1例源于阴道苗勒囊腺癌报道

Background. We report a case of adenocarcinoma arising in a vaginal müllerian cyst. Although the most common pathological type of vaginal cysts is müllerian cyst, malignant change of a müllerian cyst has not been reported before. Case. A 48-year-old woman presented with a 3 cm-sized ruptured vaginal cyst. The cyst had been asymptomatic for 20 years, but ruptured 2 months before her visit. After the diagnosis of atypical glands was made on punch biopsy of cyst wall, she underwent an operative excision and the final histopathologic examination revealed an adenocarcinoma arising in the müllerian cyst. After the surgery, she received a course of external radiation therapy followed by brachytherapy. At 6 months following treatment, the patient remained without evidence of disease. Conclusion. To our knowledge, this is the first case report of an adenocarcinoma arising from a müllerian cyst. The possibility of malignant transformation should be considered and careful follow-up is warranted even in cases of asymptomatic vaginal cysts.

Evaluation and simplification of risk factors in FIGO 2000 scoring system for gestational trophoblastic neoplasia:a 19-year retrospective analysis

Objective The International Federation of Gynecology and Obstetrics(FIGO)2000 scoring system classifies gestational trophoblastic neoplasia(GTN)patients into low-and high-risk groups,so that single-or multi-agent chemotherapy can be administered accordingly.However,a number of FIGO-defined low-risk patients still exhibit resistance to single-agent regimens,and the risk factors currently adopted in the FIGO scoring system possess inequable values for predicting single-agent chemoresistance.The purpose of this study is therefore to evaluate the efficacy of risk factors in predicting single-agent chemoresistance and explore the feasibility of simplifying the FIGO 2000 scoring system for GTN.Methods The clinical data of 578 GTN patients who received chemotherapy between January 2000 and December 2018 were retrospectively reviewed.Univariate and multivariate logistic regression analyses were carried out to identify risk factors associated with single-agent chemoresistance in low-risk GTN patients.Then,simplified models were built and compared with the original FIGO 2000 scoring system.Results Among the eight FIGO risk factors,the univariate and multivariate analyses identified that pretreatment serum human chorionic gonadotropin(hCG)level and interval from antecedent pregnancy were consistently independent predictors for both first-line and subsequent single-agent chemoresistance.The simplified model with two independent factors showed a better performance in predicting single-agent chemoresistance than the model with the other four non-independent factors.However,the addition of other co-factors did improve the efficiency.Overall,simplified models can achieve favorable performance,but the original FIGO 2000 prognostic system still features the highest discrimination.Conclusions Pretreatment serum hCG level and interval from antecedent pregnancy were independent predictors for both first-line and subsequent single-agent chemoresistance,and they had greater weight than other non-independent factors in predicting single-agent chemoresistance.The simplified model composed of certain selected factors is a promising alternative to the original FIGO 2000 prognostic system,and it shows comparable performance.