Megestrol acetate plus metformin for fertility-sparing treatment of atypical endometrial hyperplasia and early-stage endometrial adenocarcinoma: a prospective study

Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinoma(G1 EAC)and the recurrence rate after treatment.Methods Sixty patients(aged 20-42 years)with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups(n=30)to receive oral MA treatment at the daily dose of 160 mg(control)or MA plus oral metformin(850 mg,twice a day)for at least 6 months.The treatment could extend to 12 months until a complete response(CR)was achieved,and follow-up hysteroscopy and curettage were performed every 3 months.For all the patients who achieved CR,endometrial expressions of IGFBP-rP1,p-Akt and p-AMPK were detected immunohistochemically.Results A total of 58 patients completed the treatment.After 9 months of treatment,23(76.7%)patients in the combined treatment group and 20(71.4%)in the control group achieved CR;two patients in the control group achieved CR after converting to the combined treatment.The recurrence rate did not differ significantly between the control group and combined treatment group(30.0%vs 22.7%,P>0.05).Ten(35.7%)patients in the control group experienced significant weight gain of 5.7±6.1 kg,while none of the patients receiving the combined treatment exhibited significant body weight changes.Compared with the control group,the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression.Conclusion Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC,and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.

Efficacy of Oncoxin-Viusid on the Reduction of Adverse Reactions to Chemotherapy and Radiotherapy in Patients Diagnosed with Cervical Cancer and Endometrial Adenocarcinoma

Introduction: Oncoxin-Viusid (OV) has shown antioxidant, immunomodulatory and anti-tumour capabilities in experimental studies on humans and animal subjects. Acute toxicity of Radiation Therapy (RT) and Chemotherapy (CT) in patients with cervical cancer and endometrial adenocarcinoma impact quality of life and, therefore, outcomes of these therapies. Objective: To identify Oncoxin-Viusid’s efficacy in reducing acute toxicity produced by onco-specific treatments in patients with cervical cancer and endometrial adenocarcinoma. Materials and Methods: A controlled, randomised double-blind phase II clinical trial was performed with a sample size of 63 patients distributed into 2 groups: one receiving the standard treatment plus the Oncoxin-Viusid nutritional supplement (OV group) and another receiving the standard treatment and placebo (P group). The primary efficacy variable is the proportion of secondary disruptions to acute adverse reactions produced by RT and CT. Results: The number of patients suffering adverse events from chemotherapy was 20.6% less in the OV group (70.0%) than in the placebo group (90.6%) (p = 0.04). We recorded consistently normal values of haemoglobin (-6.2 OV group vs -8.3 P group, p = 0.009), platelet count (-17.4 OV group vs -27.6 P group, p = 0.009) and leukocytes (-31.8 OV group vs -41.4 P group, p = 0.025) in the OV group, tolerating 4 more cytostatic doses on average than the placebo group. Significant increase in quality of life (QLQ-30) was registered in the OV group with a large effect size on such issues as emotional and social function (Cohen’s d = 0.9), as well as in the reduction of symptoms like dyspnea 60%, insomnia 15% and anorexia 30% (item CX-2), (Cohen’s d = 0.98), which were higher than the placebo group. Conclusions: OV administration reduces onco-specific adverse events and improves quality of life in patients diagnosed with cervical cancer and endometrial adenocarcinoma undergoing radiation therapy and chemotherapy.

LECTIN HISTOCHEMICAL STUDY ON ENDOMETRIAL PROLIFERATION, HYPERPLASIA AND ADENOCARCINOMA

The binding capacity of 5 lectins in endemetrial proliferation, hyperplasia and adenocarcinoma were studied histochemicaily. The staining density of ConA and WGA bound to intercellular and basal protion, the positive reaction and the density of both agglutinins to luminal borders were increased with the proliferative degree of endometrial glandular cells from proliferation to neoplasm, with the most significant binding in adenocarcinomaHowever, WGA and RCA binding to basal portion of malignant cells was weak, but stronger in the outer edge of tumor mass. The authors suggest that lectin binding capacity provides a new probe to judge the proliferative degree and malignant transformation of endometrial glandular cells.

Oral malignant acanthosis nigricans associated with endometrial adenocarcinoma

We report a 59-year-old patient with malignant acanthosis nigricans associated with metastasis of endometrial carcinoma. The patient presented papillomatosis lesions that appeared to be benign on multiple skins of body folds, particularly on lips. The lesions in lips and axilla had histological characteristic appearances of acanthosis nigricans, while the masses in abdomen and pelvis were metastasis endometrial adenocarcinoma. The article highlights the importance of biopsy and histopathological diagnosis in presumed benign lesions and the role of doctors in screening for body internal tumors.

Hypercalcemia Due to Parathyroid Hormone-Related Protein Induced by Primary Endometrial Clear Cell Adenocarcinoma: Case Report

Humoral Hypercalcemia of Malignancy (HHM) has been reported in association with a number of malignancies. In gynecologic malignancies, ovarian Clear Cell Carcinoma (CCC) is one of the most commonhistologic subtypes, whereas HHM caused by endometrial CCC is very rare. We report a case of endometrial CCC with HHM, with a low serum intact PTH level, elevated serum PTH-related Peptide (PTH-rP), and immunohistochemically demonstrated PTH-rP in the neoplasm.

Atypical Polypoid Adenomyoma (APAM) of the Uterine: Relationship with Endometrial Cancer

Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pathologically, APAM consist of irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells within the stroma, and have a similar form to adenocarcinoma, adenofibroma, adenosarcoma, and carcinosarcoma. Therefore, differential diagnosis is required in many cases. APAM is pathologically classified as a benign lesion and clinically has a comparatively favorable outcome. However, treatment and follow-up observation should be performed carefully because recurrence and residual lesions occur in many patients after conservative treatment. Concomitant development of endometrial adenocarcinoma also occurs in many cases and it is difficult to differentiate this disease from APAM. Thus, diagnosis of APAM should be made carefully, particularly since the number of cases of endometrial adenocarcinoma has increased in recent years. Furthermore, APAM tends to develop during a woman’s reproductive years, and fertility sparing treatment should be considered. Here, we review the clinicopathological characteristics of APAM, including the difficulty of diagnosis as a benign or malignant uterine tumor, and we examine the relationship between APAM and endometrial cancer.

Clinicopathological Significance of Increased ZIC1 Expression in Human Endometrial Cancer

Summary： Zinc finger of the cerebellum （ZIC 1）, one of ZIC family genes, has been shown to play im- portant roles in many cancers such as gastric cancer and breast cancer. However, there is little known about the expression and significance of ZIC1 in endometrial cancer. The aim of this study was to de- termine the expression pattern and clinicopathological significance of ZIC1 in endometrial cancer. The rnRNA and protein expression of ZIC1 in endometrial cancer tissues was detected using the reverse- transcription polymerase chain reaction and Western blotting, respectively. Immunostaining of ZIC1 in 99 endometrial cancer samples was examined and its associations with clinicopathological parameters were analyzed. Hec-l-B cells were transfected with Z1CI-shRNA or sc-shRNA, and cell proliferation was assayed. Hec-l-B cells stably transfected with ZICI-shRNA or sc-shRNA were subcutaneously in- oculated into nude mice, and the tumor weight was measured. A significantly increased expression of ZIC1 mRNA and protein was observed in endometrial cancer tissues compared to that in normal endo- metrial tissues （P〈0.05）. Immunohistochemical analysis showed that strong cytoplasmic immunostain- ing of ZIC1 was observed in almost all endometrial cancer samples （90/99） while light and moderate immunostaining of ZIC 1 was only detected in 17 of 30 （56.7%） normal tissues. Moreover, up-regulation of ZIC1 was significantly correlated with age, disease stage, TNM stage and FIGO stage （P〈0.05）. The down-regulated expression of ZIC1 contributed to the inhibition of cell proliferation, and inhibited the growth of tumor. It was concluded that ZIC1 is over-expressed in endometrial cancer tissue but not in normal tissue, and positively correlated to the malignant biological behavior of endometrial carcino- genesis.

Type I endometrial cancer after chemoradiation therapy for carcinoma of the cervix: a case report

Standard treatment for cervical cancer has been radiation and chemotherapy. Ionizing radiation has been associated with damage to normal tissues included in the radiation field. Post-radiation uterine cancers are characterized by high stage, high grade, and a preponderance of type II histologic subtypes. We report a case of type I endometrioid adenocarcinoma diagnosed 19 years after definitive chemoradiation for cervical cancer.

肥胖相关子宫内膜腺癌关键基因筛选研究

目的探讨肥胖相关子宫内膜腺癌的生物标志物,并进一步分析其在子宫内膜腺癌中的预后意义。方法在癌症基因组图谱(TCGA)数据库中检索407例子宫内膜腺瘤或腺癌患者的基因表达数据,在基因表达综合数据库中检索肥胖基因表达数据集GSE12050,筛选肥胖相关子宫内膜腺癌的差异基因和关键基因,对关键基因进行功能富集分析。结果对TCGA数据库中子宫内膜腺癌基因表达数据进行基因差异表达分析,获得差异基因5479个;对GSE12050数据集中肥胖基因表达数据进行差异分析,获得差异基因171个。GO功能富集分析显示,差异基因主要涉及NADP代谢过程、含胶原蛋白的细胞外基质和内肽酶活力等功能;KEGG通路富集分析显示,差异基因主要涉及谷胱甘肽代谢、碳代谢和戊糖磷酸等途径。肥胖相关子宫内膜腺癌发生、发展相关基因为COL11A1、DBI、EGFL6、SFRP1、FMO2等,其中COL11A1、DBI基因对子宫内膜腺癌的预后效果更准确。关键基因MANIA网络分析显示,肥胖相关子宫内膜腺癌关键基因涉及NADP代谢过程、蛋白质氧化、氧化还原酶活等功能。癌症组织DBI相关蛋白丰度表达量高于癌旁组织,差异有统计学意义(P<0.01)。子宫内膜腺癌组织DBI基因表达量高于癌旁组织,差异有统计学意义(P<0.01)。结论COL11A1和DBI基因在子宫内膜腺癌尤其是与肥胖相关的子宫内膜腺癌中发挥着重要作用,或许可以作为肥胖相关子宫内膜腺癌早期诊断、精准治疗、预测预后的指标。

以异常阴道出血为首发症状的肺腺癌子宫内膜转移一例并文献复习

原发性支气管肺癌简称肺癌,是世界各国发病率和死亡率较高的恶性肿瘤之一。近年来,女性肺癌发病率升高且多为肺腺癌。因肺癌早期症状隐匿,发现时常伴有转移。报道1例肺腺癌子宫内膜转移病例,该患者因异常阴道出血就诊,诊刮术后病理提示腺癌。结合免疫组织化学检查和影像学检查,排除其他部位肿瘤来源可能后,确诊为肺腺癌转移至子宫内膜。肺癌转移至子宫内膜极其罕见,极可能被漏诊、误诊。回顾性分析该病例资料并复习相关文献,以期提高临床对肺腺癌子宫内膜转移的警惕。

Yes相关蛋白在子宫内膜样腺癌中的表达及意义

目的 探讨Yes相关蛋白(YAP)在子宫内膜癌中的表达及临床意义。方法 收集2018年9月至2019年12月在山西医科大学第一医院就诊并行全面分期手术的子宫内膜样腺癌病例共56例,年龄43~69岁(中位年龄为54岁),术前均未接受放、化疗且不合并其他系统肿瘤。对病理组织库中已行取材、石蜡包埋处理的对应病例癌、癌旁组织蜡块进行IHC法(切片、制片、一抗孵育、二抗孵育、脱水、封片)检测YAP表达情况,并分别计算高、低表达例数。比较子宫内膜样腺癌组织及正常癌旁组织YAP的表达。采用免疫组化法比较其表达与各临床病理学参数的关系,运用SPSS 22.0进行统计学分析,探讨YAP表达与各临床病理学特征之间的关系。结果 YAP主要表达在细胞核及胞浆中,且在癌组织中的表达明显高于癌旁组织,与组织学分级、手术病理分期、肌层浸润深度相关(P<0.05)。结论 YAP与子宫内膜样腺癌的发生发展有关,可能作为临床治疗的新靶点。

原发于宫角的子宫内膜癌临床误诊原因探讨

目的探讨原发于宫角的子宫内膜癌误诊为子宫肌瘤变性的原因及防范误诊措施,以降低误诊率。方法回顾分析2022年3月收治原发于宫角的子宫内膜癌误诊子宫肌瘤变性1例临床资料。结果本例因绝经3年、左下腹痛半年就诊,彩超提示左宫角囊实性占位性病变(子宫肌瘤变性?),查癌抗原125和癌胚抗原正常。后行宫腔刮出物病理学检查考虑子宫内膜样腺癌,手术病理示左宫角子宫内膜样腺癌Ⅲ级伴部分梭形细胞分化,结合免疫组化结果诊断为子宫内膜样腺癌Ⅲ期。误诊时间6 d。给予手术治疗,术后予紫杉醇联合卡铂化疗2个疗程,患者一般状态尚可,未见复发或转移,尚在随访中。结论原发于宫角的子宫内膜癌临床症状及影像学表现不典型,早期容易误诊为子宫肌瘤变性等疾病。对于绝经期宫角占位性病变者应考虑到多种疾病的可能,结合患者病史(包括现病史、既往史)、实验室检查、影像学检查及病理检查有助于降低误诊率。

子宫体中肾样腺癌1例病例分析及文献复习

中肾样腺癌(MLA)是一种新型的子宫内膜和卵巢肿瘤,多常见于子宫体和卵巢,并具有独特的形态学和免疫表型特征。子宫体MLA极为罕见,约占所有子宫内膜癌的1%,且可出现多种生长模式,易被误诊为低级别子宫内膜样腺癌、透明细胞癌和浆液性腺癌,故诊断该病极具挑战。本文报道了1例55岁子宫体MLA的病例,通过分析该病例的特点,对子宫体MLA的病理、临床症状、诊断、治疗和预后进行文献复习,以期提高临床医师和病理医师对该病的认识,从而避免误诊和误治。

子宫内膜中肾样腺癌累及宫颈管间质一例

子宫内膜中肾样腺癌是一种罕见的妇科恶性肿瘤,发病率低,侵袭性较强,容易复发和转移,该类疾病的患者通常就诊时已处于晚期,目前暂无明确的治疗方案,故预后较差。报道1例子宫内膜中肾样腺癌累及宫颈管间质患者的诊治过程及随访情况。患者因绝经后阴道流液2次,不规则阴道出血20余天就诊。于2022年11月18日行宫腔镜检查术(初次手术),术后病理检查结果提示子宫内膜样腺癌,遂于2022年12月1日行经腹筋膜外全子宫切除术+双侧卵巢动静脉高位结扎术+双侧输卵管卵巢切除术+腹主动脉旁淋巴结切除术+盆腔淋巴结清扫术(二次手术)。结合两次手术病理检查结果,诊断子宫内膜中肾样腺癌Ⅱ期。术后给予5个周期紫杉醇联合卡铂化疗,1个疗程盆腔外照射放疗和1次阴道残端后装近距离放疗。随访至2024年4月10日,未见疾病复发转移。

β-肌动蛋白、高迁移率蛋白A2在子宫内膜腺癌组织中的表达及与预后的关系

目的:探讨β肌动蛋白(ACTB)、高迁移率蛋白A2(HMGA2)在子宫内膜腺癌组织中的表达及与预后的关系.方法:选择2017年10月-2020年10月河北省唐山市妇幼保健院收治的206例子宫内膜腺癌患者,取手术切除的癌组织和癌旁组织,实时荧光定量聚合酶连反应检测子宫内膜腺癌组织和癌旁组织中ACTB、HMGA2表达,比较不同病理特征子宫内膜腺癌组织的ACTB、HMGA2表达差异,术后定期电话随访至2022年10月,分析ACTB、HMG GA2表达与预后的关系.结果:子宫内膜腺癌组织ACTBmRNA及HMGA2mRNA表达水平分别高于其相应癌旁组织(3.65±1.09比1.12±0.36,P<0.05)及(5.03±1.46比1.65±0.47)差异有统计学意义(P<0.05),TNM分期Ⅲ期、深层浸润、盆腔淋巴结转移患者的子宫内膜癌组织中ACTBmRNA、HMGA2mRNA表达高于TNM分期Ⅰ~Ⅱ期、无盆腔淋巴结转移宫颈癌患者(P<0.05).中位随访48(24~60)个月,随访期间死亡62例,ACTBmRNA、HMG GA2mRNA高表达的子宫内膜腺癌患者总生存率为59.1%、61.3%,低于低表达患者的81.2%、79.0%(P<0.05).统计学分析显示盆腔淋巴结转移、ACTBmRNA高表达、HMGA2mRNA高表达是子宫内膜腺癌患者不良预后的独立危险因素(P<0.05).结论:子宫内膜腺癌组织中ACTBmRNA、HMGA2mRNA表达上调,且与子宫内膜腺癌恶性进展和总生存率低下相关.

免疫组化技术诊断子宫内膜腺癌的价值分析

目的:分析免疫组化技术诊断子宫内膜腺癌的价值。方法:选取2021年1月-2023年1月临沂市兰陵县人民医院收治的80例子宫内膜腺癌患者作为观察组,选取同期收治的80例单纯子宫内膜增生患者作为对照组。应用免疫组化技术检测所有患者S100蛋白水平,以病理检查结果为“金标准”,评估免疫组化技术诊断子宫内膜腺癌的灵敏度、准确度,比较两组S100蛋白表达情况及不同临床分期子宫内膜腺癌患者S100蛋白表达情况。结果:观察组S100蛋白水平高于对照组,差异有统计学意义(P<0.001)。不同分期子宫内膜腺癌患者S100蛋白表达水平比较,Ⅲ期>Ⅱ期>Ⅰ期,差异有统计学意义(P<0.05)。免疫组化技术诊断子宫内膜腺癌的灵敏度为96.15%(75/78),准确度为96.25%(77/80)。结论:免疫组化技术在子宫内膜腺癌的诊断中具有一定应用价值,能够为治疗方案的制定提供可靠的分子生物学依据。

MMP2过表达在子宫内膜腺癌的临床意义

目的：探讨MMP2表达与子宫内膜腺癌临床参数和预后之间相关性。方法我们收集了81例子宫内膜腺癌患者石蜡标本。这些患者的年龄在32-80岁之间。随后，利用免疫组化SP方法检测了81例子宫内膜腺癌中MMP2表达情况。最后，我们使用SPSS软件统计分析了MMP2表达与与子宫内膜腺癌进展和预后之间相关性。结果MMP2在子宫内膜腺癌胞浆中表达。此外，过表达的MMP2与子宫内膜腺癌分化程度（P=0.015）以及预后（P=0.041）呈负性相关。结论MMP2过表达是子宫内膜腺癌患者的一个恶性标志物。

ER、VIM、CEA和p16四联检测在宫颈原发腺癌和子宫内膜癌诊断和鉴别中的应用

目的探讨ER、VIM、CEA和p16四联检测在宫颈原发腺癌和子宫内膜腺癌诊断和鉴别诊断中的应用价值。方法采用免疫组化EnVison法染色,观察ER、VIM、CEA和p16蛋白在31例宫颈原发腺癌和30例子宫内膜腺癌组织中的表达情况,比较四联检测和三联检测(ER、VIM和CEA)诊断宫颈原发腺癌和子宫内膜腺癌的特异性、敏感性、阳性预告值、阴性预告值和准确度。结果ER、VIM、CEA和p16在宫颈原发腺癌中的阳性表达率分别为35.5%、19.4%、77.4%和67.7%,在子宫内膜腺癌中则分别为70%、73.3%、40%和13.3%,差异均有统计学意义。四联检测对于诊断宫颈原发腺癌的特异性、敏感性、阳性预告值和准确度要高于三联检测-分别为96.3%(90.2%),65.1%(57.6%),94.9%(89.4%)和85.8%(80.6%),对于诊断子宫内膜腺癌的阴性预告值和准确度要高于三联检测-分别为58.7%(51.9%)和75.4%(68.6%),其他指标则基本相当。结论在传统三联检测中加入p16对于提高宫颈原发腺癌和子宫内膜腺癌的诊断和鉴别诊断准确有重要临床意义,尽管对于诊断敏感性的提高不够显著。

子宫内膜增生及内膜癌中PTEN、Ki-67蛋白的表达

目的 研究子宫内膜增生组织及内膜癌组织中PTEN、Ki 6 7蛋白的异常表达 ,探讨其与子宫内膜癌变的关系及作为早期癌变生物学标志的可能性。方法 应用免疫组化S P法对 12例正常增生期子宫内膜组织、4 0例子宫内膜增殖症组织、4 2例内膜腺癌组织中PTEN、Ki 6 7蛋白的表达进行研究。结果 在正常增生期子宫内膜、子宫内膜增殖症 (单纯增生、复杂型增生、不典型增生 )、子宫内膜腺癌组织中PTEN蛋白的阳性表达率呈递减趋势 ;Ki 6 7蛋白的阳性表达率呈递增趋势。等级相关分析结果显示PTEN、Ki 6 7表达异常与子宫内膜组织学分级均显著相关 (相关系数r分别为 - 0 5 4 1和 0 4 96 ,P值均<0 0 1)。子宫内膜癌与除不典型增生外的子宫内膜增殖症组织及正常增生期子宫内膜组织的PTEN、Ki 6 7蛋白表达差异有显著性 ,正常增生期子宫内膜、单纯增生与不典型增生组织的PTEN蛋白表达差异有显著性 ,不典型增生与单纯增生组织的Ki 6 7蛋白表达差异有显著性。PTEN、Ki 6 7蛋白表达存在负相关性 (r =- 0 4 2 8,P <0 0 1)。PTEN、Ki 6 7蛋白的表达与子宫内膜癌的手术分期、组织学分级、肌层浸润无关 (P >0 0 5 )。结论 PTEN、Ki 6 7蛋白的异常表达与子宫内膜的癌变过程相关 ,PTEN基因表达异常及细胞增殖异常与子宫内膜?

CD44v6、bcl-2和VEGF在子宫内膜腺癌中的表达及其意义

背景与目的:子宫内膜癌的发病机理至今尚未完全阐明,本研究拟探讨CD44v6、bcl-2、血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)在子宫内膜腺癌发生、发展中的作用。方法:运用免疫组化技术SP法检测CD44v6、bcl-2、VEGF在55例子宫内膜腺癌及10例正常增生期子宫内膜、10例子宫内膜单纯性增生和10例不典型增生组织中的表达情况。结果:(1)在正常增生期子宫内膜、单纯性增生、不典型增生、子宫内膜腺癌中CD44v6及VEGF的阳性表达率分别为10.00%、40.00%、60.00%、78.18%和0%、0%、10.00%、83.84%,均有显著性差异(P<0.001,P<0.001),而bcl-2表达无显著差异;(2)55例子宫内膜腺癌组织中,CD44v6表达强度与手术分期及淋巴结有无转移呈负相关(P<0.05,P<0.01)bcl-2的表达强度在子宫内膜腺癌中与分化程度显著相关VEGF的表达强度与手术分期、肌层浸润、淋巴结有无转移显著相关;(3)bcl-2与VEGF、CD44v6在子宫内膜腺癌中有协同表达(P<0.05,P<0.05);(4)单因素生存分析CD44v及bcl-2与子宫内膜腺癌患者预后有关(P<0.01,P<0.05)多因素Cox模型分析筛选出患者的年龄、手术分期和CD44v是独立的预后影响因素,CD44v6阴性表达者的生存时间较阳性表达者短。结论:CD44v6、VEGF及bcl-2在子宫内膜腺癌的发生、发展过程中起不?