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Xiao Y, Chen W, Long X, Li M, Zhang L, Liu C, Deng Y, Li C, He B, Chen J, Wang J. 3D MR elastography-based stiffness as a marker for predicting tumor grade and subtype in cervical cancer. Magn Reson Imaging 2024; 109:173-179. [PMID: 38484948 DOI: 10.1016/j.mri.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Increasing evidence has indicated that high tissue stiffness (TS) may be a potential biomarker for evaluation of tumor aggressiveness. PURPOSE To investigate the value of magnetic resonance elastography (MRE)-based quantitative parameters preoperatively predicting the tumor grade and subtype of cervical cancer (CC). STUDY TYPE Retrospective. POPULATION Twenty-five histopathology-proven CC patients and 7 healthy participants. FIELD STRENGTH/SEQUENCE 3.0T, magnetic resonance imaging (MRI) (LAVA-flex) and MRE with a three-dimensional spin-echo echo-planar imaging. ASSESSMENT The regions of interest (ROIs) were manually drawn by two observers in tumors to measure mean TS, storage modulus (G'), loss modulus (G″) and damping ratio (DR) values. Surgical specimens were evaluated for tumor grades and subtypes. STATISTICAL TESTS Intraclass correlation coefficient (ICC) was expressed in terms of inter-observer agreements. t-test or Mann-Whitney nonparametric test was used to compare the complex modulus and apparent diffusion coefficient (ADC) values between different tumor groups. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the diagnostic performance. RESULTS The TS of endocervical adenocarcinoma (ECA) group was significantly higher than that in squamous cell carcinoma (SCC) group (5.27 kPa vs. 3.44 kPa, P = 0.042). The TS also showed significant difference between poorly and well/moderately differentiated CC (5.21 kPa vs. 3.47 kPa, P = 0.038), CC patients and healthy participants (4.18 kPa vs. 1.99 kPa, P < 0.001). The cutoff value of TS to discriminate ECA from SCC was 4.10 kPa (AUC: 0.80), while it was 4.42 kPa to discriminate poorly from well/moderately differentiated CC (AUC: 0.83), and 2.25 kPa to distinguish normal cervix from CC (AUC: 0.88), respectively. There were no significant difference in G″, DR and ADC values between any subgroups except for comparison of healthy participants and CC patients (P = 0.001, P = 0.004, P < 0.001, respectively). DATA CONCLUSION 3D MRE-assessed TS shows promise as a potential biomarker to preoperatively assess tumor grade and subtype of CC.
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Affiliation(s)
- Yuanqiang Xiao
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Wenying Chen
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Xi Long
- Department of Radiology, Meizhou People's Hospital (Huangtang Hospital), Meizhou 51403, China.
| | - Mengsi Li
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Lina Zhang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Chang Liu
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Ying Deng
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Chao Li
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Bingjun He
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Jun Chen
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
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Takač I, Kavalar R, Lovrec MR, Lovrec VG. Concomitant ectopic Enterobius vermicularis infection in uterine cervical cancer. BMC Womens Health 2024; 24:265. [PMID: 38678281 PMCID: PMC11055370 DOI: 10.1186/s12905-024-03073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Enterobius vermicularis (E. vermicularis), also referred to as pinworm, is a widespread human intestinal parasite which predominantly occurs in young children, making their caretakers a population at risk for the transmission of this helminth. It can occasionally affect extraintestinal organs and tissues, including the female genital tract. Infestation can be asymptomatic or manifest as different kinds of gynaecological disorders, such as pelvic inflammation mimicking tumours, abnormal uterine bleeding, or vaginitis. Diagnosis is made by identifying ova in the sample collected from the perineal skin using a transparent adhesive tape or microscopic examination of resected tissue. Mebendazole is the first-line medication and should also be administered to all household members. CASE PRESENTATION We present a case of a patient who had undergone surgery for invasive cervical cancer with an accidental finding of E. vermicularis eggs in the cervix. CONCLUSIONS Although not very common, infestation with E. vermicularis should be considered in differential diagnoses of various gynaecological disorders accompanied by histological findings of granulomatous inflammation.
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Affiliation(s)
- Iztok Takač
- Division for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska ul. 5, Maribor, 2000, Slovenia
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Maribor, Maribor, 2000, Slovenia
| | - Rajko Kavalar
- Department of Pathology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Matija Rudolf Lovrec
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Maribor, Maribor, 2000, Slovenia
| | - Vida Gavrić Lovrec
- Division for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska ul. 5, Maribor, 2000, Slovenia.
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Maribor, Maribor, 2000, Slovenia.
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Wang Y, Lu J, Qiu H, Yang C. Post-surgical rapid metastasis in stage IB2 mixed adenoneuroendocrine cervical carcinoma: An insightful reflective case study. Asian J Surg 2024:S1015-9584(24)00685-7. [PMID: 38653703 DOI: 10.1016/j.asjsur.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Yan Wang
- Life Sciences Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou First People's Hospital, Hangzhou, China; Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiahao Lu
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Qiu
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Chunxu Yang
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Bao Y, Zhang H, Huang W, Luo X, Yao L, Feng G, Yuan L. Novel predictors for identifying cervical minimal deviation adenocarcinoma patients with poor prognosis: a long-term observational study in a tertiary centre. Arch Gynecol Obstet 2024; 309:1483-1490. [PMID: 37695371 DOI: 10.1007/s00404-023-07207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To elucidate the clinicopathological features and prognostic factors of minimal deviation adenocarcinoma (MDA) of the uterine cervix, a clinically rare but highly invasive disease. METHODS This was a retrospective, observational, real-world study of 43 patients with pathologically confirmed MDA at the Obstetrics and Gynaecology Hospital of Fudan University between November 2010 and November 2021. Baseline clinicopathological data were collected and reviewed. Prognostic factors for progression-free survival (PFS) and overall survival (OS) were investigated by univariate and multivariate Cox proportional hazards analyses. RESULTS Chief complaints included irregular vaginal discharge and/or bleeding (74.4%). Preoperative diagnosis was difficult, the detection rate was low (36.8%), all cases showed endophytic lesions, and 88.4% had deep stromal invasion, with biologically aggressive characteristics. The ovarian metastasis rate was high (16.3%, 7/43). The median maximum diameter of the tumour (MDOT) was 4.3 cm (range, 0.5-8.0 cm). MDOT was significantly associated with OS (P = 0.009), and the optimal cut-off value to define bulky MDA was 5.5 cm (P < 0.0001, χ= 21.161) using X-tile software. Independent prognostic factors included MDOT (HR = 10.095, P = 0.001) and ovarian metastasis (HR = 5.888, P = 0.008) for OS and MDOT (HR = 3.944, P = 0.028), ovarian metastasis (HR = 9.285, P = 0.001), and deep infiltration (HR = 3.627, P = 0.048) for PFS. CONCLUSION Endophytic lesion development and ovarian metastasis are likely in MDA. A bulky tumour and ovarian metastasis indicate a worse prognosis. Given the special biological features of MDA, it is more appropriate to use 5.5 cm as the threshold for defining a bulky tumour than it is to use 4 cm. Ovary removal should be given higher priority to improve prognosis.
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Affiliation(s)
- Yiting Bao
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Hao Zhang
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wu Huang
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xukai Luo
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Liangqing Yao
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Guannan Feng
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China.
| | - Lei Yuan
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
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Szalai L, Vereczkey I, Szemes M, Rókusz A, Csernák E, Tóth E, Melegh Z. NTRK-rearranged spindle cell sarcoma of the uterine cervix with a novel NUMA1::NTRK1 fusion. Virchows Arch 2024; 484:527-531. [PMID: 38151535 PMCID: PMC11021316 DOI: 10.1007/s00428-023-03724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023]
Abstract
NTRK-rearranged uterine sarcoma is a recently described entity that represents a subset of uterine sarcomas with distinct clinicopathological features. From a molecular point of view, this tumour is defined by NTRK gene rearrangement, resulting in overexpression or constitutive activation of Trk receptors. The presence of NTRK fusion is indicative of treatment response with a selective small-molecule inhibitor of the Trk kinases. Here, we report a case of an NTRK-rearranged sarcoma of the uterine cervix in a 43-year-old patient, measuring 80 mm in its largest dimension, with a novel NUMA1-NTRK1 fusion, not previously reported in NTRK-rearranged uterine sarcomas or other NTRK-rearranged tumours. The fusion, involving NUMA1 exon 14 (NM_006185.4) and NTRK1 exon 11 (NM_002529.4), was identified by next-generation sequencing (NGS) studies (FusionPlex Pan Solid Tumor v2 panel). Although the presence of NTRK fusion has been reported in a variety of neoplasms, a fusion involving NUMA1 (nuclear mitotic apparatus protein 1) and a tyrosine kinase partner has previously been reported in human neoplasms only in a handful of cases. The resulting fusion protein comprises the oligomerization domain of NUMA1, which is predicted to cause constant activation of the tyrosine kinase domain of NTRK1. The recognition and accurate diagnosis of these tumours are important due to the availability of potential targeted therapeutic options.
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Affiliation(s)
- Luca Szalai
- Department of Surgical and Molecular Pathology, National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Ildikó Vereczkey
- Department of Surgical and Molecular Pathology, National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | | | - András Rókusz
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Erzsébet Csernák
- Department of Surgical and Molecular Pathology, National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Erika Tóth
- Department of Surgical and Molecular Pathology, National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Zsombor Melegh
- Department of Surgical and Molecular Pathology, National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary.
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Urbute A, Frederiksen K, Thomsen LT, Kesmodel US, Kjaer SK. Overweight and obesity as risk factors for cervical cancer and detection of precancers among screened women: A nationwide, population-based cohort study. Gynecol Oncol 2024; 181:20-27. [PMID: 38103421 DOI: 10.1016/j.ygyno.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Obesity is a known risk factor for many types of cancer. However, there is no clear evidence whether overweight and obesity increases the risk of cervical cancer. We investigated the association between body mass index (BMI) and detection of squamous and glandular cervical cancer and precancer. METHODS Based on the Medical Birth Registry, we conducted a nationwide cohort study in Denmark of 384,559 women with BMI ≥18.5 kg/m2 (pre-pregnancy BMI reported at the start of the pregnancy) having a cervical cytology screening at age 23-49 years within 5 years following the date of childbirth. The cohort was followed for 10 years from the first cervical cytology screening after the childbirth. We assessed absolute risks of cervical lesions according to BMI with the Aalen-Johansen estimator. We conducted Cox proportional hazards regression analyses to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses were adjusted for age, calendar year, parity, oral contraception use, HPV vaccination, smoking, country of origin, and education. RESULTS Overweight and obesity were associated with higher rates of cervical cancer (HR = 1.24, 95% CI 1.04-1.49 and HR = 1.14, 95% CI 0.91-1.43, respectively) and lower rates of cervical precancer detection (HR = 0.88, 95% CI 0.84-0.92 and HR = 0.67, 95% CI 0.63-0.71, respectively). CONCLUSIONS Higher than normal BMI was associated with higher incidence rates of cervical cancer and lower rates of precancer detection, emphasizing the importance of further research in possible mechanisms behind this association.
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Affiliation(s)
- Aivara Urbute
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data analysis, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Reberbansgade 9, Aalborg, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.
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Rohr Thomsen C, Leonhard AK, Strandbo Schmidt Jensen M, Bor P, Hinge M, Uldbjerg N, Sandager P. Quantitative strain elastography of the uterine cervix assessed by the GE Voluson E10 system in combination with a force-measuring device. J Matern Fetal Neonatal Med 2023; 36:2213797. [PMID: 37202178 DOI: 10.1080/14767058.2023.2213797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE During pregnancy, the stiffness of the cervical tissue decreases long before the cervical length decreases. Therefore, several approaches have been proposed in order to ensure a more objective assessment of cervical stiffness than that achieved by digital evaluation. Strain elastography has shown promising results. This technique is based on an ultrasound assessment of the tissue deformation that occurs when the examiner applies pressure on the tissue with the ultrasound probe. However, the results are only semi-quantitative as they depend on the unmeasured force used by the examiner. We, therefore, hypothesized that a force-measuring device applied to the handle of the ultrasound probe may render the technique quantitative. With this approach, the stiffness is the force (measured by the device) divided by the compression (measured by the elastography platform). One perspective is the early identification of women at risk of preterm birth in whom cervical stiffness may decrease long before cervical shortening. Another perspective is cervical evaluation when planning labor induction. In this feasibility study, we aimed to evaluate how quantitative strain elastography performs when a commercially available strain elastography platform (by which the algorithm is unavailable) is combined with a custom-made, force-measuring device. We studied how the assessments were associated with the gestational age in women with uncomplicated pregnancies and how they were associated with cervical dilatation time from 4 to 10 cm in women undergoing labor induction. METHODS In the analysis, we included quantitative strain elastography assessments from 47 women with uncomplicated singleton pregnancies, with gestational age between 12+0 and 40+0, and from 27 singleton term-pregnant women undergoing labor induction. The force-measuring device was mounted on the handle of a transvaginal probe. The strain values (i.e. the compression of the cervical tissue) were obtained by the elastography software of the ultrasound scanner (GE Voluson E10). The region of interest was placed within the central part of the anterior cervical lip. Based on the force data and strain values, we calculated the outcomes cervical elastography indexGE (CEIGE) and the cervical strength indexGE (CEIGE x cervical length: CSIGE). RESULTS The average CEIGE was 0.24 N at week 12 and 0.15 N at week 30-34. For CSIGE these figures were 8.2 and 4.7 N mm, respectively (p = 0.002). Among women undergoing labor induction, the CEIGE was associated with a cervical dilatation time (4-10 cm) beyond 7 h. For nulliparous women, this area under the ROC curve was 0.94. CONCLUSION Quantitative strain elastography may constitute a tool for the evaluation of a uterine cervix with normal length in women at risk of preterm birth and in women undergoing labor induction. The performance of this tool deserves evaluation in larger clinical trials.
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Affiliation(s)
- Christine Rohr Thomsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, University of Aarhus
| | - Anne Katrine Leonhard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus
| | - Maria Strandbo Schmidt Jensen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus
- Department of Clinical Medicine, Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, University of Aarhus
| | - Mogens Hinge
- Department of Biological and Chemical Engineering, Aarhus University, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus
- Department of Clinical Medicine, Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
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Zhang H, Liu C, Zhai X, Zhang Q, Zhou Y, Huang H, Ding M, Shi Q, Liu Y, Tang Y, Liu G, Wang H. Disfunction of communication among immune cells in minimal-deviation adenocarcinoma of the cervix as an immunotherapeutic opportunity. Int Immunopharmacol 2023; 124:110907. [PMID: 37683397 DOI: 10.1016/j.intimp.2023.110907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/19/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
Minimal deviation adenocarcinoma (MDA) of the uterine cervix, also referred to as malignant adenoma, is a rare subtype of cervical adenocarcinoma that exhibits histological characteristics resembling those of benign tumors, resulting in a low diagnostic rate and a lack of effective treatment options. The transcriptomic features of MDA at the single-cell resolution and within the tumor microenvironment (TME) remain unclear. In this study, we conducted single-cell transcriptomic analyses of MDA samples (Ca) and adjacent normal tissues (PCa). The present study reveals the prevalence of dendritic cells (DCs) and T cells in the carcinoma (Ca) of mammary ductal adenocarcinoma (MDA), with DCs undergoing significant metabolic reprogramming and immune stress. Additionally, our findings demonstrate the crucial involvement of DCs and T cells in the pathogenesis and metastatic progression of MDA, as evidenced by single-cell transcriptomic profiling of MDA and HPV samples. This resource provides a more profound understanding of the indolent nature of MDA and may prove useful in the development of MDA immunotherapy.
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Affiliation(s)
- Hui Zhang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Chunhua Liu
- Department of Physiology and Neurobiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250012, China
| | - Xiaoqian Zhai
- Department of Pathology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Qianqian Zhang
- Department of Obstetrics and Gynecology, Central Hospital Affiliated to Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250012, China
| | - Yao Zhou
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Hu Huang
- Department of Pathology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Mingde Ding
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Qiang Shi
- Department of Radiology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Yan Liu
- Department of Ultrasound, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Ying Tang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No.87, Dingjiaqiao, Gulou District, Nanjing, 210009, China
| | - Guanghai Liu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China.
| | - Hongmei Wang
- School of Medicine, Southeast University, No.87, Dingjiaqiao, Gulou District, Nanjing, 210009, China.
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Thipsanthiah K, Kamsa-ard S, Musika W, Teemuangsai M, Hawlader MDH. Factors Affecting Non-Histologically Proven Invasive Cancer of the Uterine Cervix that Had an Abnormal Pap Smear: Results of the CCS Program. Asian Pac J Cancer Prev 2023; 24:3429-3436. [PMID: 37898847 PMCID: PMC10770662 DOI: 10.31557/apjcp.2023.24.10.3429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) ranks fourth among cancers diagnosed around the world, but early detection and treatment can reduce invasive cervical cancer and mortality. Screening programs (CCSP), such as the one covering Thailand's 75 provinces, use histology to confirm cases. The study determined the incidence rate (IR) and investigated the factors associated with non-histologically proven invasive cancer of the uterine cervix (non-HPICUC) with an abnormal pap smear from the CCSP at Mahasarakham Hospital, Thailand. METHODS The CCSP was used to analyse a retrospective cohort of 288 women between 30 and 60 years of age. All abnormal pap smears were followed up until April 30, 2022. We estimated the IR and assessed the relationship between various independent variables and non-HPICUC using the generalised linear model (GLM) for testing association data. We reported the adjusted RR and 95% confidence intervals (95%CI). RESULTS 260 non-HPICUC cases had abnormal CCSP pap smears for an overall IR of 90.0 (95% CI: 86.3 - 93.2). After adjusting the model for all variables, age at recruitment and pregnancy had a statistically significant association with non-HPICUC (p-value < 0.05). We found that the risk of non-HPICUC increased 1.02 times for every 20-year increment in age compared to below that age (adjusted RR=1.02, 95% CI: 1.01 - 1.04). Pregnancy at risk for non-HPICUC was 0.89 times compared to non-pregnancy (adjusted RR=0.89, 95% CI: 0.80 - 0.99). Pathological vaginal discharge (PVD) did not have a statistically significant association with non-HPICUC (p-value = 0.094); notwithstanding, women with PVD had 1.08 times the risk of non-HPICUC compared to women without PVD (adjusted RR=1.08, 95% CI: 0.97 - 1.20). CONCLUSIONS Based on an abnormal pap smear from the CCS Program at Mahasarakham Hospital Thailand, age and pregnancy are associated with an increased risk of non-HPICUC. High-risk groups with abnormal pap smears should be targeted for CC campaigns.
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Affiliation(s)
| | - Supot Kamsa-ard
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
- ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Wachiraporn Musika
- Bueng Khong Long Hospital, Bueng Khong Long District, Bueng Kan Province, Thailand.
| | - Musika Teemuangsai
- Department of Community Nursing, Mahasarakham Hospital, Mahasarakham Province, Thailand.
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Chao A, Wu RC, Lin CY, Chang TC, Lai CH. Small cell neuroendocrine carcinoma of the cervix: From molecular basis to therapeutic advances. Biomed J 2023; 46:100633. [PMID: 37467967 PMCID: PMC10522988 DOI: 10.1016/j.bj.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
Small cell neuroendocrine carcinoma of the cervix (SCNECC) is an uncommon but aggressive uterine malignancy, the cause of which is generally associated with human papillomavirus (HPV) infection. A lack of clinical trials and evidence-based treatment guidelines poses therapeutic challenges to this rare tumor. At present, published data remain limited to case series and case reports. While clinical management has traditionally followed those of small cell neuroendocrine (SCNE) lung cancer relying on surgery, chemoradiation, and systemic chemotherapy, the prognosis remains dismal. Immune checkpoint inhibitors (ICIs), such as monoclonal antibodies that target programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1), atezolizumab and durvalumab have proven effective in extensive-stage SCNE lung cancer. Moreover, pembrolizumab has also proven beneficial effects when added onto chemotherapy in metastatic and recurrent HPV-associated non-SCNE cervical cancer. It holds promise to use ICIs in combination with chemoradiation to improve the clinical outcomes of patients with SCNECC. Future advances in our understanding of SCNECC biology - associated with the study of its genomic and molecular aberrations as well as knowledge from SCNE of lung and other extrapulmonary sites- would be helpful in discovering new molecular targets for drug development. Collaborative efforts and establishment of a SCNECC-specific biobank will be essential to achieve this goal.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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11
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Wu Y, Ying H, Wang J. Myxoid leiomyosarcoma of the uterine cervix: A case report. Asian J Surg 2023; 46:3835-3836. [PMID: 37019779 DOI: 10.1016/j.asjsur.2023.03.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Yangchun Wu
- Department of Gynecology, Haining Maternal and Child Health Hospital, No. 309, East Shuiyueting Road, Xishi Street, Haining, Zhejiang, 314400, People's Republic of China.
| | - Haixia Ying
- Department of Gynecology, Haining Maternal and Child Health Hospital, No. 309, East Shuiyueting Road, Xishi Street, Haining, Zhejiang, 314400, People's Republic of China
| | - Jianlie Wang
- Department of Gynecology, Haining Maternal and Child Health Hospital, No. 309, East Shuiyueting Road, Xishi Street, Haining, Zhejiang, 314400, People's Republic of China
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12
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Shin E, Yu J, Hong SW. Trouble-makers in cytologic interpretation of the uterine cervix. J Pathol Transl Med 2023; 57:139-146. [PMID: 37194148 DOI: 10.4132/jptm.2023.04.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
The development and standardization of cytologic screening of the uterine cervix has dramatically decreased the prevalence of squamous cell carcinoma of the uterine cervix. Advances in the understanding of biology of human papillomavirus have contributed to upgrading the histologic diagnosis of the uterine cervix; however, cytologic screening that should triage those that need further management still poses several difficulties in interpretation. Cytologic features of high grade intraepithelial squamous lesion (HSIL) mimics including atrophy, immature metaplasia, and transitional metaplasia, and glandular lesion masquerades including tubal metaplasia and HSIL with glandular involvement are described with accentuation mainly on the differential points. When the cytologic features lie in a gray zone between the differentials, the most important key to the more accurate interpretation is sticking to the very basics of cytology; screening the background and cellular architecture, and then scrutinizing the nuclear and cytoplasmic details.
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Affiliation(s)
- Eunah Shin
- Department of Pathology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jaeeun Yu
- Department of Pathology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Soon Won Hong
- Department of Pathology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
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13
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Moshi JM, Ummelen M, Broers JLV, Ramaekers FCS, Hopman AHN. Impact of antigen retrieval protocols on the immunohistochemical detection of epigenetic DNA modifications. Histochem Cell Biol 2023:10.1007/s00418-023-02187-4. [PMID: 37010548 DOI: 10.1007/s00418-023-02187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 04/04/2023]
Abstract
This study compares three different pretreatment protocols for the immunohistochemical detection of 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) in nuclear DNA. The human biological samples analyzed included formalin-fixed and paraffin-embedded (FFPE) normal squamous epithelium, ethanol-fixed cultured cells, and metaphase chromosomes. The antigen retrieval methods included low pH Citrate and high pH Tris-ethylenediaminetetraacetic acid (EDTA) protocols, as well as a method using Pepsin pretreatment combined with HCl for DNA denaturation. A gradual increase in the detection levels of 5-mC and 5-hmC was observed when going from Citrate via Tris/EDTA to Pepsin/HCl retrieval. While the Citrate retrieval protocol was the least efficient for the detection of 5-mC and 5-hmC, it did preserve nuclear morphology and enabled visualization of differences in intra- and internuclear distribution patterns in tissue and cell culture samples by single- and double-fluorescence detection. Quantification of (hydroxy)methylation levels in FFPE material demonstrated a significant heterogeneity and differences in 5-mC and 5-hmC levels within and between nuclei in the different compartments of normal squamous epithelium. It was concluded that immunohistochemical detection of 5-mC and 5-hmC enables the correlation of these DNA modifications with histomorphological features in heterogeneous tissues, but this is influenced by different pretreatment protocols that must be carefully chosen to allow an appropriate interpretation of these epigenetic switches.
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Affiliation(s)
- Jobran M Moshi
- Department of Molecular Cell Biology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Monique Ummelen
- Department of Molecular Cell Biology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jos L V Broers
- Department of Molecular Cell Biology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frans C S Ramaekers
- Department of Molecular Cell Biology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Anton H N Hopman
- Department of Molecular Cell Biology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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14
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Weyl A, Sanson C, Roumiguié M, Chaynes P, Rimailho J, Martinez A, Chantalat E. The lymphatic system of the uterine cervix: towards a more precise definition of the drainage routes. Surg Radiol Anat 2023; 45:653-659. [PMID: 36964332 DOI: 10.1007/s00276-023-03129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Lymph node involvement in cancer of the uterine cervix is a major independent prognostic factor for overall survival. The aim of our study was to examine the lymphatic drainage regions of the different parts of the uterine cervix. METHODS An anatomical study of fresh cadavers was conducted by injecting patent blue in the anterior or posterior lip of the uterine cervix and dissecting drainage regions. Furthermore, a retrospective radiological and pathological studies were conducted on patients who were treated for early-stage cancer of the uterine cervix with lymph node involvement. Radiological analysis of pre-therapeutic MRIs and/or pathological analysis of surgical specimens showed the precise location of the tumour. A correlation between the anatomy of the primary lesion site and the lymphatic area involved was established. RESULTS We administered 15 cadaveric injections: 8 in the anterior lip of the uterine cervix and 7 in the posterior one. For 100% of the anterior lip injections, lymphatic drainage was bilateral ileo-obturator (n = 8/8) combined with bilateral parametrial drainage. For the posterior injections, there was never any ileo-obturator drainage, and 6 of the 7 (75%) posterior injections drained in the posterior uterine serosa. Concerning the clinical study, we included 21 patients. We observed a non-significant tendency towards bilateral lymph node involvement when the tumour of the anterior lip. CONCLUSION Physiological lymphatic drainage of the uterine cervix presents anatomical specificities, depending on the structure studied, anterior or posterior lip of the cervix. Better knowledge of these specificities should allow personalized surgery for each patient.
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Affiliation(s)
- Ariane Weyl
- Department of Gynaecological Surgery, University Hospital of Toulouse, Rangueil, Toulouse, France.
- Department of Anatomy, Faculty of Medicine, Rangueil, Paul Sabatier Toulouse III University, Toulouse, France.
- Department of Oncological Surgery, University Hospital of Toulouse, Toulouse University Cancer Institute-Oncopole, Toulouse, France.
| | - Claire Sanson
- Department of Gynaecological Surgery, University Hospital of Toulouse, Rangueil, Toulouse, France
- Department of Anatomy, Faculty of Medicine, Rangueil, Paul Sabatier Toulouse III University, Toulouse, France
- Department of Oncological Surgery, University Hospital of Toulouse, Toulouse University Cancer Institute-Oncopole, Toulouse, France
| | - Matthieu Roumiguié
- Department of Anatomy, Faculty of Medicine, Rangueil, Paul Sabatier Toulouse III University, Toulouse, France
- Department of Gynaecological Surgery, University Hospital of Toulouse, Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - Patrick Chaynes
- Department of Anatomy, Faculty of Medicine, Rangueil, Paul Sabatier Toulouse III University, Toulouse, France
- Department of Neurosurgery, Pierre Paul Riquet University Hospital of Toulouse, Toulouse, France
| | - Jacques Rimailho
- Department of Gynaecological Surgery, University Hospital of Toulouse, Rangueil, Toulouse, France
- Department of Anatomy, Faculty of Medicine, Rangueil, Paul Sabatier Toulouse III University, Toulouse, France
- Department of Oncological Surgery, University Hospital of Toulouse, Toulouse University Cancer Institute-Oncopole, Toulouse, France
| | - Alejandra Martinez
- Department of Oncological Surgery, Claudius Régaud Institute, Toulouse University Cancer Institute-Oncopole, Toulouse, France
| | - Elodie Chantalat
- Department of Gynaecological Surgery, University Hospital of Toulouse, Rangueil, Toulouse, France
- Department of Anatomy, Faculty of Medicine, Rangueil, Paul Sabatier Toulouse III University, Toulouse, France
- Department of Oncological Surgery, University Hospital of Toulouse, Toulouse University Cancer Institute-Oncopole, Toulouse, France
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15
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Weng X, Huang M, Zhang M, Yang Y, Liu X, Huang Y. Primary lymphoma of the uterine cervix: a clinicopathologic study of 13 cases with review of additional 54 cases in the literature. Virchows Arch 2023; 482:419-429. [PMID: 36350409 DOI: 10.1007/s00428-022-03436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
Primary lymphoma of the uterine cervix (LUCX) is extremely rare, and its diagnosis is challenging. However, its clinicopathological features have not been well characterized. Thirteen primary LUCX patients were retrospectively studied, and 54 patients from the literature were reviewed. Primary LUCX was identified in 0.22% (13/6000) of patients with uterine cervical malignancies in our institution. The patients' median age was 51 years (range: 22-85 years). All patients had a bulk of neoplasms in the uterine cervix. The median tumour diameter was 6 cm (range: 1.5-10 cm). Approximately 78.0% (39/50) of the patients initially presented with irregular vaginal bleeding or discharge. Moreover, 86.7% (39/45) had Ann Arbor stage I or II. Diffuse large B-cell lymphoma, not otherwise specified, was the most common type, accounting for 85.0% (57/67) of primary LUCX cases. Follicular lymphoma (7.5%, 5/67), extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (4.5%, 3/67), mantle cell lymphoma (MCL), blastoid variant (1.5%, 1/67), and peripheral T-cell lymphoma (1.5%, 1/67) were occasionally observed. Three patients (7.1%, 3/42) with DLBCL, NOS died from the disease during the follow-up period. Their 5-year overall survival (OS) rate was 93.5%. The patient with MCL, blastoid variant in our present cohort died of the disease 33 months after diagnosis. Primary LUCX is an extremely rare condition. The clinical symptoms are non-specific. DLBCL, NOS is the most common histologic type, showing a favourable outcome with accurate diagnosis and timely and optimal treatment.
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Affiliation(s)
- Xin Weng
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Mayan Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Meng Zhang
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yajie Yang
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xia Liu
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yuhua Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
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16
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Tang X, Feng M, Shen Y, Chen Q. Perivascular epithelioid cell tumor of the uterine cervix identified on the liquid-based cytology: a case report. Diagn Pathol 2023; 18:7. [PMID: 36647157 PMCID: PMC9841702 DOI: 10.1186/s13000-023-01290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumor (PEComa) occurring in the female genital tract are rare, and typically found in the uterine corpus. PEComa occurring in the cervix is extremely rare, and very few cases have been reported till now. Cytological diagnosis of cervical PEComa is even rarer. So far, only two cases of PEComa diagnosed by conventional cervical smears have been reported. CASE PRESENTATION A 55-year-old postmenopausal woman presented with abnormal vagina discharge for 3 months. A liquid-based cytology test was performed. Microscopically, some loosely cohesive epithelioid cells were uniform with abundant clear cytoplasm, showing predominantly round or oval nuclei with finely stippled chromatin. Distinct round nucleoli were visible in some cells, notably with numerous melanin pigments in the cytoplasm. The cytopathological features were well correlated with cell block and histopathological findings. Upon immunohistochemistry (IHC), the tumor cells were positive for HMB45 and TFE3, focally positive for MelanA, while negative for muscle marker. Fluorescence in situ hybridization (FISH) confirmed TFE3 gene rearrangement. The final pathological diagnosis was PEComa identified by the liquid-based cytology, cell block, cervical biopsy, IHC and FISH result. The patient underwent a total hysterectomy with bilateral salpingo-oophorectomy and was followed up for 2 years with no evidence of disease. CONCLUSION The cytologic characteristics of the tumor can provide sufficient clues for PEComa diagnosis, which includes loosely cohesive, epithelioid morphology with abundant clear or eosinophilic cytoplasm, low-grade nuclear atypia, cytoplasmic melanin pigments. This will help cytopathologists to recognize this rare tumor that occurred in the cervix, and the combination of predictive morphology evaluation, immunophenotype, and molecular testing can achieve the definitive diagnosis of PEComa.
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Affiliation(s)
- Xiao Tang
- grid.461863.e0000 0004 1757 9397Department of Pathology, West China Second University Hospital, Sichuan University, No.20, Section 3, South Renmin Road, Chengdu, 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Min Feng
- grid.461863.e0000 0004 1757 9397Department of Pathology, West China Second University Hospital, Sichuan University, No.20, Section 3, South Renmin Road, Chengdu, 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yangmei Shen
- grid.461863.e0000 0004 1757 9397Department of Pathology, West China Second University Hospital, Sichuan University, No.20, Section 3, South Renmin Road, Chengdu, 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qijun Chen
- grid.461863.e0000 0004 1757 9397Department of Pathology, West China Second University Hospital, Sichuan University, No.20, Section 3, South Renmin Road, Chengdu, 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Loménie N, Bertrand C, Fick RH, Ben Hadj S, Tayart B, Tilmant C, Farré I, Azdad SZ, Dahmani S, Dequen G, Feng M, Xu K, Li Z, Prevot S, Bergeron C, Bataillon G, Devouassoux-Shisheboran M, Glaser C, Delaune A, Valmary-Degano S, Bertheau P. Can AI predict epithelial lesion categories via automated analysis of cervical biopsies: The TissueNet challenge? J Pathol Inform 2022; 13:100149. [PMID: 36605109 PMCID: PMC9808029 DOI: 10.1016/j.jpi.2022.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 12/26/2022] Open
Abstract
The French Society of Pathology (SFP) organized its first data challenge in 2020 with the help of the Health Data Hub (HDH). The organization of this event first consisted of recruiting nearly 5000 cervical biopsy slides obtained from 20 pathology centers. After ensuring that patients did not refuse to include their slides in the project, the slides were anonymized, digitized, and annotated by expert pathologists, and finally uploaded to a data challenge platform for competitors from around the world. Competing teams had to develop algorithms that could distinguish 4 diagnostic classes in cervical epithelial lesions. Among the many submissions from competitors, the best algorithms achieved an overall score close to 95%. The final part of the competition lasted only 6 weeks, and the goal of SFP and HDH is now to allow for the collection to be published in open access for the scientific community. In this report, we have performed a "post-competition analysis" of the results. We first described the algorithmic pipelines of 3 top competitors. We then analyzed several difficult cases that even the top competitors could not predict correctly. A medical committee of several expert pathologists looked for possible explanations for these erroneous results by reviewing the images, and we present their findings here targeted for a large audience of pathologists and data scientists in the field of digital pathology.
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Affiliation(s)
- Nicolas Loménie
- LIPADE, UFR Mathématiques-Informatiques, Université Paris Cité, 45 rue des Saints-Pères, 75006 Paris, France,Corresponding author.
| | | | | | | | | | | | | | | | - Samy Dahmani
- Algoscope, 9 rue Gaspard Monge, 60200 Compiègne, France
| | - Gilles Dequen
- Laboratoire Modélisation, Information, Systèmes (MIS), Université de Picardie Jules Verne, 80080 Amiens, France
| | | | - Kele Xu
- Tongji University, Shanghai, China
| | - Zimu Li
- Tongji University, Shanghai, China
| | - Sophie Prevot
- Pathologie, CHU Bicêtre, APHP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | | | | | - Mojgan Devouassoux-Shisheboran
- Centre de Pathologie Sud des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite Cedex, France
| | - Claire Glaser
- Pathologie, CHG Versailles, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Agathe Delaune
- Plateforme de données de santé - Health Data Hub, 9 rue Georges Pitard, 75015 Paris, France
| | - Séverine Valmary-Degano
- Pathologie, Université Grenoble Alpes, Inserm U1209, CNRS UMR5309, Institute for Advanced Biosciences, CHU, Grenoble 38000, France
| | - Philippe Bertheau
- Pathologie, CHU Saint-Louis, APHP, Université Paris Cité, 1 avenue Claude Vellefaux, 75010 Paris, France
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Dhanaraj PC, Ulaganathan M, Renuka RR, Pandiyan R, Periasamy P. Histomorphological Evaluation of Non-Neoplastic Lesions of Uterine Cervix and a Correlation of the Lesion with the Clinical Factors. Cardiovasc Hematol Agents Med Chem 2022; 21:31-41. [PMID: 35658885 DOI: 10.2174/1871525720666220603111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/05/2022] [Accepted: 03/30/2022] [Indexed: 02/08/2023]
Abstract
AIM This study investigates the prevalence of non-malignant lesions of the cervix among various biopsy samples. METHODS This case study consists of 50 cases of cervical biopsy over almost two years. The case history and clinical details of the patients were obtained. RESULTS 60% of the cases that participated in this study reported white discharge per vaginum as a common clinical symptom. 4 cases (8%) showed koilocytic changes specific to the human papillomavirus during the study. Only 2% of the non-specific cervicitis showed lymphoid aggregates. Endocervical changes projected papillary endocervicitis with 9 cases (18%), squamous metaplasia with 7 cases (14%), and nabothian follicle cyst with 3 cases (6%). CONCLUSION It has been concluded that 50 cases were studied histologically, which had adequate representation of both ecto and endocervical tissue. Moreover, 31-40 years of age of patients showed the highest percentage of non-neoplastic lesions of the cervix when compared to other age groups.
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Affiliation(s)
- Prem Charles Dhanaraj
- Department of Pathology, Government Erode Medical College, Perundurai, Erode, Tamilnadu-638 052, India
| | - Manohar Ulaganathan
- Department of Pathology, Rajah Muthiah Medical College and Hospitals, Annamalai Nagar, Chidambaram, Tamilnadu- 608 002, India
| | - Remya Rajan Renuka
- Department of Materials Engineering and Regenerative Medicine, Bharath Institute of Higher Education and Research, 173, Agharam Road, Selaiyur, Chennai, Tamilnadu-600 073, India
| | - Rajesh Pandiyan
- Department of Materials Engineering and Regenerative Medicine, Bharath Institute of Higher Education and Research, 173, Agharam Road, Selaiyur, Chennai, Tamilnadu-600 073, India
| | - Panneerselvam Periasamy
- Department of Physiology, Government Erode Medical College, Perundurai, Erode, Tamilnadu-638 052, India
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19
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Urbute A, Kjaer SK, Kesmodel US, Frederiksen K, Thomsen LT. Women with obesity participate less in cervical cancer screening and are more likely to have unsatisfactory smears: Results from a nationwide Danish cohort study. Prev Med 2022; 159:107072. [PMID: 35460722 DOI: 10.1016/j.ypmed.2022.107072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022]
Abstract
Some studies found an association between obesity and increased cervical cancer risk, but potential mechanisms are unknown. In this nationwide register-based cohort study, we investigated the association between overweight/obesity and cervical cancer screening participation and risk of unsatisfactory smears. The study population was identified in the Danish Medical Birth Registry. We included 342,526 women aged 23-49 years with pre-pregnancy body mass index (BMI) registered during 2004-2013. Screening participation and unsatisfactory smears during up to four years after child birth were identified in a nationwide pathology register. We used absolute risk regression to estimate the relative absolute risk (RAR) with 95% confidence intervals (CIs) of screening participation according to BMI, adjusted for age, calendar year, sociodemographic characteristics, parity and previous high-grade cervical intraepithelial neoplasia. Among those who were screened (n = 295,482), we used log-binomial regression to investigate the relative risk (RR) of an unsatisfactory smear according to BMI, adjusted for age, year, parity, oral contraceptive use and pathology department. A lower proportion of obese women (79.3%) than women of normal weight (85.8%) were screened, and obese women had lower adjusted probability of being screened than women of normal weight (RARadjusted = 0.94, 95% CI, 0.93-0.95). A higher proportion of obese women (2.4%) than women of normal weight (1.7%) had an unsatisfactory smear, and this association remained after adjustments (RRadjusted = 1.28, 95% CI, 1.19-1.38). In conclusion, women with obesity were less likely to participate in cervical cancer screening and more likely to have an unsatisfactory smear than women of normal weight.
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Cimic A, Smithgall MC, Khoury-Collado F, Liu-Jarin X, Vranic S. Value of additional sections: Tissue handling of small biopsies in detecting squamous dysplasia of the uterine cervix. Ann Diagn Pathol 2021; 56:151872. [PMID: 34896888 DOI: 10.1016/j.anndiagpath.2021.151872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/29/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
Abstract
Cervical cancer screening is currently based on high-risk human papillomavirus (HR-HPV) molecular testing, Pap cytology testing, and histologic evaluation of cervical biopsies. As primary HPV screening for cervical cancer becomes widely used, some of the recommended screening guidelines propose colposcopy and biopsies following positivity for HPV16/18 without cytologic triage. In such instances, a biopsy would be the only tissue sample available for informing further management. The use of additional histologic levels on cervical biopsies is commonly employed to achieve a diagnosis, although no set criteria for when to obtain additional levels exist. In this study, we evaluated the value of additional sections in cervical biopsy and endocervical curetting, as well as clinical and histologic features that should be considered when ordering additional levels. Additional levels were obtained for the following scenarios: benign mucosa with Pap discrepancy (HSIL or ASC-H interpretation), size discrepancy with the gross description, suspicious atypia for a high-grade lesion, and long-standing high-risk HPV infection. A change in diagnosis was observed in 21.4% of the cases, with an upgrade to a high-grade squamous intraepithelial lesion (CIN2-3) in 12.1% of cases. An initial impression of atypia significantly correlated with both a change in diagnosis and an upgrade to CIN2-3. In the era of primary HPV screening, when evaluating tissue samples following positive HPV test, small, atypical foci should be followed by additional levels. We recommend six (6) initial levels on all cervical biopsies, particularly if there is no loss of tissue between the levels, to ensure an accurate interpretation. This will be crucial in the timely and accurate identification of HPV-related intraepithelial lesions and proper subsequent management.
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Affiliation(s)
- Adela Cimic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, United States.
| | - Marie C Smithgall
- Department of Pathology, Weill Cornell Medicine, New York, NY, United States
| | - Fady Khoury-Collado
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Xiaolin Liu-Jarin
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, United States
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar; Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
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21
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Torino G, Roberti A, Turrà F, Donofrio V, Bifano D, Abate M, Iorio GD. Laparoscopic Trachelectomy for Cervix Yolk Sac Tumor in 11-Month-Old Girl: The Youngest Case. J Pediatr Adolesc Gynecol 2021; 34:872-875. [PMID: 34157379 DOI: 10.1016/j.jpag.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Yolk sac tumor (YST) is a malignant entity that often occurs in girls less than 3 years of age and is the most frequent type of primary extragonadal germ cell tumor. CASE We describe the case of an 11-month-old girl who was referred to our center for vaginal bleeding with evidence of a uterine mass on ultrasonography. Preoperative investigations confirmed YST of the uterine cervix without metastasis. After 4 cycles of systemic chemotherapy, the patient was treated with laparoscopic trachelectomy (fertility-sparing surgery) without perioperative complications. SUMMARY AND CONCLUSION After 12 months of follow-up, no residual mass was seen. The laparoscopic technique for trachelectomy for uterine cervix YST seems to be feasible and safe in children under 1 year of age.
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Affiliation(s)
- Giovanni Torino
- Pediatric Urology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Agnese Roberti
- Pediatric Urology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Francesco Turrà
- Pediatric Urology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Vittoria Donofrio
- Pediatric Pathology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Delfina Bifano
- Pediatric Pathology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Massimo Abate
- Pediatric Oncology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Di Iorio
- Pediatric Urology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
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22
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Yoo SH, Kim KR, Park NJY. Transitional cell metaplasia of the uterine cervix: A histopathological and immunohistochemical analysis suggesting a possible role of androgenic conversion during urothelial-like differentiation in peri/postmenopausal women. Ann Diagn Pathol 2021; 56:151839. [PMID: 34784541 DOI: 10.1016/j.anndiagpath.2021.151839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
Transitional cell metaplasia (TCM) of the uterine cervix and vagina is typically seen in patients with adrenogenital syndrome with high serum androgen levels and in those under androgen treatment as well as in some peri/postmenopausal women. Considering that TCM occurs in patients with increased serum androgen levels, a microenvironment with altered sex hormones might be involved in the urothelial-like differentiation observed in TCM. To investigate a histogenetic role of androgen in TCM development, we compared the distribution patterns and intensity of androgen receptor (AR), estrogen receptor (ER), GATA3 (a transcription factor involved in androgen regulation), Ki-67, and AKR1C3 (an enzyme involved in androgen biosynthesis) expression in normal exocervical mucosa in young women (n = 25), senile atrophy (n = 23), and TCM (n = 29). In TCM, AR, ER, AKR1C3, and GATA3, expression was stronger and significantly increased upward into the intermediate and superficial layers compared with the senile atrophic mucosa and normal mucosa in young women. The epithelial layer in TCM is thicker than that in senile atrophic mucosa, although both conditions may occur in the same age group. Proliferation in TCM was significantly lower than that in young women but slightly higher than that in senile atrophy. Considering the conversion activity of AKR1C3, thicker epithelial layers in TCM compared with those in senile atrophy might be due to increased conversion of androstenedione to testosterone via increased AKR1C3 activity, increased conversion of testosterone to 17β-estradiol by aromatization, and AR activation.
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Affiliation(s)
- Su Hyun Yoo
- Department of Pathology, University of Inje Collage of Medicine, Sanggye Baik Hospital, Seoul, Republic of Korea
| | - Kyu-Rae Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Nora Jee-Young Park
- Department of Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
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23
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Xu J, Zhang W. Cervical adenosquamous carcinomas: A case report. Asian J Surg 2021; 44:1423-1424. [PMID: 34312055 DOI: 10.1016/j.asjsur.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jian Xu
- Department of Pathology, Zhongnan Hospital of Wuhan University; Wuhan, 430071, Hubei, China
| | - Wanyu Zhang
- Department of Pathology, Zhongnan Hospital of Wuhan University; Wuhan, 430071, Hubei, China.
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24
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Chen J, Sun Y, Chen L, Zang L, Lin C, Lu Y, Lin L, Lin A, Dan H, Chen Y, He H. Prognostic factors and treatment of neuroendocrine tumors of the uterine cervix based on the FIGO 2018 staging system: a single-institution study of 172 patients. PeerJ 2021; 9:e11563. [PMID: 34268005 PMCID: PMC8269661 DOI: 10.7717/peerj.11563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/14/2021] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to explore the prognostic factors and outcomes of patients with neuroendocrine tumors (NETs) of the cervix and to determine appropriate treatment. Methods A single-institution retrospective analysis of 172 patients with NETs was performed based on the new International Federation of Gynecology and Obstetrics (FIGO 2018) staging system. Results Among the 172 eligible patients, 161 were diagnosed with small cell neuroendocrine carcinoma (SCNEC), six with large cell neuroendocrine carcinoma, four with typical carcinoid tumors and one with SCNEC combined with an atypical carcinoid tumor. According to the FIGO 2018 staging guidelines, 31 were stage I, 66 were stage II, 57 were stage III, and 18 were stage IV. The 5-year survival rates of patients with stage I–IV disease were 74.8%, 56.2%, 41.4% and 0%, respectively. The 5-year progression-free survival rates of patients with stage I–IV disease were 63.8%, 54.5%, 30.8% and 0%, respectively. In the multivariate analysis, advanced FIGO stage, large tumor and older age were identified as independent variables for 5-year survival in patients with stage I–IV disease. FIGO stage, tumor size and para-aortic lymph node metastasis were independent prognostic factors for 5-year progression-free survival in patients with stage I–IV disease. For the patients receiving surgery (n = 108), tumor size and pelvic lymph node metastasis were independent prognostic factors for 5-year survival, and pelvic lymph node metastasis for 5-year progression-free survival. In stage IVB, at least six cycles of chemotherapy (n = 7) was associated with significantly better 2-year OS (83.3% vs. 9.1%, p < 0.001) and 2-year PFS (57.1% vs. 0%, p = 0.01) than fewer than six cycles of chemotherapy(n = 11). Conclusion Advanced FIGO stage, large tumor, older age and lymph node metastasis are independent prognostic factors for NETs of the cervix. The TP/TC and EP regimens were the most commonly used regimens, with similar efficacies and toxicities. Standardized and complete multimodality treatment may improve the survival of patients with NETs.
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Affiliation(s)
- Jian Chen
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yang Sun
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Li Chen
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Lele Zang
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Cuibo Lin
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yongwei Lu
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Liang Lin
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - An Lin
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Hu Dan
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yiyu Chen
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Haixin He
- Department of Gynecological-Surgical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
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25
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Pei X, Xiang L, Chen W, Jiang W, Yin L, Shen X, Zhou X, Yang H. The next generation sequencing of cancer-related genes in small cell neuroendocrine carcinoma of the cervix. Gynecol Oncol 2021; 161:779-786. [PMID: 33888337 DOI: 10.1016/j.ygyno.2021.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Small cell neuroendocrine carcinoma of the cervix (SCNEC) is a lethal malignancy and little treatment progress has been made for decades. We sought to map its genetic profiles, and identify whether SCNEC harbor mutations and potential targets for therapeutic interventions. METHODS Primary tumor tissue and blood samples were obtained from 51 patients with SCNEC. The next-generation sequencing was carried out to detect mutations of 520 cancer-related genes, including the entire exon regions of 312 genes and the hotspot mutation regions of 208 genes. Quantitative multiplex PCR was performed for the detection of seven high-risk HPV types. RESULTS Of the 51 detected patients, 92.16% were positive for HPV 18. Ninety-eight percent of cases harbored genetic alterations. Two cases were observed with hypermutated phenotype and determined as MSI-H/dMMR. Genetic mutations were clustering in RTK/RAS(42.86%), PI3K-AKT(38.78%), p53 pathway(22.45%) and MYC family(20.41%). Mutations in genes involved in the p53 pathway indicate a poorer prognosis (3-year OS, 33.5% vs 59.9%, p = 0.031). A total of seven patients harboring mutations in homogeneous recombination repair (HRR) genes were reported. In addition, IRS2 and SOX2 were amplified in 14.9% and 6.12% of SCNEC patients, respectively. CONCLUSIONS SCNEC is specifically associated with HPV 18 infection. Its genetic alterations are characterized by a combined feature of high-risk HPV driven events and mutations observed in common neuroendocrine carcinoma. We identified several targetable mutated genes, including KRAS, PIK3CA, IRS2, SOX2, and HRR genes, indicating the potential efficacy of target therapies in these patients. MSI-H/dMMR individuals may benefit from checkpoint blockade therapies.
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Affiliation(s)
- Xuan Pei
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Libing Xiang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan hospital, Fudan University, Shanghai 200032, China
| | - Wei Chen
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, The Central Hospital of Minhang District, Shanghai 200032, China
| | - Wei Jiang
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lina Yin
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xuxia Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Pathology, Fudan university Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaoyan Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Pathology, Fudan university Shanghai Cancer Center, Shanghai 200032, China
| | - Huijuan Yang
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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26
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Breitkopf DM. Lateral decubitus position to facilitate pelvic examination of the patient with severe obesity. BMC Womens Health 2021; 21:143. [PMID: 33827544 DOI: 10.1186/s12905-021-01289-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/30/2021] [Indexed: 12/22/2022]
Abstract
Background Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. Methods A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized. Results Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. Conclusions In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.
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27
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Park JY, Lee YH, Chong GO, Hong DG. A uterine cervix supporting device (Con-CapTM) for reducing canal stenosis after Loop Electrosurgical Excisional Procedure. Technol Health Care 2021; 29:955-962. [PMID: 33843706 DOI: 10.3233/thc-202639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACGROUND Cervical stenoses are one of the main long-term consequences after conization of the uterine cervix. OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of a uterine cervix supporting device (Con-CapTM) in reducing uterine cervical stenosis after Loop Electrosurgical Excisional Procedure (LEEP). METHODS We enrolled 112 patients who underwent LEEP between March 2017 to May 2019. Con-CapTM was inserted into the uterine endocervical canal for 4 weeks after LEEP. Laboratory values and clinical symptoms were evaluated. The presence of uterine cervical narrowing was determined at 2 weeks after removal of the Con-CapTM. Data were analyzed using the two-sample t test and χ2 test. RESULTS A total of 78 women completed the 6-week study period. Thirty-four patients did not complete the study period. The diameter of the uterine cervical canal was significantly greater at postoperative 6 weeks than preoperatively (Hegar dilator No, 2.10 ± 0.56 vs. 3.21 ± 0.71, P< 0.01). The complications were acceptable. CONCLUSIONS Con-CapTM can be used to reduce uterine cervical stenosis safely and effectively after conization of uterine cervix.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Xu Q, Sun L, Zhang W, Wu H, Jiao C, Xu L, Qian X, Yao H, Chen Q, Xu F, Fu F, Feng Y, Wang L, Chen X. A novel visceral pain model of uterine cervix inflammation in rat. Eur J Pharmacol 2021; 900:174080. [PMID: 33811839 DOI: 10.1016/j.ejphar.2021.174080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Treatment of visceral pain originating from the uterine cervix is a substantial clinical problem. The underlying mechanisms of such visceral pain remain unclear mainly due to a lack of reliable model. This study aimed to develop and evaluate the performance of a rat model of pain induced by uterine cervix inflammation. Rats were randomized to six groups according to the solution injected into the uterine cervix: normal saline, vehicle, capsaicin (0.3 mg, 0.6 mg, 0.9 mg), capsaicin 0.9 mg + morphine (n = 15 in each group). Spontaneous behaviors after cervical injection were recorded by a computerized video system and analyzed offline. An equation for calculating a novel pain score was derived from particular behaviors, based on Pearson's correlation analysis and regression analysis. c-Fos expression in the spinal cord was detected. The pain score and c-fos expression in the spinal cord were highest in the 0.9 mg capsaicin group and lowest in the normal saline and vehicle groups (P < 0.05). Intrathecal morphine significantly decreased the pain score (P < 0.05) and c-fos expression in the spinal cord (P < 0.05). Injection of capsaicin into the uterine cervix in rats could be a practical model of inflammatory cervical pain, which can be evaluated using our novel pain score. This model will provide further insight into the mechanism underlying visceral pain originating from the uterine cervix.
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Affiliation(s)
- Qi Xu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihong Sun
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenxin Zhang
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cuicui Jiao
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lili Xu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaowei Qian
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huaqi Yao
- Department of Anesthesia, Maternity and Child Care Hospital, Huzhou, China
| | - Qing Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Xu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Fu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Feng
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyang Wang
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinzhong Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Latul YP, Kastelein AW, Beemster PWT, van Trommel NE, Ince C, Roovers JPWR. Noninvasive, in vivo assessment of the cervical microcirculation using incident dark field imaging. Microvasc Res 2021; 135:104145. [PMID: 33571547 DOI: 10.1016/j.mvr.2021.104145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
AIM This study evaluates the feasibility of handheld vital microscopy for noninvasive, objective assessment of the microcirculation of the human uterine cervix. We qualitatively and quantitatively describe the microcirculation in healthy subjects in order to provide a basis for its application in cervical pathology. METHODS Incident dark field imaging was used to image the microcirculation in four quadrants of the uterine ectocervix in ten healthy participants. If the squamocolumnar junction was visible, measurements were repeated on the endocervical columnar epithelium as well. Image acquisition time was recorded and participants scored the experienced level of discomfort. Angioarchitecture was classified according to Weber's classification. Quantitative parameters included capillary density (CD), total and perfused vessel density (TVD, PVD), proportion of perfused vessels (PPV) and microvascular flow index (MFI). RESULTS Image acquisition was easy, fast and well tolerated. Angioarchitecture was characterized by two distinctive and organized patterns; capillary loops underneath the squamous epithelium of the ectocervix and vascular networks underneath the columnar epithelium. In the image sequences containing capillary loops, mean CD was 33.2 cpll/mm2 (95% CI 28.2-38.2 cpll/mm2). In the image sequences with vascular networks, mean TVD was 12.5 mm/mm2 (95% CI 11.2-13.77 mm/mm2), mean PVD was 12.2 (95% CI 11.0-13.5 mm/mm2), MFI was 3 and PPV was 100%. CONCLUSIONS Incident dark field imaging allows for noninvasive, real time visualization and objective evaluation and quantification of the microcirculation of the uterine cervix. The organized vascular patterns and optimal perfusion observed in healthy subjects allow for comparison with cervical pathology, for example in patients with cervical dysplasia or cervical cancer.
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Affiliation(s)
- Yani P Latul
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Arnoud W Kastelein
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Patricia W T Beemster
- Bergman Clinics, Department of Gynaecology, Bergman Vrouwenzorg, Nijenburg 152, 1081 GG Amsterdam, the Netherlands
| | - Nienke E van Trommel
- Center for Gynecologic Oncology Amsterdam, Location Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Can Ince
- Erasmus Medical Center, Department of Intensive Care, Laboratory of Translational Intensive Care, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Jan-Paul W R Roovers
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Bergman Clinics, Department of Gynaecology, Bergman Vrouwenzorg, Nijenburg 152, 1081 GG Amsterdam, the Netherlands
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Srisomboon S, Tantipalakorn C, Muangmool T, Srisomboon J. Risk of High-Grade Cervical Lesions in Atypical Squamous Cells of Undetermined Significance (ASC-US) Cytology: Comparison between HIV-Infected and HIV-Negative Women. Asian Pac J Cancer Prev 2021; 22:547-551. [PMID: 33639672 PMCID: PMC8190363 DOI: 10.31557/apjcp.2021.22.2.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background and objective: Women with human immunodeficiency virus (HIV) infection have an increased risk of HPV infection, cervical neoplasia. This study was undertaken to compare the risk of having high-grade cervical lesions defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HIV-infected versus HIV-uninfected women who had atypical squamous cells of undetermined significance (ASC-US) on cervical cytology. Methods: Fifty-seven HIV-positive women aged 25-65 years with ASC-US cytology undergoing colposcopic examination between January 2008 and December 2020 at Chiang Mai University Hospital were reviewed. By matching 1:5 ratio, 285 HIV-negative women with ASC-US cytology in the same period were recruited as controlled subjects for comparison. The patient characteristics, HIV status, CD4 cell count within 6 months of colposcopy, antiretroviral therapy, parity, contraception, smoking history, number of sexual partners, and histopathology on cervical biopsy were analyzed. Results: Mean age ± SD of the HIV-positive and HIV-negative groups was 44.28 ± 8.53 years and 44.28 ± 9.68 years, respectively. HIV-positive women were significantly less likely to use contraceptive methods (36.8 % versus 48.8 % in HIV-negative women; P = 0.002). HIV-infected women significantly had more sexual partners than HIV-uninfected women. Both groups had similar risk for CIN 2+ (5.3 % in HIV-positive women compared with 4.9 % in HIV-negative women; odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.30 –3.87). After adjustment for no contraception use and number of sexual partners, the risk of CIN2+ in HIV-infected women remained unchanged; adjusted OR= 1.15, 95% CI = 0.27-4.92, P= 0.846). Conclusion: The risk of underlying high-grade cervical lesions in women with ASC-US on cervical cytology was approximately 5 %, regardless of HIV status.
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Affiliation(s)
- Santipap Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Charuwan Tantipalakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jatupol Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Ran R, Wang M, Li X, Liu Q. A prospective study of photodynamic therapy for cervical squamous intraepithelial lesion. Photodiagnosis Photodyn Ther 2021; 34:102185. [PMID: 33454394 DOI: 10.1016/j.pdpdt.2021.102185] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/19/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for the treatment of cervical squamous intraepithelial lesion (SIL). METHODS We prospectively screened and enrolled patients with cervical SIL and persistent high-risk human papilloma virus (HR-HPV) infection to receive ALA-PDT from March 27, 2019, to January 23, 2020, at Beijing Youan Hospital, China. The primary outcome was the remission rate of SIL and HPV. The secondary outcome was the symptom improvement and adverse events of ALA-PDT in these cases. RESULTS 54 patients with cervical SIL and persistent HR-HPV infection were enrolled and divided these individuals into three groups: high-grade squamous intraepithelial lesion (HSIL) group (10 patients), low-grade squamous intraepithelial lesion (LSIL) group (33 patients), and simple HR-HPV infection group (11 patients). 49 of 54 patients finished six sessions treatment and 46 of 49 patients complete the follow-up. After six sessions' treatment, HR-HPV remission rates were 71.43 %(5/7)in the simple HR-HPV infection group, 63.64 %(14/22) in the LSIL group, and 50 %(4/8) in the HSIL group. The histology remission rates were 80 %(4/5) in the simple HR-HPV infection group, 69.57 %(16/23)in the LSIL group, and 75 % (6/8) in the HSIL group. Symptoms improvement rates in the simple HR-HPV infection, LSIL group, and HSIL group were 100 %(5/5), 66.67 %(5/15) and 71.43 %(5/7). No severe adverse events or systemic side effects were observed in treatment. CONCLUSION Topical ALA-PDT is an effective and safe treatment for cervical SIL.
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Affiliation(s)
- Ran Ran
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ming Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiulan Li
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Qing Liu
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
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Hajsadeghi S, Pakbaz M, Sadeghipour A, Zeraatian Nejad Davani S, Shamsedini A. A rare case of cardiac metastasis from uterine cervical adenocarcinoma. J Cardiol Cases 2020; 24:30-33. [PMID: 34257758 DOI: 10.1016/j.jccase.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Metastatic cardiac tumors are rare and are usually from lung, breast, and esophageal cancers. Although uterine cervical cancer is relatively common, its metastasis to the heart is extremely rare. Herein, we report an unusual case of metastatic cervical adenocarcinoma to the heart presenting with a huge right atrial mass and tamponade. The cardiac mass was surgically resected and pathologic study with immunohistochemistry staining confirmed the diagnosis. <Learning objective: Metastatic cardiac tumors are rare. They usually originate from lung, breast, and esophageal cancers and mostly involve the pericardium and myocardium. The endocardium is rarely affected. Cervical cancer is one of the most common gynecologic cancers with a relatively favorable prognosis unless it metastasizes to distant organs. Metastases to the heart are rarely reported. The patient may be asymptomatic or present with hemodynamic instability due to tamponade state and/or a huge intracardiac mass.>.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Professor of Cardiology, Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Pakbaz
- Assistant Professor of Cardiology, Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Sattar-khan Avenue, Niyayesh Street, 1445613131 Tehran, Iran
| | - Alireza Sadeghipour
- Professor of Pathology, Department of Pathology and Oncopathology Research Venter, Iran University of Medical Sciences, Tehran, Iran
| | - Sam Zeraatian Nejad Davani
- Assistant Professor of Cardiac Surgery, Department of Cardiac Surgery, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Shamsedini
- Resident of Cardiology, Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Nohuz E, Chêne G, Maréchal C, Atallah A, Chabert P, Michy T, Lamblin G. [How I do… to find the cervical canal in the event of an impassable stenosis of the cervix before a hysteroscopy]. ACTA ACUST UNITED AC 2020; 49:632-634. [PMID: 33276134 DOI: 10.1016/j.gofs.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- E Nohuz
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France.
| | - G Chêne
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France; Université Claude Bernard Lyon 1, EMR 3738, 69000 Lyon, France
| | - C Maréchal
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - A Atallah
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - P Chabert
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - T Michy
- Service de gynécologie-obstétrique, hôpital Couple-Enfant, CHU de Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - G Lamblin
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
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De Gregorio V, La Rocca A, Urciuolo F, Annunziata C, Tornesello ML, Buonaguro FM, Netti PA, Imparato G. Modeling the epithelial-mesenchymal transition process in a 3D organotypic cervical neoplasia. Acta Biomater 2020; 116:209-222. [PMID: 32911106 DOI: 10.1016/j.actbio.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 01/03/2023]
Abstract
Here, we proposed an innovative organotypic cervical tumor model able to investigate the bi-directional crosstalk between epithelium and stroma as well as the key disease features of the epithelial-mesenchymal transition (EMT) process in vitro. By using a modular tissue assembling approach, we developed 3D cervical stromal models composed of primary human cervical fibroblasts (HCFs) or cervical cancer-associated fibroblasts (CCAFs) embedded in their own ECM to produce 3D normal cervical-instructed stroma (NCIS) or 3D cervical cancer-instructed stroma (CCIS), respectively. Then, we demonstrate the role of the tumor microenvironment (TME) in potentiating the intrinsic invasive attitude of cervical cancer derived SiHa cells and increasing their early viral gene expression by comparing the SiHa behavior when cultured on NCIS or CCIS (SiHa-NCIS or SiHa-CCIS). We proved the crucial role of the CCAFs and stromal microenvironment in the mesenchymalization of the cancer epithelial cells by analyzing several EMT markers. We further assessed the expression of the epithelial adhesion molecules, matricellular enzymes, non-collagenous proteins as well as ECM remodeling in terms of collagen fibers texture and assembly. This cervical tumor model, closely recapitulating key cervical carcinogenesis features, may provide efficient and relevant support to current approaches characterizing cancer progression and develop new anticancer therapy targeting stroma rather than cancer cells.
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Urbute A, Thomsen LT, Belmonte F, Kesmodel US, Frederiksen K, Kjaer SK. The role of body mass index in incidence and persistence of cervical human papillomavirus infection. Ann Epidemiol 2020; 49:36-41. [PMID: 32711054 DOI: 10.1016/j.annepidem.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to assess the association between body mass index and incident or persistent cervical high-risk human papillomavirus (hrHPV) infection. METHODS This cohort study included 6809 women from the general Danish population who participated in two clinical visits (in 1991-1993 and in 1993-1995). Height and weight were measured by nurses, lifestyle data were obtained by structured interviews, and cervical cytology samples were obtained for hrHPV DNA testing. We conducted log-binomial regression to estimate risk ratios (RRs) with 95% confidence intervals (CIs) of incident and type-specific persistent hrHPV infection according to body mass index, adjusting for age, education, smoking, and the number of sexual partners in the past year. RESULTS We found no increased risk of incident hrHPV infection in women who were underweight (RRadjusted, 0.97; 95% CI, 0.64-1.48), overweight (RRadjusted, 0.98, 95% CI, 0.82-1.17), or obese (RRadjusted, 0.93; 95% CI, 0.63-1.36) compared with women of normal weight. The risk of hrHPV persistence was similar in overweight (RRadjusted, 0.98; 95% CI, 0.71-1.34) and obese (RRadjusted, 1.00; 95% CI, 0.56-1.79) women compared with women of normal weight, whereas underweight women had a lower risk (RRadjusted, 0.32; 95% CI, 0.11-0.95). CONCLUSIONS Overweight and obesity were not associated with HPV incidence or persistence when adjusting for sexual behavior.
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Affiliation(s)
- Aivara Urbute
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Federica Belmonte
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Murata H, Nakamura H, Ohta Y, Kitamura M, Nakastuka S, Ishikawa J, Kamiura S. Two cases of spindle cell variant diffuse large B-cell lymphoma of the uterine cervix. Gynecol Oncol Rep 2020; 33:100611. [PMID: 32743038 DOI: 10.1016/j.gore.2020.100611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/21/2022] Open
Abstract
Lymphoma with prominent spindle cell features is a morphological variant of diffuse large B-cell lymphoma (DLBCL) and is categorized as a rare variant by the WHO classification. Most cases arise from the skin, with only two cases reported in the uterine cervix to date. Here, we report two cases of spindle cell variant DLBCL of the uterine cervix. Although these cases might be rare, we believe that, as gynecologists and pathologists increase their knowledge of this variant type, more cases will be diagnosed properly.
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Shinkai S, Ishioka S, Mariya T, Fujibe Y, Kim M, Someya M, Saito T. Pregnancies after vaginal radical trachelectomy (RT) in patients with early invasive uterine cervical cancer: results from a single institute. BMC Pregnancy Childbirth 2020; 20:248. [PMID: 32334568 PMCID: PMC7183613 DOI: 10.1186/s12884-020-02949-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background Radical tracheletomy (RT) with pelvic lymphadenectomy has become an option for young patients with early invasive uterine cervical cancer who desire to maintain their fertility. However, this operative method entails a high risk for the following pregnancy due to its radicality. Methods We have performed vaginal RT for 71 patients and have experienced 28 pregnancies in 21 patients. They were followed up carefully according to the follow-up methods we reported previously. Their pregnancy courses and prognoses after the pregnancy were retrospectively reviewed. Results All the vaginal RTs were performed safely without serious complications, including 6 patients who underwent the operation during pregnancy. The median time to be pregnant after RT was 29.5 months. 13 patients (46%) became pregnant without artificial insemination by husband or assisted reproductive technology. Cesarean section was performed for all of them. The median time of pregnancy was 34 weeks, and emergent cesarean section was performed for 7 pregnancies (25%). The median birth weight was 2156 g. Four patients had trouble with cervical cerclage, and they suffered from sudden premature preterm rupture of the membrane (pPROM) during the second trimester of pregnancy. We underwent transabdominal cerclage (TAC) for all of them and careful management for the prevention of uterine infection was performed. One patient had a recurrence of cancer during pregnancy. Conclusions Both the obstetrical prognosis and oncological prognosis after vaginal RT have become favorable for pregnant patients after vaginal RT.
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Affiliation(s)
- Shota Shinkai
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Shinichi Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan.
| | - Tasuku Mariya
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Yuya Fujibe
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Miseon Kim
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Masayuki Someya
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
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Ito K, Yano M, Ogasawara A, Miwa M, Kozawa E, Yasuda M. A unique uterine cervical "teratocarcinosarcoma": a case report. Diagn Pathol 2019; 14:122. [PMID: 31684979 PMCID: PMC6827231 DOI: 10.1186/s13000-019-0890-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/12/2019] [Indexed: 12/02/2022] Open
Abstract
Background Teratocarcinosarcoma (TCS) is a rare aggressive tumor of the nasal cavity and paranasal sinuses and has both epithelial and two or more mesenchymal components. In other organs, 5 cases of ovarian tumors closely resembling TCS have been reported; however, there has been no published case of cervical TCS. Herein, we describe a unique case of cervical tumor that had carcinosarcomatous and teratomatous features, resembling a sinonasal TCS. Case presentation A 45-year-old woman presented to our hospital for evaluation of a cervical lesion. The gynecologist found a large polypoid mass, whose biopsy showed glandular components of probable germ cell origin based on the immunohistochemical features. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy. The cervical polypoid mass was found to consist of both epithelial and mesenchymal tissues, including immature glandular structure resembling fetal enteric tubules, neuroepithelial cells, hyaline cartilage, and rhabdomyosarcoma cells. This tumor was diagnosed as TCS of the uterine cervix. Following the surgery, the patient received radiotherapy and has been free of disease for 13 months. Conclusion This is the first case report of cervical TCS. The tumor is thought to be histogenetically less associated with HPV infection, and its teratomatous components with an absence of cytogenetic abnormalities (including isochromosome 12p (i(12p)) suggest a analogous histogenesis compared to pure mature or immature teratoma.
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Affiliation(s)
- Kozue Ito
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.,Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu-shi, Oita, 879-5593, Japan
| | - Aiko Ogasawara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Maiko Miwa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Eito Kozawa
- Department of Diagnostic Radiology, Saitama Medical University Hospital, Moroyama, Saitama, 350-0495, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.
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Gitas G, Ertan K, Rody A, Baum S, Tsolakidis D, Alkatout I. Papillary squamotransitional cell carcinoma of the uterine cervix: a case report and review of the literature. J Med Case Rep 2019; 13:319. [PMID: 31655625 PMCID: PMC6815390 DOI: 10.1186/s13256-019-2217-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/02/2019] [Indexed: 12/01/2022] Open
Abstract
Background Papillary squamotransitional cell carcinoma of the uterine cervix is a rare neoplasm, a subtype of transitional cervical carcinoma that appears to be a variation of squamous cervical carcinoma. It has a disposition toward metastasis at an advanced stage and local recurrence. Owing to the difficulty of illustrating the invasion histologically, misdiagnosis is likely to affect the patient’s prognosis. Case presentation We present a case report of an 81-year-old Caucasian patient with squamotransitional cell carcinoma with unusual clinical behavior that was primarily thought to be ovarian cancer. According to the clinical examination and radiologic imaging, the patient had no vaginal bleeding and a normal cervix. Nevertheless, the tumor was already metastasized at the retroperitoneal tissue and at the right ovary. Computed tomography-guided biopsy of the right adnexa gave no further clarification. Although the tumor resembled urothelial cancer, this diagnosis was dismissed because of the results of immunohistochemistry analysis with CK7+, CK5+, and CK20−. Because of the differential diagnosis of ovarian cancer, we decided in favor of an exploratory surgical approach. Hysterectomy with bilateral adnexectomy, extensive retroperitoneal tumor debulking, and infragastric omentectomy was performed by laparotomy. Histopathology revealed a squamotransitional cervical cancer as the primary tumor with a tumor stage of pT3b, pN1 (1/2), V0, RX, G2, corresponding to International Federation of Gynecology and Obstetrics stage IIIB. Conclusions As far as we are aware, this is the first report of papillary squamotransitional cell carcinoma of the uterine cervix metastatic to the ovary without vaginal bleeding and with a clinically and radiologically unsuspicious cervix. Physicians should always contemplate papillary squamotransitional cell carcinoma of the uterine cervix in unclear cases with ovarian metastasis, especially if the histology indicates a transitional cancer (CK7+ and CK20−), before proceeding with treatment. More cases are needed to illuminate the clinical characteristics and categorization of papillary squamotransitional cell carcinoma of the uterine cervix.
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Affiliation(s)
- Georgios Gitas
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany
| | - Kubilay Ertan
- Department of Gynecology and Obstetrics, Leverkusen Municipal Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany
| | - Achim Rody
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany
| | - Sascha Baum
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany
| | - Dimitrios Tsolakidis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Kiel, Arnold-Heller-Strasse 3, House 24, 24105, Kiel, Germany.
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Rexhepi M, Trajkovska E, Koprivnjak K. An Unusually Large Fibroepithelial Polyp of Uterine Cervix: Case Report and Review of Literature. Open Access Maced J Med Sci 2019; 7:1998-2001. [PMID: 31406544 PMCID: PMC6684419 DOI: 10.3889/oamjms.2019.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: Fibroepithelial cervical polyps (FEPs) are benign growths protruding from the inner surface of the cervix. They are typically asymptomatic, but a very small minority can undergo malignant change. Giant cervical polyps with a size greater than 4 cm are rare entities with only 23 reported cases in the literature. Cervical polyps develop as a result of focal hyperplasia of the columnar epithelium of the endocervix. CASE PRESENTATION: We present the case of a giant fibroepithelial polyp measuring approximately 11 x 6 x 4 cm which was protruding from the anterior lip of the uterine cervix in a 51-year-old woman who clinically presented vaginal bleeding. She was nulligravida and doesn’t have a child. The speculum examination revealed a soft, mobile, painless irregular cerebriform mass on the cervix, protruding through the vagina. The polyp was excised using a scalpel, and the pedicle was sutured using the Vicryl 1-0 under short-term intravenous anaesthesia. Histopathological examination revealed a polypoidal tumour mass composed of cellular fibrovascular stroma covered with stratified squamous epithelium. Three months after the initial surgery, there was no recurrence seen. CONCLUSION: Cervical giant polyps are rare entities and occur mostly in perimenopausal women. Transvaginal polypectomy, as performed for this patient followed by histopathological examination is an adequate procedure for these lesions.
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Affiliation(s)
- Meral Rexhepi
- Department of Obstetrics and Gynecology, Clinical Hospital, Tetovo, Republic of Macedonia.,Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | | | - Kazimir Koprivnjak
- Department of Obstetrics and Gynecology, Clinical Hospital, Tetovo, Republic of Macedonia
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Zhang D, Ma X. Prognostic factors and outcomes of early-stage small cell neuroendocrine carcinoma of the cervix: 37 cases from a single center. PeerJ 2019; 7:e6868. [PMID: 31110926 PMCID: PMC6501769 DOI: 10.7717/peerj.6868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/29/2019] [Indexed: 02/03/2023] Open
Abstract
Background The objective of this study is to investigate small cell neuroendocrine carcinoma of the cervix (SCCC), using a retrospective clinicopathological characteristic and treatment approach. Method We retrospectively analyzed cases of early-stage SCCC, identified between 2006 and 2016, in women who received radical surgery and adjuvant chemotherapy with or without radiotherapy. Kaplan–Meier and one-way ANOVA analyses were performed. Result A total of 37 cases of SCCC are presented in this study, of which 21 had stage IB1 SCCC, 12 had stage IB2, 3 had stage IIA1, and 1 had stage IIA2. All patients were treated with radical surgery and adjuvant chemotherapy, specifically, 26 with radical surgery followed by adjuvant chemotherapy plus radiation and 11 with neoadjuvant chemotherapy (NACT) followed by radical surgery. After a median follow-up time of 27 months (range, 8–115 months), the 2-year and 5-year disease-free survival rate for all patients was 51.9% and 34.1%, respectively, and the overall survival rate was 60.3% and 38.6%, respectively. Univariate analysis showed that International Federation of Gynecology and Obstetrics (FIGO) stage and tumor size may be a predictor of a poor prognosis. NACT and adjuvant radiation did not improve survival over adjuvant chemotherapy alone but should not be a significant independent prognostic factor for survival. Conclusion Even in patients with early-stage SCCC, the prognosis is poor, although FIGO stage and tumor size may act as surrogate factors prognostic of survival.
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Affiliation(s)
- Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shengyang, China
| | - Xiaoxin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shengyang, China
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Bonin L, Devouassoux-Shisheboran M, Golfier F. Clinicopathological characteristics of patients with mucinous adenocarcinoma of the uterine cervix: A retrospective study of 21 cases. J Gynecol Obstet Hum Reprod 2019; 48:319-327. [PMID: 30807852 DOI: 10.1016/j.jogoh.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 02/19/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Few studies in the literature take into account the WHO's 2014 redefinition of the characteristics of mucinous adenocarcinoma of the uterine cervix. Our objective was to describe the characteristics of a group of these patients. MATERIAL AND METHODS This was a retrospective descriptive study of patients diagnosed between 1 January 2005 and 31 May 2016 in three hospitals in Lyon, France. All the cases of cervical adenocarcinoma were reanalysed by an expert in gynaecological pathology to retain the mucinous subtypes as defined in the 2014 WHO classification. We analysed their clinical and pathological characteristics. RESULTS Among the 82 cases of cervical adenocarcinoma, 21 (26%) were diagnosed as mucinous. Ten were gastric type, of which four were in the extremely well differentiated form of minimal deviation adenocarcinomas, six were intestinal type, two were signet-ring cell type, and three were not otherwise specified. The patients' mean age was 42 years and 18 patients were premenopausal. The revealing symptom was metrorrhagia in eight cases (38%) and mucinous vaginal discharge in four (19%). Fifteen (72%) of the cervical smear were abnormal. Five (31%) of the 16 patients with gastric or intestinal type adenocarcinoma had a specific radiological presentation: multiple cysts of the uterine isthmus, visible on ultrasound and with T2 hyperintensity on MRI. CONCLUSION Mucinous adenocarcinoma is a rare form of cervical cancer that can be confused with other pathological types. It can be detected using cervical smears and should be suspected in cases of mucinous discharge and characteristic MRI features.
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Affiliation(s)
- Lucie Bonin
- Department of Gynaecological Surgery and Oncology, Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France.
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - François Golfier
- Department of Gynaecological Surgery and Oncology, Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
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Bonin L, Devouassoux-Shisheboran M, Golfier F. [Focus on mucinous adenocarcinoma of the uterine cervix]. ACTA ACUST UNITED AC 2019; 47:352-361. [PMID: 30771514 DOI: 10.1016/j.gofs.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 12/24/2022]
Abstract
Cancer of the uterine cervix is the fourth most common cancer in women worldwide, and the fourth leading cause of cancer death in women. Squamous cell carcinoma is the first type of cervical cancer (about 75% of cases), and adenocarcinoma the second. Adenocarcinoma of the uterine cervix were redefined in the 2014 WHO classification. Endocervical adenocarcinoma, usual type, is the mose common. Mucinous adenocarcinoma were classified by this classification into different subtypes: gatric type, intestinal type and signet-ring cell type. This literature review shows the caracteristics of these various subtypes of cervical cancer, little known. These are physiopathological, clinical, cytological histological, pronostic caracteristics, and their treatments.
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Affiliation(s)
- L Bonin
- Service de chirurgie gynécologique oncologique et obstétrique, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
| | - M Devouassoux-Shisheboran
- Service d'anatomie et de cytologie pathologiques, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique oncologique et obstétrique, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France
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Zhang M, Lucas E, Xiong H, Liu S, Molberg K, Jiang Q, Zheng W. Superficially invasive cervical squamous cell carcinoma metastatic to ovarian endometriotic cyst wall, a case report and brief review of the literature. J Ovarian Res 2018; 11:44. [PMID: 29848369 PMCID: PMC5975711 DOI: 10.1186/s13048-018-0417-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/20/2018] [Indexed: 08/22/2023] Open
Abstract
Background Although cases of cervical squamous cell carcinoma metastatic to the ovary have been previously documented, we report the first case of superficially invasive squamous cell carcinoma metastatic to the ovary. Case presentation A 45-year-old woman with a two-year history of ovarian endometriosis confirmed by ultrasound underwent oophorectomy. On microscopic examination, a focus of malignant stratified epithelium, initially interpreted as transitional cell carcinoma, was identified within the endometriotic cyst wall. Examination of the hysterectomy specimen revealed superficially invasive squamous carcinoma of the cervix. In addition, two triploid, CD45-negative cells were detected during the analysis of the peripheral blood for circulating tumor cells (CTC). High-risk HPV was detected on the sections of endometriosis containing cancerous area by using hybrid capture 2 assay, supporting the diagnosis of metastatic squamous cell carcinoma originating from the uterine cervix. Conclusion This is the first report of superficially invasive squamous cell carcinoma metastatic to the ovary. Such finding could be misdiagnosed as primary ovarian transitional cell carcinoma, squamous cell carcinoma originating from metaplastic epithelium within endometriosis, or squamous cell carcinoma arising in a teratoma.
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Affiliation(s)
- Minfen Zhang
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, People's Republic of China
| | - Elena Lucas
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Hanzhen Xiong
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, People's Republic of China
| | - Shaoyan Liu
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, People's Republic of China
| | - Kyle Molberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Qingping Jiang
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, People's Republic of China. .,Key Laboratory of Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, China. .,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA. .,Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
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Li P, Ma J, Zhang X, Guo Y, Liu Y, Li X, Zhao D, Wang Z. Cervical small cell carcinoma frequently presented in multiple high risk HPV infection and often associated with other type of epithelial tumors. Diagn Pathol 2018; 13:31. [PMID: 29788963 PMCID: PMC5964718 DOI: 10.1186/s13000-018-0709-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/06/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Small cell carcinoma of the uterine cervix is a rare and highly malignant tumor, and its etiopathogenesis is strongly related to high-risk HPV infections. METHODS The clinicopathological data of 30 cases of cervical primary small cell carcinoma were retrospectively analyzed. In situ hybridization, polymerase chain reaction and reverse dot-blot hybridization were employed to detect HPV DNA in both small cell carcinoma and other coexisting epithelial tumors. Immunohistochemistry was used to detect the protein expression of p16 and p53. RESULTS Amongst 30 patients with cervical primary small cell carcinoma, 15 patients simultaneously exhibited other types of epithelial tumors, including squamous cell carcinoma, adenocarcinoma, squamous cell carcinoma in situ, and adenocarcinoma in situ. Most tumor cells infected with HPV presented integrated patterns in the nuclei by in situ hybridization. HPV DNA was detected in every small cell carcinoma case (100%) by polymerase chain reaction and reverse dot blot hybridization. 27 cases (90%) harbored type 18, and 15 (50%) displayed multiple HPV18 and 16 infections. The prevalence of HPV 18 infection in small cell carcinoma was higher than in cervical squamous and glandular epithelial neoplasms (P = 0.002). However, similar infection rates of HPV 16 were detected in both tumors (P = 0.383). Both small cell carcinoma and other types of epithelial tumors exhibited strong nuclear and cytoplasmic staining for p16 in all cases. Three cases of small cell carcinoma revealed completely negative p53 immunohistochemical expression in 15 cases of composite tumors, which suggested TP53 nonsense mutation pattern. The pure small cell carcinoma of uterine cervix had similar mutation or wild type pattern for TP53 compared with composite tumor (P = 0.224). CONCLUSIONS Cervical small cell carcinomas are often associated with squamous or glandular epithelial tumors, which might result from multiple HPV infections, especially HPV 16 infection. Multiple HPV infections were not correlated with tumor stage, size, lymphovascular invasion, lymph node metastasis, or prognosis. Furthermore, careful observation of specimens is very important in finding little proportion of small cell carcinoma in the composite lesions, specifically in cervical biopsy specimens, in order to avoid the missed diagnosis of small cell carcinoma.
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Affiliation(s)
- Peifeng Li
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China
| | - Jing Ma
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China
| | - Xiumin Zhang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China
| | - Yong Guo
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China
| | - Yixiong Liu
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China
| | - Xia Li
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China
| | - Danhui Zhao
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China
| | - Zhe Wang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, The Fourth Military Medical University, Changle West Road #169, Xi'an, 710032, Shaan Xi Province, China.
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Missaoui N, Mestiri S, Bdioui A, Zahmoul T, Hamchi H, Mokni M, Hmissa S. HPV infection and p16 INK4A and TP53 expression in rare cancers of the uterine cervix. Pathol Res Pract 2018; 214:498-506. [PMID: 29572122 DOI: 10.1016/j.prp.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/10/2018] [Accepted: 03/02/2018] [Indexed: 01/04/2023]
Abstract
Cervix cancer remains among most commonly diagnosed cancer in developing countries. Except squamous cell carcinoma and adenocarcinoma, the etiopathology and oncogenic mechanisms of rare cancers remain largely unknown. The study was performed to investigate the value of HPV infection and the expression of p16INK4A and TP53 in rare primitive cancers of the cervix. We conducted a retrospective study of rare primitive cancers of the cervix. Main clinicopathological features were reported. HPV infection was detected by in situ hybridization. Expression of p16INK4A and TP53 was analyzed by immunohistochemistry. Overall, seven cases were identified, including basaloid squamous cell carcinoma (BSCC, n = 2), small cell neuroendocrine carcinoma (SCNEC), granulocytic sarcoma without acute myeloid leukemia, leiomyosarcoma, primitive neuroectodermal tumor and botryoid-type embryonic rhabdomyosarcoma. The mean age of patients was 53.7 years. Four cancers were diagnosed at advanced stages. The prognosis was unfavorable and associated with patient death in five cases. HPV types 16/18 were detected in BSCCs and SCNEC. Strong and diffuse p16INK4A overexpression was described in the nucleus and the cytoplasm of all tumor cells of BSCCs and SCNEC. The remaining cancers exhibited only scattered and focal p16INK4A staining. Mutated TP53 protein was detected in BSCC (case 1) and GS. Rare cancers of the cervix are aggressive and associated with poor prognosis. In contrast to mesenchymal tumors, BSCCs and SCNEC are etiologically related to high-risk HPV infection and could be identified by block positive p16INK4A overexpression as common cancers of the cervix. TP53 mutations are not a negligible genetic event in rare cervical cancers.
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Affiliation(s)
- Nabiha Missaoui
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia; Faculty of Sciences and Technologies of Sidi Bouzid, University of Kairouan, Tunisia.
| | - Sarra Mestiri
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Ahlem Bdioui
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Thouraya Zahmoul
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Hajer Hamchi
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Moncef Mokni
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Sihem Hmissa
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
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Mutoh T, Takatsuki H, Mannoji K, Kawamura K, Okura N, Ohshima K. Regression of uterine cervical diffuse large B-cell lymphoma transformed from mucosa-associated lymphoid tissue lymphoma subsequent to Chlamydia trachomatis eradication. Rinsho Ketsueki 2017; 58:912-916. [PMID: 28883273 DOI: 10.11406/rinketsu.58.912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 37-year-old-woman was referred to our center after her uterine cervix health screening presented abnormal findings. We performed a biopsy of the uterine cervix to examine for cervical dysplasia, and diagnosed a diffuse large B-cell lymphoma transformed from mucosa-associated lymphoid tissue (MALT) lymphoma of the cervix. The patient presented with concurrent chlamydial cervicitis and received eradication therapy for Chlamydia trachomatis. Four months later, the CD20 positive abnormal lymphocyte disappeared and complete remission was achieved. MALT lymphoma is considered to correlate with infection and inflammation. Particularly, the relationship between gastric MALT lymphoma and Helicobacter pylori is well known. MALT lymphoma of the uterine cervix is rare, and its relationship with C.trachomatis infection is unknown. Further studies are warranted to investigate this association.
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Affiliation(s)
- Toshitaka Mutoh
- Department of Hematological Internal Medicine, Kokura Medical Center, National Hospital Organization
| | - Hiroshi Takatsuki
- Department of Hematological Internal Medicine, Kokura Medical Center, National Hospital Organization
| | - Kiyohito Mannoji
- Department of Hematological Internal Medicine, Kokura Medical Center, National Hospital Organization
| | - Kyoko Kawamura
- Department of Obstetrics and Gynecology, Kokura Medical Center, National Hospital Organization
| | - Naofumi Okura
- Department of Obstetrics and Gynecology, Kokura Medical Center, National Hospital Organization
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine
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Mutombo AB, Tozin R, Simoens C, Lisbeth R, Bogers J, Van Geertruyden JP, Jacquemyn Y. Efficacy of antiviral drug AV2 in the treatment of human papillomavirus-associated precancerous lesions of the uterine cervix: A randomized placebo-controlled clinical trial in Kinshasa, DR Congo. (KINVAV study). Contemp Clin Trials Commun 2017; 8:135-9. [PMID: 29696202 DOI: 10.1016/j.conctc.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/12/2017] [Accepted: 09/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background Cervical Cancer (CC) is a major public health problem in DR Congo; the high incidence of CC is due to the inexistence of effective screening programs based on cytology and/or HPV detection followed by appropriate treatments. This situation highlights the need to implement efficacious and inexpensive treatment methods. This study aims at evaluating the efficacy of a topical antiviral drug named AV2® as a treatment for HPV-associated lesions of the cervix. Methods Women will undergo cytology sampling, HPV testing and Visual inspection of the cervix after application of 5% acetic acid (VIA). VIA-positive women will be randomized to one of two groups to receive treatment by either AV2®or placebo. They will undergo control examinations after two months and after six months. In case of persistent lesions on VIA, treatment by cryotherapy will be done. The primary outcomes will be the change of lesions, the clearance of HPV DNA, and the correlation of the two 2 months after treatment with AV2®. Conclusion This study is the first large-scale study in Africa to evaluate systematically the efficacy and safety of a topical antiviral drug for the treatment of HPV— associated lesions of the cervix. Its findings will direct the planning of suitable algorithms for CC screening and treatment. Clinical trial registration ClinicalTrials.gov – Unique identifier: NCT02346227, registered on November 8, 2014.
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Satabongkoch N, Khunamornpong S, Pongsuvareeyakul T, Settakorn J, Sukpan K, Soongkhaw A, intaraphet S, Suprasert P, Siriaunkgul S. Prognostic Value of Tumor Budding in Early-Stage Cervical Adenocarcinomas. Asian Pac J Cancer Prev 2017; 18:1717-1722. [PMID: 28670894 PMCID: PMC6373798 DOI: 10.22034/apjcp.2017.18.6.1717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Tumor budding has recently been reported as an independent adverse prognostic factor for
colorectal adenocarcinomas and other types of carcinoma in the digestive tract. This study aimed to evaluate the
prognostic value of tumor budding in patients with early-stage cervical adenocarcinomas and any associations
with other clinical and pathological features. Methods: Histological slides of patients with early-stage (IB-IIA)
usual-type endocervical adenocarcinoma who underwent radical hysterectomy and pelvic lymph node dissection,
without preoperative chemotherapy, between January 2006 and December 2012 were reviewed. Tumor budding
was evaluated in routinely-stained sections and defined as detached single cells or clusters of fewer than 5 cells in a
tumor invasive front and was stratified based on the number of bud counts in 10-high-power fields as low (<15 buds)
and high (≥15 buds). Correlations between tumor bud count and other clinical and pathological variables including
follow-up outcomes were assessed. Results: Of 129 patients, a high tumor bud count was observed in 15 (11.6%),
positively associated with histologic grade 3 (p<0.001), invasive pattern C (Silva System) (p=0.004), lymph node
metastasis (p=0.008), stage IB2-IIA (p=0.016), and tumor size >2 cm (p=0.036). Kaplan-Meyer analysis showed a
significant decrease in both disease-free survival and cancer-specific survival for patients with a high tumor bud count
(p=0.027 and 0.031, respectively). On multivariate analysis, histologic grade 3 was the only independent predictor for
decreased disease-free survival (p=0.004) and cancer-specific survival (p=0.003). Conclusions: A high tumor budding
count based on assessment of routinely-stained sections was found to be associated with decreased disease-free and
cancer-specific survival in patients with early-stage cervical adenocarcinomas. However, it was not found to be an
independent prognostic predictor in this study.
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Affiliation(s)
- Nopporn Satabongkoch
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Reddy OL, Shintaku PI, Moatamed NA. Programmed death-ligand 1 (PD-L1) is expressed in a significant number of the uterine cervical carcinomas. Diagn Pathol 2017; 12:45. [PMID: 28623908 PMCID: PMC5473984 DOI: 10.1186/s13000-017-0631-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/05/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The programmed death-1/programmed death-ligand-1 (PD-1/PD-L1) immune regulatory axis has emerged as a promising new target for cancer therapeutics, with lasting responses seen in the treatment of metastatic renal and lung carcinomas, as well as melanomas. As tumor surface expression of PD-L1 has been found to correlate with objective responses to anti-PD-L1 immunotherapies, we investigated the expression of PD-L1 in human cervical tumors and provide an adopted scoring system for the systematic evaluation of PD-L1 staining. METHODS Immunohistochemical staining for PD-L1 expression was performed on a tissue microarray of 101 normal and neoplastic cervical tissues. Neoplastic cores were divided into three groups: squamous cell carcinoma, adenosquamous carcinoma, and endocervical adenocarcinoma. PD-L1 expression was scored based on an adopted scoring system accounting to percentage and intensity of positivity, and results provided alongside available clinical and demographic data. RESULTS Overall, PD-L1 was positive in 32 of 93 (34.4%) cervical carcinomas. Subcategorically, PD-L1 was positive in 28 of 74 (37.8%) squamous cell carcinomas, two of seven (28.6%) adenosquamous carcinomas, and two of 12 (16.7%) endocervical adenocarcinomas. It was negative in six benign cervical tissues. CONCLUSIONS This study shows a significant expression of PD-L1 in 34.4% of cervical carcinomas and no expression of PD-L1 in benign cervical tissues. These findings suggest a role for further investigation of anti-PD-L1/PD-1 immunotherapies in the treatment of PD-L1-positive cervical tumors. In addition, our adopted scoring system will facilitate more systematic correlations between tumor reactivity and response to treatment.
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Affiliation(s)
- Opal L. Reddy
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, BOX 951732, 1P-241 CHS, Los Angeles, CA 90095-1732 USA
| | - Peter I. Shintaku
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, BOX 951732, 1P-241 CHS, Los Angeles, CA 90095-1732 USA
| | - Neda A. Moatamed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, BOX 951732, 1P-241 CHS, Los Angeles, CA 90095-1732 USA
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