TCT联合HPV检测诊断宫颈病变的临床价值分析

目的:探讨新柏氏液基细胞学技术(TCT)联合人乳头瘤病毒(human papilloma virus,HPV)检测诊断宫颈病变的临床价值。方法:选择哈尔滨医科大学附属第一医院妇科门诊收治的6752例患者,采集其宫颈脱落细胞进行TCT检测,登记患者的年龄及宫颈外观。分别随机选取TCT阳性和阴性结果的患者144例进行HPV检测及阴道镜下活检,分析和比较TCT单独及联合HPV检测诊断宫颈病变的敏感性和特异性。结果:宫颈柱状上皮细胞的外移程度及患者的年龄与宫颈TCT结果均无显著相关性。单独TCT检测诊断宫颈病变的灵敏度为87.04%,特异性为58.55%;单独HPV检测诊断宫颈病变的灵敏度为62.96%,特异性为81.62%;而联合测诊断宫颈病变的灵敏度为100%,特异度为48.29%。结论:TCT联合HPV检测可显著降低宫颈病变的漏诊率。     

Ultrasound characteristics of uterine myoma before and after uterine artery embolization

The diagnosis and treatment of uterine leiomyoma are topical problems of modern gynecology and radiodiagnosis. Organ-saving treatments for uterine myoma, one of which is uterine artery embolization, are gaining wide acceptance now. The objective of the study was to increase the informative value of ultrasound study to predict the uterine myoma after uterine artery embolization. One hundred uterine myoma patients aged 20 to 52 years were examined. Small pelvic Doppler ultrasonography was carried out in all the patients. The reduction of myomatous nodules was estimated after uterine artery embolization. The decrease in uterine myoma sizes was found to be due to the reduction in their vascularization and the occurrence of ischemia with degeneration in the myoma. Ultrasonography was found to be most accessible and informative in the prognostic and postoperative evaluation of the efficiency of X-ray endovascular treatment for uterine myoma.     

Determination by echography of uterine changes around puberty in gilts and evaluation of a diagnosis of puberty

Three experiments were carried out to evaluate the use of ultrasonography in assessing the onset of puberty in gilts. In experiment 1, gilts (n = 17) were scanned 3 times per week beginning at 133 and continuing until 187 days of age. The ultrasonic appearance of the uterus was described, quantified and compared with the reproductive status observed at slaughter. The quantification of the pictures showed a different correlation in time for infantile, impubertal, prepubertal and pubertal stages. For pubertal females, "uterine area" increased at around 180 days of age, well-defined sections of the uterine horns appeared 3 +/- 0.5 days before puberty. In infantile and impubertal gilts during the same period of age, uterine images remained dark and homogeneous; no significant change in the "uterine area" was observed. This difference in images allowed an evaluation of the diagnosis of puberty. In experiment 2, the gilts (n = 123) were scanned, the result was verified at slaughter the day after by examination of the genital tract. The uterine weight of the gilts that had reached a prepubertal or pubertal stage was significantly greater (P = 0.0001) than that in impubertal gilts. The sensitivity and the specificity of the diagnosis were 91.9% and 96.5% respectively. Experiment 3 was performed on a farm and echographic examinations were carried out one and five days after gilts (n = 117) arrived at the piggery. Oestrus detection or blood sampling for progesterone determinations were used as tools to determine the reproductive status. The sensitivity and the specificity of the diagnosis were 98.9% and 100% respectively. This diagnosis of puberty is thus accurate.     

超声技术鉴别子宫肌瘤和子宫腺肌病

子宫肌瘤和腺肌病的准确鉴别在妇科临床诊治中有十分重要的意义,各种鉴别诊断技术中,超声技术因其无损性、简便性而成为常规的一种方法。超声成像技术是其中较为成熟的方法。在综述B型成像、彩色血流成像结合脉冲多普勒、彩色血流功率成像和三维彩色功率成像等四种超声成像技术鉴别子宫肌瘤和子宫腺肌病情况的基础上,介绍了两种新的超声鉴别方法：超声弹性检测技术、基于其他声学特征参数检测的组织定征技术。     

Uterine injuries complicating hypertonic saline abortion

Two cases of uterine injury complicating midtrimester abortion induced by hypertonic saline are described, one with an extensive laceration of the cervix and the other with a rupture of the lower uterine segment extending into the vault of the vagina. The etiology, diagnosis and possible obstetric sequelae are discussed.     

宫腔镜联合B超诊断异常子宫出血124例临床分析

目的：探讨宫腔镜联合B超在诊治异常子宫出血的临床价值。方法：对124例异常子宫出血的病例进行回顾性分析,所有患者作B超及宫腔镜检查,宫腔内切除物或刮出物均送病理检查。结果：124例患者经病理检查确诊为子宫内膜息肉84例（67．7％）,合并宫颈息肉10例;子宫内膜增生症16例（12．9％）,其中单纯性增生12例,复杂性增生4例;子宫内膜不典型增生1例（0．8％）;子宫粘膜下肌瘤12例（9．7％）;子宫内膜样腺癌6例（4．8％）;子宫内膜炎3例（2．4％）;胚物残留2例（1．6％）。结论：宫腔镜联合B超检查是诊断异常子宫出血最好的方法.     

Cytologic features of a primary myxoid malignant fibrous histiocytoma arising in the uterus: a case report.

BACKGROUND: Primary malignant fibrous histiocytoma (MFH) of the uterus is extremely rare. The 10 cases reported in the literature all involved the pleomorphic variant, and to the best of our knowledge, the myxoid variant has not been reported before. We describe the cytologic findings of primary uterine myxoid MFH in relation to the myxoid component, potentially leading to an incorrect diagnosis. CASE: A 68-year-old woman presented with a primary uterine tumor. Endometrial cytology showed numerous loosely arranged, spindle-shaped fibroblastlike cells; atypical histiocytelike cells; and giant cells with a necrotic background. The overall cytologic picture was of a degenerated pleomorphic leiomyosarcoma with an inconclusive diagnosis. A diagnosis of myxoid MFH was established after electron microscopic and immunohistochemical studies of the primary tumor and tumor transplanted, as primary cultured cells, in nude mice. The patient underwent an exploratory laparotomy and died of tumor progression 38 days after the initial consultation, without treatment. CONCLUSION: Because of overlapping cytologic features among uterine sarcomas with myxoid stroma, it is important to recognize the histiocytic lineage of tumor cells by immunohistochemistry and electron microscopy in various presentations of fresh samples.     

The assessment of LIF in uterine flushing--a possible new diagnostic tool in states of impaired fertility

The objective of this study was to assess the LIF (leukemia inhibitory factor) concentration in uterine flushing and serum (ELISA) of women with proven fertility, infertile women and women with recurrent miscarriage. In addition, progesterone level was determined in serum. A decreased production of LIF in the uterine microenvironment was found in states of impaired fertility. With a cut-off point of 8.23 pg/ml for LIF level in uterine flushings we have achieved 86.7% sensitivity and 100% specificity in detection of women with idiopathic infertility compared to fertile controls. No correlation between LIF in serum and uterine flushing was demonstrated, rendering LIF measurements in serum useless for diagnosis of impaired infertility. We conclude that LIF measurement in uterine flushing could be a useful diagnostic tool to predict unsuccessful implantation.     

Ultrasonic observation of postpartum uterine involution in the cow

To learn about the progress of postpartum uterine involution in the dairy cow, the authors wanted to know whether the ultrasonic linear scanner is applicable for this purpose. The uterus was observed by the transducer, which was inserted into the rectum. Clear cross-sectional images of the endometrium were obtained in this way; however, those of the myometrium and the perimetrium were not very clear. Observation on the progress of uterine involution was started on Day 8 postpartum and continued to Day 43 postpartum. The diameter and area of the uterine horn and the endometrium in cross-sectional ultrasonograph images of the endometrium were estimated using a Magiscan 2 image analyzer. The relationship between the estimated dimensions of the uterine horn and postpartum days were satisfactorily fitted into polynomial regressions. Using the ultrasonic linear scanner, it was confirmed that uterine involution was completed at approximately 40 d postpartum. The applicability of the ultrasonic linear scanner for diagnosis of uterine involution in the postpartum cow is demonstrated by the results of the present study.     

Primary malignant lymphoma of the uterine corpus diagnosed by endometrial cytology. A case report

BACKGROUND: A relatively small number of cases of primary malignant lymphoma of the uterine corpus have been reported, and it is rare for cases to be preoperatively diagnosed by cytology. CASE: A 59-year-old female experienced abnormal uterine bleeding of two months' duration. Preoperative evaluation of endometrial cytology revealed malignant cells. These cells demonstrated a rather round or oval configuration, with a markedly increased nuclear/cytoplasmic ratio, and were isolated and scattered in an inflammatory background. The nuclei were round or oval, and macronucleoli were marked. The cytologic diagnosis was malignant lymphoma. Postoperative histologic evaluation verified the presence of a primary malignant lymphoma in the uterine corpus, with a B-cell phenotype. CONCLUSION: Preoperative endometrial cytology correctly demonstrated malignant lymphoma of the uterine corpus.     

首例圈养大熊猫难产的治疗与原因分析

2004年8月,成都大熊猫繁育研究基地1只雌性大熊猫发生难产,临床表现以阵缩及努责匮乏为主要特征,经过B超检查、药物辅助治疗等一系列保守措施后,胎儿于4天后排出。鉴于大熊猫难产病例在国内外至今未见报道,现将该病的临床特点、诊断和处治情况介绍如下。     

Cervical and peritoneal fluid cytology of uterine sarcomas

OBJECTIVE: To study the cytologic features of uterine sarcoma. STUDY DESIGN: The pathology records of 102 patients with uterine sarcoma were reviewed. Four patients, including one case of leiomyosarcoma (LMS), one high grade stromal sarcoma (HGSS) and two malignant mixed müllerian tumor (MMMT), had abnormal cervical and/or peritoneal cytologic findings. Three abnormal cervical smears and two abnormal peritoneal fluids from these patients, including immunohistochemically stained sections of cell block, were reviewed. RESULTS: The diagnostic cells appeared in clusters or in isolation. They had enlarged and hyperchromatic nuclei. Occasional mitotic figures were seen. The cells were considered suspicious for malignancy in cervical smears of HGSS and in the peritoneal fluid of LMS. Adenocarcinoma cells were identified in both the cervical smear and peritoneal fluid of one patient with MMMT. Atypical cells were found in another patient with MMMT. CONCLUSION: Positive cervical or peritoneal cytology is uncommonly detected in association with uterine sarcomas. Even when abnormal cells are found, it may be difficult to give a definitive diagnosis of uterine sarcoma based directly on the cytomorphologic characteristics of cervical or peritoneal smears. However, such a possibility should be kept in mind by the cytopathologist to avoid missing the diagnosis.     

ORIGINAL ARTICLE: Medical and surgical management of reproductive neoplasia in two western lowland gorillas (Gorilla gorilla gorilla)

Background Reports of female reproductive tract neoplasia are infrequent in great apes. Methods Two captive‐born, female western lowland gorillas (Gorilla gorilla gorilla) housed at the North Carolina Zoological Park were diagnosed with reproductive neoplasia. Results The first gorilla had uterine endometrial thickening and uterine fibroids diagnosed during a routine annual examination. Subsequently, the animal underwent several uterine curettage procedures in an attempt to debulk the uterine mass. Biopsy results indicated uterine adenocarcinoma. The animal was treated with an ovariohysterectomy followed by a combination of megestrol acetate and medroxyprogesterone acetate. The second gorilla was diagnosed with squamous cell carcinoma of the vagina, cervix, and uterus after presenting for intermittent vaginal bleeding of 1‐month duration. This animal underwent palliative radiation therapy, receiving two rounds of radiation treatment 8 weeks apart. Conclusions The following report describes the diagnosis and management of the two cases.     

The Cytological Features of Invasive Adenocarcinoma of the Cervix Uteri

Seventy cases of invasive adenocarcinoma of the uterine cervix were predicted on cytological grounds and confirmed by histopathology. The cervical smears from these cases were further analysed and classified into well and poorly differentiated adenocarcinoma on the basis of the pattern of the cells in the smear and their nuclear detail. Using this method of analysis it is possible to increase the accuracy of cytology for the diagnosis of adenocarcinoma of the uterine cervix.     

剖宫产疤痕妊娠30例临床分析

摘要目的：探讨子宫剖宫产疤痕妊娠（CSP）的诊断和最佳治疗方法,为后续的临床研究工作提供理论依据和临床资料。方法：回顾性分析我院2010年2月．2012年2月收治的30例CSP患者的临床资料。结果：30例患者中,有25例行双侧子宫动脉栓塞（UAE）＋MTX灌注术后,再行清宫术,手术均获得成功,术后无任何并发症出现;另外5例患者因误诊为宫内妊娠后行人工流产术时发生大出血转至我院进行抢救,其中,4例成功实施了子宫动脉栓塞术,达到了止血目的,1例因子宫破裂直接行全子宫切除术。结论：对子宫剖宫产疤痕妊娠（CSP）患者实施双侧子宫动脉栓塞术＋MTX灌注术后,借助B超监测,再行刮宫术,是治疗剖宫产切口妊娠的有效方法。     

宫腔镜联合B 超诊断异常子宫出血124 例临床分析

目的:探讨宫腔镜联合B超在诊治异常子宫出血的临床价值。方法:对124例异常子宫出血的病例进行回顾性分析,所有患者作B超及宫腔镜检查,宫腔内切除物或刮出物均送病理检查。结果:124例患者经病理检查确诊为子宫内膜息肉84例(67.7%),合并宫颈息肉10例;子宫内膜增生症16例(12.9%),其中单纯性增生12例,复杂性增生4例;子宫内膜不典型增生1例(0.8%);子宫粘膜下肌瘤12例(9.7%);子宫内膜样腺癌6例(4.8%);子宫内膜炎3例(2.4%);胚物残留2例(1.6%)。结论:宫腔镜联合B超检查是诊断异常子宫出血最好的方法。     

女性微创妇科手术中隐匿性子宫肉瘤的危险因素分析

为了确定影响子宫平滑肌肉瘤风险的因素,本研究采用回顾性病例对照研究,选择72例接受微创妇科手术治疗子宫肌瘤的妇女为研究对象,对平滑肌肉瘤(病例)的患者在年龄、手术年限和外科医生专业方面进行对照研究。妇科病理学家通过对病理学数据库中的病例进行鉴定,确诊平滑肌肉瘤或平滑肌瘤。通过计算平滑肌肉瘤的累积风险,并使用条件逻辑回归研究预测平滑肌肉瘤风险升高的因素。本研究中确诊了15名平滑肌肉瘤的患者,并与57名对照组进行对照,发现进行微创妇科手术后,病理诊断子宫平滑肌肉瘤的累积风险为0.19%(95%置信区间[CI],0.06%~0.56%)。多变量分析显示血细胞比容值<30%(校正比值比[aOR],20;95%CI,1.08~100;p=5.05)与子宫平滑肌肉瘤的诊断独立相关。增加的肌瘤大小(aOR,9.73;95%CI,0.75~1.26;p=5.08)和孤立性肌瘤(aOR,3.85;95%CI,0.65~25;p=5.14)与更大的子宫平滑肌肉瘤风险相关;但是差异没有统计学意义。本研究表明,贫血和肌瘤大小>7 cm可能与隐匿性平滑肌肉瘤相关;但是这些标准仍不具有足够的区分性以用于术前鉴别子宫肉瘤患者。     

The computed tomographic semiotics of inflammatory diseases of the adnexa uteri

The authors sum up the results of CT and clinical investigation of 46 women with inflammatory diseases of the uterine appendages: salpingo-oophoritis, pyosalpinx, pyoovarium, and 2 types of tuboovarian abscesses. They have shown CT potentialities in differential diagnosis of inflammations of the uterine appendages with cysts and true ovarian tumors on the basis of routine investigation and an iv contrast study of intensified images. Retrospective analysis of the most typical diagnostic errors is given.     

子宫特殊部位妊娠18例分析

目的：探讨子宫特殊部位妊娠的临床诊断及处理。方法：回顾性分析2005年7月至2010年12月我院收治的18例子宫特殊部位妊娠患者的临床表现、诊断、处理及预后。结果：宫颈妊娠6例、宫角妊娠6例、残角子宫妊娠2例、子宫剖宫产瘢痕处妊娠4例。宫颈妊娠通过子宫动脉介入栓塞后清宫术治愈;宫角妊娠经MTX保守治疗后在超声或官腔镜引导下清宫术痊愈。残角子宫妊娠均行残角子宫切除术治愈。子宫剖宫产瘢痕处妊娠根据分型分别行超声引导下清宫＋水囊压迫、局部注射MTX保守治疗治愈。结论：子宫特殊部位妊娠病情凶险,临床表现各异,但有其特异性,超声辅助检查有助于早期诊断,MTX、子宫动脉介入栓塞治疗后刮宫是有效治疗手段。     

Mice-lacking LMP2, immuno-proteasome subunit,as an animal model of spontaneous uterine leiomyosarcoma

Uterine tumors are the most common type of gynecologic neoplasm. Uterine leiomyosarcoma (LMS) is rare, accounting for 2% to 5% of tumors of the uterine body. Uterine LMS develops more often in the muscle tissue layer of the uterine body than in the uterine cervix. The development of gynecologic tumors is often correlated with female hormone secretion; however, the development of uterine LMS is not substantially correlated with hormonal conditions, and the risk factors are not yet known. Radiographic evaluation combined with PET/CT can be useless in the diagnosis and surveillance of uterine LMS. Importantly, a diagnostic biomarker, which distinguishes malignant LMS and benign tumor leiomyoma (LMA) is yet to be established. Accordingly, it is necessary to analyze risk factors associated with uterine LMS in order to establish a method of treatment. LMP2-deficient mice spontaneously develop uterine LMS, with a disease prevalence of ~40% by 14 months of age. It is therefore of interest whether human uterine LMS shows a loss of LMP2 expression. We found LMP2 expression is absent in human LMS, but present in human LMA. Therefore, defective LMP2 expression may be one of the risk factors for LMS. LMP2 is potentially a diagnostic biomarker for uterine LMS, and gene therapy with LMP2-encording DNA may be a new therapeutic approach.