[Benign ovarian tumor with ascites and high serum levels of CA125: report of 3 cases]

OBJECTIVE

To describe the clinical characteristics of benign ovarian tumor/mass which manifest as pelvic mass, ascites and high serum levels of CA(125).

METHOD

Clinical data of 3 cases of such disease in Peking Union Medical College Hospital were analyzed and relevant literatures were reviewed.

RESULTS

The patients all were misdiagnosed as ovarian carcinoma, and operations designed for malignant ovarian tumor were performed on all of them. There was no definite proof of malignant tumor, such as positive findings of pathology and/or cytology, in any patients before operation. Among these diseases, pelvic tuberculosis, ovarian endometrioid cyst and ovarian fibroma are the three most common ones, others are: fibrothecoma, thecoma, struma ovarii, adenofibroma, benign Brenner tumor, mature theratoma, ovarian edema and fibromatosis.

CONCLUSIONS

Pelvic mass, ascites and high serum level of CA(125) can't always result of a diagnosis of ovarian carcinoma. Positive findings of pathology and/or cytology is the only definite proof of a diagnosis of ovarian malignant tumor. On the susceptible case, laparoscopy is a useful and reliable method.

[Transitional cell carcinoma of the ovary: one kind of uncommon type of ovarian epithelial carcinoma]

OBJECTIVE

To evaluated clinico-biologic behavior, prognosis and relative prognostic factors of transitional cell carcinoma of the ovary.

METHODS

The clinical records of 58 patients with transitional cell carcinoma of the ovary, who received treatment in the department of Obstetrics and Gynecology, Peking Union Medical College Hospital in 20 years, were reviewed retrospectively. The data were analyzed statistically by SPSS 10.0.

RESULTS

Among 58 cases, the median age was 55 +/- 10 (35 - 75) years old. 31% of them had bilateral ovary involvement, and the median level of CA(125) was (687 +/- 365) U/L. All patients received cytoreductive surgery in our hospital, 69% of them got optimal cytoreduction. Pathologic results showed that G(1), G(2), G(3) were 7%, 45% and 48% respectively, 40% were demonstrated lymph node metastasis. Nearly 80% of patients were classified to International Federation of Gynecology and Obstetrics (FIGO) stage III and IV. Different courses of chemotherapy were given to all patients. The recurrence occurred in 45% of cases and the death rate was 53%. The Cox hazards regression model was used to analyze the possible prognostic factors and revealed that tumor residuals (P < 0.01), preoperative level of CA(125) (P < 0.01), bilateral ovary involvement (P < 0.05) and lymph node metastasis (P < 0.05) were the most important prognostic factors.

CONCLUSIONS

Transitional cell carcinoma of ovary is an uncommon type of ovarian cancer. It usually behaves better prognosis when compared with papillary serous cystadenocarcinoma of the ovary.

[Clinical analyses of 42 cases of urinary tract injury in gynecologic surgery]

OBJECTIVE

To determine the clinical characteristics and management of urinary tract injuries incidental to gynecologic surgery.

METHODS

During the study period from Jan. 1, 1990 to Dec. 31, 2001, forty-two patients with urinary tract injuries in gynecologic surgery were analyzed retrospectively focusing on type and time of injury, diagnostic methods and managements of urinary fistula.

RESULTS

Forty-two urological injuries were incurred during the performance of 12 849 gynecologic surgical procedures, an incidence of 0.33% including of 11 ureteral injuries and 31 bladder injuries, an incidence of 0.09% and 0.24% respectively. Of the 11 ureteral injuries 5 occurred in the lower ureter, 4 occurred at the level of vecical entrance and 2 were in the region of the infundibulopelvic ligaments. Of the bladder injuries, all 31 occurred at the bottom or back of the bladder. Urinary tract injury was made intraoperatively in 32 patients (76%) and made postoperatively in 10 patients (24%). Urinary fistulae occurred in 14 patients (33%). Ten patients with urinary fistulae were diagnosed by comparing the concentration of electrolyte, urea nitrogen and creatine in drainage fluid with those in urine and blood. Infusion of methylene blue and/or cystoscopy were checked in 9 patients and 4 bladder fistulae were found positive results. All 8 ureteral fistulae were diagnosed by intravenous pyelography. An appropriate repair during operation, putting the double J-catheter and/or catheterization was useful. Forty-one patients were healed.

CONCLUSION

Most of urinary tract injuries in gynecologic surgery had optimal results when they were diagnosed early and managed correctly.

[Role of positron emission tomography in detecting recurrent epithelial ovarian carcinoma]

OBJECTIVE

To investigate the efficiency of positron emission tomography (PET) with (fluorine-18)-2-deoxyglucose ((18)FDG) for detecting recurrent epithelial ovarian carcinoma.

METHODS

Fifteen (18)FDG-PET scanning were performed on 13 patients, who was clinically free of disease after optimal cytoreductive surgery and sufficient chemotherapy, with suspicion of recurrence. Ten second-look or re-debulking operation were given after PET scanning.

RESULTS

In all 8 cases with and 1 without elevated serum CA(125), PET demonstrated sites of increased (18)FDG uptake, which correlated well with surgical-pathologic findings (100%). Computed tomography scan and B ultrasonography each detected 1 recurrence. One of the 6 patients with negative PET scan results underwent a second-look operation, which found no malignancy. The other 5 were closely followed up for 11 to 13 months. No sign of recurrence was noticed within 8 months. One patient received her second PET scanning after the serum CA(125) began to elevate in the 9th month. Recurrent tumor was found by the second PET scan and confirmed by the operation after that.

CONCLUSIONS

PET is accurate in detecting the recurrent epithelial ovarian carcinoma. As a non-invasive method, PET might be a fairly effective tool for monitoring and locating the recurrence of ovarian carcinoma.

[Influence of surgical methods on survival and recurrence of stage I endometrial carcinoma]

OBJECTIVE

To determine the influence of different surgical procedure on post-operative survival rate and recurrence of stage I endometrial carcinoma.

METHODS

From 1986 to 1996, 110 patients with stage I endometrial carcinoma surgically treated in our hospital were studied retrospectively. They were divided into three groups, including total hysterectomy plus bilateral salpingo-oophorectomy (group A), radical or modified radical hysterectomy (group B) and total hysterectomy plus bilateral salpingo-oophorectomy or radical hysterectomy or modified radical hysterectomy + pelvic lymphadenectomy (group C). Survival and recurrent rates were analysed according to the follow-up data.

RESULTS

Five-year survival rate of the three groups are 89.5%, 90.5% and 95.1% respectively (P > 0.05). Of the 71 cases followed up for more than two years, 9 relapsed. The recurrent rates were 12.7%. Seven relapsed within three years after operation. Eight patients had local recurrence and 5 had distant metastasis. Recurrent rates of three groups are 13.9%, 9.1% and 12.5% (P > 0.05), local recurrent rates are 13.9%, 9.1% and 8.3% (P > 0.05), distant metastasis rates are 2.8%, 9.1% and 12.5% respectively (P > 0.05) with no statistical significance.

CONCLUSIONS

Surgical method is not the main factor influenced the survive of stage I endometrial carcinoma. Radical operation or lymphadenectomy will not increase the survival rate of stage I endometrial carcinoma significantly. The purpose of such operation is to find out the exact stage and the possible prognosis. Distant metastasis is remarkable, and should be considered in the adjuvant therapy.

Genetic basis of glycogen storage disease type 1a: prevalent mutations at the glucose-6-phosphatase locus

Diagnosis of glycogen storage disease (GSD) type 1a currently is established by demonstrating the lack of glucose-6-phosphatase (G6Pase) activity in the patient's biopsied liver specimen. Recent cloning of the G6Pase gene and identification of mutations within the gene that causes GSD type 1a allow for the development of a DNA-based diagnostic method. Using SSCP analysis and DNA sequencing, we characterized the G6Pase gene of 70 unrelated patients with enzymatically confirmed diagnosis of GSD type 1a and detected mutations in all except 17 alleles (88%). Sixteen mutations were uncovered that were shown by expression to abolish or greatly reduce G6Pase activity and that therefore are responsible for the GSD type 1a disorder. R83C and Q347X are the most prevalent mutations found in Caucasians, 130X and R83C are most prevalent in Hispanics, and R83H is most prevalent in Chinese. The Q347X mutation has thus far been identified only in Caucasian patients, and the 130X mutation has been identified only in Hispanic patients. Our results demonstrate that the DNA-based analysis can accurately, rapidly, and noninvasively detect the majority of mutations in GSD type 1a. This DNA-based diagnosis now permits prenatal diagnosis among at-risk patients and serves as a database in screening and counseling patients clinically suspected of having this disease.

CD4+ beta islet cell-reactive T cell clones that suppress autoimmune diabetes in nonobese diabetic mice

We report the isolation of a panel of CD4+ T helper type 1 autoreactive T cell clones from the spleen of unprimed nonobese diabetic mice, a murine model of human insulin-dependent diabetes mellitus. The T cell clones express a diverse repertoire of T cell receptors, three of which recognize beta islet cell autoantigen(s). The islet cell-reactive T cell clones inhibit adoptive transfer of insulin-dependent diabetes mellitus and intraislet lymphocytic infiltration. The protective capacity of the T cell clones correlates with their ability to produce a novel immunoregulatory activity that potently inhibits in vitro allogeneic mixed lymphocyte reaction. The partially purified activity significantly inhibited the adoptive transfer of diabetes. Our work provides evidence in support of the existence of T helper type 1, CD4+ T cells reactive to beta islet cell autoantigens that have acquired a protective instead of a diabetogenic effector function. These T cells mediate their protective action in part by production of an immunoregulatory activity capable of down-regulating immune responses, and they are likely to represent a population of regulatory T cells that normally plays a role in maintaining peripheral tolerance.

[Reproductive activities as a risk factor of endometriosis]

A case-control study, involving 203 cases of pelvic endometriosis and 406 randomly selected and age-matched community controls, was conducted. The results were as following: 1) A decreased risk for endometriosis was found to be related to pregnancy. The relative risk was 0.34 for para 1 and 0.08 for para 2 or more. A similar tendency was also showed in the analysis of gravidity, but this protective effect totally disappeared after adjustment for parity. Therefore, it may be revealed that it is the parity but not the gravidity which protects the women against the endometriosis. 2) There was an increased risk of 15.35 for endometriosis in women with infertility. 3) No relation emerged with age at first pregnancy to the occurrence of endometriosis as indicated in the literature. 4) The frequency of induced abortion was 42.4% in the cases and that was 63.7% in the controls. The association with the risk of the disease adjusted for education, menstruation, parity and contraception was not significant by a attentive stratification the data. 5) Two groups were relatively similar with respect to recorded condom and oral contraceptive use. However, more cases than controls did not use any contraception or only used rhythm method and coitus interruptus, and more controls than cases used an intrauterine device. The results of multivariate analysis did not approve of opinion that IUD is a risk factor of endometriosis. The results did not negate the likelihood of diminished chance of developing endometriosis in women with using oral contraceptives.

[Menstrual status as risk factors of endometriosis: a case-control study]

A case-control study, involving 203 cases of pelvic endometriosis and 406 randomly selected and age-matched community controls, was conducted. The results showed that women characterized by earlier menarche (< or = 12 years) and longer period (> 7 days) were associated with an elevated risk. Longer cycle (> 35 days) seemed to have a protective effect. There are a tendency to increasing risk for endometriosis associated with primary dysmenorrhea and energetic physical activities during menstruation. The results indicate that intensive treatment of primary dysmenorrhea and avoidance of strenuous exercise during menstruation may prevent pelvic endometriosis.

Regulation of the steady state level of Fc gamma RI mRNA by IFN-gamma and dexamethasone in human monocytes, neutrophils, and U-937 cells

The high affinity IgG FcR Fc gamma RI, CD64, plays important roles in the immune response. Fc gamma RI is predominantly expressed on monocytes and macrophages, and barely detectable on neutrophils. rIFN-gamma markedly increases the expression of Fc gamma RI on neutrophils, monocytes, macrophages and myeloid cell lines such as U-937, HL-60, and THP-1. Glucocorticoids inhibit the augmentation of Fc gamma RI expression by rIFN-gamma on neutrophils and myeloid cell lines, but enhance the augmentation of Fc gamma RI expression by rIFN-gamma on monocytes. In this study, we examined the effect of rIFN-gamma and dexamethasone (Dex) on the steady state level of Fc gamma RI mRNA in U-937 cells, neutrophils, and monocytes by hybridizing total RNA with the Fc gamma RI cDNA probe, p135. We found that the amount of Fc gamma RI mRNA increased within 1 h of treatment with rIFN-gamma in all three cell types. This initial induction of Fc gamma RI mRNA by rIFN-gamma was completely blocked by an inhibitor of RNA synthesis, actinomycin D, suggesting that the rIFN-gamma-mediated induction of Fc gamma RI mRNA is dependent on gene transcription. Dex, used in combination with rIFN-gamma, partially blocked the induction of Fc gamma RI mRNA by rIFN-gamma in U-937 cells and neutrophils, but caused a synergistic increase in Fc gamma RI mRNA levels in monocytes. The inhibitory effect of Dex on the steady state level of Fc gamma RI mRNA in U-937 cells was blocked by an inhibitor of protein synthesis, cycloheximide, suggesting that Dex-induced proteins were involved in the regulation of Fc gamma RI expression. This study indicates that the regulation of Fc gamma RI expression on U-937 cells, neutrophils, and monocytes by rIFN-gamma and Dex occurs, at least in part, at the mRNA level. rIFN-gamma increases the steady state level of Fc gamma RI mRNA through a common pathway among U-937 cells, neutrophils, and monocytes, whereas the effect of Dex on rIFN-gamma-induced Fc gamma RI mRNA is cell-type specific.

Regulation of the steady state level of Fc gamma RI mRNA by IFN-gamma and dexamethasone in human monocytes, neutrophils, and U-937 cells

The high affinity IgG FcR Fc gamma RI, CD64, plays important roles in the immune response. Fc gamma RI is predominantly expressed on monocytes and macrophages, and barely detectable on neutrophils. rIFN-gamma markedly increases the expression of Fc gamma RI on neutrophils, monocytes, macrophages and myeloid cell lines such as U-937, HL-60, and THP-1. Glucocorticoids inhibit the augmentation of Fc gamma RI expression by rIFN-gamma on neutrophils and myeloid cell lines, but enhance the augmentation of Fc gamma RI expression by rIFN-gamma on monocytes. In this study, we examined the effect of rIFN-gamma and dexamethasone (Dex) on the steady state level of Fc gamma RI mRNA in U-937 cells, neutrophils, and monocytes by hybridizing total RNA with the Fc gamma RI cDNA probe, p135. We found that the amount of Fc gamma RI mRNA increased within 1 h of treatment with rIFN-gamma in all three cell types. This initial induction of Fc gamma RI mRNA by rIFN-gamma was completely blocked by an inhibitor of RNA synthesis, actinomycin D, suggesting that the rIFN-gamma-mediated induction of Fc gamma RI mRNA is dependent on gene transcription. Dex, used in combination with rIFN-gamma, partially blocked the induction of Fc gamma RI mRNA by rIFN-gamma in U-937 cells and neutrophils, but caused a synergistic increase in Fc gamma RI mRNA levels in monocytes. The inhibitory effect of Dex on the steady state level of Fc gamma RI mRNA in U-937 cells was blocked by an inhibitor of protein synthesis, cycloheximide, suggesting that Dex-induced proteins were involved in the regulation of Fc gamma RI expression. This study indicates that the regulation of Fc gamma RI expression on U-937 cells, neutrophils, and monocytes by rIFN-gamma and Dex occurs, at least in part, at the mRNA level. rIFN-gamma increases the steady state level of Fc gamma RI mRNA through a common pathway among U-937 cells, neutrophils, and monocytes, whereas the effect of Dex on rIFN-gamma-induced Fc gamma RI mRNA is cell-type specific.

Individual and combined tumoricidal effects of dexamethasone and interferons on human leukocyte cell lines

We investigated the influence of glucocorticoids on two effects of interferons (IFNs) which are thought to relate to their antitumor actions: cytotoxic activity and induction of HLA antigen expression. We treated human myeloid cell lines (U-937, HL-60, THP-1, K-562, and KG-1a), and T-(MOLT-4) and B- (Daudi) lymphoblastic cell lines with concentrations of IFN-alpha, IFN-gamma, and dexamethasone (Dex) which are commonly achieved in the circulation following therapeutic administration. The results show that for every cell line except Daudi, the greatest inhibition of cell growth occurred when IFN-gamma and Dex treatments were combined. The advantage of combined IFN-gamma and Dex treatment over treatment with either agent alone was most dramatic for the three cell lines (U-937, HL-60, and THP-1) which have monocytoid characteristics. There was also more growth inhibition by the combination of IFN-alpha and Dex than by either agent alone for all seven cell lines tested. The induction of HLA antigen expression by IFN-alpha and IFN-gamma, an effect which could increase recognition of the tumor cells by the immune system, was as great or greater in the presence of Dex as in its absence. These results demonstrate that glucocorticoids do not inhibit, and in some cases enhance, two effects of IFNs that appear to be related to their antitumor actions: inhibition of tumor cell proliferation and enhancement of HLA antigen expression.