Clinicopathological Features and Prognosis of Small Cell Carcinoma of the Cervix

Small cell carcinoma of cervix (SCCC) is a rare disease with highly aggressive behaviour and is pathologically hard to diagnose.In this study, the clinicopathological features, diagnosis, treatment and prognosis of the condition were examined.Clinical records and follow-up data of 7 cases of SCCC were retrospectively studied.Our results showed that five non-recurrent cases initially presented irregular vaginal bleeding or increased apocenosis of varying degrees.Pathological examination revealed that the stroma was diffusely infiltrated with small monomorphous cells ranging from round to oval shape.Three cases were immunohistochemically confirmed.One case was accompanied with squamous cell cancer.Of the 7 cases, one case was classified as stage Ⅰb 1, two stageⅠ b2, one stage Ⅱ a, one stage Ⅱb , and one stage Ⅲ b.On the basis of their stages of condition, one subject with stage III b underwent chemotherapy, and one with stage Ib2 received extensive hysterectomy plus pelvic lymphadenectomy, while the other 5 cases were treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre-and/or post-operative adjuvant chemotherapy and radiotherapy.Of the 7 patients, 4 had relapse-free survival of 14, 14, 16 and 28 months respectively.It is concluded that SCCC is an aggressive tumor with propensity for early pelvis lymph node metastases.Early-stage patients should be treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre-and/or post-operative adjuvant chemotherapy and radiotherapy.

The role of punch biopsy in the management of carcinoma of the cervix in a low resource centre

Background: Carcinoma of the cervix is the commonest malignant tumor of the female genital tract in Northern Nigeria and the leading cause of cancer-related death in women in developing countries. The predicament is further worsened by poor uptake of cytological screening programs, which are either not available or where available are underutilized due ?to lack of widespread awareness and the cost as ???an average Nigerian earns less than a dollar per day. In addition to the above constrains, majority of these patients also presents late to the hospital for intervention. Objective: To emphasize the significance of punch biopsy and clinical staging of advanced carcinoma of the cervix and see how we can shift from our traditional, Examination under Anesthesia (EUA) to Clinical staging and punch biopsy for advanced carcinoma of the cervix. Methodology: Review of existing literature and experience from our own center. Results: The punch biopsy has 88.8% positive predictive value in making a diagnosis of cancer of the cervix. Late presentation was as high as 81.7 percent for carcinoma of the cervix in our centre. The patients present late for care;majority actually presents in stages III & IV when little or nothing can be done for them. Conclusion: In view of these predicaments that face a gynecological oncologist practicing in low resources settings like ours, there is a need to consider the role of punch biopsy, clinical staging and radio-logical assessment for making a diagnosis, especially among those women who cannot afford EUA or are having renal complication that makes EUA unachievable.

Adenoid Cystic Carcinoma of the Cervix: Case Report

Adenoid cystic carcinoma (ACC) is usually an epithelial neoplasm of the salivary glands but can also occur in the lacrimal glands and the mucous glands of the respiratory tract, breasts and skin. Very rarely, it may affect the uterine cervix. We report here a case of a woman with postmenopausal bleeding for 7 months, who on physical examination presented with a vegetative and friable tumor lesion in the uterine cervix, measuring about 5 cm in diameter. The abdominal and pelvic computed tomography scans showed a hypodense and heterogeneous mass in the cervix and uterine isthmus. Histopathological examination and immunohistochemical assays confirmed the diagnosis of ACC. The different pathological aspects, therapeutic options and prognostic factors of ACC are discussed.

Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy

Objective:To investigate the recurrence sites,risk factors,and prognosis of patients with persistent or recurrent squamous cell carcinoma(SCC)of the cervix within one year after undergoing concurrent chemoradiotherapy(CCRT).Methods:Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between July 2006 and July 2011 were analyzed retrospectively.These data were compared with those of 35 SCC cases with no signs of recurrence after complete remission.These 35 patients were treated during the same period(between 2006 and 2011)and selected randomly.Results:Among these 30 patients,25 exhibited distant metastases of which 14 were observed within 6 months after CCRT.Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag>10 ng/mL in the group with persistent or recurrent disease before treatment(P<0.01).Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were the independent risk factors.Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease.The 2-year survival rate was 21.7%,and the median survival time was 17 months.Conclusion:Patients with persistent or recurrent SCC of the cervix after CCRT exhibited a high rate of distant metastasis with poor prognosis.The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were identified as the independent risk factors for persistent or recurrent SCC within 1 year after CCRT.

Analysis of Prognosis and Prognostic Factors of Cervical Adenocarcinoma and Adenosqumous Carcinoma of the Cervix

OBJECTIVE To analyze clinical characteristics and treatmentmethods of the patients with adenocarcinoma of the uterine cervix(AUC) and adenosquamous carcinoma of the cervix (ASCC). Tocompare the survival time of the patients in 2 groups and analyzethe prognostic factors.METHODS Clinical data of both 123 patients with AUC and32 patients with ASCC treated at the Cancer Hospital, ChineseAcademy of Medical Science (CAMS) & Peking Union MedicalCollege (PUMC), were retrospectively analyzed.RESULTS The median age of the AUC patients was 50 years, andthat of the ASCC patients was 44, P = 0.019. Poorly-differentiated(grade 3) cases accounted for 59.5% of the total ASCC patients,while only 32.5% of the AUC patients were in grade 3, P = 0.002.In 123 AUC patients, relapse or failure of the treatment occurredin 63 of the patients (51.2%), and the median relapse time was6 months (0-59 months). In 32 ASCC patients, relapse or failureof the treatment occurred in 8 of these patients (51.2%), with amedian relapse time of 4.5 months (0-52 months). The overall5-year survival rate of the AUC patients was 49.8%, which wassignificantly lower than that of the ASCC patients (74.1%), P =0.015. The 5-year survival rates of the ASCC patients in Stage Ⅰ-Ⅲwere higher than that of the AUC patients with the same stages.However, statistical significant difference could only be foundamong the patients in Stage Ⅱ, P = 0.006. The 5-year survival ratesof the ASCC patients with various differential grade were higherthan those of the AUC patients with the same differential grade,but statistical significant difference could only be found amongthe patients in the two groups with moderately differentiation,P = 0.039. It was found by Cox regression analysis that onlyclinical stage (P < 0.001) and histological type (P = 0.046) were theindependent prognostic factors.CONCLUSION Clinical stage and histological type were theindependent prognostic factors of the AUC and ASCC patients.The prognosis of ASCC patients is better than that of the AUCpatients.

Adenoid Basal Carcinoma of the Cervix with Squamous Differentiation:A Case Report and Literature Review

Adenoid basal carcinoma(ABC)of the cervix is a rare and low-incidence low-grade cervical cancer.In our practice,we encountered a case of cervical ABC with squamous differentiation and high-grade squamous intraepithelial lesion(HSIL)with gland involvement in the peripheral cervix.Reviewing relevant literature and analyzing its clinical manifestations,pathological morphology,and immunohistochemical characteristics would help deepen the understanding of this malignant tumor,so as to make a comprehensive diagnosis with differential diagnosis and prevent misdiagnosis.

Neuroendocrine carcinoma of the cervix:A comprehensive clinicopathologic study and literature review

Aims Neuroendocrine carcinoma of the cervix(NECC)is a rare variant of cervical cancer.This study aims to investigate the clinicopathological features and prognosis of NECC.Methods A retrospective analysis was conducted on twenty-one patients diagnosed with NECC between May 2008 and September 2021at Peking University People's Hospital.The study involved histopathological examination,immunohistochemistry,ThinPrep cytology test(TCT),and high-risk HPV hybrid capture 2(HC2)assay.Follow-up was conducted through telephone interviews and medical records for a range of 3–160 months,with an average follow-up period of 49.8 months.Results The average age of the patients was 48.6 years(range:33–69 years).Seventeen patients were diagnosed with neuroendocrine carcinoma through biopsy.Nine cases underwent TCT and HC2 tests before biopsy,and TCT results of four cases showed high-grade squamous intraepithelial lesion(HSIL).High-risk HPV(HR-HPV)positive was detected in seven cases.The cancer cells exhibited consistent morphological features,including sparse cytoplasm,intensely stained nuclei,and extensive neoplastic necrosis.Thirteen cases were classified as pure NECC(61.9%),while eight cases were mixed types(38.1%).Three cases were associated with squamous cell carcinoma(SCC),and five cases were associated with adenocarcinoma.Prognosis varied significantly among these subtypes(p<0.05).The overall survival rate in the follow-up period was 66.7%(12/18).Conclusions NECC is an extremely rare and highly aggressive tumor with a poor prognosis,particularly in cases of mixed histology.It is strongly associated with HPV infection.TCT and HPV testing significantly enhance the detection rate before the biopsy.The diagnosis of NECC relies on histological and immunohistochemical examinations.This study provides valuable clinical observations on NECC and emphasizes the importance of early detection and accurate diagnosis for improved patient outcomes.

Papillary serous carcinoma of the uterine cervix:a clinicopathological analysis of 4 cases and a literature review

Objective To investigate the clinicopathological characteristics and clinical treatment outcomes of patients with papillary serous carcinoma of the uterine cervix(PSCC).Methods In this study, 4 patients with histologically confirmed papillary serous carcinoma of the uterine cervix were retrospectively investigated. Pap smears, human papillomavirus(HPV) screening, tumor marker status, biopsy analysis, and relevant imaging examinations were conducted for the confirmation of primary diagnosis and recurrence. Patients underwent surgery, chemotherapy, or radiotherapy, and survival were the main endpoint.Results The 4 patients were diagnosed with IB1, IB1, IIA, or IIIB disease. Two patients(2/4) presented with recurrence within 18 months after primary therapy. Compared with chemotherapy alone(progressionfree survival(PFS): 11 months), radiotherapy combined with adjuvant chemotherapy showed favorable PFS rates(PFS: 20, 36, 13 months in 3 cases), although valid statistical analysis was not feasible because of the small sample size. The 5-year survival rate was 0%, and the 3-year survival rate was 75%. Our data, in agreement with the literature evidence, showed that the number of moderate-risk and high-risk factors in patients diagnosed with PSCC at an early stage was higher than that in patients diagnosed with common adenocarcinoma/squamous carcinoma of the uterine cervix.Conclusion PSCC has a poor clinical prognosis, and compared with chemotherapy alone, radiotherapy combined with adjuvant chemotherapy may lead to improved PFS.

Dosimetric Comparison of Fixed and Flexible Geometry ICRT Applicators in Patients Treated for Carcinoma Cervix

In intracavitary radiotherapy (ICRT) for cancer cervix, applicator geometry has the potential to impact the doses to organs at risk (OARs) and the coverage of the target volume. At our centre two Varian made Fletcher-style applicator sets, namely defined (fixed) geometry and flexible geometry, are used for ICRT. In the present work, the two types of applicators were compared dosimetrically as per the recommendations of the International Commission on Radiation Units and Measurements (ICRU-38) while delivering high dose rate brachytherapy. Twenty four patients who underwent ICRT were considered for this study. Radiographic method was used for treatment planning on Abacus planning system. ICRU-38 recommended parameters were estimated and compared. Flexible geometry applicator showed 8.8% and 16% higher bladder and rectum point doses as compared to the fixed geometry one but the difference was statistically not significant. The thickness of the pear-shaped isodose volume was larger for the flexible geometry implant also indicating towards higher doses to OARs. The higher bladder and rectum point doses in the case of flexible applicator will need to be validated by a larger data set.

Does Change in the Effect of Source Strength of the High Dose Rate ¹⁹²Iridium Radio-Isotope on Local Control and Late Normal Tissue Toxicity (Bladder and Rectum) in the Treatment of Carcinoma Cervix

Aim: To analyse and assess the effect of dose rate of 192ir-source strength on late complications and local control rate during treatment of carcinoma cervix. Materials and Methods: One hundred and two cases of carcinoma cervix were included in the study. All patients were treated with a curative intent with radical dose of radiation as per the department protocol. All patients were treated with both EBRT plus Brachytherapy with Inj. Cisplatin 40 mg/m2 weekly. Patients were divided into 2 groups based on activity i.e. group A (10-6Ci) and group B (5-2Ci). After brachytherapy, point doses were analysed based on ICRU 38 recommendations. During follow up, morbidities were evaluated using RTOG grading system. Results: There was no difference in local control and distant metastasis in both groups after six months of follow up. Late Complications were comparable in both groups irrespective of source strength. Bladder complications were minimal with no significant difference in both study groups. Further Patients were divided into four groups i.e. BED of ICRU rectal point (3 and ≥100 Gy3) and source strength (10-6Ci and 5-2Ci), when BED was >100 Gy3 resulted in higher late rectal complication rate (P 3. Conclusion: This study suggests that change in source activity did not make a difference in local control, late rectal and bladder morbidities at 6 months of follow up. Longer follow up is required to assess long term results and morbidities.

Clear Cell Carcinoma of the Uterine Cervix Arising from an Interstitial Cyst Complicated with Endometriosis: A Case Report

Clear cell carcinoma (CCC) of the uterine cervix is rare, and its etiology is unclear, except for reports of prenatal diethylstilbestrol (DES) exposure. In this case report of a 78-year-old postmenopausal Japanese woman with pelvic endometriosis, cervical CCC presented as a deep interstitial tumor, strongly suggesting the patient suffered from cervical endometriosis for a long time. A cystic lesion without solid components was detected in the uterine cervix. Although the patient had regular gynecological examinations every 6 months, she presented 5 years later with a complaint of watery vaginal discharge. Ultrasonography and magnetic resonance imaging (MRI) detected a uterine cervical cystic mass with a solid component. Although no malignancy was confirmed preoperatively, surgery was performed under a high suspicion of cervical cancer. Intraoperative pathology revealed CCC in a solid tumor, so debulking surgery, including lymphadenectomy, was done. Endometrial tissue was found adjacent to the tumor, strongly suggesting the tumor arose from cervical endometriosis. Because endometriosis in ectopic sites carries a risk of carcinogenesis, as is the case in ovarian endometriosis, it may be recommended that a cervical cystic lesion with pelvic endometriosis should be followed up regularly for the early detection of uterine cancer.

STAGE IB, HA AND PROXIMAL IIB, CARCINOMA OF THE UTERINE CERVIX, TREATED BY IRRADIATION ALONE OR IN COMBINATION WITH SURGERY

This is a report of a nonrandomized comparison of treatment results of 139 patients with stage IB, HA and proximal IIB carcinoma of the uterine cervix treated by radiation alone and 113 treated with a combination of radiation and surgery. The five-year tumor free acturial survival for the patients with stage IB either with irradiation alone (RT) or combined with surgery (RS) was approximately 87%. For stage Ⅱ the tumor free actuarial five-year survival 79% with patients of RS, and 76% with RT. In the 113 patients treated with RS there were 18 (16%). In the 139 patients treated by RT there were 18 (13%) recurrences of pelvic, 4 local recurrences, 11 combined with parametrial, and free parametrial recurrences. There was no significant difference in the survival and recurrence rate of the patients treated with either method. Major complications were comparable in both groups (RT approximately 25% and RS approximately 10%), but 2/3 of those complications recovered without sequelae. The most frequent minor complication in the patients treated with RT was rectosigmoiditis.

宫颈腺样基底细胞癌6例临床病理分析

目的:宫颈腺样基底细胞癌(cervical adenoid basal carcinoma,CABC)是一种罕见的宫颈肿瘤,恶性程度低,预后良好,但临床上容易误诊。本研究旨在通过探讨CABC的临床病理特点、免疫表型、诊断、鉴别及预后以提高对该肿瘤的认识。方法:收集6例CABC的临床病理资料行光镜观察及免疫组织化学染色,并复习相关文献。结果:6例患者均为绝经后女性,年龄为62~73岁。4例患者无明显临床症状,因宫颈细胞学检测异常而就诊;1例因绝经后阴道出血就诊;1例因外阴恶性肿瘤就诊。3例行人乳头瘤病毒(human papilloma virus,HPV)检测,结果为阳性,1例复查提示HPV阳性。6例患者均行全子宫+双附件等手术切除。大体观:6例宫颈处均未见明显肿物,均可见不同程度的宫颈外口糜烂。镜检:肿瘤由小而圆的基底样细胞构成实性或筛状细胞巢,在宫颈的浅表间质中呈浸润性生长,浸润深度2~6 mm,细胞巢周围间质反应不明显,其中1例癌巢周围间质黏液样变性;肿瘤细胞巢外围细胞呈栅栏状排列,部分巢中央有腺样或筛样;肿瘤细胞体积小,形态温和一致,排列紧密,核呈圆形或椭圆形,细胞质稀少,核分裂象偶见,2例部分肿瘤细胞巢呈鳞状细胞分化。其中5例合并高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)累及腺体,1例合并鳞状细胞癌。免疫表型:P16为弥漫阳性,细胞角蛋白(cytokeratin,CK)5/6、P63和P40均为阳性,3例行CD117检测为阴性,Ki-67表达具有异质性,鳞状分化区域阳性指数较高,基底细胞样区域及腺样结构区域阳性指数低,阳性率为5%~20%。6例患者术后随访5个月至7年,均无复发和转移。结论:CABC是一种罕见的低度恶性的宫颈肿瘤,预后良好,罕见转移,肿瘤总体预后取决于合并的其他肿瘤类型。

子宫颈浸润性复层产黏液的癌临床与病理分析(附12例)

目的:探讨子宫颈浸润性复层产黏液的癌(ISMC)临床病理学特征、诊断、鉴别诊断及治疗预后。方法:收集我院近3年诊断的子宫颈ISMC 12例,整理及分析其临床病理及随访资料并复习相关文献。结果:12例患者发病年龄为(51.1±7.4)岁,9例(75%)以阴道出血为主要症状,临床分期9例(75%)为Ib2期,2例(17%)为Ib3期,1例(8%)为Ⅲc2期;11例患者均在术后补充放、化疗,其中10例(91%)无复发,1例伴双肺多发转移;肿物最大径(32.4±5.5)mm;8例(67%)形成糜烂及结节状肿物,4例(33%)呈息肉样;镜下均可见典型的浸润性复层、实性、含黏液的癌细胞巢,巢周细胞呈栅栏状排列,除3例(25%)为纯的ISMC外,9例(75%)均合并其他类型的浸润性癌;12例(100%)查见宫颈上皮原位病变,包括子宫颈复层产黏液的上皮内病变、鳞状上皮内病变和原位腺癌;免疫表型ISMC表达腺上皮标记物,过碘酸酸酶/阿利新蓝染色(PAS/AB)染色阳性;10例行人乳头瘤病毒(HPV)检测,6例(50%)为18型,4例(33%)为16型。结论:ISMC具有独特的病理学特征,本文报道病例平均年龄偏大,临床分期偏早,虽然存在脉管癌栓,但随访至撰稿前仅1例发现转移,本文数据可为临床对该肿瘤的认识提供参考和补充。

Transvaginal Color Doppler in the Assessment of Cervical Carcinoma and Pre-Cancer: Evidence from a Case Control Study Using Colour Doppler Ultrasonography Pulsatility Index of Uterine Vasculature

Introduction: Transvaginal colour Doppler is a non-invasive ultrasound-based technique that allows an in-vivo assessment of tumor vascularization. Several researches done in the last decade have evaluated the role of this technique in assessing carcinoma of the cervix. However there is a significant paucity of literature linked to pre-malignant lesions of the cervix and its diagnosis based on transvaginal colour doppler and its pulstality index (PI). In this paper we present a case control study conducted to assess the validity of transvaginal colour doppler scan and PI in diagnosing malignant and pre-malignant lesions of the cervix. Methodology: A case control study with a total sample of 57 women was conducted at the Nawaloka Hospital for duration of two years. 19 cases of recently diagnosed patients with cervical carcinoma, using cytobrush and colposcopy guided biopsy, evaluated by a consultant histopathologist, were recruited. Staging was done according to FIGO classification. 40 age-matched patients with histologically confirmed normal cervix were selected as controls and 2 were excluded from the study due to the presence of cervical infection. All cases and controls were subjected to transvaginal colour doppler sonography using a 5 MHz 3D probe using GEvolusion6 US machine. The machine was also set for high pass filter at 100 Hz to eliminate low frequency signals occurring from vessel-wall motion. Cervical colour doppler ultrasonography pattern was captured in each case of malignancy, pre-malignancy and controls, and pulstality index (PI) was assessed by the lead gynecologist accredited with ISUOG standards. The highest PI was assessed and recorded in the descending branch of the uterine artery. Results: Women’s mean age was 55.5 years (range 35 - 78). According to clinical staging, there were 4 females with carcinoma in situ, 4 Females with Stage I a, 3 with Stage I b, 4 with Stage II a and 4 with Stage III a. Histologic examination revealed 13 women with squamous cell carcinoma, 2 women with adenocarcinoma and 4 with carcinoma in situ (CIN III) of the cervix. Mean PI value for the cases were 1.94 (range 1.2 - 3.1) and the mean PI value for the controls were 0.805 (range 0.3 - 1.5). Neovascularization was markedly seen in the patients with invasive cervical carcinoma with a PI ranging between 1.99 and 3.10. Chi square test results showed a very high statistically significant difference of PI values between cases and controls (p value < 0.0001). An ROC analysis revealed the optimal cut-off value of PI at 1.475 with a sensitivity of 89.5% and a specificity of 93.5%. Conclusion: Transvaginal doppler ultrasonography and PI of the descending cervical branch of the uterine artery and its branch vasculature allow a non-invasive assessment of tumor vascularization in cervical carcinoma and pre-malignancy. PI with a cut off value of 1.475, can be reliably used to detect and screen pre-malignancies and malignancies at a relatively early stage with a sensitivity of 89.5% and a specificity of 93.5% enabling further definitive evaluation, in a routine gynecology trans vaginal ultrasound assessment.

宫颈小细胞神经内分泌癌预后因素分析及列线图模型构建

目的:分析宫颈小细胞神经内分泌癌(SCNECC)患者预后的重要风险因素,构建列线图预测患者总生存率。方法:从SEER数据库收集2000年至2018年诊断为SCNECC的553例患者数据,按7∶3分成建模组和验证组。采用最小绝对值收缩和选择算子(Lasso)回归和Cox回归分析筛选预后相关因素,构建列线图预后模型。通过一致性指数、校准曲线、ROC曲线和决策曲线对模型性能进行分析,比较模型与FIGO分期系统的预测性能。结果:年龄、FIGO分期、化疗、检出淋巴结状态和肝转移是SCNECC患者预后的独立影响因素。建模组和验证组模型的C指数分别为0.756和0.724,高于FIGO分期。ROC曲线结果表明,两组患者的1、3、5年AUC均大于0.75。校准图显示模型与实际一致性较好,决策曲线结果提示列线图模型临床收益更高。结论:年龄、FIGO分期、化疗、检出淋巴结和肝转移是SCNECC患者预后的独立影响因素,所构建的列线图模型准确且具有临床实用性,能为SCNECC患者提供可视化和量化的预后评估,为临床医生治疗决策提供参考。

Psoas muscle metastasis from cervical carcinoma:Correlation and comparison of diagnostic features on FDG-PET/CT and diffusion-weighted MRI

Psoas muscle metastasis, though rare, is the commonest site of skeletal muscle involvement in cervical carcinoma. The appropriate clinical management of this condition, particularly of the pain related to malignant psoas syndrome, is still evolving and the diagnostic features on conventional morphological imaging modalities are often non specific, with the differential diagnosis lying between sarcoma, hematoma, and abscess. In this report, a comparison of various morphofunctional imaging modalities was made. Fluorodeoxyglucosepositron emission tomography(FDG-PET)/computed tomography(CT) was the first to suspect disease involvement of the psoas muscle, demonstrating intense FDG uptake(compared with the contralateral muscle), while ultrasound showed heterogeneous echotexture, and magnetic resonance imaging(MRI) showed subtle altered signal intensity in the right psoas muscle. Both anatomical imaging modalities and non contrast CT of the PET-CT examination demonstrated a bulky psoas muscle, without any focal abnormality. On diffusionweighted imaging of MRI(DWI-MRI), restricted diffusion of the involved muscle was an important observation. The psoas muscle metastatic involvement was proven histopathologically. Thus, enhanced glucose metabolism and restricted diffusion in the newer noninvasive molecular imaging modalities(e.g., PET/CT and DWI-MRI) could serve as valuable adjunctive parameters in diagnosing this entity in the absence of a focal abnormality in the anatomical modalities. In the treatment response monitoring scenario, FDG-PET/CT demonstrated near complete resolution following administration of 3 cycles of systemic chemotherapy and local external radiotherapy.

The expression of Fas, FasL and their biological behavior in human cervical carcinoma

Objective： To investigate the relationship between the expression of Fas and Fas ligand （FasL） and its biological behavior in human cervix carcinoma. Methods： Immunohistochemisty technique was used to detect the expression of Fas and FasL in 47 cases of cervical carcinoma, 16 cases of cervical interaepithelial neoplasia, 10 cases of chronic cervicitis and 10 cases of normal cervix. TUNEL technique was used to observe the apoptic cells in 47 cases of cervical carcinoma. Retrospective study was carried out to find the relationship between the expression of Fas and FasL and cell apoptosis, clinical stage, pathological classification, lymph node metastasis, prognosis and age. Results： The expression of Fas and FasL was significantly different in different cervix （P 〈 0.01）, and also related to the degree of differentiation, lymph node metastasis and prognosis （P 〈 0.05）. But had no relation with clinical stage or age （P 〉 0.05） ; Cervix carcinoma cells apoptosis in different pathological classification appeared negative relation （Rs=-0.35, P 〈 0.05 ）. Cervix carcinoma cell apoptosis was significantly higher in Fas-positive and FasL- positive than that in Fas-negative and FasL-negative （P 〈 0.05）. By retrospective investigation, Fas-negative and FasL-positive were related to poor prognoses of the patients with cervical carcinoma （P 〈 0.05 ）. Conclusion： The development of apoptosis in cervix carcinoma has a promoting regulation function in Fas and FasL expression. Gene treatment can alter apoptosis abnormality, thus induce apoptosis in cancerous cell expressing Fas and FasL. Fas or FasL may be taken as a marker in the prognostic character- ization.

免疫组化法与RNAscope原位杂交法检测宫颈鳞状细胞癌组织中PD⁃1和PD⁃L1表达一致性研究

目的研究免疫组化法与RNAscope原位杂交法检测宫颈鳞状细胞癌组织中程序性死亡分子1(PD⁃1)和程序性死亡分子1配体(PD⁃L1)表达一致性。方法回顾性分析2019年3月至2021年2月被江阴市中医院病理科诊断为宫颈鳞状细胞癌的80例患者石蜡组织标本。采用免疫组化法与RNAscope原位杂交法测定宫颈鳞状细胞癌组织中PD⁃1和PD⁃L1表达情况,分析此2种方法检测癌组织中PD⁃1和PD⁃L1表达一致性。分析RNAscope原位杂交法检测癌组织中PD⁃1mRNA、PD⁃L1mRNA表达与其临床病理特征的关系。随访1年,记录所有患者总生存时间。结果免疫组化法结果显示,80例宫颈鳞状细胞癌组织标本中PD⁃1蛋白阳性52例,阳性率为65.00%;PD⁃L1蛋白阳性60例,阳性率为75.00%。RNAscope原位杂交法结果显示,80例宫颈鳞状细胞癌组织标本中PD⁃1蛋白阳性49例,阳性率为61.25%;PD⁃L1蛋白阳性57例,阳性率为71.25%。免疫组化法与RNAscope原位杂交法检测PD⁃1表达一致性良好(Kappa值=0.847,P>0.05);免疫组化法与RNA⁃scope原位杂交法检测PD⁃L1表达一致性良好(Kappa值=0.861,P>0.05)。PD⁃1mRNA、PD⁃L1mRNA表达与患者年龄、脉管侵犯、淋巴结转移、神经侵犯、肿瘤分期(TNM)、肿瘤直径无关(P>0.05)。随访1年,PD⁃1mRNA阳性表达与PD⁃1mRNA阴性表达的总生存曲线比较差异无统计学意义(P>0.05);PD⁃L1mRNA阳性表达与PD⁃L1mRNA阴性表达的总生存曲线比较差异无统计学意义(P>0.05)。结论免疫组化法与RNAscope原位杂交法检测宫颈鳞状细胞癌组织中PD⁃1和PD⁃L1表达一致性较好,且PD⁃1mRNA、PD⁃L1mRNA表达与患者总生存时间无关。

宫颈黏液腺癌的诊治进展

宫颈黏液腺癌是宫颈恶性肿瘤中一种罕见的、特殊的组织学类型,其分类主要有宫颈胃型腺癌、宫颈肠型腺癌和宫颈原发印戒细胞型腺癌等。由于宫颈黏液腺癌的发病机制与人乳头瘤病毒(human papilloma virus,HPV)感染之间的不确定性,因此难以通过常规宫颈癌筛查加以提示。同时,宫颈黏液腺癌的病因及发病机制均不明确,且缺乏典型临床表现及早期诊断方法,临床病理特征及治疗与宫颈普通腺癌有所不同,导致患者易错过最佳治疗时机,因此宫颈黏液腺癌较宫颈普通型腺癌的预后差。近年来,由于对HPV疫苗的普及,宫颈黏液腺癌相对发病率较前略有升高,关于宫颈黏液腺癌的研究越来越受到重视,综述宫颈黏液腺癌的国内外相关研究,探讨宫颈黏液腺癌的相关发病机制、临床特征及治疗,以期为宫颈黏液腺癌的临床诊治提供参考。