Epithelioid trophoblastic tumor of the lower uterine segment and cervical canal:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT) is the rarest type of gestational trophoblastic tumor(GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a case of ETT within the lower uterine segment and cervical canal and discuss its manifestations,possible causes, and related influencing factors.CASE SUMMARY A 35-year-old woman(gravida 7, miscarriage 3, induction 2 with 1 being twins,para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made.Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue.Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%.CONCLUSION A search of the PubMed database using the search terms "cesarean section" and "epithelioid trophoblastic tumor" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present case is the 14th reported case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.

Knockdown of circular RNA (CircRNA)_001896 inhibits cervical cancer proliferation and stemness in vivo and in vitro

Objective:Previous studies indicated that aberrant circular RNA(circRNA)expression affects gene expression regulatory networks,leading to the aberrant activation of tumor pathways and promoting tumor cell growth.However,the expression,clinical significance,and effects on cell propagation,invasion,and dissemination of circRNA_001896 in cervical cancer(CC)tissues remain unclear.Methods:The Gene Expression Omnibus(GEO)datasets(GSE113696 and GSE102686)were used to examine differential circRNA expression in CC and adjacent tissues.The expression of circRNA_001896 was detected in 72 CC patients usingfluorescence quantitative PCR.Correlation analysis with clinical pathological features was performed through COX multivariate and univariate analysis.The effect of circRNA_001896 downregulation on CC cell propagation was examined using the cell counting kit-8(CCK-8)test,clonogenic,3D sphere formation,and in vivo tumorigenesis assays.Results:Intersection of the GSE113696 and GSE102686 datasets revealed an increased expression of four circRNAs,including circRNA_001896,in CC tissues.Fluorescence quantitative PCR confirmed circRNA_001896 as a circular RNA.High expression of circRNA_001896 was considerably associated with lymph node metastasis,International Federation of Gynecologists and Obstetricians(FIGO)stage,tumor diameter,and survival period in CC patients.Proportional hazards model(COX)univariate and multivariate analyses revealed that circRNA_001896 expressions are a distinct risk factor affecting CC patients’prognosis.Cellular functional experiments showed that downregulating circRNA_001896 substantially suppressed CC cell growth,colony formation,and 3D sphere-forming ability.In vivo,tumorigenesis analysis in nude mice demonstrated that downregulating circRNA_001896 remarkably reduced the in vivo proliferation capacity of CC cells.Conclusion:CircRNA_001896 is highly expressed in CC tissues and is substantially related to lymph node metastasis,FIGO stage,tumor size,and survival period in patients.Moreover,downregulating circRNA_001896 significantly inhibits both in vivo and in vitro propagation of CC cells.Therefore,circRNA_001896 might be used as a biomarker for targeted therapy in cervical cancer.

Uterine artery pseudoaneurysm caused by hysteroscopic surgery: A case report

BACKGROUND We report a case of uterine artery pseudoaneurysm(UAP)occurrence during hysteroscopic endometrial polypectomy and its treatment via uterine artery embolization(UAE).CASE SUMMARY A 48-year-old primigravid,primiparous patient was incidentally found to have an endometrial polyp during a health checkup,and underwent a hysteroscopic polypectomy at another hospital.Her cervix was dilated with a Laminken-R®device.After the Laminken-R®was withdrawn,a large amount of genital bleeding was observed.This bleeding persisted after the hysteroscopic polypectomy,and,as hemostasis became impossible,the patient was transferred to our hospital by ambulance.On arrival,transvaginal ultrasonography revealed a 3-cm hypoechoic mass with a swirling internal pulse on the right side of the uterus,and color Doppler ultrasonography showed feeder vessels penetrating the mass.Pelvic contrast-enhanced computed tomography(CT)confirmed the presence of a mass at this site,and vascular proliferation was observed within the uterine cavity.Consequently,UAP was diagnosed,and UAE was performed.The patient’s postoperative course was uneventful,and 6 mo post-UAE,no recurrence of blood flow to the UAP was observed.CONCLUSION When abnormal genital bleeding occurs during hysteroscopic surgery,ultrasonography and contrast-enhanced CT can assist in the detection of early UAPs.

Subgroups of peripheral immune effector cells in cervical cancer patients are more sensitive to radiation therapy than chemotherapy

Background:CD8 positive T lymphocytes and natural killer(NK)cells in the peripheral blood of cervical cancer patients exhibit varying sensitivities to radiotherapy and chemotherapy.Methods:A total of 50 healthy peoples and 60 cervical cancer patients were recruited.The patients with cervical cancer were separated into two groups:radiation and chemotherapy,and blood sample were collected before and after treatment.Data on the proportion of CD8 positive T lymphocytes and NK cells were gathered for analytical evaluation.Results:Compared to healthy individuals,patients with cervical cancer exhibit a reduced proportion of CD8 positive T cells within their peripheral blood.And for patients with cervical cancer,radiation therapy has been found to be more effective than chemotherapy in increasing the proportion of CD8 positive T lymphocytes and NK cells.Conclusions:These results suggest that radiation therapy increases the levels of CD8 positive T lymphocytes and NK cells within the peripheral blood of patients with cervical cancer.The study hypothesis that the changes in the percentage of CD8 positive T lymphocytes may serve as a potential indicator for predicting treatment efficacy.

Expression of Bmi-1,P16,and CD44v6 in Uterine Cervical Carcinoma and Its Clinical Significance

Objective Bmi-1, a putative proto-oncogene, is a core member of the polycomb gene family, which is expressed in many human tumors. The p16 protein negatively regulated cell proliferation, whereas CD44v6 is associated with proliferation as an important protein. Additionally, CD44v6 is an important nuclear antigen closely correlated to tumor metastasis. Tlle present study aims to investigate the expression and significance of Bmi-1, p16, and CD44v6 in uterine cervical carcinoma （UCC）. Methods A total of 62 UCC, 30 cervical neoplasic, and 20 normal cervical mucosal tissues were used ill the current study. The expression of Bmi-1, p16, and CD44v6 in these tissues was determined using immunohistochemical assay. The relationships among the expression of these indices, the clinicopathologic features of UCC, and the survival rate of UCC patients were also discussed. The correlation between Bmi-1 protein expression and p16 or CD44v6 protein in UCC was analyzed. Results The expression of Bmi-l, p16, and CD44v6 was significantly high in cervical carcinoma compared with that in tlle cervical neoplasia and normal colorectal mucosa （P〈0.05）. The over-expression of Bmi-1 protein in UCC was apparently related to the distant metastasis （P〈0.01） and the tumor, nodes and metastasis-classification, i.e. the TNM staging, World Health Organization （P〈0.05）. Nevertheless, the positive expression of p16 protein in UCC was not significantly associated with the clinicopathologic features （P〉0.05）. The Kaplan-Meier survival analysis showed that the over-expression of Bmi-1 significantly decreased the survival rate of UCC patients （P〈0.05）. A strong correlation indicated that there was statistical significance between the expression of Bmi-1 and CD44V6 proteins in UCC （r=0.419, P=0.001）. Conclusions The over-expression of Bmi-1 and CD44v6 protein closely correlate to the tumorigenesis, metastasis, and prognosis of UCC. Bmi-I and CD44v6 may be used to predict the prognosis of cervical carcinoma. Bmi-1 may indirectly regulate the expression of CD44v6 in UCC patients. The positive expression of p16 protein is possibly associated with the tumorigenesis, but not with the metastasis or prognosis of UCC.

Clinical Significance of CENP-H Expression in Uterine Cervical Cancer

Objective This work aims to investigate the expression pattern and clinicopathologic significance of centromere protein H(CENP-H) in uterine cervical cancer(UCC). Methods The level of CENP-H expression in the paraffin sections of 62 UCC cases was determined by the SP immunohistochemical method,with complete clinicopathologic data in all cases.Statistical analysis was conducted to evaluate the prognostic and diagnostic significance of CENP-H using SPSS13.0 software package. Results Immunohistochemical assay showed strong CENP-H expression in 61.29% (38/62) of the paraffin-embedded cervical cancer tissues.Statistical analysis revealed a strong correlation between the CENP-H expression and the clinical classification(P=0.038) of the cervical carcinoma.The expression increased with rise of the stages.The analysis of Cox proportional hazards regression model suggested that CENP-H expression(P=0.002) and tumor stage(P=0.001) were independent prognostic markers for the survival of UCC patients.The survival analysis showed that the survival rate was significantly lower in patients with high expression of CENP-H than in those with low expression of CENP-H(P=0.001). Conclusions CENP-H is likely to be a valuable marker for carcinogenesis and progression of UCC.It might be used as the important diagnostic and prognostic marker for cervical carcinoma patients,especially for those at early stage.

Viable Second Trimester Cervical Ectopic Pregnancy Managed Successfully with Uterine Preservation: Case Report

Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5% of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were misleading. Several weeks later, a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.

Conservative management of cervical pregnancy: The utility of methotrexate treatment and uterine artery embolization

The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.

CXCL3 overexpression promotes the tumorigenic potential of uterine cervical cancer cells via the MAPK/ERK pathway

CXCL3 belongs to the CXC-type chemokine family and is known to play a multifaceted role in various human malignancies.While it's clinical significance and mechanisms of action in uterine cervical cancer(UCC)remain unclear.This investigation demonstrated that the UCC cell line HeL.a expressed CXCL3,and strong expression of CXCL3 was detected in UCC tissues relative to nontumor tissues.In addition,CXCL3 expression was strongly correlated with CXCL5 expression in UCC tissues.In vitro,HeLa cells overexpressing CXCL3,HeLa cells treated with exogenous CXCL3 or treated with conditioned medium from WPMY cells overexpresing CXCL3,exhibited enhanced proliferation and migration activities.

Pharmacokinetic comparison between ultraselection of uterine artery and peripheral vein chemotherapy of carboplatin in cervical cancer

Objective:The present study is to compare pharmacokinetics difference of carboplatin by using ultraselection uterine artery with by using peripheral vein in cervical cancer.Methods:Thirteen patients with locally advanced cervical cancer who had been proved by pathobiology were randomly divided into two groups:the ultraselection uterine artery group(group A, n = 6) and the peripheral vein(group B, n = 7).Carboplatin was administered by infusing into artery or vein in both groups at the dosage of 300 mg/m2.Tissues from the cervical tumor were collected at different times after infusion in both groups and then analyzed.Results:The peak concentration of platinum in tumor tissue was about 2.79 times higher in group A than that of group B(P < 0.05).The platinum concentrations in tumor in group A reached its peak levels immediately after infusion.But, group B had delayed time.While, for the time point of 0 min, when the administration finished immediately, the platinum concentration in tumor was significantly higher when compared with group B(P < 0.05).The tumor tissue area under the concentration(AUC) of carboplatin was about 2 times higher in group A than that of group B(P < 0.05).Conclusion:We observed the pharmacological advantages of chemotherapy by using ultraselection uterine artery administration of chemotherapeutic agent carboplatin in tumor tissue which provided theoretical basis and laboratory parameters of the intra-arterial chemotherapy for gynecologic malignancy.

Uterine Cervical Melanocytic Tumours—A Single Institution Experience with Review of Literature

Primary melanocytic tumours of the uterine cervix are rare. These include blue nevi and malignant melanoma. Blue nevi are benign melanocytic lesions which occur as incidental finding. Primary cervical melanomas are rare mucosal melanomas with aggressive behaviour. In small biopsies, they can mimic poorly differentiated carcinomas. Here we present the cases of melanocytic tumours reported from our institute during the last 6 years

Effect of preoperative hyperselective uterine arterial chemoembolization on the infiltrative growth of cancer cells in locally advanced cervical cancer

Objective:To study the effect of preoperative hyperselective uterine arterial chemoembolization on the infiltrative growth of cancer cells in locally advanced cervical cancer.Methods: Patients with locally advanced cervical cancer who underwent surgical resection in Ankang Municipality Maternity and Child Care between February 2015 and October 2017 were selected and randomly divided into the observation group who received preoperative hyperselective uterine arterial chemoembolization and the control group who received routine preoperative preparation. The contents of tumor markers in serum were determined at diagnosis and 1 day before undergoing surgery;the expression levels of tumor suppressor genes and invasion genes were determined after surgical resection.Results: 1 day before undergoing surgery, serum CA125, TSGF, SCC and HE4 levels of observation group were lower than those at diagnosis whereas serum CA125, TSGF, SCC and HE4 levels of control group were not significant different from those at diagnosis;after surgical resection, RASSF2A, FHIT, eIF4E3, RIZ1, DAPK and Syk protein expression in cervical cancer lesions of observation group were significantly higher than those of control group;whereas RbAp48, Vimentin, N-cadherin, Sox2,β-catenin and MMP9 protein expression were significantly lower than those of control group.Conclusion: Preoperative hyperselective uterine arterial chemoembolization can inhibit the infiltrative growth of cancer cells in locally advanced cervical cancer.

Relationship between Circulating Plasma Galectin-3 Levels and T-Cell Activation during Cervical Cancer Chemotherapy

Objective: Despite the existence of several therapeutic strategies, the management of cervical cancer remains challenging. Our region has very little data on the interaction between the immune system and the clinical response to chemotherapy. This work examines plasma levels of galectin-3 (Gal-3) and percentages of activated T cells in patients with cervical cancer treated with chemotherapy and investigates if there is a relationship between the rates of these two elements. Methods: We compared data from 37 patients with cervical cancer undergoing chemotherapy and 42 controls with normal cervical cytology. Plasma Gal-3 concentrations were assessed by ELISA and expression of activation markers by T cells (CD69 and HLA-DR) was assessed by flow cytometry at three different time points during chemotherapy. Results: Our results showed that patients had a significantly higher concentration of Gal-3 compared to controls (4.025 vs. 1.340, p 0.001), similarly, they had a significantly high percentage of activated lymphocytes (2.610 vs. 0.731;p 0.0001). According to the response to treatment, patients with no response to treatment had a lower concentration of circulating Gal-3 but had approximately the same percentage of activated CD4 and CD8 lymphocytes as patients with a partial or total response. In addition, we found a positive correlation between the Gal-3 level and CD4 T cells expressing the activation marker CD69 (p 0.05;rho = 0.44). Conclusion: In conclusion, our results show that there would be a relationship between circulating galectin-3 and the percentage of peripheral CD4+CD69+ cells in cervical cancer.

The Establishment and Characterization of a Continuous Cell Line of Mouse Cervical Carcinoma

OBJECTIVE To establish a murine uterine cervical cancer cell line and to define its biological characters. METHODS Transplanted tumor tissue was used for in vitro primary culture of U14 cervical carcinoma cells. After 20 passages, we examined its morphology, chromosomes, tumorigenicity and produced a growth curve. CK was detected by immunohistochemistry, the cell cycle determined by flow cytometry and the metastatic potential assessed in 615 and C57BL/c mice. We also transfected the cells with the pEGFP-N1 plasmid. RESULTS A newly established murine cell line was passaged 50 times over a period of 10 months. The cells grow as a partially suspended culture, and are immunohistochemically CK（＋）. The cell line is characterized by a hypotetraploid karyotype, a chromosomal number of 64-68 and a doubling time of 21.8 h. Exponential growth occurs by the third and forth day of culture. Cell cycle analysis showed G1 34%, G2 26%, and 40% in the S phase. The tumorigenicity was 100% upon implantation. No mycoplasma contamination was detected. A monoclonal continuous U14-GFP cell strain which was 100% GFP （＋） was also produced. CONCLUSION We successfully established a new murine cervical U14 carcinoma cell line and an U14-GFP monoclonal strain. These cell lines are ideal for combined in vivo and in vitro tumor research.

<i>FAS</i>-670 Gene Promoter Region Polymorphism in Cervical Intraepithelial Neoplasia Grade 3 (CIN 3) and Invasive Cervical Cancer

The human papillomavirus (HPV) is the etiologic agent of genital cancer, but alone it is incapable of inducing oncogenesis. Rather, progression to invasive lesions is associated with host immunity and interference in the process of cellular apoptosis. Among the several genes involved in cell death, theFAS gene appears to be an important factor. The aim of this study was to evaluate whether there is an association between polymorphisms of the FAS-670 gene promoter region and preinvasive and invasive lesions of the cervix. The FAS gene was evaluated for the presence of polymorphisms using polymerase chain reaction and restriction fragment length polymorphism techniques in 225 blood samples for the control group, as well as cervical tissue from patients with cervical intraepithelial neoplasia grade 3 (CIN 3;75 cases) or invasive carcinoma (214 cases). The AG genotype of the FAS-670 gene promoter region was significantly more frequent in women with CIN 3, with an estimated risk of three times (OR = 3.0). No difference, however, was observed in the control group and women with cervical cancer. In women with cancer, the genotypes were similar in the different histological types and degree of tumor differentiation. Assessing allelic distribution (A or G), we observed no difference in frequency of genotypes in studied groups. These data suggest that polymorphism of the promoter region of the FAS-670 gene is associated with increased risk of CIN 3, but not for invasive cancer of the cervix.

PET in uterine malignancies

Positron Emission Tomography (PET) or integrated PET/Computed Tomography (PET/CT) with 18F-Fluoro-Deoxy-Glucose (18F-FDG) is a functional imaging modality, useful in the characterization of undetermined morphological findings, and in the staging/re-staging of a large number of malignancies. Although its use in uterine malignancies has been poorly investigated, in recent years the employment of this technique has constantly increased. In this review, we evaluate the role of PET (/CT) with 18FFDG in uterine malignancies (cervical and endometrial cancers as well as uterine sarcomas), underlying its advantages and discussing its limitations. Metabolic and anatomic information given by PET/CT with 18F-FDG could be useful in the evaluation of local and distant disease involvement at the staging, in the detection of disease recurrence, and in the evaluation of the response after chemotherapy and/or radio-therapy.

Clinical Analysis on the Effectiveness of Transvaginal Cervical Cerclage in Singleton Pregnancies and Its Predictive Factors

Objective: To evaluate the effectiveness of transvaginal cervical cerclage in singleton pregnancies with cervical incompetence, determine the predictive factors of success and failure, and then compare elective and emergency cerclage. Study Design: This was a retrospective study of 62 patients who underwent cervical cerclage in The First Hospital of Jilin University, China, between May 2015 and January 2018. Successful group was defined as those who delivered live babies and failure group who experienced abortion or stillbirth. Results: Out of 104 patients, 62 met inclusion criteria. In 62 cases, 47 (75.8%) succeeded and 15 (24.2%) failed. In successful group, 21 (44.7%) women delivered pretermly and 26 (55.3%) termly. No severe complications occurred except cervical laceration (2, 3.23%), premature rupture of membranes (13, 20.97%). In 62 cases, 40 (64.5%) have ≤2 previous second-trimester losses and 22 (35.5%) have >2 previous second-trimester losses. No significant differences were found in neonatal outcomes. Analysis revealed that higher postoperative C-reactive protein and presence of premature rupture of membranes were the strongest predictors of cerclage failure. Among 62 cases, 48 (77.4%) were allocated in elective and 14 (22.6%) in emergency cerclage. Pregnancy prolongation was significantly more (P = 0.014) in elective group with no significant differences in premature rupture of membranes, neonatal outcomes (all P > 0.05) except Apgar score at 5 min (P = 0.042). Conclusion: Achieving 75.8% live births proves that transvaginal cervical cerclage is an effective and safe technique in prolonging the gestational age, improving the obstetric outcomes in singleton pregnancies with cervical incompetence under various cerclage indications. Postoperative C-reactive protein and premature rupture of membranes are the predictive factors related to success or failure. Elective cerclage is more effective in prolonging the pregnancy compared to emergency cerclage, no significant differences are seen regarding neonatal outcomes and complications.

Quantitative Detection of Screening for Cervical Lesions with ThinPrep Cytology Test

OBJECTIVE To investigate the available parameters in gynecological screening for cervical lesions by liquid-based cytology technology （ThinPrep Cytology Test, TCT） and The Bethesda System （TBS）, also with computer image analysis. METHODS With application of the image analysis system, all grades of cervical lesion cells were detected quantitatively and sorted in atypical squamous cells of undetermined significance （ASCUS）, atypical squamous cells-cannot exclude HSIL （ASC-H）, low-grade squamous intraepithelial lesion （LSIL）, high-grade squamous intraepithelial lesion （HSIL） and cervical squamous cell carcinoma （SCC） with the mean optical density （MOD）, average grey （AG）, positive units （PU）, and nucleus to cytoplasmic ratio （N： C）. Differences between each group of cells were compared and analyzed statistically. RESULTS Apart from four stereologic parameters in LSIL and HSIL groups there were no differences among them, in the other groups, there was statistically significant in differences between MOD, AG and PU values. Differences between them in the ratio of nucleus to cytoplasm were highly statistically significant. CONCLUSION Stereological indexes may serve as a screening tool for cervical lesions. The image analysis system is expected to become a new means of cytological assisted diagnosis.

Preoperative detecting metastases of cervical cancer in pelvic and para-aortic lymph nodes:comparison of integrated ^(18)F-FDG PET/CT with or without contrast enhancement

Purpose: Compared the performance of contrast-enhanced PET/CT and non-enhanced PET/CT for preoperatively detecting pelvic and para-aortic lymph node metastases in patients with cervical cancer. Methods: This prospective study included 72 patients with clinically M0 cervical cancer. They underwent surgery within two weeks of PET/CT imaging. Imaging consisted of a whole-body PET/CT protocol without intravenous contrast, followed by abdominal and pelvic PET/CT protocol including contrast-enhanced CT. We compared the diagnostic efficiency between the methods on per-patient and per-lesion basis. Results: Patient-based analysis showed that the sensitivity, specificity, and accuracy of contrast-enhanced PET/CT were 63.6% (14/22), 94.0% (47/50), and 84.7%(61/72), respectively, whereas those of non-enhanced PET/CT were 54.5% (12/22), 88.0% (44/50), and 77.8% (56/72), respectively, and those of enhanced CT alone were 36.4% (8/22), 80.0% (40/50), and 66.7% (48/72), respectively. Lesion-based analysis showed that the sensitivity, specificity, and accuracy of contrast-enhanced PET/CT were 77.7% (87/112), 98.7%(938/950), and 96.5% (1025/1062), respectively, whereas those of non-enhanced PET/CT were 69.6% (78/112), 97.5% (926/950), and 94.5% (1004/1062), respectively, and those of enhanced CT were 54.4% (61/112), 96.1% (913/950), and 91.7% (974/1062), respectively. Contrast-enhanced PET/CT had the best sensitivity, specificity and accuracy. Although patient-based analysis showed no significant difference between contrast-enhanced PET/CT and non-enhanced PET/CT (p =0.540, 0.295 and 0.286), the specificity and accuracy of these two methods were significantly different on lesion-based analysis (p =0.043 and 0.027).

宫颈环扎术治疗三胎妊娠合并宫颈机能不全二例

三胎妊娠围产期并发症和合并症较单胎和双胎妊娠明显升高,其中最值得关注的是早产和早产儿发病及死亡,如果三胎妊娠合并宫颈机能不全则流产或早产的风险更高。报道2例通过辅助生殖技术受孕的三胎妊娠(双绒毛膜三羊膜囊)合并宫颈机能不全患者,1例孕前行腹腔镜宫颈环扎术,另1例在孕15+5周行经阴道宫颈环扎术,孕期均定期产检阴道超声监测宫颈长度并及时治疗预防早产,分别在孕33+2周和孕33+3周成功剖宫产分娩三活婴。对于不愿意采用减胎术的三胎妊娠合并宫颈机能不全患者,宫颈环扎术是一个可靠的治疗方案,定期随访对防治早产、指导临床用药及适时拆除宫颈环扎线并改善母儿预后至关重要。