自噬基因PULK、PI3KC3在宫颈病变的表达及相关性研究

目的探讨自噬基因PULK、PI3KC3在正常宫颈组织及病变宫颈组织的表达及相关性。方法随机抽取正常宫颈组织30例、CIN20例及宫颈癌45例,采用qRT-PCR法检测组织中PULK和PI3KC3基因表达水平,免疫组织化学染色方法定性检测PULK、PI3KC3在正常宫颈组织及病变宫颈组织中的表达情况。结果免疫组化结果显示,PULK和PI3KC3在CIN及宫颈癌组织中的阳性表达显著低于正常宫颈组织,CIN及宫颈癌组织的PULK和PI3KC3表达水平均低于正常宫颈组织(P0.05或P0.01)。PULK与PI3KC3表达呈正相关(r=0.862,P0.01)。结论 PULK和PI3KC3可能参与宫颈病变的恶性转变过程。     

CO2激光治疗重度宫颈糜烂

作者用ＣＯ２激光治疗了重度宫颈糜烂２９２例,单纯型２４例,颗粒型１６６例,乳突型１０２例。结果：２８２例获治愈（９６．２％）,其中２４９例（８５．２％）一次性痊愈,１０例好转,无一例无效。说明该疗法简便,迅速,无明显副作用,疗效显著,是治疗重度宫颈糜烂的有效方法。     

Origin of adenocarcinoma cells observed on cervical cytology

OBJECTIVE: To clarify the ratio of diseases suspected when malignant glandular cells are observed on cervical cytology. STUDY DESIGN: Seventy cases of cervical adenocarcinoma/adenosquamous carcinoma, 207 cases of endometrial adenocarcinoma, 7 cases of tubal adenocarcinoma and 83 cases of ovarian adenocarcinoma were reviewed. The positive rate in cervical cytology performed 3 months before surgery was calculated. Based on the positive rate for each entity and the number of cases treated in the previous 10 years, we estimated the incidence of disease responsible for malignant glandular cells on cytology. RESULTS: The positive rate was 93% in cervical adenocarcinoma/adenosquamous carcinoma, 45% in endometrial adenocarcinoma, 14% in tubal adenocarcinoma and 6% in ovarian adenocarcinoma. These positive rates and case numbers at our institute indicated the percentage of suspicious diseases to be 38% for cervical aaenocarcinoma/adenosquamous carcinoma, 53% for endometrial adenocarcinoma, 1% for tubal adenocarcinoma and 8% for ovarian adenocarcinoma. CONCLUSION: When a cytologic specimen suggested the existence of adenocarcinoma, the most probable disease was endometrial adenocarcinoma, and the second was cervical adenocarcinoma/adenosquamous carcinoma. Adnexal malignancies were responsible in 9% of cases. In the case of positive cervical cytology suggesting adenocarcinoma, the ratio of suspicious diseases is as valuable as the cytologic findings for the differential diagnosis.     

宫颈脱落细胞中HCCR的表达及意义

目的研究人宫颈癌基因(HCCR)在宫颈脱落细胞中的表达情况,探讨其对宫颈癌及癌前病变诊断的意义。方法采用Western blot及免疫组化SP法对79例宫颈脱落细胞中HCCR蛋白进行检测,其中正常宫颈上皮脱落细胞11例、宫颈上皮内瘤样病变(CIN)53例、宫颈癌(CCa)15例。所有标本均来自中国医科大学附属第一医院。结果HCCR基因在正常宫颈脱落细胞中不表达或阳性率较低,在宫颈上皮内瘤变及宫颈癌中表达阳性率随病变加重而逐级升高。结论HCCR与宫颈上皮内瘤变及宫颈癌的发生密切相关,检测宫颈脱落细胞中HCCR蛋白的水平对宫颈癌的筛查和诊断可能具有重要意义。     

The invasive cervical cancer review: psychological issues surrounding disclosure

An audit of the screening history of all new cervical cancer cases has been a requirement since April 2007. While NHS cervical screening programmes (NHSCSP) guidance requires that women diagnosed with cervical cancer are offered the findings of the audit, as yet there has been no research to investigate the psychological impact that meeting to discuss the findings might have on patients. This is in spite of the fact that cytological under‐call may play a role in as many as 20% of cervical cancer cases. This review draws on the literature concerning breaking bad news, discussing cancer and disclosing medical errors, in order to gain insight into both the negative and positive consequences that may accompany a cervical screening review meeting. We conclude that while patients are likely to experience some distress at disclosure, there are also likely to be positive aspects, such as greater trust and improved perception of care.     

Accuracy of registration of invasive cervical cancer.

The quality of the data recorded by the British Columbia Cancer Registry for 521 new cases of invasive cervical cancer was evaluated. The registry''s pathological diagnosis in all new registrations of invasive cervical cancer diagnosed in British Columbia between 1977 and 1979 was compared with a best estimate of the true diagnosis, which was determined from the results of the provincial cervical cytology screening program and the clinical charts at the Cancer Control Agency of British Columbia. The registry''s data overestimated the true incidence of invasive cervical cancer by approximately 55%, since 184 (35%) of the cases were incorrectly registered. Of the 184, 141 (77%) were cases of preinvasive cervical cancer, 26 (14%) did not meet the criteria for a true case (i.e., they were not newly diagnosed in British Columbia between 1977 and 1979) and 17 (9%) were cases of invasive cancer of another primary site. In addition, 28 cases of invasive cervical cancer diagnosed in the province during the study period had not been reported to the registry. Thus, both over-reporting and under-reporting occurred. There is a need for constant evaluation of registry data if cancer registries are to fulfil their potential contribution to cancer control programs and research.     

新疆维、汉P-gp、MRP1、GST-π与宫颈癌新辅助化疗疗效的相关性研究

目的：探讨新疆维吾尔族及汉族宫颈癌新辅助化疗前后P-gp、MRPI和GST-∏的表达及其与化疗疗效的关系。方法：运用S-P法检测分别检测维吾尔族妇女宫颈鳞癌组织22例和非宫颈鳞癌组织20例,汉族妇女宫颈鳞癌组织30例和非宫颈鳞癌组织30例,新辅助化疗前后P-gP、MRPI和GST-π的表达水平。结果：①新疆维吾尔族正常宫颈、初治宫颈癌组织中P-gp的阳性表达率分别为10%、72.7%;MRP1的阳性表达率分别为20%、40.9%;GST-π的阳性表达率分别为45%、90.9%。P-gp、和MRP1在各组间比较差异均有统计学意义（P〈0.05）,GST-π差异无统计学意义（P〉0.05）。②新疆汉族正常宫颈、初治宫颈癌组织中P-gp的阳性表达率分别为10%、56.7%;GST-π的阳性表达率分别为20%、60%,MRP1的阳性表达率分别为40%、86.7%。P-gp、GST-π和MRP1在各组间比较差异均有统计学意义（P〈0.05）。③在新疆维吾尔族妇女宫颈鳞癌组织中：NACT后宫颈癌组织中GST-π阳性表达显著上升（P〈0.05）,有统计学意义。NACT后宫颈癌组织中P-pg、MRP1阳性表达差异无统计学意义（P〉0.05）。④在新疆汉族妇女宫颈鳞癌组织中：NACT后宫颈癌组织中P-pg、GST-π阳性表达显著上升（P〈0.05）;有统计学意义。NACT后宫颈癌组织中MRP1阳性表达上升但差异无统计学意义（P〉0.05）。⑤新疆维吾尔族妇女化疗前宫颈鳞癌组织中MRP1及GST-π表达阴性和阳性患者NACT有效率无显著性差异（p〉0.05）,P-gp表达阴性患者NACT有效率显著高于P-gp表达阳性患者NACT有效率（p〈0.05）;⑥汉族化疗前宫颈鳞癌组织中P-gp、GST-π表达阴性患者NACT有效率显著高于P-gp、GST-π表达阳性患者NACT有效率（p〈0.05）;化疗前宫颈鳞癌MRP1表达阴性和阳性患者NACT有效率无显著性差异（p〉0.05）。结论：P-pg和GST-π可作为预测汉族宫颈鳞癌化疗敏感性指标。P-pg可作为预测维吾尔族宫颈鳞癌化疗敏感性指标。     

Cervical disease in women referred to colposcopy following inadequate smears

The aim of this audit was to determine if inadequate cervical smears are associated with significant cervical pathology. Case records for 52 women with three consecutive inadequate smears referred for colposcopy to the Leicester Royal Infirmary (LRI) were retrieved. Sixteen women underwent large loop excision of the transformation zone (LLETZ) and cervical intraepithelial neoplasia (CIN) was identified in six cases. There were no cases of inadequate smears initiating the diagnosis in 100 consecutive women with invasive cervical cancer. Inadequate smears are associated with high rates of treatment for a low yield of CIN. To reduce morbidity associated with colposcopy it may be acceptable to repeat an inadequate smear after 6 months rather than arranging immediate recall.     

Mesonephric hyperplasia can cause abnormal cervical smears: report of three cases with review of literature

BACKGROUND: Hyperplastic mesonephric remnants are an incidental finding in occasional uterine or cervical surgical specimens. We describe three cases in which such remnants were postulated to be the source of abnormal glandular cells in cervical smears. CASES: In all three cases abnormal glandular cells were seen in cervical smears. Subsequent histology showed the presence of hyperplastic mesonephric remnants that communicated with the endocervical canal and were likely to be the source of the abnormal glandular cells. We believe that the key features of these cells, which may aid their distinction from other causes of glandular abnormalities, are their loose clustering, lack of significant anisocytosis and cuboidal outlines. CONCLUSION: We aim to document mesonephric hyperplasia as a possible source for abnormal glandular cells in cervical smears.     

P16、P27和Ki67在宫颈病变中的表达及意义

目的探讨宫颈病变组织中P16、P27和Ki67蛋白的表达情况及临床意义。方法采用免疫组化S-P法检测30例宫颈上皮内瘤样病变(CIN)、18例宫颈鳞癌组织和12例宫颈正常鳞状上皮组织中P16、P27和Ki67蛋白的表达,分析宫颈病变形成过程中P16、P27和Ki67蛋白表达的变化以及临床病理特征的关系。结果P16和Ki67在正常宫颈、CIN和宫颈鳞癌组织中的表达率分别为0(0/12)、70%(21/30)、100%(18/18)和30%(4/12)、90%(27/30)、100%(18/18),二者在CIN和宫颈鳞癌中阳性表达率明显高于正常宫颈组织的表达,差异有显著性(P0.05);P27蛋白在正常宫颈、CIN和宫颈鳞癌组织中的表达率分别为82.22%(10/12)、53.33%(16/30)和27.78%(5/18),其在CIN和宫颈鳞癌中阳性表达率明显低于正常宫颈组织的表达,差异有显著性(P0.05)。在CIN和宫颈鳞癌组织中,P16和Ki67表达呈正相关(P0.05);P27和P16、Ki67表达呈负相关(P0.05)。结论P16、P27和Ki67参与了CIN、宫颈癌的发生。P16、Ki67和P27联合检测可作为早期诊断宫颈上皮内瘤变及宫颈癌的标记物,可提高宫颈癌的早期诊断率。     

The burden of cervical cancer in Vietnam: Synthesis of the evidence

There is currently no national cervical screening or HPV immunization program in Vietnam. This study aims to synthesize available data on the burden of disease and to project the burden of cervical cancer to 2049 if no major interventions are implemented. We reviewed published data sources on risk factors for HPV prevalence, high-grade lesions, cervical cancer incidence and mortality in Vietnam from 1990 to 2017. We then used the available data to project the number of new cervical cancer cases for the period 2013–2049. Data on cervical cancer incidence and mortality in Vietnam are limited; two Vietnamese cancer registries have been reported on by the International Agency for Research on Cancer, which cover urban populations representing ∼20% of the national population. The reported age-standardized cervical cancer incidence in Hanoi was 6.7 (1993–1997), compared to 28.8 and 14.1 per 100,000 women in Ho Chi Minh City (1995–1998 and 2009–2012, respectively). Cancer mortality data are not uniformly available from cancer registries or mortality surveys in Vietnam because cause of death has not been routinely ascertained. Based on available urban population registry data, estimated rates in the rural population, and forward projection of existing trends, we estimate that without any further intervention, the number of new cases will increase from 6930 (range 5671–8493) in 2012 to 8562 (range 5775–12,762) in 2049, giving a total of 379,617 (range 276,879–542,941) new cases over the period 2013–2049. These findings help underpin the case for the delivery of HPV vaccination and cervical screening in Vietnam, and support similar initiatives in other low- and middle-income countries.     

信号转导与转录因子3和表皮生长因子受体在宫颈不同病变组织中的表达及其临床意义

目的:探讨信号转导与转录因子3(STAT3)与表皮生长因子受体(EGFR)在宫颈不同病变组织中的表达变化及其临床意义。方法:采用Western blot与免疫组化的方法检测100例上皮内瘤样病变(CIN)组织、60例宫颈癌组织及40例正常宫颈组织中STAT3与EGFR的表达;分析STAT3与EGFR的表达与宫颈癌组织病理特征的关系;对宫颈癌组织中STAT3与EGFR的表达的相关性进行分析。结果:宫颈癌组织以及CIN组织中STAT3、EGFR的表达量和阳性率显著高于正常宫颈组织(P0.05),且宫颈癌组织中STAT3、EGFR的表达量和阳性率高于CIN组织,差异有统计学意义(P0.05);STAT3与EGFR在宫颈癌组织中的染色强度较正常宫颈组织以及CIN组织显著增强;STAT3与EGFR的异常表达与宫颈癌患者的组织学分级、临床分期以及是否发生淋巴结转移有关(P0.05),而与年龄以及病理分型无关(P0.05);宫颈癌组织中STAT3和EGFR表达呈正相关(P0.05)。结论:STAT3与EGFR表达与CIN、宫颈癌的进展紧密相关,且与宫颈癌部分病理特征相关,二者有可能作为宫颈癌诊断及预后的参考指标。     

The Cytological Prediction of Cervical Intraepithelial Neoplasia In Colposcopically Directed Biopsies

The tissue sections and preceding cervical smears of 1262 women who had colposcopic cervical biopsies were reviewed and the reports correlated. Close correlation between the cytological and histological findings, to within one histological grade of cervical intraepithelial neoplasia (CIN), was noted in 86% of cases. However, the biopsy was negative, or contained evidence of wart virus infection only, in 24% of cases where dyskaryotic cells had been observed in the cervical smear. Of particular concern was the fact that negative histological findings were recorded in 13% of cases where the smear contained cells showing a moderate dyskaryosis and in 1.26% of cases where the smear showed severe dyskaryosis. This suggests that colposcopically directed biopsies do not always reflect the underlying pathological changes in the cervix. Management of these cases is discussed. In 45 women with a normal cervical smear prior to biopsy, histology revealed seven cases of CIN 3 and one case of invasive squamous carcinoma. This indicates that referral for colposcopy is advisable whenever there is clinical suspicion of cancer, even if the cervical smear report is normal.     

P—gP、MRP1、GST-П与新疆维吾尔族宫颈癌新辅助化疗疗效的相关性研究

Ig1的：探讨新疆维吾尔族宫颈癌新辅助化疗前后P-gP、MRPI和GST-П的表达及其与化疗疗效的关系。方法：运用S-P法分别检测维吾尔族妇女宫颈鳞癌组织22例新辅助化疗前后及正常宫颈组织20例P-ge、MRPI和GST-TF的表达水平。结果：①新疆维吾尔族正常宫颈、初治宫颈癌组织中P—gp的阳性表达率分别为10％、40．9％;MRP1的阳性表达率分别为15％、31．8％;GST-П的阳性表达率分别为45％、9．01％。P．gP和GST．丌在各组间比较差异均有统计学意义（P〈0．05）MRP1差异无统计学意义（P〉0．05）。@NACT后宫颈癌组织中P．Pg阳性表达显著上升（P〈0．05）,有统计学意义。NACT后宫颈癌组织中MRP1、GST-П阳性表达上升但差异无统计学意义（P〉0．05）。⑨新疆维吾尔族妇女新辅助化疗前宫颈鳞癌组织中P—gP、MRP1及GST-Tr表达阴性和阳性患者NACT有效率无显著性差异（P〉0．05）。结论：P-pg、MRP1、GST-П无法作为化疗敏感性指标预测维吾尔族宫颈鳞癌新辅助化疗疗效     

GRP94 和CD8 在宫颈病变组织中的表达及意义

目的:探讨葡萄糖调节蛋白94(glucose-regulated protein94,GRP94)和CD8在宫颈病变组织中的表达及与HPV感染的关系。方法:采用免疫组化S-P法检测32例原发宫颈癌、27例宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及40例慢性宫颈炎组织中GRP94和CD8的表达及定位;采用western blot技术检测6例宫颈癌及6例正常宫颈组织中GRP94和CD8的表达。结果:①在宫颈癌、CIN2/3、CIN1及慢性宫颈炎组织中,GRP94的阳性表达率分别为87.5%、82.4%、40%和22.5%;CD8的阳性表达率分别为28.1%、64.7%、90%和97.5%;GRP94在宫颈癌和CIN2/3中的表达均显著高于慢性宫颈炎和CIN 1组织(P均<0.05);CD8在宫颈癌组的表达显著低于慢性宫颈炎组、CIN1组及CIN2/3组(P均<0.05)。②Western blot结果示GRP94在宫颈癌组织中的表达显著高于正常宫颈组织(P<0.01);CD8在宫颈癌组织中的表达显著低于正常宫颈组织(P<0.01)。③GRP94的表达与宫颈癌分化程度、有无脉管侵袭有关(P<0.05),而与年龄、病理类型、临床分期及有无淋巴结转移无关(P>0.05);CD8的表达与有无脉管侵袭有关(P<0.05),而与年龄、病理类型、临床分期、分化程度及有无淋巴结转移无关(P>0.05)。④宫颈病变组织中,GRP94的表达与HPV感染呈正相关(rs=0.377,P=0.000);CD8的表达与HPV感染呈负相关(rs=-0.395,P=0.000);GRP94与CD8的表达呈负相关(rs=-0.608,P=0.000)。结论:GRP94表达可能是宫颈CIN进展及宫颈癌预后判断的重要预测指标。     

Smad7和Ki-67在新疆维吾尔族宫颈鳞癌中的表达及相关性研究

目的:分析新疆维吾尔族妇女宫颈鳞癌组织中Smad7和Ki-67表达及相关性。方法:采用免疫组化SP法检测宫颈炎组织88例(汉族42例,维吾尔族46例)以及宫颈鳞癌组织120例(汉族50例,维吾尔族70例)中Smad7、Ki-67蛋白的表达。结果:Smad7、Ki-67蛋白在宫颈鳞癌中的阳性表达率(78.3%、76.7%)均分别显著高于宫颈炎组织(15.9%、23.9%),差异有统计学意义(P0.05);维吾尔族妇女宫颈鳞癌中Smad7的阳性表达率(87.1%)显著高于汉族(66%)(P0.05)。维吾尔族宫颈鳞癌患者中Smad7、Ki-67的阳性表达率呈显著正相关性(x2=1.93,r=0.138,P0.05)。结论:宫颈鳞癌组织中Smad7、Ki-67蛋白的阳性表达率显著高于宫颈炎组织,宫颈鳞癌中Smad7蛋白的表达存在民族差异,Smad7、Ki-67等多种蛋白的联合检测可能会间接提高新疆维吾尔族妇女宫颈鳞癌诊断的准确度和精确度。     

宫颈环形电切及锥切术治疗子宫颈病变临床分析

目的探讨宫颈环形电切及锥切术（LEEP）在宫颈上皮内瘤变（CIN）等宫颈病变诊疗中的应用价值。方法对我院以LEEP治疗CIN等宫颈病变69例,对比手术前后病理检查结果、并进行随访,统计其HPV感染情况。结果术前宫颈活检与术后病理检查结果符合率为76．8％（53／69）。LEEP可以一次性治疗CINⅠ和反复宫颈炎病例,在41例CINⅡ和Ⅲ病例中有2例复发。HPV感染率在CIN中70．0％（42／60）,反复宫颈炎患者中44．4％（4／9）。结论LEEP治疗CIN等宫颈病变手术操作简便,术后恢复好、复发率低,是可以推广的较为理想的诊断及治疗措施。     

Mitochondrial DNA mutations in patients with HRHPV-related cervical lesions

High risk human papillomaviruses (hr-HPV) are known to be the etiological agents of cervical cancer disease. On the other hand, other cofactors are considered to be important in cervix carcinogenesis. Mutations in mitochondrial DNA (mtDNA) as well as alterations in mtDNA content have been reported in numerous cancers examined to date. The D-loop region has been shown to be a mutational "hot spot" in human cancer. In order to evaluate the role of mtDNA mutations in cervical lesions progression, cervical specimens (from 79 women, 29-65 years old) were investigated. DNA was isolated (High Pure PCR Template, Roche Diagnostics) from cervical cells from patients with different cytology (normal cervical epithelium, ASCUS-Atypical Squamous Cells of Undetermined Significance, LGSIL-Low-Grade Intraepithelial Lesion, HGSIL-High-Grade Intraepithelial Lesion and SCC-Squamous Cell Carcinoma) and tested for HPV DNA presence (Linear Array HPV Genotyping Test, Roche Diagnostics). To elucidate a causative role of mtDNA in cervical lesions, mtDNA mutations were investigated using Mutector mtDNA kit (TrimGen Corporation). In patients with normal and ASCUS cytology, mtDNA mutations were absent. 16.66% of LGSIL patients presented mutations in D-loop region whereas 28.57% HGSIL cases showed mutations in mtDNA. Mutations were detected in 66.66% cases of SCC cases. These studies provide strong evidence that instability in the D-loop region of mtDNA may be involved in cervical dysplasia. We suggested that mtDNA mutations may play a role in cervical precursor lesions and cancer but their role in the mechanism of carcinogenesis remains to be solved.     

TLR4在宫颈癌与不同HPV亚型宫颈癌细胞株中表达及意义

目的 探讨TLR4在正常宫颈组织、宫颈上皮不典型增生、宫颈癌组织以及不同HPV亚型宫颈癌细胞株中表达与意义.方法 采用SP免疫组织化（IHC）检测TLR4在12例正常宫颈组织、30例宫颈轻度不典型增生（cervical intraepithelial neoplasia Ⅰ,CINⅠ）、30例宫颈中-重度不典型增生（cervical intraepithelial neoplasiaⅡ-Ⅲ,CIN Ⅱ-Ⅲ）以及49例宫颈癌（invasive cervical carcinoma,ICC）组织中的表达;应用细胞免疫荧光法、逆转录聚合酶链反应（RT-PCR）检测TLR4在不同HPV亚型宫颈癌细胞株HPV18（＋）HeLa、HPV16（＋）Siha以及HPV（-）C33a宫颈癌细胞株上的表达.结果 TLR4的表达随着宫颈病变程度的增高逐渐增强,在正常宫颈组织、CINⅠ、CIN Ⅱ～Ⅲ、ICC中阳性表达率分别为8.33 %（1/12）、20.00 %（6/30）、26.67 %（8/30）和55.10 %（27/49）,ICC与正常宫颈组织、CINⅠ、CINⅡ～Ⅲ之间均有显著性差异（P＜0.01）.TLR4表达与HPV感染有关,在HPV阳性宫颈癌细胞株上表达强于HPV阴性细胞株.结论 TLR4可能参与宫颈癌起始、发展,TLR4的表达与功能与HPV感染有关.     

Earlier Diagnosis of Cervical Cancer—An Analysis of Reports to the California Tumor Registry from 1942 to 1963

The mortality rate for cervical cancer in California declined during the period 1950-64. Indirect evidence shows that the incidence is also declining, but it is difficult to assess this decline because of the effect of the increasing use of cytologic examination on incidence rates for cervical cancer.Cervical cancer, in the 57 hospitals reporting to the California Tumor Registry, is being diagnosed at an earlier stage than in previous years. The proportion of cases diagnosed with the lesion still in the in situ stage rose from zero in 1942 to 56 per cent in 1963, and invasive cervical cancer, as a proportion of all invasive cancer in women, decreased from 15 per cent to 9 per cent. There is wide variation among hospitals in the proportion of cervical cancer cases that are in situ at time of diagnosis.