Objective To study the histopathologieal features,growth pattern and distribution on the uterine cervix of high-grade cervical intraepithelial neoplasia(CIN).Methods Cone biopsy and hysterectomy specimens of 592 women with hish.grade CIN(CIN Ⅱ or Ⅲ)were reviewed morphologically.Of all cases.the gross appearance of the external os was recorded,and the frequency of eervical quadrants involved in hish-grade CIN was assessed.Two hundred specimens were selected randomly to observe micrographieal changes,including the extent,depth,growth pattern and cell types of hish-grade CIN and the alteration of stroma surrounding CIN.Results Of 592 specimens,external os showed smoothness in 46 cases(7.8%),mild erosion in 151 cases(25.5%),moderate or severe erosion in 395 cases(66.7%),hypertrophy in 48 cases(8.1%),and neoplasm in 4 cases(0.7%).Higll-grade CIN involvement was equally frequent on each quadrant of cervix(P>0.05).Of 200 cases of hish-grade CIN reviewed micrographically,the depth of the deepest involred crypt was le88 than 3 mm in 188 specimens (94.O%).between 3 to 5 nnn in 12 specimens(6.O%),and more than 5 mm in none.High-grade CIN with isolated endocervieal crypt involvement was detected in 77 cases(38.5%),multiple crypt involvement in 143 cases(71.5%).and confluent crypt involvement in 73 cases(36.5%).Hish-grade CIN showed explanate in 81.0%(162/200)of cases,endophytie in 49.0%(98/200)of cages,and exophytic in 6.5%(13/200)of cases.Abrupt transition between CIN and normal epithelia were found in 167 specimens (83.5%),whereas gradual transition in 66 specimens(33.0%).A variety of cell types,but basaloid type predominantly.were observed in hiSh-grade CIN.In 28.5%-45.0%of ca8es,the stroma surroundin CIN displayed oedema,desmoplastic and lymphocytic responses.Conclusions Our data suggest that gross examination is of little importance for diagnoses of CIN.CIN trend to spread horizontally and Mong the endocervical crypts,and are mainly distributed to a depth less than 3 nLrn.These data also suggest that there are a variety of cell types of CIN,and stroma responses to CIN may exist in part of high-grade CIN.

Objective To develop a method for speciation analysis of selenium in plant samples by H2O2-HNO3 microwave-assisted digestion-HGAFS. Methods Plant samples were prepared using H2O2-HNO3 by microwave-assisted digestion. The contents of soluble inorganic Se(IV)and Se(VI)in the samples were determined by HGAFS after separation most of the soluble organic compounds by XAD-2 resin column in HNO3 medium at pH=3. The contents of soluble Se,insoluble Se,inorganic Se (IV)and Se (VI)and organic Se could be calculated. Results The linear range and detection limit of Se(IV)were 0-80 ?g/L and 0.05 ?g/L respectively. The RSD for the total Se detection was 1.7%(n=5?雪. The total Se content in the reference standard substance obtained by this method agreed well with the reference value. Conclusion The method for preparation of plant samples using microwave-assisted digestion could avoid the loss of Se through volatilization. The pretreatment using XAD-2 resin could remove the interference of organic compounds on detecting results of Se(Ⅳ)in the plant samples,which could widen the application of the method in the speciation analysis. The analytical scheme of the method could determine the contents of total,soluble,insoluble,soluble inorganic Se(IV?雪?Se(VI?雪,and organic Se in plant samples. The method was simple and practical.

0 1, for both). Conclusion Decreased expression of placental EGFR was found in women with PIH, and that may play a role in the pathogenesis of PIH.

Objective To assess the efficacy and pathological change of fertility-sparing treatment with progestin for endometrial carcinoma (EC) of stage Ⅰ a and complex atypical hyperplasia (CAH) and to observe the prognosis of the treatment.Methods Nine EC patients of stage Ⅰ a and 21 CAH patients aged under 40 years who desired childbearing and retaining their fertility were enrolled into this study.All patients were given a daily oral high-dose of progestin with duration of treatment ranging from 6 to 9 months.Diagnostic curettage was performed every 3 months as a modality for seeing the histologic change of neoplastic tissues and endometrial tissue.A careful and long-term follow-up is necessary for patients with complete response (CR).Results During the first period of fertility-sparing management,according to histologic change,5 EC patients and 18 CAH patients showed CR with no evidence of endometrial adenocarcinoma or hyperplasia,2 EC patients and 2 CAH patients showed partial response with a regression to complex or simple hyperplasia without atypia,2 EC patients and 1 CAH patient showed stable disease or progressive disease.Accordingly,a total of 26 patients showed CR (26 of 30 patients).The median time to CR was 6 months (range,3 to 21 months) of progestin treatment.The median follow-up time was 55.5 months (range,24 to 104 months) and all patients were alive.During follow-up,among the 26 patients with CR,3 of 6 EC patients achieved CR recurred disease after a median time interval of 10 months (range,6 to 51 months),7 of 20 CAH patients achieved CR had recurrent disease after a median time interval of 12 months (range,6 to 55 months).Four of 7 CAH with recurrent disease achieved CR to progestin retreatment.Eight of 26 patients achieved CR continued a further 3 or 6 months of consolidation therapy,3 of them had recurrent disease,the remaining 18 stopped progesterone treatment after CR and 7 patients had recurrent disease; there was no significant statistical difference between the two groups (P=1.000).EC patients succeeded in 4 pregnancies,CAH patients succeeded in 10 pregnancies,they gave birth to 16 healthy babies in all.Conclusions EC of stage Ⅰ a and CAH had slow progression of symptoms.Progestin treatment in EC of stage Ⅰ a and CAH patients was effective.A careful and long-term follow-up is required because of the substantial high rate of recurrence.Progestin re-treatment in most patients with recurrent endometrial cancer is effective and safe.

Objective To evaluate the clinical characteristics of epithelioid trophoblastic tumor (ETT).Methods Six cases of ETT treated in Women's Hospital,School of Medicine,Zhejiang University from 2005 to 2007 were retrospectively analyzed,together with a literature review.Results Six cases of ETT were diagnosed pathologically after surgery.The age of patients ranged from 27 to 46 years.The most common presentation was abnormal vaginal bleeding(5/6).The preceding gestational events were hydatidiform mole in 1 case,abortion in 2 cases,and term delivery in 3 cases.The interval between the preceding gestation and the diagnosis of ETT ranged from 15-48 months.The serum human chorionic gonadotropin(hCG)level was 46-121 147 IU/L.Four cases presented with metastasis,including lung metastasis in all of the 4 cases,liver metastasis in 1 case,and pancreas metastasis in another 1 case.The main therapies were surgery combined with chemotherapy.All of the 6 cases received total abdominal hysterectomy.and 1 case also had lung lobectomy.One ease had a recurrence but refused any treatment again,and was lost to follow up;the therapy of 1 case unfinished;another 4 cases were without evidence of disease 9 to 19 months after surgery.Condusions The confirmation of ETF diagnosis is difficult before surgery.Surgical management is mostly recommended in ETT. The role of chemotherapy in ETT is not clear yet.

Objective To explore the relationship between tubal intraepithelial carcinoma (TIC) of the fimbria and pelvic high-grade serous carcinoma.Methods All 34 cases of pelvic high-grade serous carcinoma with clear fimbria were evaluated from January 2009 to June 2010,including ovarian carcinoma (n=26),tubal carcinoma (n=7) and peritoneal carcinoma (n=1).Among of these ovarian carcinomas,12 cases were surface deposits and the other 14 cases within ovarian parenchyma.All 42 cases of non highgrade serous carcinoma in this period including 13 endometrioid ovary carcinomas,11 clear cell ovary carcinomas,11 mucinous ovary carcinomas,6 low-grade serous ovary carcinomas,1 low-grade serous tubal carcinoma,were also collected as a reference.The presence of tubal intraepithelial carcinomas was assessed.Based on the presence of TIC,high-grade serous ovary carcinomas were divided into TIC positive (+) and TIC negative (-) groups,and the clinical and pathological features of them were also evaluated.Results Fifteen cases (44％) were identified TIC in 34 high-grade pelvic serous carcinomas,and all of them were in the fimbria only,while none of TIC was found in control cases.There were significant difference between the two groups (x2=23.086,P=0.000).Eleven cases(42％) were identified TIC in all 26 high-grade ovarian serous carcinomas,in which 8 cases with unilateral ovary carcinomas were associated with ipsilateral TIC,2 cases with bilateral ovary carcinomas associated with unilateral TIC and one case with bilateral ovary carcinoma was associated with bilateral TIC.Four TIC (4/7) were identified in 7 cases with high-grade tubal serous carcinomas,and there was no presence of TIC in the 1 high-grade serous peritoneal carcinoma.Of all 26 high-grade ovarian serous carcinomas,6/11 cases were surface deposits,and 5/11 were parenchyma tumors in TIC (+) group while 6/15 cases were surface deposits and 9/15 were parenchyma tumors in TIC (-) group,in which there were correlated in distribution of TIC between the two groups( P＞0.05 ).The average diameter of ovarian cancer were 6.9 and 6.5 cm between the two groups with no significant differences ( t=0.409,P=0.690).Conclusion TIC is specific to high-grade serous carcinomas and maybe have something to do with the pathogenesis of pelvic serous carcinomas.

OBJECTIVETo study the significance of Fas and Fas-L expression in adenocarcinoma of uterine cervix.

METHODSBoth carcinoma tissue and their surrounding tissues from 36 patients with adenocarcinoma of uterine cervix, previously untreated either by radiation or chemotherapy, were studied for the expression of Fas and Fas-L by immunohistochemical stain with DNA apoptosis fragment detected by TUNEL.

RESULTSThe TUNEL labeling index was negatively correlated with differentiation of adenocarcinoma of cervix. Compared to highly differentiated and moderately differentiated tumor, the TUNEL labeling index was reduced obviously in poorly differentiated adenocarcinoma (P < 0.01). Fas expression was detected in 31 cases (86%) while there were only 3 weakly stained in the normal endocervical glands around the carcinoma. The 5 unstained carcinomas were 3 highly differentiated and 2 moderately differentiated. The positively stained Fas was associated with differentiation; the stronger the stain, the less differentiation there was. The Fas-L expression was detected in all adenocarcinomas while there was only 1 weakly stained in the normal ones. No significant difference was found in the expression of Fas-L in carcinomas with different degrees of differentiation. No correlation was observed between Fas and Fas-L expression.

CONCLUSIONSThe Fas expression is positively correlated with the different degrees of differentiation and Fas-L expression may be associated with the escape from of immunal surveillance.

Adenocarcinoma ; diagnosis ; metabolism ; Apoptosis ; physiology ; Biomarkers, Tumor ; biosynthesis ; Cell Differentiation ; physiology ; Fas Ligand Protein ; Female ; Humans ; Immunohistochemistry ; Membrane Glycoproteins ; biosynthesis ; Uterine Cervical Neoplasms ; diagnosis ; metabolism ; fas Receptor ; biosynthesis

Objective: To investigate clinicopathological characteristics of vaginal tubulo-squamous polyp (TSP). Methods: Clinical and pathological data of 4 cases of vaginal TSP diagnosed at Women′s Hospital, School of Medicine, Zhejiang University from 2007 to 2018 were analyzed by hematoxylin-eosin and EnVision two-step immunohistochemical staining technique. Results: The age of the 4 patients ranged from 62 to 71 years, with a mean of 66 years. Histologically, the polyps consisted of an admixture of squamous epithelium and tubules within a fibrous stroma. Immunohistochemically, the cells lining the tubules showed positive staining of prostatic acid phosphatase (PSAP) and/or prostate-specific antigen (PSA) in all 4 cases. Available follow-up in 3 patients for 4 to 6 months (mean of 5.3 months) showed no tumor recurrence. Conclusion TSP is an under-recognized benign vaginal polypoid disease that may develop from paraurethral Skene glands.

Objective To explore and compare the clinical curative effect of tocilizumab and leflunomide in the treatment of rheumatoid arthritis and to evaluate the safety. Methods From March 2015 to March 2016,70 cases of rheumatoid arthritis treated in the department of rheumatism in this hospital were divided into treatment group and control group by using a random number table method,35 cases in each group.The patients in the observation group were intravenously treated with tocilizumab,at dosage of 8 mg·kg-1,once every four weeks.The control group was treated by oral administration of leflunomide tablets,at 50 mg·d-1from the 1st to 3rd day,and at 20 mg·d-1from the fourth day to the end of the treatment.The treatment period was 24 weeks in the two groups.Joint swelling,joint pain,morning stiffness,ESR,CRP,IL-6 and IL-8 were recorded and compared before and during the treatment.Total effective rate of treatment was compared between the two groups.Adverse drug reaction was recorded and the incidence of adverse drug reactions was compared. Results After the treatment,joint swelling, joint pain,morning stiffness,ESR,CRP,IL-6 and IL-8 were significantly lower in the treatment group than those in the control group (P<0.05).After the treatment,the total effective rate of the treatment was significantly higher than that of the control group (P<0.05).After the treatment,incidence of adverse reaction was significantly lower in the treatment group than that in the control group(P<0.05). Conclusion Tocilizumab and leflunomide has certain curative effect in the treatment of rheumatoid arthritis, but tocilizumab is more effective,with low incidence of adverse reaction and a high clinical value.

Objective: To elucidate the clinicopathologic characteristics of atypical epithelioid trophoblastic lesions with cyst and fistula formation after cesarean section. Methods: The clinical and pathological data of 4 cases of post-cesarean atypical epithelioid trophoblastic lesions with cyst and fistula formation diagnosed at Women′s Hospital, School of Medicine, Zhejiang University during April 2007 to June 2018 were evaluated by hematoxylin and eosin stain and EnVision two-step immunohistochemical staining technique. Results: The age of the 4 patients ranged from 32 to 41 years, with a mean age of 36.5 years. Three patients recieved cystectomy and one underwent subtotal hysterectomy. Histologically, the lesions were well circumscribed and consisted of uniform cells of medium size, irregularly enlarged with hyperchromatic nuclei and 1 to 2 inconspicuous nucleoli embedded in abundant hyalinized matrix with fibrinoid material in the center. The cells exhibited immunohistochemical feature of chorionic-type intermediate trophoblastic cells (CK18+, p63+ and CD146-). All patients were alive without recurrence during follow-up of 1 to 40 months (mean=22 months). Conclusion Atypical epithelioid trophoblastic lesion with cyst and fistula formation after cesarean section has unique histological features, and its biological behavior and prognosis are still unclear, which need further exploration.