Epithelioid trophoblastic tumor (ETT) is a rare subtype of gestational trophoblastic neoplasia, most commonly arising in the cervix or lower uterine segment and often associated with mildly elevated serum human chorionic gonadotropin (hCG). Owing to its nonspecific clinical and imaging features, preoperative diagnosis remains challenging, particularly when the tumor exhibits hypervascular characteristics mimicking uterine arteriovenous malformation (AVM). We report the case of a 48-year-old perimenopausal woman who presented with sudden-onset massive vaginal bleeding following a short period of amenorrhea. Transvaginal color Doppler ultrasonography and contrast-enhanced computed tomography revealed a hypervascular cervical mass with multiple enlarged and tortuous vessels, raising strong suspicion of uterine AVM. Given the high risk of hemorrhage, preoperative uterine artery embolization was performed, followed by laparoscopic total hysterectomy with bilateral salpingo-oophorectomy. Histopathological and immunohistochemical examination confirmed the diagnosis of epithelioid trophoblastic tumor. Retrospective assessment revealed mildly elevated serum hCG levels. This case highlights the diagnostic challenge of epithelioid trophoblastic tumor presenting as a hypervascular cervical lesion mimicking uterine arteriovenous malformation. In perimenopausal women with acute vaginal bleeding and AVM-like imaging findings, ETT should be included in the differential diagnosis to avoid delayed recognition and to guide appropriate perioperative management.

Purpose: Nowadays the diagnosis of ovarian endometriosis is mainly through laparoscopy. The purpose of this study is to explore the clinical value of multiple noninvasive tests such as carbohydrate antigen 125 (CA125), inflammatory factors and coagulation indexes in the diagnosis of ovarian endometriosis. Methods: We retrospectively analyzed the general clinical data, inflammatory factors, coagulation indexes and CA125 of patients in our hospital. SPSS26.0 and R4.2.2 were used for statistical analysis. Results: CA125 and prothrombin time (TT) were statistically different between ovarian endometriosis and control groups (p<0.05). Correlation analysis showed that CA125, fibrinogen (FIB) and lymphocyte count were positively correlated with the stage (p<0.05). The diagnostic value of CA125, TT and combined-markers was compared using receiver operating characteristic (ROC) curves. The area under the curve (AUC) of CA125, TT and the combined-marker were 0.819, 0.601 and 0.714 respectively, with the sensitivity 82.9%, 36.8% and 59.0% respectively, the specificity 75.9%, 80.2% and 79.2% respectively. Conclusion: TT is associated with the occurrence and has no relation with stage. FIB was related to the stage. The model established by CA125 and TT has good predictive value in the diagnosis of ovarian endometriosis. Keywords: Ovarian endometriosis, Carbohydrate antigen 125, Fibrinogen, Thrombin time.

Objective: To establish a reliable nomogram model to predict the recurrence rate of ovarian cancer after surgery. Methods: We retrospectively reviewed 216 patients diagnosed with ovarian cancer in our hospital, of which 164 cases were considered valid. Chi-square test and binary logistic regression model were used to analyze the possible predictors. After that, a nomogram model based on those significantly related predictors was established. We used the bootstrap to internally validate the predictive ability of the nomogram model and used the decision curve analysis (DCA) to compare the performance of the FIGO stage with this model. Results: The nomogram included four significant recurrence predictors: FIGO stage (advanced ovarian cancer), omentum involvement, lymphovascular space invasion (LVSI), CA125. The accuracy of predicting the recurrence was 81.7%. The Maximum Deviation (Emax) and the Average Deviation (Eavg) of bootstrap were 0.035 and 0.007, and the area under the curve (AUC) was 0.863, which demonstrated this model had a good predictive ability. Compared with the FIGO stage, this hybrid model is more superior in predicting recurrence risk in ovarian cancer patients Conclusions: We developed and validated a non-invasion and user-friendly nomogram model to predict the recurrence risk of patients with ovarian cancer after surgery. Keywords : Nomogram; recurrence; ovarian cancer.

Endometrial cancer(EC)is the second most prevalent fe-male reproductive system tumor after cervical cancer and its incidence is rising globally.1 Recently,N6-methyl-adenosine(m6A)has emerged as an important regulator of a variety of physiological and pathological processes,especially in promoting EC progression.2,3 However,the potential roles of m6A modification in EC and its immune landscape remain unknown.

Background Endodermal sinus tumor (EST) is a malignant tumor originating from the ovary or testis. In most case, ultrasound examination shows ovarian mass. But there is a special kind of extra-gonadal endodermal sinus tumor, which occur in organs other than gonads with insidious onset. Here we reported a case of endodermal sinus tumor, which originated from the sacral ligament presenting as an acute lower abdominal pain. Case presentation A 14-year-old girl was admitted to the hospital because of acute lower abdominal pain. The ultrasound showed a mass with 72 mm × 64 mm × 50 mm in Douglas, and there was no abnormality in bilateral ovaries and fallopian tubes. Laparoscopic exploration showed a large amount of blood clots in the pelvic cavity. After removal of the blood, we found rotten fish-like tissue in the left sacral ligament, rapid pathology suggested endodermal sinus tumor. After the operation, we retrospectively examined the value of alpha-fetoprotein (AFP), which was found to be elevated, and post-operative paraffin pathology confirmed the diagnosis. After four cycles of BEP chemotherapy, exploratory laparotomy was performed to remove the visible lesion, but postoperative pathology showed no abnormality. At the one-year follow-up, the patient remained recurrence-free. Conclusion Extra-gonadal germ cell tumors are rarely reported. When young teenagers complain of acute lower abdominal pain with elevated AFP, but there was no lesion in bilateral ovaries and fallopian tubes, we must think about the possibility of endodermal sinus tumors. Accurate diagnosis facilitates complete resection of lesions and improves patient’s outcomes.

OBJECTIVE:We aimed to explore the association between manganese (Mn) and the progression of invasive adenocarcinoma of the cervix (IAC), together with the corresponding mechanisms.MATERIALS:Venous blood was collected from 65 IAC patients and 65 normal controls (female, participated in physical examination) in the fasting state. The levels of Mn and of inflammatory factors in the venous blood were measured using graphite furnace atomic absorption spectrometry (GAS) and enzyme-linked immunosorbent assay (ELISA), respectively. To investigate the relationships between Mn/inflammatory reactions and tumor progression, IAC patients were divided into two groups (I/II and III/IV) according to tumor grade. In vitro studies were also performed using human cervical cancer (CC) cell lines that were HPV-16 positive (Caski) or negative (C-33A). Following treatment with Mn, cell proliferation was detected by CCK-8, cell apoptosis was examined with flow cytometry, and the level of inflammatory factors was measured using qRT-PCR.RESULTS:The levels of Mn and of the anti-inflammatory factor interleukin-10 (IL-10) in the blood of IAC patients were lower than in normal controls, whereas levels of the pro-inflammatory factors interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were higher. Additionally, the serum electrolyte concentrations of Ca, Mg and K were lower in most IAC patients. The blood Mn level was positively correlated with IL-10, but negatively correlated with IL-6 and TNF-α. Higher Mn level and mild inflammatory response were associated with lower tumor grade. Human CC cells treated in vitro with Mn showed reduced cell proliferation ability, increased apoptosis abilities, and reduced inflammatory reaction.CONCLUSION:Mn deficiency may enhance the inflammatory reaction that could in turn promote the progression of IAC.

Objective RNA interference holds tremendous potential in the treatment of malignant tumors. However, efficient and biocompatible delivery methods are needed for systemic delivery of small interfering RNA (siRNA). In this study, we explored the delivery efficiency and therapy effect of si-UBB-5A2SC8 in ovarian cancer. Methods and materials Si-UBB-5A2SC8 nanoparticles were successfully prepared according to the established procedure and the characteristic of nanoparticles was determined by digital laser scanning. Flow cytometry and confocal analysis demonstrated si-UBB was efficiently transfected to cell by the delivery of 5A2SC8 complexes. The in vitro gene knockdown efficiency of ubiquitin B was demonstrated by RT-qPCR and Western blot analysis, which was further verified by the inhibition of proliferation and migration of ovarian cancer cells. Accumulative efficiency of si-UBB-5A2SC8 nanoparticles was investigated in BALB/c mice bearing SKOV3-GFP tumor xenograft. In vivo imaging was adopted to test the accurate location of the nanoparticle in the tumor. The feature of the tumor and pivotal organ was determined. TUNEL and caspase-3 expression was used to analyze the underling mechanism of the inhibition effect. Results The average size and the zeta potential of the si-UBB-5A2SC8 was (150 ± 11) nm and − (20 ± 4) mV, respectively. Transmission electronic microscopy showed the nanoparticle was near-spherical with the mean size of (100 ± 15) nm. Flow cytometry and confocal microscopic images demonstrated 5A2SC8 complex could successfully deliver Cy5.5-siRNA to the cytoplasm of ovarian cancer cells. qRT-PCR and western blot demonstrated the mRNA and protein expression of ubiquitin B was decreased to 62.5% and 36.5% of the control group, which was accompanied with the decreased proliferation and migration ability in si-UBB-5A2SC8-transfected cells. Ex vivo fluorescence imaging demonstrated 5A2SC8 complex could successfully carry siRNA to the tumor lesion and exert the inhibition effect, which was verified by the decreased tumor weight and increased apoptosis and caspase-3 expression in mice treated with si-UBB-5A2SC8. Conclusions 5A2SC8 complex was a safe and efficient gene delivery vehicle and ubiquitin B was a potential target for the ovarian cancer targeted therapy.

Objective : To establish a reliable nomogram model to predict the recurrence rate of ovarian cancer after surgery. Methods: We retrospectively reviewed 216 patients diagnosed with ovarian cancer in our hospital, of which 164 cases were considered valid. Logistic regression model was used to analyze the possible predictors. After that, a nomogram model based on those significantly related predictors was established. We used the bootstrap to internally validate the predictive ability of the nomogram model and used the decision curve analysis (DCA) to compare the performance of the FIGO stage with this model. Results: The nomogram included seven significant recurrence predictors: age, histology type, FIGO stage, omentum involvement, lymphovascular space invasion (LVSI), liver metastasis, and serum CA125. The measurement values for accuracy were Brier score 0.131, correction slope 1.00, and c-index 0.870. which demonstrated this model had a good predictive ability. Compared with the FIGO stage, this hybrid model is more superior in predicting recurrence risk in ovarian cancer patients. Conclusions: We developed and validated a non-invasion and user-friendly nomogram model to predict the recurrence risk of patients with ovarian cancer after surgery.

The transvaginal excision of lesion seems to a feasible and safe approach to treat cesarean scar pregnancy.

Background/Aim: Cesarean scar pregnancy is a long term complication of cesarean section. There is a lot of controversy about the best treatment methods. We retrospectively summarized the clinical characteristics of patients with cesarean scar pregnancy and explored the advantages and disadvantages of fertility-preservation treatment method. Methods: From January 2008 to September 2017, a total of 204 cases of cesarean scar pregnancy were retrospectively reviewed. 145 patients underwent transvaginal clearance, 33 patients underwent endoscopic surgery, and 26 patients underwent uterine artery embolism. The clinical characteristics, diagnosis, various treatment methods, and clinical outcomes were analyzed. Results: There were no significant differences among the three groups in terms of patient age, number of previous cesarean sections, serum human chorionic gonadotropin, and clinical symptoms. The difference in mean gestational sac diameter (23.5 +/- 2.1mm vs 31.3 +/- 2.4mm vs 30.8 +/- 1.9mm), surgical time (31.4 +/- 2.5min vs. 45.8 +/- 2.2min vs. 51.4 +/- 1.9min), blood loss (53.3 +/- 5.5mL vs. 105.2 +/- 3.2mL vs. 75.6 +/- 3.5mL), blood transfusion (1/145 case vs.3/33 case vs. 0/26 case), discomfort (1/145 case vs.9/33 case vs. 16/26 case), hospital stay (6.1 +/- 1.1 day vs. 7.4 +/- 0.9 day vs.18.6 +/- 1.5 day), fever duration (1.0 +/- 0.5 day vs. 2.1 +/- 2.8 day vs. 5.7 +/- 3.5 day), and hospital expense ((sic) 7825.9 +/- 234.9 vs. (sic) 10248.3 +/- 312.9 vs. (sic) 18774.9 +/- 243.6) in transvaginal pregnancy tissue clearance, endoscopic surgery, and uterine artery embolism groups were significantly different. Conclusion: Transvaginal clearance is an effective and relatively safe treatment option for patients with cesarean scar pregnancy.

Dysregulation of microRNAs (miRs) is implicated in the carcinogenesis of various types of malignant tumor by manipulating cell growth and apoptosis. Abnormal expression of miR‑320a is involved in tumorigenesis of many types of cancer. The potential association of miR‑320a and the possible regulatory mechanisms in endometrial carcinoma is rarely elucidated. In the present study, it was demonstrated that miR‑320a expression was decreased in endometrial carcinoma tissues and cell lines. The present results also indicated that overexpression of miR‑320a suppressed cell proliferation through inducing G2/M phrase arrest and apoptosis. Insulin‑like growth factor receptror‑1 (IGF‑1R) was verified to be the potential target of miR‑320a by computational analysis and luciferase reporter assays. In addition, overexpression of miR‑320a reduced endogenous IGF‑1R expression in cells. Furthermore, it was demonstrated that upregulation of miR‑320a inhibited phosphorylated (p)‑protein kinase B and p‑mechanistic target of rapamycin activation and promoted B cell lymphoma‑2‑associated death promoter expression. Reintroduction of IGF‑1R into miR‑320a‑overexpressed cells antagonized the impact of miR‑320a on its downstream protein, which demonstrated that the tumor suppressive role of miR‑320a in endometrial carcinoma is exerted by the signal pathway mediated by IGF‑1R. It was therefore concluded that miR‑320a served an anti‑tumor role on endometrial carcinoma through the regulation of IGF‑1R, and miR‑320a may be used as the target for the gene therapy of endometrial carcinoma.

*These authors contributed equally to this work Background/Aim: Cesarean scar pregnancy is a long term complication of cesarean section. There is a lot of controversy about the best treatment methods. We retrospectively summarized the clinical characteristics of patients with cesarean scar pregnancy and explored the advantages and disadvantages of fertility-preservation treatment method. Methods: From January 2008 to September 2017, a total of 204 cases of cesarean scar pregnancy were retrospectively reviewed. 145 patients underwent transvaginal clearance, 33 patients underwent endoscopic surgery, and 26 patients underwent uterine artery embolism. The clinical characteristics, diagnosis, various treatment methods, and clinical outcomes were analyzed. Results: There were no significant differences among the three groups in terms of patient age, number of previous cesarean sections, serum human chorionic gonadotropin, and clinical symptoms. The difference in mean gestational sac diameter (23.5±2.1mm vs 31.3 ±2.4mm vs 30.8± 1.9mm), surgical time (31.4±2.5min vs. 45.8±2.2min vs. 51.4±1.9min), blood loss (53.3± 5.5mL vs. 105.2±3.2mL vs. 75.6 ±3.5mL), blood transfusion (1/145 case vs.3/33 case vs. 0/26 case), discomfort (1/145 case vs.9/33 case vs. 16/26 case), hospital stay (6.1±1.1 day vs. 7.4±0.9 day vs.18.6±1.5 day), fever duration (1.0±0.5 day vs. 2.1±2.8 day vs. 5.7±3.5 day), and hospital expense (¥ 7825.9±234.9 vs. ¥ 10248.3± 312.9 vs. ¥ 18774.9 ±243.6) in transvaginal pregnancy tissue clearance, endoscopic surgery, and uterine artery embolism groups were significantly different. Conclusion: Transvaginal clearance is an effective and relatively safe treatment option for patients with cesarean scar pregnancy.

Although numerous miRNAs are reported to contribute to the carcinogenesis of malignant tumor, the specific role of miR-424 in endometrial carcinoma is seldom reported. To explore the effect of miR-424 on epithelial-mesenchymal transition and its underlying mechanism, we detected miR-424 expression in endometrial carcinoma tissue and cells. We found that miR-424 was significantly downregulated in endometrial carcinoma tissues and cells, especially in HEC-1B cells. To perform the functional analysis, we transfected HEC-1B with miR-424-mi, miR-424-inh, mi-control, and inh-control, respectively. We found that overexpression of miR-424 significantly decreases cell proliferation and migration, accompanied with the increased E-cadherin/Vimentin expression and the transition of mesenchymal to epithelial cell phenotype. We identified that insulin-like growth factor-1 receptor (IGF-1R) was a potential target of miR-424 by computational analysis followed by luciferase reporter assays. Of note, we found that the downregulation of miR-424 in HEC-1B cells enhanced endogenous IGF-1R expression. Further mechanistic analysis revealed that forced expression of IGF-1R in miR-424-mim transfected cells remedied the weakened migration resulting from overexpression of IGF-1R. Taken together, the results of the current study demonstrated that miR-424 was a tumor suppressor for endometrial carcinoma and a favorable factor against tumor progression through targeting IGF-1R, thus providing a target for the treatment of endometrial carcinoma.

稽留流产( missed abortion )是妇产科常见病,容易导致凝血功能障碍,但以阴道大量流血,失血性休克合并弥散性血管内凝血 ( disseminated intravascular coagulation ,DIC)而需要进行多次转诊抢救的病例少见,若转诊处理不当必将危及患者生命,有关抢救的经验教训报道更少. 现报道1例停经时间不详,以阴道大量流血、失血性休克为首发症状的稽留流产合并DIC病例误诊及转诊处理不当后的抢救过程,从中吸取处理不当和处理成功的经验教训,以提高基层妇产科医务工作者的转诊及急诊处理水平.

1病例报告 患者,50岁,因子宫颈癌术后放化疗后3+月,发现肺部结节1天,于2017年10月16日入院.患者半年前诊断为宫颈鳞状细胞癌ⅡA期,于4月17日在全身麻醉下行腹腔镜下广泛性子宫切除术+盆腔淋巴结切除术+输尿管镜下双侧输尿管D-J管置入术+肠粘连松解术,术后病理检查报告示:①宫颈低分化鳞状细胞癌,浸润深度＞ 1/2肌层,累及宫颈管下段,阴道壁切缘未见癌;两侧宫旁及宫角未见癌;免疫组化:P16(+),CK5/6(+),34β3E12(+),P63(+),P53(-),ki-6770％(+).②阴道壁各残端均未见癌;③共切除淋巴结16枚,均未见癌转移.术后诊断:宫颈低分化鳞状细胞癌ⅡA期.术后第12天拔出导尿管,第13天带双侧输尿管DJ管出院.于5月16日至6月29日同期放化疗,期间监测血白细胞计数最低为2.99×109/L,予重组人粒细胞刺激因子注射液对症处理;术后2月(6月16日)膀胱镜下拔出双侧输尿管支架后查尿常规见白细胞、红细胞均升高,泌尿系彩超检查提示双肾轻度积水,遂于6月23日再次行经尿道双侧输尿管D-J管置入术,并给予留置导尿、抗感染处理,复查血尿常规好转后拔除尿管出院.

Fibroblast growth factor receptor 4 (FGFR4) is a member of receptor tyrosine kinase family. A functional Gly388Arg (rs351855 G>A) polymorphism in FGFR4 gene causes a glycine-to-arginine change at codon 388 within the transmembrane domain of the receptor. Although the FGFR4 rs351855 G>A polymorphism has been implicated in cancer development, its association with cancer risk remains controversial. Here, we have systematically analyzed the association between the rs351855 G>A polymorphism and cancer risk by performing a meta-analysis of 27 studies consisting of 8,682 cases and 9,731 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to measure the strength of the association. The rs351855 G>A polymorphism was associated with an increased cancer risk under the recessive model (OR=1.19, 95% CI=1.01-1.41). Stratified analysis by cancer type indicated the rs351855 G>A polymorphism was associated with an increased risk of breast and prostate cancer, but a decreased risk of lung cancer. This meta-analysis demonstrates the FGFR rs351855 G>A polymorphism is associated with increased cancer risk and suggests it could potentially serve as a chemotherapeutic target or biomarker to screen high-risk individuals.

Intravenous leiomyomatosis (IVL) is a benign smooth muscle tumor which may cause fatal outcome. Furthermore, the clinical manifestations are variable and nonspecific, typically resulting in misdiagnosis. Computerized Tomography (CT) played a vital role in the diagnostic process and pre-surgical assessment. Here we describe one case of IVL extending from the inferior vena cava to the right atrium and ventricle, then review the literature and discuss the imaging findings and clinical manifestation of this tumor. It is suggestive for clinicians to be aware of this condition and highly suspect a middle-aged woman with a history of uterine leiomyoma presenting with an inferior vena cava filling defect or mass shadow to early diagnose and treat.

To investigate the improvement of dysmenorrhea and menorrhagia after wedge-shaped resection of uterus. The clinical data of 15 patients who experienced wedge-shaped resection of uterus for adenomyosis were retrospectively analyzed from September 2012 to October 2013. We use the amount of the completed soaked napkins to measure the menstrual blood volume, and the visual analog scale to evaluate the degree of dysmenorrhea. We used the 2 index to evaluate the improvement of dysmenorrhea and menorrhagia after operation. All operations were successful, no serious complication occurred. Before the operation, all 15 patients used more than 25 pieces of completed soaked napkins, after the operation, 13 patients had significantly decreased menstrual flow, the average amount of completed soaked napkins was 3.6. Meanwhile, 2 patients had no menstrual after surgery. Before the operation, among the 10 patients with severe dysmenorrhea, 9 patients had significant relief on pain, they only experienced slight pain after surgery, only 1 patient still experienced moderate pain. Two patients with slight pain had no pain after operation. Among the 3 patients with moderate pain, 2 patients experienced slight pain and 1 patient felt no pain after operation. The wedge-shaped resection of uterus is a safe and effective procedure to significantly reduce menorrhagia and alleviate the extent of dysmenorrhea, which is a promising alternative for patient who suffered from dysmenorrhea and menorrhagia for adenomyosis.

To explore the feasibility and efficacy of radiofrequency ablation in treating uterine fibroids.Ninety patients with multiple uterine fibroids, who had undergone hysterectomy were included in the study. After the uterus was resected, the temperature of 60, 80, 100°C were adopted to ablate the in vitro fibroid with each temperature dealing with 30 patients. Simultaneously, 5 patients were included, whose in vivo fibroid were ablated with the temperature of 100°C before the fibroids were removed after laparotomy. After the fibroids were ablated, the smooth muscle in the ablated center (group A), the ablated edge (group B) and 1 cm away from the ablated edge (group C) were taken. Then, the samples were stained with hematoxylin and eosin (HE) to examine the histopathological changes, and immunohistochemistry was performed to detect the expression of estrogen receptor (ER) and progesterone receptor (PR).After radiofrequency ablation, the ablated lesions were round, toast tan, and dry on gross appearance. There were no obvious tissue carbonization and there were distinct boundary from periphery tissue. In vitro: On automated analysis, the average optical density of ER and PR in group A, B, and C was lower than the control group (P < 0.05), and which were gradually raised with the increased distance to electrode. In the same treatment group, ER optical density was gradually decreased with the increased temperature among 3 different groups. The PR optical density was decreased with the increased temperature under different temperatures in group A and group B, there was significant difference among groups (P < 0.05). But in group C, there was no difference in PR expression among the temperature of 60, 80, and 100°C (P > 0.05). In vivo: Compared with the control group, the average optical density of ER and PR were significantly different among group A, B, and C (P < 0.05), what's more, it was gradually raised with the increased distance to electrode.After radiofrequency ablation, the tissues displayed coagulative necrosis, and decreased ER and PR expression. Radiofrequency ablation may be considered a minimally invasive alternative for those women who wish to retain their reproductive potential. Eighty degree Celsius was expected to be the optimum temperature in radiofrequency ablation treatment of uterine fibroid.