炎性肌纤维母细胞肿瘤( inflammatory myofibroblastic tumor,IMT)是由大量新陈代谢增生的炎性肌纤维母细胞、纤维细胞和一些数量不等的炎性淋巴细胞、浆细胞等多种炎症性细胞共同组合构成,可在多个部位反复发生的一种中间性间叶性肿瘤.IMT 通常发生在人体内脏和局部软组织,临床表现通常无特异性.由于IMT形态结构复杂,易与纤维组织细胞瘤、结节性筋膜炎和炎性假瘤等梭形细胞肿瘤混淆,给病理诊断带来困难[1].子宫IMT的组织学表现与子宫外IMT相似,临床上大多数IMT是良性的,但由于其有局部复发的倾向,需要手术切除.文献报道的累及妇科器官的IMT均局限于子宫[2].本文介绍近期在我院接受手术治疗的1例子宫IMT患者,通过整理和结合相关文献资料进行复习.

先天性阴道闭锁(congenital atresia of vagina)是由泌尿生殖窦及苗勒管末端发育异常而未形成贯通的阴道所致,发病率较低.阴道完全闭锁也称为Ⅱ型阴道闭锁,多合并宫颈的发育不良,子宫体发育不良或子宫畸形,在临床上更为罕见.本文对2018年10月吉林大学第二医院妇产科收治后又转诊至北京协和医院的1例Ⅱ型阴道闭锁病例进行临床分析并复习相关文献,总结目前国内外诊断、分型和治疗的进展,以期医生能更好地认识这种生殖道畸形,患者得到个体化治疗,实现更佳预后.

宫颈纳氏腺囊肿为妇科常见的良性疾病,多为分娩、炎症、人工流产等因素对宫颈的损伤所致.此病为直径在数毫米至4厘米的较小的宫颈囊肿,可为单发或多发,患者多无自觉症状,较大者罕见,性生活可有不适.临床对于宫颈巨大纳氏腺囊肿的术前识别至关重要,与宫颈恶性疾病相鉴别可避免扩大手术范围,提高患者的术后生存质量.巨大宫颈纳氏腺囊肿与阴道苗勒管囊肿、宫颈恶性腺瘤术前易混淆,超声检查不具有绝对性诊断价值.巨大宫颈纳氏腺囊肿病因不清,报告1例合并完全性纵隔子宫且妊娠至足月分娩病例,巨大宫颈纳氏腺囊肿的发生与子宫先天性畸形之间是否有关仍有待研究.

多囊卵巢综合征(PCOS)是一种复杂的妇科内分泌综合征,具有生殖和代谢异常.常常发生于青春期月经初潮后,由于青春期PCOS的临床表现与青春期女性的正常生理现象非常相似,往往被忽视、漏诊或治疗不及时而导致其生殖障碍,远期并发症增加,严重危害她们的身心健康,所以对于青春期PCOS的诊治至关重要.本文对青春期PCOS的临床表现、诊断和治疗的进展进行综述.

阑尾黏液腺癌是原发于阑尾黏液上皮的低度恶性肿瘤,发病率低,约占阑尾肿瘤的0.01％～0.08％,发病高峰年龄为50～60岁[1].主要病理类型为阑尾腺癌和类癌.随着病情进展,阑尾黏液腺癌可直接播散至腹腔,形成腹膜假性黏液瘤(pseudomyxoma peritonei).腹膜假性黏液瘤是一种较少见的临床疾病,主要特点为腹腔内大量胶冻状黏液.阑尾黏液腺癌无特异性症状和体征,女性患者极易术前被妇科误诊为卵巢肿瘤.本研究分析了阑尾黏液腺癌向卵巢、子宫的转移,腹膜假性黏液瘤形成误诊为卵巢肿瘤1例,旨在为临床医生对阑尾黏液腺癌的诊断提供帮助与指导.

卵巢畸胎瘤是一种卵巢生殖细胞肿瘤[1] ,它由三个胚层(外胚层、中胚层、内胚层)组织构成,分为成熟畸胎瘤( mature teratoma, MT ) 、未成熟畸胎瘤( immature teratoma,IT)和成熟畸胎瘤恶变( malignant transformation of mature cystic teratoma,TMT),其中IT和TMT均属于卵巢恶性畸胎瘤,前者约占卵巢畸胎瘤的1 % ~3 %,后者约占卵巢畸胎瘤的2 % ~4 % [2] .本文回顾性分析近10年来我院收治的8 例确诊为卵巢恶性畸胎瘤患者的临床资料,通过对其临床特点及病理特征的总结及文献回顾,以增加临床医师对卵巢恶性畸胎瘤的认识.

近年不孕症的发病率不断增加,使促排卵治疗及药物使用变得越来越普遍,引起了人们对其潜在不良反应的关注.有研究发现卵巢持续排卵可能是引起卵巢癌的一个重要因素[1].本文就卵巢肿瘤与促排卵治疗的研究进展进行综述.

多囊卵巢综合征(polycystic ovariam syndrome,PCOS)是女性最常见的内分泌疾病之一,遗传及内分泌因素等与该病发生有关,PCOS会引起育龄女性不孕,增加子宫内膜癌及心血管疾病的发生风险.最近研究发现PCOS患者存在许多自身免疫抗体,尤其是抗甲状腺抗体,从而并发了相应的自身免疫性疾病,这可能与雌孕激素不均衡和维生素D水平较低有关,这启发临床上可以通过调节激素水平及补充维生素D来规避PCOS并发自身免疫性疾病的风险.目前对于PCOS与自身免疫性疾病之间相关性的研究受到广泛关注,本文就两者相关性的研究进展进行综述,分析两者相关性的机制,为寻找PCOS的治疗方案提供新思路.

目的:探讨卵巢恶性Brenner瘤(malignant Brenner tumor,MBT)的临床诊断及治疗进展,分析其临床特点,加强对卵巢恶性Brenner瘤的认识.方法:对2017年9月吉林大学第二医院收治的1例卵巢恶性Brenner瘤进行临床分析并复习相关文献,总结目前国内外诊断及治疗的进展.结果:患者经手术组织病理学及免疫组化标记确诊,术前并无特异的临床表现,免疫组化显示锌脂结构转录因子(GATA3)阳性,细胞角蛋白7(CK7)阳性,特殊的是P53与P63均表达阳性.结论:该类疾病临床表现及影像学表现缺乏特异性,诊断依靠组织病理学及免疫组化标记物,需注意与移行细胞癌相鉴别,手术切除是主要的治疗方法,标准化疗方案是卡铂加紫杉醇.

宫颈微小偏离型腺癌(MDA)原名为宫颈恶性腺瘤(CAM),是一种较为少见的特殊类型宫颈腺癌.由于其组织学的似"良性"表现,而生物学行为具有浸润和转移的恶性特征,极易误诊、漏诊,因此早期诊断和治疗可以改善其预后.为提高对宫颈MDA的认识,现回顾性分析1例宫颈MDA患者的临床资料,结合文献进一步分析其临床表现和病理特征,以加深临床医生对宫颈MDA的认识,提高诊断和治疗水平.

宫颈癌是世界上第3 常见的妇科恶性肿瘤,在我国居女性生殖系统恶性肿瘤发病率第1 位[1].99％以上的宫颈癌患者伴有人乳头瘤病毒( HPV )感染[2] ,但是90％的HPV感染可以自行治愈,仅有5％左右的HPV感染会发展为持续性感染,且仅有持续的高危型 HPV ( HR-HPV )感染才能引起宫颈癌[3] ,所以早期筛选、诊断和治疗是预防和控制宫颈癌发病和死亡的关键[4]. 目前,宫颈癌筛查的发展趋势已经由简单关注是否有HR-HPV感染,转向于关注是否有HPV E6/E7 mRNA转录及HPV E6/E7蛋白的过度表达. HPV E6/E7 现已成为新的研究热点,本文就其在宫颈癌中的研究进展作一综述.

女性假两性畸形是指核型为46,XX,内生殖器为女性生殖腺而外生殖器类似男性的一种常染色体隐性遗传疾病,在新生儿性别畸形中的发病率为1/16000~1/20000[1].其中,单纯男性化先天性肾上腺皮质增生症(CAH)所致的女性假两性畸形,通常由于只有外阴发育异常而无失盐表现、患者及家属对此病的认识不足、患者的自卑情绪等精神心理障碍及就诊医院较低的医疗水平,导致就诊及确诊较晚,甚至延误诊治.本研究为提高对单纯男性化先天性肾上腺皮质增生症致女性假两性畸形的认识,回顾性分析2017年6月1日于吉林大学第二医院(我院)就诊的1例该病患者的临床资料,并通过复习相关文献探讨其诊断及治疗.

Loop-mediated isothermal amplification (LAMP), an attractive DNA amplification method, was developed as a valuable tool for the rapid detection of Toxoplasma gondii. In this study, species-specific LAMP primers were designed by targeting the AF146527 sequence, which was a conserved sequence of 200- to 300-fold repetitive 529 bp fragment of T.gondii. LAMP reaction system was optimized so that it could detect the minimal DNA sample such as a single tachyzoite or 10 copies of recombinant plasmid. No cross-reactivity was found when using DNA from other parasites as templates. Subsequently, a total of 200 human blood samples were directly investigated by two diagnostic methods, LAMP and conventional PCR. Fourteen of 200 (7%) samples were positive for Toxoplasma by LAMP (the primers developed in this study), whereas only 5 of 200 (2.5%) were proved positive by conventional PCR. The procedure of the LAMP assay was very simple, as the reaction would be carried out in a single tube under isothermal conditions at 64°C and the result would be read out with 1 h (as early as 35 min with loop primers). Thus, this method has the advantages of rapid amplification, simple operation, and easy detection and would be useful for rapid and reliable clinical diagnosis of acute toxoplasmosis, especially in developing countries.

输卵管绒毛膜癌是一种极为罕见的滋养细胞恶性肿瘤.因其发病率低、临床表现及辅助检查均无特殊性,不易与输卵管异位妊娠相鉴别,极易发生误诊误治,造成肿瘤转移,影响患者预后,故应引起临床医师重视,现报告2例如下.

目的:探讨Tn抗原在宫颈癌组织中的发生、发展中的作用,为宫颈癌的早期诊断、治疗提供一定的参考依据.方法:选择2013-2015年吉林大学第二医院的102例临床样本,其中正常宫颈组织14例,宫颈上皮内瘤变(CIN)组织22例,宫颈癌组织66例,采用免疫组织化学方法以半乳糖胺特异性凝集素蚕豆凝集素(vicia villosa lectin,VVL)作为抗体检测不同宫颈组织中Tn抗原表达情况.结果:Tn抗原极少表达于正常宫颈鳞状上皮(7.1％),在CIN和宫颈鳞癌中表达率分别为45.5％和68.8％,而在宫颈腺癌中表达率高达94.1％.在宫颈鳞癌中,Tn抗原的表达与是否存在淋巴结转移有关(r=0.363,P＜0.05).在宫颈腺癌中,Tn抗原表达与肌层浸润深度有关(r=0.361,P＜0.05).结论:Tn抗原可能作为宫颈腺癌的一种肿瘤标志物,有助于宫颈腺癌的筛查诊断,并可能更早地提示宫颈鳞癌淋巴结转移的潜在风险.

As a gynecological oncology, ovarian cancer has high incidence and mortality. To study the mechanisms of ovarian cancer, the present study analyzed the GSE37582 microarray. GSE37582 was downloaded from Gene Expression Omnibus and included data from 74 ovarian cancer cases and 47 healthy controls. The differentially-expressed genes (DEGs) were screened using linear models for microarray data package in R and were further screened for functional annotation. Next, Gene Ontology and pathway enrichment analysis of the DEGs was conducted. The interaction associations of the proteins encoded by the DEGs were searched using the Search Tool for the Retrieval of Interacting Genes, and the protein-protein interaction (PPI) network was visualized by Cytoscape. Moreover, module analysis of the PPI network was performed using the BioNet analysis tool in R. A total of 284 DEGs were screened, consisting of 145 upregulated genes and 139 downregulated genes. In particular, downregulated FBJ murine osteosarcoma viral oncogene homolog (FOS) was an oncogene, while downregulated cyclin-dependent kinase inhibitor 1A (CDKN1A) was a tumor suppressor gene and upregulated cluster of differentiation 44 (CD44) was classed as an 'other' gene. The enriched functions included collagen catabolic process, stress-activated mitogen-activated protein kinases cascade and insulin receptor signaling pathway. Meanwhile, FOS (degree, 15), CD44 (degree, 9), B-cell CLL/lymphoma 2 (BCL2; degree, 7), CDKN1A (degree, 7) and matrix metallopeptidase 3 (MMP3; degree, 6) had higher connectivity degrees in the PPI network for the DEGs. These genes may be involved in ovarian cancer by interacting with other genes in the module of the PPI network (e.g., BCL2-FOS, BCL2-CDKN1A, FOS-CDKN1A, FOS-CD44, MMP3-MMP7 and MMP7-CD44). Overall, BCL2, FOS, CDKN1A, CD44, MMP3 and MMP7 may be correlated with ovarian cancer.

6刘忠虎，陈艾江，马新刚，等．斑蝥酸钠维生素 B6注射液辅以胸腔镜内脏神经切断术治疗癌腹痛〔J〕．国际肿瘤学杂志，2013；40（5）：398－9．<br>　　7赵晓艳．晚期上皮性卵巢癌新辅助化疗的疗效分析〔J〕．国际肿瘤学杂志，2014；41（10）：792－4．<br>　　〔<br>　　2015－12－31修回<br>　　〕<br>　　（编辑曲莉）

白色念珠菌是临床上引起真菌感染的主要条件致病菌之一,随着医学科学技术的发展,基因分型分子生物学方法已经越来越广泛地应用于临床真菌病的研究中.本文综述了脉冲电泳核型-PFGE、限制性片段长度多态-RFLP、随机扩增多态性DNA-RAPD、扩增片段长度多态性-AFLP及微卫星多态性-MLP和多位点序列分型-MLST等分子生物学技术在白念珠菌基因分型方面的相关研究,比较了它们的优缺点,为白色念珠菌临床诊断、治疗及新型抗真菌药物开发提供依据.

Objective: To investigate the azole susceptibility of Candida albicans(C.albicans)from vulvovaginal candidosis patients and to analyze the relationship between ERG11 gene mutations in these isolates and azole resistance.Methods: Three hundred and two clinical isolates of Candida species were collected.Azole susceptibility was tested in vitro in microdilution studies. The ERG11 genes of 17 isolates of C. albicans(2 susceptibles, 5 dose-dependent resistants and 10 resistants) were amplified and sequenced.Results: Of the 302 isolates collected, 70.2% were C. albicans, of which 8.5%, 3.8% and4.2% were resistant to fluconazole, itraconazole and voriconazole, respectively. In total,27 missense mutations were detected in ERG11 genes from resistant/susceptible dosedependent isolates. Among them, Y132 H, A114 S, and Y257 H substitutions were most prevalent and were known to cause fluconazole resistance. G464 S and F72 S also have been proved to cause fluconazole resistance. Two novel substitutions(T285A, S457P) in hotspot regions were identified.Conclusions: Twenty seven mutations in the ERG11 gene were identified in azoleresistant C. albicans isolates, which indicated a possible relation with the increase in resistance to azole drugs and the recurrence of vulvovaginal candidosis. The relationship of two novel substitutions(T285A, S457P) with fluconazole resistance needs to be further verified by site-directed mutagenesis.