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Diagnostic challenges and individualized treatment of cervical adenocarcinoma metastases to the breast:A case report

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World Journal of Clinical Cases 2024年第2期12卷 412-417页

作者： Allison Akers Susan Read John Feldman Casey Gooden Diana P English Department of Obstetrics and Gynecology University of South FloridaTampaFL 33606United States Department of gynecologic Oncology Sky Ridge Medical CenterLone TreeCO 80124United States Department of Radiology University of South FloridaTampaFL 33606United States Department of pathology University of South FloridaTampaFL 33606United States

BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in *** metastases are associated with poor *** following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized *** SUMMARY A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina,parametria and lymph node *** biopsies confirmed high grade adenocarcinoma with mucinous features.A positron emission tomography/computed tomography(PET/CT)did not show evidence of metastatic *** received concurrent cisplatin with external beam radiation *** up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic *** was lost to follow up for six *** was re-imaged on re-presentation and found to have widely metastatic disease including breast *** biopsy confirmed programmed death-ligand 1 positive metastatic cervical *** patient received six cycles of carboplatin and paclitaxel with *** imaging demonstrated *** continued on pembrolizumab with disease *** Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis *** history and immunohistochemical evaluation of breast lesion,and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the ***,the prognosis is poor,but immunotherapy can be considered in select patients and may result in good disease response.

关键词： Cervical adenocarcinoma Breast metastases Immunotherapy Pembrolizumab Carboplatin Paclitaxel Case report

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Efficacy and safety of transvaginal mesh repair in a cohort with a minimum of 10-year follow-up

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Science China(Life Sciences) 2024年第5期67卷 1061-1068页

作者： Zhibo Zhang Jianbin Guo Weijie Tian Ye Zhang Yuelun Zhang Tianshu Sun Jiali Duan Xinmiao Bao Yuan Wang Yang Ye Qianqian Gao Honghui Shi Abraham Nick Morse Juan Chen Lan Zhu Departmentof Obstetrics and Gynecology Peking Union MedicalCollege HospitalChinese Academyof Medical Sciences&Peking Union MedicalCollegeNational Clinical Research Center for Obstetricand Gynecologic DiseasesBeijing 100730China Department of Gynecology Guizhou Provincial People’s HospitalMedical College of Guizhou UniversityGuiyang 550002China Department of Obstetrics and Gynecology The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450000China Medical Research Center Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Medical Doctor Program Chinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of pathology Peking Union Medical College HospitalBeijing 100730China Tufts University School of Medicine Boston MA 02111USA

Although transvaginal mesh(TVM)repair is no longer used in some countries,long-term outcomes after TVM surgery are of great importance ***,reports with follow-up>10 years are ***,this study aimed to report outcomes in a prospective cohort with at least 10 years of *** with stageⅢ–Ⅳsymptomatic prolapse were approached consecutively from 2008 to 2013 at one tertiary *** main outcome measure was symptomatic *** outcomes included anatomic failure,recurrence,patient satisfaction,complications,and *** Kaplan-Meier curve was used to estimate the cumulative failure *** the 121 patients enrolled in the study,103(85.1%)completed a median follow-up of 11 *** estimated probability rates of symptomatic and anatomic failure were 17.6%and 8.8%in 11 years,*** estimated incidence of symptomatic failure increased by 8.2%between 5 and 11 years;however,the corresponding rate for anatomic failure was 3.7%.The most common complication was vaginal mesh exposure,and its estimated probability increased from 19.3%to 28.4%from 5 to 11 years,*** trimming resolved 80.0%of vaginal *** patients did not report decreased overall *** with vaginal mesh exposure requiring>3 office procedures or mesh removal in the operating room(5.8%by 11 years)had lower satisfaction rates(P<0.01)and were defined as having severe mesh *** rates of postoperative pain,reoperation,and Patient Global Impression of Improvement≥2 were 2.5%,3.3%,and 94.2%,*** results of this study implied that TVM treatment gradually increased the symptomatic failure rate but provided durable anatomical support of the vaginal *** mesh exposure was common in women who were largely not sexually active;however,80%of the cases could be managed in the outpatient clinic,which did not affect patient satisfaction.

关键词： complication efficacy long-term follow-up pelvic organ prolapse safety transvaginal mesh

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DNMT3A:A Multifunctional Mediator of Cancer Progression

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Medicinal Plant 2024年第3期15卷 75-78页

作者： Zijie WEI Jiaji ZHANG Ziqian KOU Yu CHENG Department of Basic Medical Sciences Chengde Medical UniversityChegnde 067000China Department of pathology Chengde Medical UniversityChengde 067000China

The advances in the research on the structure and function of DNMT3A and the role of DNMT3A in tumorigenesis and development were reviewed,including gynecologic cancers,hematologic tumors,melanoma,amelanoma,colorectal... 详细信息

关键词： DNMT3A Cancer Methylation

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Paired box proteins as diagnostic biomarkers for endocervical adenocarcinoma

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World Journal of Clinical Cases 2024年第26期12卷 5854-5858页

作者： Jia-Hui Zhou Xiang-Ning Zhang pathology Department Lishui Central HospitalLishui 323000Zhejiang ProvinceChina Pathophysiology Department Guangdong Medical UniversityDongguan 523808Guangdong ProvinceChina

In this editorial,we commented on the article by Akers et al published in the recent issue of the World Journal of Clinical *** focused specifically on the role of the transcription factor paired box protein 8(PAX8)belonging to the family PAX in the carcinogenesis of a gynecologic tumor,endocervical adenocarcinoma,arising from the tissue of mesonephric origin,and the potential diagnostic value for the same type of *** global vaccination program of human papillomavirus(HPV)has dramatically reduced the incidence of cervical cancer,including cases of *** type of adenoid epithelial origin has a lower frequency of HPV detection but tends to be more aggressive and *** of endocervical adenocarcinoma occurring in females of menopause age have been described in the 2023 volume of the World Journal of Clinical Cases and in our study recently published in Oncol *** histopathological findings and immunohistochemical assays showed that the lesions had glandular morphology,and the specimens in these two reports were immunohistochemically positive for the transcription factor PAX8,albeit that they had opposing expression profiles of tumor suppressor p16 and estrogen receptor and the presence of the HPV *** presence of a mucin protein,MUC 5AC,as revealed in both studies suggested target molecules for the diagnosis of mucinous adenoid type of uterine tumor and other histological *** clinical outcome was unfavorable due to metastasis and *** prompted the improvement of the antitumor modality,with the introduction of precise targeting *** has now been reported to be the therapeutic target for adenocarcinomas.

关键词： Cervical adenocarcinoma Diagnostic biomarker Paired box protein 8 Embryogenesis Transcription factor

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Laparoscopic management of a giant mucinous benign ovarian mass weighing 10150 grams:A case report

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World Journal of Clinical Cases 2020年第16期8卷 3527-3533页

作者： Elisabetta Sanna Clelia Madeddu Luca Melis Sonia Nemolato Antonio Macciò Department of gynecologic Oncology Azienda Ospedaliera BrotzuCagliari 09100Italy Department of Medical Sciences and Public Health University of CagliariMonserrato 09042Italy Department of Nuclear Medicine Azienda Ospedaliera BrotzuCagiari 09100Italy Department of pathology Azienda Ospedaliera BrotzuCagliari 09100Italy

BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are *** size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been *** we report a case of a large 10-kg multi-locular ovarian mass,which was successfully laparoscopically removed:Our aim was to innovate the surgical practice in this field by providing a safe,effective,and minimally invasive management method for such complex and rare *** SUMMARY A 49-year-old nulliparous woman presented with abdominal distension,lasting from six Mo prior to admission;she reported worsening abdominal pain,abdominal swelling,and mild *** showed a presumed benign multi-locular(>10 locules)left ovarian cyst that measured about 30 cm in *** on the IOTA-ADNEX model the mass had a 27.5%risk of being a borderline or malignant *** patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy,followed by the external drainage of the *** spillage was successfully avoided during this *** final volume of the drained mucinous content was 8950 L;the cyst wall,extracted through the minilaparotomy,weighed about 1200 *** pathologic gross examination revealed a 24 cm×15 cm×10 cm mass;the histologic examination diagnosed a mucinous *** our knowledge,this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external *** Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.

关键词： Giant ovarian cyst Minimally-invasive surgery Laparoscopy Benign ovarian mass Spillage Case report

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

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World Journal of Clinical Cases 2023年第4期11卷 938-944页

作者： Ling-Qin Yuan Ting Hao Guo-You Pan Hui Guo Da-Peng Li Nai-Fu Liu Department of gynecologic Oncology Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinan 250117Shandong ProvinceChina Department of pathology Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinan 250117Shandong ProvinceChina

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 *** 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 *** 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 *** 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.

关键词： Epithelioid trophoblastic tumor Lower uterine segment Cervical canal p63 Gestational trophoblastic tumor Case report

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Accuracy of tumor grade by preoperative curettage and associated clinicopathologic factors in clinical stage Ⅰ endometriod adenocarcinoma

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Chinese Medical Journal 2009年第16期122卷 1843-1846页

作者： WANG Xin-yu PAN Zi-min CHEN Xiao-duan LU Wei-guo XIE Xing Department of gynecologic Oncology Women's Hospital School of Medicine Zhejiang University Hangzhou Zhejiang 310006 China Department of pathology Women's Hospital School of Medicine Zhejiang University Hangzhou 310006 China

Background Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage Ⅰ endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage Ⅰ endometriod adenocarcinoma. Methods Clinical data of totally 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed. Results In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% （281/687） and an upgraded rate of 24.7% （170/687）. The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively. Conclusions Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage Ⅰ endometriod adenocarcinoma.

关键词： endometrial neoplasms dilatation and curettage diagnosis tumor grade

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Clinicopathological characteristics and treatment of carcinosarcoma of the female genital tract

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Oncology and Translational Medicine 2015年第5期1卷 233-238页

作者： Jun Zhu Hao Wen Xiaohua Wu Department of gynecologic Oncology Cancer Hospital of Fudan University

Carcinosarcomas of the female genital tract are highly aggressive and rare tumors,differing from other malignant gynecological tumors in that they contain both malignant carcinomatous and sarcomatous elements. Because carcinosarcomas are rapidly progressive,less sensitive to chemotherapy or radiotherapy,and have a high probability of recurrence,patients with advanced uterine and ovarian carcinosarcomas have poorer survival than those with endometrial or high-grade serous carcinomas. Although the treatment strategies are controversial,a comprehensive management approach is recommended,which involves complete debulking surgery followed by adjuvant chemotherapy and/or radiotherapy. Molecular-targeted therapies are promising for the management and improvement in the overall survival of patients with carcinosarcomas.

关键词： carcinosarcoma pathology treatment prognosis

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BKCa participates in E2 inducing endometrial adenocarcinoma by activating MEK/ERK pathway

BKCa participates in E2 inducing endometrial adenocarcinoma ...

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2018年浙江省妇科肿瘤学学术年会暨温台妇产科年会

作者： Fenfen Wang Qin Chen Genping Huang Xuedong Guo Na Li Yang Li Baohua Li Department of gynecologic Oncology Women's HospitalSchool of MedicineZhejiang University Department of pathology Women's HospitalSchool of MedicineZhejiang University

Background:The large-conductance,voltage-gated,calcium(Ca(2+))-activated potassium channel(BKCa)plays an important role in regulating Ca(2+) signaling and cell physiological function,and is aberrantly expressed in some types of *** present study focuses on identifying the oncogenic potential and clinical significance of BKCa in endometrial adenocarcinoma,as well as exploring the mechanistic relevance by 17 β-estradiol(E2)inducing aberrant activation of MEK1/2 and ERK1/2 via ***:The expression of BKCa,ERK1/2 and p-ERK1/2 were examined by immunohistochemical staining in 263 cases,including 185 primary types Ⅰ endometrial cancer tissues,38 endometrial atypical neoplasm tissues and 40 normal endometrium *** growth,cycle,apoptosis rate,migration and invasion was separately tested in Ishikawa cells using siRNA-BKCa and/or E2 treatment,as well as the expression of these interested proteins by western blot ***:We showed that expression of BKCa is significantly elevated in 185 types Ⅰ endometrial carcinoma tissues compared to those of the normal endometrium and endometrial atypical neoplasms ***,in vitro observations revealed that down-regulation of BKCa expression inhibited cell growth by both enhancing apoptosis and blocking G1/S transition,suppressed cell migration and invasion in Ishakiwa cells,and decreased the expression of p-MEK1/2 and p-ERK1/***,RNAi-mediated knockdown of BKCa attenuated the increased cellular growth and invasion,as well as the elevated expression of p-MEK1/2 and p-ERK1/2 proteins,induced by E2 *** importantly,the aberrant expression of BKCa and p-ERK1/2 were closely related with poor prognostic factors in type Ⅰ endometrial cancer,and up-regulated expression of p-ERK1/2 was significantly associated with shorter disease-free survival(DFS) and overall survival(OS) and was an independent prognostic factor in type Ⅰ endometrial cancer ***:Our results demonstra

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评价导致斯洛文尼亚宫颈癌发病率升高的原因

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世界核心医学期刊文摘（妇产科学分册） 2005年第4期1卷 30-31页

作者： Smrkolj S. Rakar S. Mo■ina A Er■en M. 赵巍 unit of gynecologic pathology Dept. of Obstetrics and Gynecology Univ. Med. Ctr. Ljubljana S. Ljubljana Slovenia

Objective: In Slovenia the opportunistic cervical cancer (CC)screening programme has been performed within the regular gynaecological practice since 1960. The incidence rate 28.8/105 decreased to 16.1/105 in 1982, and increased to 23/105 in 1996. To explain the increased CC incidence the patientsscreening histories, occurrence of symptoms, and details of preventive measures were studied on the basis of medical records and questionnaire. Errors of cytological screening were analysed by reviewing previous smears. Material: The answers obtained from 324 women, treated for CC in the period 1995-2000, were analysed in relation to age, stage and histology. The mean womens age was 46.76 ±13.07 (S.D.) years (range 23-85 years). After therapy, 271 patients were followedup by the end of January 2004, (mean followup time 80.3 ±20 S.D. months, range 29.7-110.3 months). Statistical analysis was performed using Chisquare test. Results: In 208 (80%) cases, CC was detected in stage 1, in 43 (17%) in stages 2A to 3B. Squamouscell carcinoma (192, 74.1%) was followed by adenocarcinoma (61, 23.5%) and (5, 1.9%) other malignancies. The screening interval ranged from 6 months to 4 years. Statistically significant differences existed between clinical and screening variables. CC was diagnosed in higher stages in women who were ignorant of the Pap test. Rescreened smears (n=126) showed 27.8%of false negative results. Conclusions: The reasons for high incidence of CC are poor performance of cytological screening, failures in gynecological examinations and diagnostic procedures, and the patientsnegligence of attending regular screening.

关键词：宫颈癌发病率细胞学筛查妇科查体检查和假阴性率恶性瘤鳞状细胞癌统计学显著性筛检预防措施

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