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 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.

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.

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 evaluate the prognosis and fertility outcomes of patients with early stage of cervical cancer treated by vaginal radical trachelectomy ( VRT ) in combination with laparoscopic pelvic lymphadenectomy.Methods The surgical data , disease recurrences and fertility outcomes were analyzed retrospectively for 51 patients who received VRT in Peking Union Medical College Hospital from Dec.2003 to Nov.2013.Results Forty-eight patients succeeded in preserving fertility.The median age was 29 years.International Federation of Gynecology and Obstetrics ( FIGO ) stage: 5 cases Ⅰa1 with lymph vascular space invasion (LVSI),4 cases Ⅰa2 and 39 cases in stage Ⅰb1.Tumor size: 20 cases with no visible lesion, 20 cases with tumor size ≤2 cm, 8 cases with tumor size >2 cm.Histological type:42 cases with squamous carcinoma , 6 cases with adenocarcinoma or adeno-squamous carcinoma.The mean excised cervical length and parametrial width was ( 2.6 ±0.6 ) cm and ( 1.9 ±0.5 ) cm, respectively.Six recurrences ( 12%) were observed after following up for a mean duration of ( 35 ±21 ) months.The recurrent rate in patients with tumor size >2 cm was 3/8, which was significantly higher than that of the
patients with tumor size ≤2 cm (8%, 3/40;P<0.01).Of the 35 patients who desired to conceive after the surgery, 13 women had 17 pregnancies and the pregnant rate was 37% (13/35).Nine women obtained 10 healthy live birth babies.The fertility rate was 26%( 9/35 ).Conclusions VRT in combination with laparoscopic pelvic lymphadenectomy could preserve the fertility of patients with early stage of cervical cancer with acceptable oncologic and fertility outcomes.Tumor size ≤2 cm should be emphasized as the indication of VRT in considering of the higher recurrent rate in patients with tumor size >2 cm.

Objective To study the clinical features,treatment and prognosis of struma ovarii.Methods From January 1990 to January 2012,a total of 68 patients were diagnosed struma ovarii at the Department of Obstetrics and Gynecology,Peking Union Medical College Hospital.Clinical data of these patients were studied retrospectively.Results (1) Characteristics of patients:the median age of patients was 42 years old (17-81 years).Of those patients,64 cases (94％) were diagnosed begin struma ovarii and 4(6％) were malignant struma ovarii.(2) Clinical feature:32(47％,32/68) patients were identified with pelvic mass by ultrasonic test,28 cases(41％) had clinical abdominal pain,8(12％) touched a mass from abdominal wall.Preoperative CA125 were tested in 54 patients,but only 8 cases(15％) had moderate elevation.All patients receive ultrasound examination,and 51 cases (75％) were mulitcystic lesions with many septi,3(4％) solid lesions and 14(21％) solid-cystic tumors.The mean diameter of tumors was(8 ± 3) cm.Ascites was present in 4 (6％,4/68)patients.Sixty-seven patients had unilateral lesions,and 1 patient had bilateral lesions.No patient had hyperthyroidism presentation.Nineteen cases underwent thyroid function test after operation,and the results were normal.(3) Treatment:all patients underwent surgical treatment.Among patients with begin struma ovarii,25 cases underwent cystectomy,15 cases unilateral,2 bilateral salpingo-oophorectomy,22 cases hysterectomy + unilateral or bilateral salpingo-oophorectomy.Four malignant struma ovarii,1 patient underwent fertility-sparing staging surgery,2 patients unilateral salpingo-oophorectomy,1 case hysterectomy + bilateral salpingo-oophorectomy.Two patients received chemotherapy after surgery.(4) Prognosis:all patients were followed up in Peking Union Medical College Hospital.The median follow-up time of benign struma ovarii was 5.4 years (6 months-21 years) and there were no recurrence.The median follow-up time of malignant struma ovarii was 11.5 years (9-20 years).Three cases had long-term recurrence at 2,7 and 16 years respectively after surgery.They were received surgical treatment after recurrence and all were alive.Two cases were given by thyroidectomy and 131I treatment.Conclusions Struma ovarii is a rare ovarian monodermal teratoma.Tumorectomy or salpingo-oophorectomy is the appropriate therapeutic treatment for benign struma ovarii.The incidence of malignant struma ovarii is low,and there are no standard treatments.Because of higher long-term recurrence rate,these patients need close follow-up.