Epidemiology and outcome of individuals with intraductal papillary neoplasms of the bile duct

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically displays mucin-hypersecretion or a papillary growth pattern,and results in cystic dilatation[1].IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts,and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma.IPNBs have similar phenotypic changes in the occurrence and development of all subtypes,and the prognosis is significantly better than that of traditional(nonpapillary)cholangiocarcinoma.AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.METHODS Invasive IPNB,invasive intraductal papillary mucinous neoplasm of the pancreas(IPMN),and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Annual percentage changes(APCs)in the incidence and incidence-based(IB)mortality were calculated.We identified the independent predictors of overall survival(OS)and cancer-specific survival(CSS)in indivi duals with invasive IPNB.RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases,with an APC of-4.5%(95%CI:-5.1%to-3.8%)and-3.3%(95%CI:-4.1%to-2.6%)(P<0.001),respectively.Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma.Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma.A total of 1635 individuals with invasive IPNB were included in our prognosis analysis.The most common tumor sites were the pancreaticobiliary ampulla(47.9%)and perihilar tract(36.7%),but the mucin-related subtype of invasive IPNB was the main type,intrahepatically(approximately 90%).In the univariate and multivariate Cox regression analysis,age,tumor site,grade and stage,subtype,surgery,and chemotherapy were associated with OS and CSS(P<0.05).CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward.The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.

Breast cancer: Epidemiology, risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally,epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer.This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography,ultrasound, magnetic resonance imaging(MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.

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.

Endometrial Hyperplasia: Epidemiological Profile of Patients and Anatomical and Clinical Aspects of Lesions at Conakry University Hospital

Summary: Estimate the incidence of endometrial hyperplasia according to socio-demographic parameters and the type of lesions histological. Methodology: This was a retrospective, and 15-year descriptive study from January 1, 2000 to December 31, 2014 conducted at the Department of Anatomy and Pathological Cytology of the National Hospital Donka in collaboration with the obstetric gynecology departments of the Conakry University Hospital. Results: We collected 296 cases of malignant and benign endometrial hyperplasia in 15 years, accounting for 37% of all endometrial biopsy curettages examined. The age group 47 to 56 years was the most affected (81 cases) or 27, 36%. The mean age was 53.6 years with extremes of 27 and 83 years. Metrorrhagia was the main reason for consultation (206 cases), i.e. 69.59%. The suspicion of endometrial hyperplasia by physicians was the most frequently diagnosed circumstance (149 cases) or 50.33%. Biopsy curettage was the most frequently used method (176 cases), is 59.45%. Histological endometrial lesions of atypical complex adenomatous hyperplasia (79 cases) represented 26.69%. Benign behavior was most frequently observed in (235 cases) or 79.39%. Conclusion: Endometrial hyperplasia is an endometrial lesion whose atypical histological types represent the borderline lesions between benignity and malignancy.

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.

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.

Prognostic impact of tumor deposits on overall survival in colorectal cancer:Based on Surveillance, Epidemiology, and End Results database

BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately.AIM To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count.METHODS The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival(OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs.RESULTS Overall, 103755 patients were enrolled with 14131(13.6%) TD-positive and 89624(86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3%(95%CI, 46.5%-48.1%) and 77.5%(95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS(hazard ratio, 1.35;95%CI, 1.31-1.38;P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965(4.4%) N1 patients were restaged as p N2, with worse outcomes than patients restaged as p N1(3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively;P < 0.0001).CONCLUSION TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.

Epidemiology of Cancer in Systemic Sclerosis—Systematic Review and Meta-Analysis of Cancer Incidence, Predictors and Mortality

Objectives: The study was conducted to improve our understanding of the epidemiology of cancer in systemic sclerosis (SSc) by evaluating the incidence, prevalence, relative risk of overall and site-specific malignancies, predictors and cancer-attributable mortality. Methods: MEDLINE, CINAHL, EMBASE and Cochrane Library (inception-May 2012) were searched. Estimates were combined using a random effects model. Consistency was evaluated using the I2 statistic. Results: 4876 citations were searched to identify 60 articles. The average incidence of malignancy in SSc was 14 cases/1000 person-years;the prevalence ranged between 4%-22%. Cancer was the leading cause of non-SSc related deaths with a mean of 38%. Overall SIR for all-site malignancy risk was 1.85 (95%CI 1.52, 2.25;I276%). There was a greater risk of lung (SIR 4.69, 95%CI 2.84, 7.75;I293%) and haematological (SIR 2.58, CI 95% 1.75, 3.81;I20%) malignancies, including non-Hodgkin’s lymphoma (SIR 2.55, 95%CI 1.40, 4.67;I20%). SSc patients were at a higher risk of leukemia (SIR 2.79, 95%CI 1.22, 6.37;I20%), malignant melanoma (SIR 2.92, 95%CI 1.76, 4.83;I235%), liver (SIR 4.75, 95%CI 3.09, 7.31;I20%), cervical (SIR 2.28, 95%CI 1.26, 4.09;I254%) and oropharyngeal (SIR 5.0, 95%CI 2.18, 11.47;I258%) cancers. Risk factors include a-RNAP I/III seropositivity, male sex, and late onset SSc. Smoking and longstanding interstitial lung disease increase the risk of lung cancer;Barrett’s esophagus and a positive family history of breast cancer, respectively, increase the risk of esophageal adenocarcinoma and breast cancer. Conclusions: SSc patients have a two-fold increase in all-site malignancy, and greater risk of lung and haematological malignancies that contribute significantly to mortality. Vigilance should be considered in SSc patients with risk factors for cancer.

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.

MRI基于2023版国际妇产科联盟分期评估子宫内膜癌进展

子宫内膜癌(EC)是常见妇科恶性肿瘤;MRI对EC评估具有重要价值。2023年国际妇产科联盟(FIGO)分期做出重大修订,以更细致地对EC进行风险分层,也使MRI面临新的挑战。本文就MRI基于2023版FIGO分期评估EC进展进行综述。

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。

铜死亡在妇科恶性肿瘤中的研究进展

铜离子作为重要的辅酶,参与了广泛的代谢过程,包括有氧呼吸、肽酰胺化、铁转运、超氧化物歧化和细胞外基质的生物合成。铜稳态是维持细胞活性的重要机制。铜死亡是由铜离子积累引发的细胞死亡形式,其特点是铜稳态失衡,细胞内铜积累,选择性地扰乱三羧酸循环,使脂酰化线粒体酶聚集和铁硫蛋白丢失,引起线粒体蛋白质毒性应激,细胞膜裂解,最终导致细胞死亡。妇科恶性肿瘤是引起女性癌症死亡的重要原因。研究发现,铜死亡与妇科恶性肿瘤的发生、发展、预后及耐药密切相关。一些铜死亡调节剂可通过抑制血管生成、调节癌细胞的耐药性,抑制肿瘤转移和复发,因此铜死亡是治疗妇科恶性肿瘤有价值的研究方向。

子宫内膜腺纤维瘤1例报告并文献复习

子宫内膜腺纤维瘤是一种苗勒管起源的良性混合肿瘤,具有组织学良性、诊断困难、高复发率的特点。本文对该病的发病特点、临床表现、影像学表现、诊断及治疗进行分析,并复习相关文献,为了解该病特点、指导临床诊治提供帮助。

m6A修饰与妇科恶性肿瘤相关性的研究进展

N6-甲基腺苷(m6A)修饰是一种常见的表观遗传学修饰,动态调控RNA代谢的整个过程。m6A包括甲基转移酶、去甲基酶及m6A结合蛋白。m6A的甲基化修饰通过调节RNA的衰变、运输、剪切、翻译来调节细胞的增殖和分化,m6A与妇科恶性肿瘤的发生发展有关。笔者就近年来m6A甲基化修饰在宫颈癌、子宫内膜癌和卵巢癌中的相关研究进展进行回顾,分析m6A通过作用于RNA的修饰调节妇科恶性肿瘤发生发展的机制,为妇科恶性肿瘤的治疗、改善预后提供新的方向。

免疫细胞和免疫因子在子宫内膜癌中的作用

子宫内膜癌是常见的妇科恶性肿瘤,严重威胁女性的生活质量和生命健康。近年研究显示,在子宫内膜癌免疫微环境中,树突状细胞等免疫细胞与免疫增强因子相互作用可增强抗肿瘤的免疫效应,而肿瘤相关巨噬细胞等免疫细胞与免疫抑制因子通过抑制免疫应答可发挥促肿瘤的免疫效应。综述子宫内膜癌免疫微环境中部分免疫细胞、免疫抑制因子及免疫增强因子的研究进展,为深入研究子宫内膜癌的发病机制及免疫治疗方法提供新思路。

miR-20a在妇科常见恶性肿瘤中的作用机制

宫颈癌、子宫内膜癌及卵巢癌作为妇科最常见的三大恶性肿瘤,其发病率近年来在各年龄段中呈上升趋势,已严重威胁我国女性健康。尽管多种靶向药物的应用已使该类患者的生存期明显延长,但其仍是一类无法被精准诊断和治疗的疾病。miR-17-92基因簇作为最早被确定为癌基因的微小RNA(micro RNA,miRNA)家族,其作用机制一直被广泛关注。miR-20a是miR-17-92基因簇中的一员,可通过降低或上调表达的方式发挥转录后调控功能,进而影响下游基因通路,调控恶性肿瘤细胞的增殖、侵袭及转移,并最终实现恶性肿瘤的发生及进展。根据目前研究进展,miR-20a在宫颈癌、子宫内膜癌及卵巢癌中表达特异性升高通常与疾病的恶性进展有关,综述miR-20a在妇科常见三大恶性肿瘤发病机制中作用的最新研究。