Cervical carcinoma is a continuous pathological procedure from preinvasive lesion to carcinoma.Cervicalintraepithelial neoplasia-the preinvasive disease of cervix carcinoma-is currently regarded to be associated with HPV infection.HPV is a small double-stranded DNA virus composed of protein shell and DNA core.The gene group includes early coding region,late coding region and long control region.E6 and E7 protein which are coded in the early coding region play a crucial role in virus copy.HPVs in reproductive system are very common in sex-active people.At least 75% of women who have sexual life will infect HPVs in some period of their life.Most of them can regress,and only those infected by high risk type virus and combined with other high risk factors could progress to HSIL or cervical carcinoma.As to HPV infection,people should neither overlook it nor got scared.Currently,treatment of the local vulva or cervical lesion caused by HPV infection is the most effective.

Objective To evaluate the current status and outcomes of pelvic exenteration (PE) for recurrent cervical cancer.Methods The following electronic databases has been searched on recurrent cervical cancer management and treatment:Chinese Biological Medicine Disk (CBM),PubMed and Cochrane library.All retrieved studies had to fulfill the following inclusion criteria:cohort studies of recurrent cervical cancer,containing information of detailed patient and operation characteristics as well as the survival rate.Only publications in the English literature were included.All eligible literatures between Jan.1990 and Aug.2013 were assessed for quality.Relevant basic characteristics,complications,survival rate and prognostic factors were reviewed.Results There were eight trials involving 607 patients with cervical cancer received PE,including 515 cases with recurrent disease and 92 cases with primary disease.Four hundred and ninety patients had received total pelvic exenteration (TPE) operation,103 underwent anterior pelvic exenteration(APE) and 14 received posterior pelvic exenteration(PPE).The 5-year overall survival rate for recurrent cervical cancer fluctuate from 26.7％ to 56.0％.Complication rates were from 34.3％ to 83.3％ and the mortality rate was 1.2％ (7/607).Among the relevant factors affecting survival time,resection margin status seemed to be the most important.Conclusion Based on this systematic review,PE does help improve the survival of recurrent cervical cancer patients on the basis of strict selection of candidates.

Objective To retrospectively analyze the treatment methods of cervical intraepithelial neoplasia (CIN) in women aged 65 years and over.Methods From July 2002 to December 2011,51 postmenopausal women aged 65 years and over with CIN were admitted to our hospital.The diagnosis and treatment were summarized and analyzed,and the CIN related literatures were discussed.Results 31 patients received colposcopy and the colposcopically directed punch biopsy.Squamocolumnar junction (SCJ) was found in 18 patients (58.1％,18/31),and not found in 13 patients (41.9％,13/31).Among the 31 patients,21 patients received conization after biopsy.9 patients were under-diagnosed by biopsy,in which 4 cases (44.4％) SCJ were found and in 5 cases (55.6％)SCJ were not found.In all patients,26 patients received conization and 20 patients received hysterectomy directly.There were 14 patients received hysterectomy after conization.Among 14 patients,the uteruses in 4 patients with conization specimen diagnosed as CIN Ⅱ-Ⅲ and negative margin were 100.0％ (4/4),and the uteruses in 3 patients with conization specimen diagnosed as CINII-Ⅲ and positive margin were 50.0％ (3/6).Conclusions For women aged 65 years and over,it is very important whether SCJ can be seen or not in colpscopy and directed punch biopsy procedure.It is better to do conization if possible.Patients with conization specimen diagnosed CINII-Ⅲ and negative margin needn't subsequent hysterectomy.Patients with positive margin but with bad general conditions or complications can continue to be monitored if they have good follow-up conditions.If patients are diagnosed as carcinoma by conization specimen,total hysterectomy or radical hysterectomy is recommended.

Cervical intraepithelial neoplasia is a preinvasive lesion of cervical carcinoma associated with HPV infection.It can be classified as low or high grade according to the degree of the lesion.Low grade lesion includes HPV infection and CIN1,and high grade lesion includes CIN2～3.HPV infection and CIN have become very common among fertile women,so more and more attention has been paid to the influence that HPV infection,cervical lesion and their treatments would have on pregnancy.HPV infection may increase during pregnancy period.Tough there will be more chances for the vaginal delivery infants to be exposed to HPV,it is not proper to draw a conclusion that cesarean must be performed for all HPV infected pregant women.If CIN1 is found during pregnancy,observation and close follow-up post partum should be advised.Pregnancy may not deteriorate CIN2～3,but clear diagnosis should be made during pregnancy if colposcopy examination result is not satisfactory or great doubt for invasive cancer exits.In this case,conization during the second semester of the pregancy is advised,which may increase the cesarean rate.Conservative therapy for CIN has not significant influnce on fertility,while cold knife conization and LEEP conization may increase the premature delivery rate,which may be associated with premature ruption of fetal membrane.

Objective To analyze the differential expression of protein in taxol-resistance from elderly females with ovarian cancer, by compared proteomics analysis and identified the candidated marker in the clinical tissues. Methods Soluble fraction proteins in two SKOV3 taxol-resistant cells, SK-TR30 and SK-TR2500 and one A2780 taxol-resistant cell, A2780-TR paired taxol-sensitive ovarian cancer cells were separated and prepared by two dimensional gel electrophoresis (2-DE). The differentially expressed proteins were selected and identified by matrix-assisted laser desorption/lonization time of flight mass spectrometry(MALDI-TOF-MS) and database search. 2-DE profiles with high resolution and reproducibility were obtained. Then highly expressed protein-cofilin1 which exist in two forms of de-phosphorylate was detected and compared between human ovarian cancer specimens including 22 elderly female with chemosensitive and 21 elderly female with chemoresistant by immunohistochemistry. Results Among the identified proteins, there were sixteen over/under-expressed proteins in taxol-resistant cell lines as compared with taxol-sensitive cell lines. In particular, overexpression of cofilin1 and destrin were displayed in all three taxol-resistant cell lines. The expression of phosphorylation of cofilin (P＜0.05), but not cofilin1, displayed much higher in chemoresistant than in chemosensitive group. Conclusions Cofilin1 may play a role of taxol resistance by phosphorylation of ovarian cancer cell. However, the mechanisms need to be elucidated further.

Objective: To determine if IFN-?2a and HSV-tk/GCV have synergy on the cell killing of the SKOV3 human ovarian tumor cell line. Methods: hytk gene retroviral vector plasmid was transduced into SKOV3 cells. Both the cytotoxicity and the bystander effect were evaluated after the treatment of GCV. IFN-?2a and HSV-tk/GCV were used together to determine if they have synergy on the tumor cell killing effect, then post-treatment cell cycle analysis was carried out.Results: A dose dependent cell killing of SKOV3/hytk was observed after treatment with GCV. Bystander effect was seen in mixed culture of hytk-positive and -negative cells. Furthermore, IFN-?2a had a significant (P

Objective The aim of this study is to evaluate the safety and prognosis of ovarian preservation in young women with early-stage endometrial cancer.Methods Women≤45 years of age with stageⅠendometrial cancer recorded from Jan 2005 to Dec 2011 in Peking Union Medical College Hospital were examined.They were further divided into two groups: ovarian preservation group and oophorectomy group.Clinical and pathological recording of these patients were compared.Results A total of 72 women, including 25 patients (34.7%) who had ovarian preservation, were identified.The ovarian preservation group was younger (P=0.007) and had a lower prevalence of lymphadenectomy (P<0.001).While there were no significant difference in stage, tumor grade, the invasion depth of myometrium and adjuvant treatment between two groups (all P>0.05).Of seventy-two cases, five patients relapsed and all survived after a median follow-up time of 89 months (rang: 7-131 months).The Kaplan-Meier curve and the log rank test showed no difference in recurrence-free survival (P=0.194).In Cox model analysis, ovarian preservation had no effect on recurrence-free survival(HR=3.08, 95% CI 0.54-18.44).Conclusions Ovarian preservation in young women with early-stage endometrial cancer is safe and has no negative effect on recurrence-free survival or overall survival.

Objective To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia(CEH) and grade 1 endometrial carcinoma(EC).Methods In a retrospective study, data were obtained for patients with CEH or grade 1 EC at presumed stage IA(without myometrial invasion) who wished to preserve fertility and were treated at the Peking Union Medical College Hospital, China, between January 1, 2000 and December 31, 2011.Patients had received oral medroxyprogesterone acetate(250-500 mg/d) or megestrol acetate(160-480 mg/d) for at least 6 months.Results Among 55 included patients, median age was 32 years(range 21-41 years).41(75%) achieved complete response after a median period of 6(3-24) months.Complete response was less frequent among obese than nonobese patients(4/12 [33%] vs 37/43 [86%];P=0.001).Disease recurrence was recorded in 10(24%) patients with complete response;the 5-year recurrence-freesurvival rate was 71%.Among the 33 patients who retained a desire to conceive, 17(52%) became pregnant.Conclusions Fertility-sparing management with oral progestin is effective and safe.Obesity is associated with a lower probability of long-term success.

Objective To study the clinical characteristics, diagnosis, treatment and its effectiveness of vulvar intraepithelial neoplasm Ⅲ(VIN Ⅲ).Methods Clinical data, including age of the patients, mode of surgical operation, pathological features, results of post-operation follow-up, of 12 cases of VIN Ⅲ admitted to the Peking Union Medical College Hospital(PUMCH)during January 1984 to December2006 were retrospectively analyzed.Results Mean age of the 12 cases was 40.3(ranging from 23 to 56)years.All the patients had symptoms of vulvar itching, three with VUlVar ulcer and one with vulvar pain.There was single neoplasm focus in two cases and multiple focuses in 10 cases, five cases with neoplasm in other sites and five with human papilloma virus(HPV)infection.All the 12 patients received surgical operation, three with simple vulvectomy(one with some residue at perianal incisal edge)and other nine with lumpectomy(four with some residue at incisal edge).Eight cases were followed-up for 9.0 months in average(ranging 1～22 months)after surgical operation, including three with some residue at incisal edge.Relapse was found in two cases three and 11 months after operation, respectively, who received re-operation, including one with residue at incisal edge and one without residue.Conclusions It is necessary to attach more importance to biopsy for the cases of suspected VIN Ⅲ, as well as colposcopic diagnosis for those with vaginal or vulvar neoplasm and testing for HPV infection.Surgical operation, including simple vulvectomy and lumpectomy with or without adjunctive measures, are main treatment for patients of VIN Ⅲ and follow-up is also important for all those with VIN Ⅲ.

Objective To study the clinical characteristic, the optimal treatments and the prognosis for the recurrence and failure of primary treatment in malignant ovarian germ cell tumors (MOGCT).Methods The clinical data of 17 recurrent and failure of primary treatment in MOGCT cases treated in Pecking Union Medical College Hospital from January 1983 to May 2008 were analyzed retrospectively to evaluate failure of primary treatment and second treatment. Results Only the 4 eases of recurrent and failure of primary treatment of MOGCT were underwent comprehensive surgical staging. After primary surgery in 1 -8 months, 16 cases received the non-standard chemotherapy were found the lesion again. The secondary debulking surgery was done for the 15 cases and also received the standard chemotherapy. Among of them, 8 cases were survival during follow up, 5 cases gave up the treatment and 4 patients were lost following up during the treatment. Conclusions The standard primary treatment is the most important for the MOGCT. Even for the recurrence and failure of primary treatment of MOGCT, the satisfied cytoreduetive surgery plus the standard chemotherapy also show the significant impact on the prognosis.