Pancreatic endometrial cyst mimics mucinous cystic neoplasm of the pancreas

Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively. This report describes the findings in a 43-year-old patient with a recent episode of acute pancreatitis who presented with a large cyst in the tail of the pancreas. Imaging demonstrated a loculated pancreatic cyst, and cyst fluid aspiration revealed an elevated amylase and carcinoembryonic antigen. The patient experienced an interval worsening of abdominal pain, fatigue, diarrhea, and a 15-pound weight loss 3 mo after the initial episode of pancreatitis. With concern for a possible pre-malignant lesion, the patient underwent a laparoscopic distal pancreatectomy with splenectomy, which revealed a 16cm×12cm×4cm lesion. Final histopathology was consistent with an intra-pancreatic endometrial cyst. Here we discuss the overlapping imaging and laboratory features of pancreatic endometrial cysts and mucinous cystic neoplasms of the pancreas.

Correlation between PTEN Expression and PI3K/Akt Signal Pathway in Endometrial Carcinoma

In order to investigate the role of the PTEN expression in carcinogenesis and development of endometrial carcinoma and clarify whether and how PTEN and PI3K/Akt pathway relate to endometrial carcinoma, the expression of PTEN and phospho-Akt was detected by semiquantitative reverse transcription-polymerase chain reaction （RT-PCR） methods and Western-blot from 24 cases of endometrial carcinoma, 10 cases of endometrial atypical hyperplasia, 10 cases of endometrial hyperplasia, and 10 cases of normal endometriurn. SP immunohistochemical methods were used to measure levels of PTEN protein expression in following 5 study groups： 31 cases of endometrium in proliferative phase, 30 cases of endometrium in secretory phase, 71 cases of endometrial hyperplasia, 25 cases of atypical hyperplasia and 73 cases of endometrial carcinoma. Immunostaining score of PTEN was 3.39±0.15 in proliferative phase, 1.90±0.21 in secretory phase, 3.34±0.29 in endometrial hyperplasia, 0.62±0.11 in atypical hyperplasia, and 0.74±0.19 in endometrial carcinoma, respectively. PTEN mRNA relative value in normal endometrium, endometrial hyperplasia, endometrial atypical hyperplasia, and endometrial carcinoma was 2.45±0.51, 2.32±0.32, 0.46±0.11, and 0.35±0.13 respectively. The expression levels of PTEN mRNA and protein in patients with endometrial carcinoma and atypical hyperplasia were significantly lower than in those of proliferative phase and with endometrial hyperplasia. The level of PTEN expression in patients with endometrial carcinoma was significantly related to tissue type （P〈0.005）, differentiation （P〈0.05） and clinical stage （P〈0.05）, but not to depth of myometrium invasion （P〉0.05）. Western blot analysis revealed that Phospho-Akt level in PTEN negative cases was significantly higher, and there was a negative correlation between PTEN and phospho-Akt （r=-0.8973, P〈0.0001）. It was suggested that loss of PTEN expression was an early event in endometrial tumorigenesis. The phosphorylation of Akt induced by the loss of PTEN took part in the tumorigenesis and development of endometrial carcinoma.

OVARIAN METASTASIS IN PATIENT WITH ENDOMETRIAL CARCINOMA

Objective： To study the clinical pathological characteristics of ovarian metastasis of endometrial carcinoma and the factors affecting prognosis. Methods： Retrospective analysis was made to the clinical pathological outcome of endometrial carcinoma patients receiving surgical treatment in our hospital from January 1990 to December 2002. Results： Among the 191 cases of endometrial carcinoma patients, 17 cases （8.9%） had ovarian metastasis and young patients were more likely to have ovarian metastasis. The multiple factor analysis showed that the independent risk factors of ovarian metastasis in endometrial carcinoma included the depth of myometrial invasion, lymph node metastasis and pathological types. Conclusion： Ovarian metastasis in patients with endometrial carcinoma is associated with poor prognosis, the depth of myometrial invasion, lymph node metastasis and histologic types are independent risk factors affecting the prognosis. For young patients at early stage of the disease, it should be prudent as to whether to retain the ovary.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.

PARP抑制剂与免疫检查点抑制剂联合治疗在妇科恶性肿瘤中的应用

近年来肿瘤靶向和免疫治疗的研究进展迅速,如多腺苷二磷酸核糖聚合酶抑制剂[poly(ADP-ribose)polymerase inhibitor,PARPi]、免疫检查点抑制剂(immune checkpoint inhibitors,ICI)等已改变了妇科肿瘤的传统治疗模式,但部分患者疗效有限或出现耐药。临床前研究发现,PARPi损伤DNA修复过程,可造成肿瘤突变负荷与肿瘤特异性抗原增加,调节肿瘤微环境,刺激肿瘤浸润淋巴细胞(tumor infiltrating lymphocytes,TIL)产生并促进抗肿瘤免疫反应,为PARPi与ICI联合治疗提供了理论基础。近年多项临床研究发现PARPi与ICI联合使用可显著改善妇科恶性肿瘤患者的预后。

Correlation between single nucleotide polymorphisms of 17β-HSD-1 and endometrial adenocarcinoma

Objective: To investigate the correlation between 17-beta-hydroxysteroid dehydrogenase type1(17β-HSD-1) gene polymorphisms and risk of endometrial adenocarcino-ma.Methods: Forty-one patients with endometrial adenocarcinoma were selected as experimen-tal group and twenty-seven healthy women were selected as control group.The three common single nucleotide polymorphism of 17β-HSD-1 gene at sites + 1004,+ 1322 and + 1954 were detected by allele-specific PCR(ASA-PCR).The allele frequencies were analyzed by SPSS13.0 software between endometrial cancer cases and controls.Results: We observed no significant difference in various frequency distribution between experimental group and control group.P1004= 0.994,P1322 = 0.974,and P1954 = 0.981.Conclusion: We found that three common SNPs with the 17β-HSD-1 gene were not associated with endometrial adenocarcinoma.We suggest that more research for 17β-HSD needs to explore.

The relationship between single nucleotide polymorphisms in estrogenmetabolizing genes CYP1A1,CYP17,COMT and estrogen receptor alpha and the risk of endometrial adenocarcinoma among the Chinese women

Objective:To explore whether polymorphisms of the genes responsible for catechol estrogen(CE)formation via estrogen biosynthesis(CYP17)and hydroxylation (CYP1A1)and CE inactivation(COMT)and ERa are associated with an elevated risk for en- dometrial adenocarcinoma in Chinese women.Methods:A multigenic case-control study was conducted,eighty-seven endometrial adenocarcinoma patients and ninety controls were recrui- ted.PCR-RFLP assays were used to determine the genotypes of estrogen-metabolizing genes and ERa gene.Results:The endometrial adenocarcinoma risk associated with individual susceptibili- ty genotypes varied among the six polymorphic sites and was the highest for CYP17,followed by CYP1 A1 Ile-Val,CYP1A1 MspI,COMT,ERa XhaI and ERa PvuII.Multivariate logistic regres- sion showed the CYP1A1 MspI genotype was the most significant determinant for endometrial adenocarcinoma development and was associated with a 3.61 fold increase in risk(95% confi- dence interval,1.73～7.55).Furthermore,a trend of increasing risk for developing endometrial adenocarcinoma was found in women harboring higher numbers of high-risk genotypes.Conclu- sion:The CYP1A1,CYP17 and ERa XbaI genotypes are related to the susceptibility of endome- trial adenocarcinoma,they may be useful markers for predicting endometrial adenocarcinoma susceptibility.The allele encoding for low acticity COMT,ERa PvuII may not be a genetic risk factor for endometrial adenocarcinoma.

Endometriosis-associated endometrioid adenocarcinoma of the fallopian tube synchronized with endometrial adenocarcinoma:A case report

BACKGROUND Endometriosis is a common gynecological disorder that affects women of reproductive age.It is characterized by a cancer-like invasion of the extra-uterine endometrium and exhibits a strong association with ovarian clear cell cancer and endometrioid cancer.Endometriosis-associated fallopian tube endometrioid adenocarcinoma synchronized with endometrial adenocarcinoma was rarely reported.CASE SUMMARY A 49-year-old woman was referred to our hospital complaining about abnormal vaginal bleeding for three years following unsatisfactory medication.Intraop-erative frozen sections unexpectedly unveiled an endometrioid cancer of the left fallopian tube with superficial invasion surrounded by diffuse endometriosis synchronized with endometrioid endometrial cancer.CONCLUSION It was difficult to make a differential diagnosis when confronted with incidental findings of fallopian tube cancer lesions synchronized with endometrial cancer.The key differential diagnosis of primary endometriosis-associated endometrioid adenocarcinoma of the fallopian tube from endometrial adenocarcinoma invol-vement relies on the pathological identification of malignant transformation in fallopian tube endometriosis disease.

PTEN coding product:a new marker for tumorigenesis and progession of endometrial carcinoma

Objective:To investigate the expression of PTEN in carcinogenesis and development of endometrial carcinoma.Methods:The expression of PTEN was detected by reverse transcription-polymerase chain reaction(RT-PCR)methods from 24 cases with endometrial carcinoma,10 cases with endometrial atypical hyperplasia,10 cases with endometrial hyperplasia and 10 cases with normal endometrium and by SP immunohistochemical methods from 73 cases with endometrial carcinoma,25 cases with endometrial atypical hyperplasia,71 cases with endometrial hyperplasia and 31 cases with normal endometrium.Results:PTEN expression of both RNA and protein in patients with endometrial carcinoma and endometrial atypical hyperplasia was significantly lower than that of patients with endometrial hyperplasia and normal endometrium.mRNA relative value was 0.35±0.13,0.46±0.11,2.32±0.32,2.45±0.51,respectively.Loss of PTEN expression rates were 66.67%(38/57),76.00%(19/25),5.63%(4/71),0(0/31),repectively.The results were also compared with clinical parameters.Loss of PTEN expression in patients with endometrial carcinoma was significantly related to histological classification(P<0.0001)and differentiation(P<0.05).It was not related to depth of myometrium invasion and clinical stage(P>0.05).Conclusion:Loss of PTEN expression is an early event in endometrial tumorigenesis.Detection of PTEN protein may be a diagnostic biomarker for endometrial precancers and adenocarcinoma.

子宫内膜样腺癌中TBX2、PAX9的表达及其相关性

目的探讨TBX2、PAX9在正常子宫内膜、子宫内膜增殖症和子宫内膜样腺癌(endometrioid adenocarcinoma,EA)组织中的表达及临床病理学意义。方法采用组织芯片技术和免疫组化检测30例正常子宫内膜组织、30例单纯性增生内膜、30例复杂伴不典型性增生内膜、82例EA组织中TBX2、PAX9蛋白的表达。结果 TBX2蛋白在子宫内膜样腺癌中的阳性表达率明显高于正常子宫内膜和子宫内膜增殖症(P均<0.01),TBX2过表达与组织学分级、临床分期、浸润程度均有相关性(P<0.01,P<0.05,P<0.01),与淋巴结转移无相关性(P>0.05);PAX9蛋白在子宫内膜样腺癌中的阳性表达率明显高于正常子宫内膜、子宫内膜单纯性增生(P均<0.01),而和复杂伴不典型性增生之间没有统计学意义(P>0.05),在复杂伴不典型增生中表达明显高于正常子宫内膜和单纯性增生内膜(P均<0.01),PAX9阳性表达与组织学分级、临床分期、浸润程度均有相关性(P<0.01,P<0.01,P<0.05),但与淋巴结转移无相关性(P>0.05)。TBX2与PAX9蛋白呈正相关(rs=0.427,P<0.01)。结论 TBX2和PAX9均在子宫内膜样腺癌中发生、发展中发挥重要作用,联合检测其表达可为子宫内膜样腺癌的早期诊断、预后判断提供有价值的指标。

COX-2、u-PA和TSP-1在胃癌及周围淋巴结中的表达及意义

目的:研究COX-2、u-PA和TSP-1在胃癌及周围淋巴结中的表达状况,探讨它们在胃癌浸润和淋巴结转移中的作用和意义。方法:用组织芯片技术和免疫组化法检测COX-2、u-PA和TSP-1的表达。结果:COX-2、u-PA和TSP-1在胃癌组阳性表达率分别为67.7%、78.1%和78.6%,均显著高于对照组(40.0%、6.7%和40.0%,P<0.05)。COX-2表达与浸润深度有关(P<0.05)。u-PA表达与浸润深度和淋巴结转移均有关(P<0.05)。TSP-1表达与浸润深度和淋巴结转移均无关(P>0.05)。COX-2、u-PA和TSP-1在转移淋巴结和对应癌组织间的表达差异无显著性(P>0.05)。COX-2和u-PA、TSP-1的表达呈正相关,u-PA和TSP-1的表达无相关关系。结论:胃癌中COX-2、u-PA和TSP-1高表达;COX-2表达与胃癌的浸润深度有关,u-PA表达与浸润深度和淋巴结转移有关。

妇科常见恶性肿瘤全专结合管理专家共识

为提升妇科恶性肿瘤患者的全程健康管理质量,充分发挥基层医疗卫生机构在妇科恶性肿瘤患者筛查、早期识别、干预及康复中的作用,首都医科大学肿瘤学系妇科肿瘤学组联合全科医学、营养学、心理学、康复医学、护理学、卫生统计学等专家,基于基层医疗机构现状,结合循证医学证据、妇科恶性肿瘤管理相关指南等,制定了本共识。妇科常见恶性肿瘤患者全专结合管理应该以妇科医生和全科医生为核心,联合肿瘤、康复等多学科团队,从妇科恶性肿瘤的预防、筛查、随访、转诊、心理疏导、运动康复、营养管理、延续护理、健康教育以及社会功能恢复等方面进行综合管理,致力于延长患者生存期和提高患者生存质量。

子宫内膜样腺癌中MDM2、Livin和Caspase-3蛋白及mRNA的表达

目的探讨鼠双微体基因(MDM2)、凋亡蛋白抑制因子(Livin)、半胱氨酸天冬氨酸特异性蛋白酶3(Caspase-3)蛋白及mRNA在正常子宫内膜、子宫内膜增殖症和子宫内膜样腺癌(EA)中的表达及临床病理学意义。方法采用组织芯片技术结合免疫组化SP法及原位分子杂交方法,检测30例正常子宫内膜、30例单纯性增生、30例复杂伴不典型性增生、72例EA组织中MDM2、Livin、Caspase-3蛋白及mRNA的表达。结果 MDM2、Livin、Caspase-3蛋白及mRNA在EA中的表达率分别为80.6%(58/72)、80.6%(58/72)、33.3%(24/72)及73.6%(53/72)、75.0%(54/72)、27.8%(20/72),MDM2和L ivin表达率明显高于正常增生内膜(P<0.01),而Caspase-3阳性率明显低于正常增生内膜(P<0.01)。MDM2蛋白及mRNA过表达与组织分化、临床分期、浸润深度和淋巴结转移均无相关性;Livin和Caspase-3蛋白及mRNA阳性表达与组织分化有关(P<0.01或P<0.05),与临床分期、浸润深度及淋巴结转移均无相关性。MDM2、Livin、Caspase-3蛋白与相应的mRNA呈正相关;Livin与Caspase-3表达在蛋白及mRNA水平均呈负相关。结论 MDM2、Livin和Caspase-3蛋白及mRNA异常表达与EA的发生发展相关,有望成为EA早期诊断和预后判断的有价值标记物。

米非司酮对子宫内膜癌细胞系E-钙粘素和核因子kappa B表达的影响

目的:探讨米非司酮(Mifepristone,MIF)对子宫内膜癌细胞中核因子kappaB(nuclear factor kappa B,NF-κB)与E-钙粘素表达的影响,及NF-κB与E-钙粘素之间的关系。方法:体外培养子宫内膜癌细胞系HHUA,以不同浓度MIF(0、0.1×10-6、0.1×10-5、1×10-5、5×10-5、1×10-4mol/L)分别作用细胞24h、48h和72h,用免疫组化法检测NF-κB p65与E-钙粘素的蛋白表达水平。结果:MIF显著抑制HHUA细胞生长。MIF显著降调NF-κB p65的蛋白表达水平(P<0.05),增加E-钙粘素的蛋白表达水平(P<0.05)。NF-κB p65表达与E-钙粘素表达呈显著负相关(r=-0.94)。结论:MIF可抑制子宫内膜癌细胞系HHUA的生长,其机制可能通过抑制NF-κB的表达,进而增加其靶基因E-钙粘素的表达,来达到抑制子宫内膜癌细胞生长的作用。

EPAS1、VEGF在胰腺癌中表达及其相关性

目的研究胰腺癌组织中缺氧诱导因子2(EPAS1/HIF-2α)、血管内皮生长因子(VEGF)和微血管密度(MVD)的表达及与临床病理特征之间的关系。方法应用逆转录聚合酶链反应(RT-PCR)、免疫印迹Western blot、免疫组化SP法检测60例胰腺癌及相应正常胰腺组织中EPAS1、VEGF mRNA和蛋白的表达和分布,同时检测MVD作为判断血管生成的指标,分析其间的相关性以及与肿瘤临床病理特征之间的关系。结果EPAS1、VEGF和MVD在胰腺癌组织中的表达明显高于正常胰腺组织,VEGF在mRNA和蛋白水平均增高(P<0.01),但EPAS1只在蛋白水平增高(P<0.01)。此外,三者之间的表达具有显著相关性(P<0.01)。EPAS1和VEGF的阳性表达与胰腺癌的TNM分期、肿瘤大小有关。结论胰腺癌组织中EPAS1和VEGF呈过量表达,且EPAS1的表达与VEGF及MVD呈显著正相关。EPAS1可通过上调VEGF表达来促进胰腺癌血管生成从而在胰腺癌的发生、发展中起重要作用。

子宫内膜癌患者血清uPA和PAI-1的含量变化及临床意义

目的：探讨子宫内膜癌患者血清尿激酶型纤溶酶原激活物（uPA）及纤溶酶原激活物抑制物-1（PAI-1）含量的变化及其临床意义。方法：用ELISA法测定35例子宫内膜癌（内膜癌组）、18例子宫内膜增生（内膜增生组）和16例正常子宫内膜患者（正常对照组）血清uPA和PAI-1含量及计算两者的比值。结果：内膜癌组患者血清uPA和PAI-1含量及uPA／PAI-1值均显著高于内膜增生组及正常对照组，差异有极显著性（P均〈0．01）。内膜增生组及正常对照组，差异无统计学意义（P〉0．05）。内膜癌组Ⅲ～Ⅳ期患者血清uPA和PAI-1含量与Ⅰ期相比差异有极显著性（P〈0．01），Ⅲ～Ⅳ期患者血清uPA和PAI-1含量高于Ⅱ期（P〈0．05），Ⅱ期患者血清uPA、PAI-1含量高于Ⅰ期（P〈0．05）。内膜癌组患者血清uPA、PAI-1含量及uPA／PAI-1值随着手术病理分期及组织学分级的增高、肌层浸润深度的增加及淋巴结的转移而升高，差异有显著性（P均〈0．05），而与患者病理类型无关（P〉0．05）。结论：子宫内膜癌患者血清uPA和PAI-1含量及uPA／PAI—1值明显升高，并与其手术病理分期、浸润转移有关，提示其可能在内膜癌的发生、发展及浸润过程中起重要作用。

miR-34、MDM2、EPAS1在子宫内膜癌中的表达及与临床特征的相关性分析

目的探究微小RNA-34(miR-34)、鼠双微基因2(MDM2)、内皮PAS1蛋白(EPAS1)在子宫内膜癌中的表达及与临床特征的相关性。方法选取2018年3月-2019年3月接受手术治疗的子宫内膜癌患者50例,自所有患者手术切除标本中取癌组织标本以及距离癌组织5 cm以上的癌旁组织待用,检测miR-34、MDM2、EPAS1相对表达量,观察miR-34、MDM2、EPAS1表达与子宫内膜癌患者肿瘤体积、病理分期、淋巴结转移情况、浸润程度、分化程度的关系。结果子宫内膜癌癌组织中miR-34表达低于癌旁组织,MDM2、EPAS1表达高于癌旁组织(P<0.01)。肿瘤体积≥5 cm^3患者miR-34表达低于肿瘤体积<5 cm^3患者,MDM2、EPAS1表达高于肿瘤体积<5cm^3患者(P<0.01)。病理分期为Ⅲ~Ⅳ的患者miR-34表达低于病理分期为Ⅰ~Ⅱ期的患者,MDM2、EPAS1表达高于病理分期为Ⅰ~Ⅱ期的患者(P<0.01)。有淋巴结转移的患者miR-34表达低于无淋巴结转移情况的患者,MDM2、EPAS1表达高于无淋巴结转移情况的患者(P<0.01)。浸润程度>1/2肌层的患者miR-34表达低于浸润程度≤1/2肌层的患者,MDM2、EPAS1表达高于浸润程度≤1/2肌层的患者(P<0.01)。低分化患者miR-34表达低于中分化、高分化患者,MDM2、EPAS1表达高于中分化、高分化患者,中分化患者miR-34表达低于高分化患者,MDM2、EPAS1表达高于高分化患者(P<0.01)。结论miR-34、MDM2、EPAS1在子宫内膜癌中呈现异常表达,且与肿瘤体积、病理分期、淋巴结转移情况、浸润程度、分化程度等临床病理参数具有一定相关性,与子宫内膜癌发生、演进过程密切相关。

PPARγ ERα和ERβ在子宫内膜癌的表达及其相关性分析

目的:探讨PPARγ、ERα和ERβ在子宫内膜癌的表达情况,分析三者之间的相互联系及临床意义。方法:采用免疫组织化学法及Western blot法检测正常子宫内膜及高中低分化子宫内膜癌组织中PPARγ、ERα和ERβ的表达。结果:PPARγ在子宫内膜癌中表达量明显降低,且随病理分级的进展,呈递减趋势;ERα在正常子宫内膜及高分化子宫内膜癌中表达量无显著性差异(P>0.05),而在中、低分化子宫内膜癌中表达量降低(P<0.05);ERβ表达量仅在低分化子宫内膜癌降低,在正常子宫内膜及高中分化子宫内膜癌中表达量无显著性差异(P>0.05)。Pearson相关分析提示ERα与PPARγ在不同子宫内膜组织中表达量呈正相关(P<0.05),而ERα与ERβ、ERβ与PPARγ间无相关性。结论:PPARγ及ERα表达水平与子宫内膜癌的分化程度、临床分期相关,在子宫内膜癌的发生发展中可能起重要作用。

基质降解酶u-PA、PAI-1与人口腔鳞状细胞癌细胞侵袭转移的相关性研究

目的 探讨体外培养细胞系TSCCa和GNM细胞的u -PA及PAI - 1活性和表达与口腔鳞状细胞癌侵袭转移的关系。方法 采用酶联免疫反应法和免疫组化法测定了两细胞系中u -PA及PAI - 1的活性和表达 ,同时对GNM细胞在BALB/CA裸鼠皮下种植瘤组织的u -PA及PAI - 1抗原表达进行了测定。结果 两细胞系均能产生u -PA及PAI- 1,但u -PA在两细胞系中的表达不同 ,在GNM细胞u -PA为高表达 ,在TSCCa细胞中u -PA为低表达 ,PAI- 1在两细胞系中均为高表达 ;种植瘤组织中u -PA呈阳性～强阳性表达 ,PAI- 1为阴性表达。结论 u