BACKGROUND Endometrial cancer is a kind of well-known tumors of female genitourinary system.Cervical stromal invasion is an adverse factor for poor prognosis of endometrial cancer.There is still controversy regarding ...BACKGROUND Endometrial cancer is a kind of well-known tumors of female genitourinary system.Cervical stromal invasion is an adverse factor for poor prognosis of endometrial cancer.There is still controversy regarding the use of magnetic resonance imaging(MRI)in the diagnosis of cervical stromal invasion of endometrial cancer.The diagnosis of cervical stromal invasion varies significantly between different observers and institutions.We present a limited case series of the particular pattern of endometrial cancer,which infiltrates the cervical stroma and is often overlooked.CASE SUMMARY We present three cases of endometrial carcinoma with cervical stromal invasion with cancer-free uterine cavity.One patient,a reproductive-aged woman,exhibited irregular menstruation and was diagnosed with endometrial polyps by hysteroscopy and segmental curettage.A MRI scan revealed polypoid nodules within the internal cervical orifice.The other two cases were postmenopausal women who presented with abnormal vaginal bleeding.Hysteroscopy and segmental curettage suggested atypical hyperplasia of the endometrium.MRI scans did not detect any malignant signs in the endometrium.In one case,a nonthickened endometrium was observed,while in another,hyperplasia of the endometrium was seen.Notably,none of these patients had malignant tumors identified in the uterine cavity via MRI scans.However,postoperative pathological results following hysterectomy consistently indicated cervical stromal invasion.CONCLUSION Cervical stromal invasion is easily missed if no cancer is found in the uterine body on MRI.Immunohistochemistry of endoscopic curettage specimens should be conducted to avoid underestimation of the disease.展开更多
Objective To investigate the expression of survivin gene among human normal endometrium,atypical hyperplasia of endometrium,and endometrial carcinoma.Methods Tissue samples of human normal endometrium during prolifera...Objective To investigate the expression of survivin gene among human normal endometrium,atypical hyperplasia of endometrium,and endometrial carcinoma.Methods Tissue samples of human normal endometrium during proliferative phase （NE,n=20）,atypical hyperplasia of endometrium （AHE,n=11）,and endometrial carcinoma （EC,n=9） were collected.Besides,Paraffin embedded sections of NE （n=20）,AHE （n=20）,and EC （n=20） were used.The expression of survivin gene was determined by immunohistochemistry and the real-time reverse transcription polymerase chain reaction.Results Survivin immunostaining appeared in the cytoplasm of endometrial epithelial cells.Both survivin staining and mRNA had higher levels in AHE or EC than those in NE （P〈0.01）.No difference was found on survivin staining and mRNA between AHE and EC （P〉0.05）.Conclusion High expression of survivin gene in human endometrium is associated with the risk of atypical hyperplasia progressing to endometrial carcinoma.The high level of survivin expression is useful as a predictive indicator for endometrial carcinoma.展开更多
Objective:The objective of the study was to compare the effects of assisted reproductive technology(ART)and spontaneous pregnancy on pregnancy outcomes in women with endometrial carcinoma(EC)and atypical endometrial h...Objective:The objective of the study was to compare the effects of assisted reproductive technology(ART)and spontaneous pregnancy on pregnancy outcomes in women with endometrial carcinoma(EC)and atypical endometrial hyperplasia(AEH)following fertility-sparing treatments.Methods:Relevant studies published through July 2020 were identified from PubMed and Web of Science literature searches.The pregnancy outcomes of ART and spontaneous pregnancy were summarized and compared for women with complete remission of EC/AEH after fertility-sparing treatments.A subgroup analysis was performed based on whether patients had received in vitro fertilization and embryo transfer(IVF-ET)treatment.The complete remission and recurrence rates of EC/AEH following fertility-sparing treatments were estimated.The effect of pregnancy on recurrence rates of EC/AEH was also calculated.Results:Sixteen observational studies reporting pregnancy outcomes or recurrence with ART or spontaneous pregnancy for women with EC/AEH after fertility-sparing treatments were included.The complete remission rate of EC/AEH was 81.5%(95%CI,78%–85%).Compared with spontaneous pregnancy,the pregnancy rate of ART was significantly higher(66.8%vs.43.7%,OR=2.64,95%CI 1.71–4.05,P<0.00001,I^(2)=14%).Subgroup analysis showed that the pregnancy rate of IVF-ET was significantly higher than that of spontaneous pregnancy(62.7%vs.35.1%,OR=2.85,95%CI 1.44-5.63,P=0.003,I^(2)=29%).The live birth rate of ART was significantly higher than that of spontaneous pregnancy(75.3%vs.47.8%,OR=3.96,95%CI1.76-8.77,P=0.0009,I^(2)=45%).The recurrence rate of EC/AEH was 31%(95%CI 24%–39%).Clinical pregnancy could reduce the recurrence rate of EC/AEH,but there was no significant evidence of an association.Conclusions:ART,especially IVF-ET,could significantly improve pregnancy outcomes in women with EC/AEH receiving fertility-sparing treatments.Following complete remission,ART treatment might be a better option for women with EC/AEH than spontaneous pregnancy.展开更多
目的探讨无不典型性的子宫内膜增生(endometrial hyperplasia without atypia,EH)患者临床特征、不同治疗方法选择时机及预后分析。方法分析2011年6月1日至2018年6月30日期间,首都医科大学附属北京朝阳医院收治的因异常子宫出血行诊断...目的探讨无不典型性的子宫内膜增生(endometrial hyperplasia without atypia,EH)患者临床特征、不同治疗方法选择时机及预后分析。方法分析2011年6月1日至2018年6月30日期间,首都医科大学附属北京朝阳医院收治的因异常子宫出血行诊断性刮宫、病理诊断无不典型性的子宫内膜增生394例患者的临床资料、病理特征、不同治疗选择对预后的影响。结果394例纳入患者依据2003年世界卫生组织(World Health Organization,WHO)子宫内膜增生的分类,子宫内膜单纯增生组258例和子宫内膜复杂增生组136例。两组无妊娠史分别是10.85%(28/258)和19.12%(26/136),差异有统计学意义(P<0.05)。两组初始治疗方式选择口服孕激素药物治疗分别占73.25%(189/258)和57.35%(78/136),子宫切除术占12.1%(31/258)和25%(35/136),两组治疗方式比较,差异有统计学意义(P<0.05)。初始孕激素口服治疗3~6个月后子宫内膜随诊显示对孕激素反应良好者两组分别为85.7%(162/189),59.0%(46/78),内膜单纯增生组明显优于复杂增生组,两组比较差异有统计学意义(P<0.05)。两组孕激素治疗方案的分布差异有统计学意义(P<0.05),单纯性增生组以孕激素周期性应用为主。单纯增生组3种孕激素治疗方案对孕激素的反应性差异无统计学意义(χ^2=3.611,P=0.161),复杂增生组高效孕激素连续应用孕激素的反应率明显高于天然黄体酮连续应用者(χ^2=6.390,P=0.041)。多因素分析显示子宫内膜组织病理学分组是子宫内膜对孕激素反应性的独立影响因素(P=0.001,OR=0.233)。初始治疗为子宫切除术者子宫内膜标本组织学诊断分布显著不同,复杂增生组子宫内膜不典型性增生的比率明显高于单纯增生组(χ^2=35.620,P<0.001)。单纯增生组2例诊断升级,1例复杂增生,1例不典型增生。复杂增生组2例子宫内膜癌(5.71%),8例不典型增生(22.8%)。两组病理升级发生率分别6.45%(2/31)和28.57%(10/35),差异有统计学意义(P<0.05)。结论无不典型性的子宫内膜增生患者对孕激素的反应性总体良好,单纯增生患者对孕激素后半期周期序贯疗法反应良好,可作为临床初始治疗的首选。复杂增生组高效孕激素反应性良好。复杂增生子宫内膜对孕激素的反应程度明显低于单纯性增生。诊断性刮宫病理诊断子宫内膜复杂增生患者约30%并存子宫内膜不典型增生。刮宫病理存在明显的过低诊断率。展开更多
文摘BACKGROUND Endometrial cancer is a kind of well-known tumors of female genitourinary system.Cervical stromal invasion is an adverse factor for poor prognosis of endometrial cancer.There is still controversy regarding the use of magnetic resonance imaging(MRI)in the diagnosis of cervical stromal invasion of endometrial cancer.The diagnosis of cervical stromal invasion varies significantly between different observers and institutions.We present a limited case series of the particular pattern of endometrial cancer,which infiltrates the cervical stroma and is often overlooked.CASE SUMMARY We present three cases of endometrial carcinoma with cervical stromal invasion with cancer-free uterine cavity.One patient,a reproductive-aged woman,exhibited irregular menstruation and was diagnosed with endometrial polyps by hysteroscopy and segmental curettage.A MRI scan revealed polypoid nodules within the internal cervical orifice.The other two cases were postmenopausal women who presented with abnormal vaginal bleeding.Hysteroscopy and segmental curettage suggested atypical hyperplasia of the endometrium.MRI scans did not detect any malignant signs in the endometrium.In one case,a nonthickened endometrium was observed,while in another,hyperplasia of the endometrium was seen.Notably,none of these patients had malignant tumors identified in the uterine cavity via MRI scans.However,postoperative pathological results following hysterectomy consistently indicated cervical stromal invasion.CONCLUSION Cervical stromal invasion is easily missed if no cancer is found in the uterine body on MRI.Immunohistochemistry of endoscopic curettage specimens should be conducted to avoid underestimation of the disease.
文摘Objective To investigate the expression of survivin gene among human normal endometrium,atypical hyperplasia of endometrium,and endometrial carcinoma.Methods Tissue samples of human normal endometrium during proliferative phase （NE,n=20）,atypical hyperplasia of endometrium （AHE,n=11）,and endometrial carcinoma （EC,n=9） were collected.Besides,Paraffin embedded sections of NE （n=20）,AHE （n=20）,and EC （n=20） were used.The expression of survivin gene was determined by immunohistochemistry and the real-time reverse transcription polymerase chain reaction.Results Survivin immunostaining appeared in the cytoplasm of endometrial epithelial cells.Both survivin staining and mRNA had higher levels in AHE or EC than those in NE （P〈0.01）.No difference was found on survivin staining and mRNA between AHE and EC （P〉0.05）.Conclusion High expression of survivin gene in human endometrium is associated with the risk of atypical hyperplasia progressing to endometrial carcinoma.The high level of survivin expression is useful as a predictive indicator for endometrial carcinoma.
基金the National Key Technology R&D Program of China(no.2019YFC1005200 and 2019YFC1005203)the National Natural Science Foundation of PR China(no.82071715)。
文摘Objective:The objective of the study was to compare the effects of assisted reproductive technology(ART)and spontaneous pregnancy on pregnancy outcomes in women with endometrial carcinoma(EC)and atypical endometrial hyperplasia(AEH)following fertility-sparing treatments.Methods:Relevant studies published through July 2020 were identified from PubMed and Web of Science literature searches.The pregnancy outcomes of ART and spontaneous pregnancy were summarized and compared for women with complete remission of EC/AEH after fertility-sparing treatments.A subgroup analysis was performed based on whether patients had received in vitro fertilization and embryo transfer(IVF-ET)treatment.The complete remission and recurrence rates of EC/AEH following fertility-sparing treatments were estimated.The effect of pregnancy on recurrence rates of EC/AEH was also calculated.Results:Sixteen observational studies reporting pregnancy outcomes or recurrence with ART or spontaneous pregnancy for women with EC/AEH after fertility-sparing treatments were included.The complete remission rate of EC/AEH was 81.5%(95%CI,78%–85%).Compared with spontaneous pregnancy,the pregnancy rate of ART was significantly higher(66.8%vs.43.7%,OR=2.64,95%CI 1.71–4.05,P<0.00001,I^(2)=14%).Subgroup analysis showed that the pregnancy rate of IVF-ET was significantly higher than that of spontaneous pregnancy(62.7%vs.35.1%,OR=2.85,95%CI 1.44-5.63,P=0.003,I^(2)=29%).The live birth rate of ART was significantly higher than that of spontaneous pregnancy(75.3%vs.47.8%,OR=3.96,95%CI1.76-8.77,P=0.0009,I^(2)=45%).The recurrence rate of EC/AEH was 31%(95%CI 24%–39%).Clinical pregnancy could reduce the recurrence rate of EC/AEH,but there was no significant evidence of an association.Conclusions:ART,especially IVF-ET,could significantly improve pregnancy outcomes in women with EC/AEH receiving fertility-sparing treatments.Following complete remission,ART treatment might be a better option for women with EC/AEH than spontaneous pregnancy.
文摘目的探讨无不典型性的子宫内膜增生(endometrial hyperplasia without atypia,EH)患者临床特征、不同治疗方法选择时机及预后分析。方法分析2011年6月1日至2018年6月30日期间,首都医科大学附属北京朝阳医院收治的因异常子宫出血行诊断性刮宫、病理诊断无不典型性的子宫内膜增生394例患者的临床资料、病理特征、不同治疗选择对预后的影响。结果394例纳入患者依据2003年世界卫生组织(World Health Organization,WHO)子宫内膜增生的分类,子宫内膜单纯增生组258例和子宫内膜复杂增生组136例。两组无妊娠史分别是10.85%(28/258)和19.12%(26/136),差异有统计学意义(P<0.05)。两组初始治疗方式选择口服孕激素药物治疗分别占73.25%(189/258)和57.35%(78/136),子宫切除术占12.1%(31/258)和25%(35/136),两组治疗方式比较,差异有统计学意义(P<0.05)。初始孕激素口服治疗3~6个月后子宫内膜随诊显示对孕激素反应良好者两组分别为85.7%(162/189),59.0%(46/78),内膜单纯增生组明显优于复杂增生组,两组比较差异有统计学意义(P<0.05)。两组孕激素治疗方案的分布差异有统计学意义(P<0.05),单纯性增生组以孕激素周期性应用为主。单纯增生组3种孕激素治疗方案对孕激素的反应性差异无统计学意义(χ^2=3.611,P=0.161),复杂增生组高效孕激素连续应用孕激素的反应率明显高于天然黄体酮连续应用者(χ^2=6.390,P=0.041)。多因素分析显示子宫内膜组织病理学分组是子宫内膜对孕激素反应性的独立影响因素(P=0.001,OR=0.233)。初始治疗为子宫切除术者子宫内膜标本组织学诊断分布显著不同,复杂增生组子宫内膜不典型性增生的比率明显高于单纯增生组(χ^2=35.620,P<0.001)。单纯增生组2例诊断升级,1例复杂增生,1例不典型增生。复杂增生组2例子宫内膜癌(5.71%),8例不典型增生(22.8%)。两组病理升级发生率分别6.45%(2/31)和28.57%(10/35),差异有统计学意义(P<0.05)。结论无不典型性的子宫内膜增生患者对孕激素的反应性总体良好,单纯增生患者对孕激素后半期周期序贯疗法反应良好,可作为临床初始治疗的首选。复杂增生组高效孕激素反应性良好。复杂增生子宫内膜对孕激素的反应程度明显低于单纯性增生。诊断性刮宫病理诊断子宫内膜复杂增生患者约30%并存子宫内膜不典型增生。刮宫病理存在明显的过低诊断率。
