. The external beam radiotherapy was given as a 'split course' because of initial concerns about acute toxicity. The treatment was well tolerated with all patients completing the prescribed radiotherapy and all patients received the intended four doses of cisplatin. One of 5 patients with stage IVB disease is alive and disease free 35 months after treatment. Six of the 11 patients with disease confined to the pelvis are alive and disease free between 28 and 53 months after treatment. One patient has required surgery for a recto-sigmoid stricture.
    背景与目标: : 在同步放疗和顺铂化疗的I/II期研究中,已对16例晚期宫颈癌患者进行了治疗。由于最初对急性毒性的担忧,将外部束放射治疗作为 “分裂过程”。所有患者均完成了规定的放射治疗,并且所有患者均接受了预期的四剂顺铂,治疗耐受性良好。5例IVB期患者中有1例在治疗后35个月存活且无病。11名局限于骨盆的患者中有6名在治疗后28至53个月内存活且无疾病。一名患者因直肠乙状结肠狭窄需要手术治疗。
  • 【使用体内压缩的应变弹性成像在怀孕期间评估子宫颈中的可靠性。】 复制标题 收藏 收藏
    DOI:10.1515/jpm-2019-0370 复制DOI
    作者列表:Kwak DW,Kim M,Oh SY,Park HS,Kim SJ,Kim MY,Hwang HS
    BACKGROUND & AIMS: :Objective To determine the reproducibility of the mean strain value in various cervical areas and new elastographic parameters for measuring cervical stiffness evaluated by strain elastography using in vivo compression generated by internal organ movement. Methods A prospective observational study (140 singleton pregnant women; 15-33 weeks of gestation) was performed at two tertiary centers. Cervical strain was evaluated using E-cervix™ elastography. The mean strain levels of various cervical areas [internal os (IOS), external os (EOS) and endocervical area] and several new parameters [i.e. the ratio of the strain level of IOS and EOS, elasticity contrast index (ECI), and hardness ratio] were assessed twice by two independent examiners. The inter-observer and intra-observer variances were calculated using the intraclass correlation coefficient (ICC) with a 95% confidence interval (CI). Bland-Altman (B-A) analysis was also performed. Results The median gestational age was 24.0 weeks, and the mean cervical length (CL) was 3.8 cm. The intra-observer and inter-observer ICCs of the mean strain levels of the specified cervical area and new elastographic parameters were statistically significant (P < 0.001, all); the intra-observer ICC was 0.639-0.725, and the inter-observer ICC was 0.538-0.718. Conclusion The reproducibility of elastographic parameter measurements using in vivo compression is improvable.
    背景与目标: : 目的确定各种颈椎区域的平均应变值的可重复性,以及通过使用内部器官运动产生的体内压缩通过应变弹性成像评估的用于测量颈椎刚度的新的弹性成像参数。方法在两个三级中心进行前瞻性观察性研究 (140名单胎孕妇; 妊娠15-33周)。使用电子子宫颈评估宫颈劳损™弹性成像。各种宫颈区域 [内部os (IOS),外部os (EOS) 和宫颈内膜区域] 的平均应变水平以及几个新参数 [即IOS和EOS的应变水平之比,弹性对比指数 (ECI),和硬度比] 由两名独立检查员评估两次。使用具有95% 置信区间 (CI) 的组内相关系数 (ICC) 计算观察者间和观察者内方差。还进行了Bland-Altman (b-a) 分析。结果中位胎龄为24.0周,平均宫颈长度 (CL) 为3.8厘米。指定颈部区域的平均应变水平和新的弹性成像参数的观察者内和观察者间ICCs具有统计学意义 (p  <  0.001,all); 观察者间ICC为0.639-0.725,观察者间ICC为0.538-0.718。结论使用体内压缩进行弹性成像参数测量的可重复性是可以改善的。
  • 【子宫颈腺癌。治疗前血清CA 125,鳞状细胞癌抗原和癌胚抗原水平与临床和组织病理学肿瘤特征的关系的预后意义。】 复制标题 收藏 收藏
    DOI:10.1002/1097-0142(19900415)65:8<1830::aid-cncr2820 复制DOI
    作者列表:Duk JM,De Bruijn HW,Groenier KH,Fleuren GJ,Aalders JG
    BACKGROUND & AIMS: :The prognostic value of the pretreatment serum CA 125, squamous cell carcinoma antigen (SCC), and carcinoembryonic antigen (CEA) levels in relation to tumor type, vascular invasion by tumor cells, and lymph node metastases was investigated in 77 patients with cervical adenocarcinoma. In Stage IB (International Federation of Gynecology and Obstetrics [FIGO]), the five-year actuarial survival of patients with pretreatment serum CA 125 levels greater than 16 U/ml was 52.4% versus 95.6% when normal serum CA 125 levels were determined (P less than 0.01). Pretreatment serum SCC or CEA levels had no substantial prognostic value. In Stage IB (FIGO), 42% of the patients with elevated serum CA 125 levels had lymph node metastases versus 4% when normal levels were found (P = 0.012). The presence of vascular invasion (P = 0.01) or lymph node metastases (P = 0.001) was associated with an increased risk for recurrent disease. Adenosquamous tumors showed a higher incidence of vascular invasion (P = 0.05) and a higher incidence of elevated serum CA 125 levels (P = 0.03). Particularly in Stage II, adenosquamous tumors were found to have a poorer prognosis than adenocarcinomas (P = 0.0566). We conclude that in cervical adenocarcinoma serum CA 125 is an important prognostic factor and an implicit indicator of tumor virulence.
    背景与目标: : 研究了77例宫颈腺癌患者的治疗前血清CA 125,鳞状细胞癌抗原 (SCC) 和癌胚抗原 (CEA) 水平与肿瘤类型,肿瘤细胞的血管浸润和淋巴结转移的关系的预后价值。在IB期 (国际妇产科联合会 [FIGO]) 中,在测定正常血清CA 125水平时,治疗前血清CA 125水平大于16 u/ml的患者的五年精算生存期为52.4%,而95.6% 为 (P小于0.01)。治疗前血清SCC或CEA水平没有实质性的预后价值。在IB期 (FIGO) 中,42% 血清CA 125水平升高的患者有淋巴结转移,而发现正常水平时则有4% (P = 0.012)。血管侵犯 (P = 0.01) 或淋巴结转移 (P = 0.001) 与复发风险增加相关。腺鳞癌的血管侵犯发生率较高 (P = 0.05),血清CA 125水平升高的发生率较高 (P = 0.03)。特别是在II期,发现腺鳞癌的预后比腺癌差 (P = 0.0566)。我们得出结论,在宫颈腺癌中,血清CA 125是重要的预后因素,也是肿瘤毒力的隐性指标。

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