Granulocytosis occurs in 40% of patients with lung and gastrointestinal cancers, 20% of patients with breast cancer, 30% of patients with brain tumor and ovarian cancer and 10% of patients with renal cell carcinoma. Granulocytosis occurs because of production of G-CSF, GM-CSF and IL-6. Uterine cervical carcinoma with granulocytosis as a paraneoplastic syndrome, however, has been rarely reported. We recently witnessed a case of invasive squamous cell carcinoma of the uterine cervix with granulocytosis. Leukocytosis developed up to 69, 000/micro L, and then normalized after chemo-radiotherapy. There was no evidence of infection, tumor necrosis, glucocorticoid administration, or myeloproliferative disease by examination of a bone marrow aspirate when granulocytosis appeared. This phenomenon was probably associated with the secretion of hematopoietic growth factors such as G-CSF, GM-CSF and IL-6 by the tumor. We suggest that, like some other solid tumors, cervical cancer can present with granulocytosis as a paraneoplastic syndrome.
Uterine Neoplasms/complications/*diagnosis ; Uterine Cervical Neoplasms/complications/*diagnosis/physiopathology ; Paraneoplastic Syndromes/*etiology ; Middle Aged ; Leukocytosis/*etiology ; Humans ; Granulocytes/*pathology ; Female

Objective: To compare the prognosis and perioperative situation of patients with stage Ⅱ endometrial cancer (EC) between radical hysterectomy/modified radical hysterectomy (RH/mRH) and simple hysterectomy (SH). Methods: A total of 47 patients diagnosed EC with stage Ⅱ [International Federation of Gynecology and Obstetrics (FIGO) 2009] by postoperative pathology, from January 2006 to January 2021 in Peking University People's Hospital, were analyzed retrospectively. The patients were (54.4±10.7) years old, and the median follow-up time was 65 months (ranged 9-138 months). They were divided into RH/mRH group (n=14) and SH group (n=33) according to the scope of operation. Then the prognosis of patients between the groups were compared, and the independent prognostic factors of stage Ⅱ EC were explored. Results: (1) The proportions of patients with hypertension in RH/mRH group and SH group were 2/14 and 45% (15/33), the amounts of intraoperative blood loss were (702±392) and (438±298) ml, and the incidence of postoperative complications were 7/14 and 15% (5/33), respectively. There were significant differences (all P<0.05). (2) The median follow-up time of RH/mRH group and SH group were 72 vs 62 months, respectively (P=0.515). According to Kaplan-Meier analysis and log-rank method, the results showed that there were no significant difference in 5-year progression-free survival (PFS) rate (94.3% vs 84.0%; P=0.501), and 5-year overall survival rate (92.3% vs 92.9%; P=0.957) between the two groups. Cox survival analysis indicated that age, pathological type, serum cancer antigen 125 (CA₁₂₅), and estrogen receptor (ER) status were associated with 5-year PFS rate (all P<0.05). But the scope of hysterectomy (RH/mRH and SH) did not affect the 5-year PFS rate of stage Ⅱ EC patients (P=0.508). And level of serum CA₁₂₅ and ER status were independent prognostic factors for 5-year PFS rate (all P<0.05). Conclusions: This study could not find any survival benefit from RH/mRH for stage Ⅱ EC, but increases the incidence of postoperative complications. Therefore, the necessity of extending the scope of hysterectomy is questionable.
Female ; Humans ; Adult ; Middle Aged ; Aged ; Disease-Free Survival ; Retrospective Studies ; Neoplasm Staging ; Prognosis ; Endometrial Neoplasms/pathology* ; Hysterectomy/methods* ; Postoperative Complications/epidemiology* ; Uterine Cervical Neoplasms/pathology*

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.
Uterine Cervical Neoplasms/complications/*pathology ; Sex Cord-Gonadal Stromal Tumors/complications/pathology ; Peutz-Jeghers Syndrome/complications/*pathology ; Ovarian Neoplasms/complications/*pathology ; Metaplasia ; Korea ; Humans ; Female ; Fallopian Tubes/pathology ; Endometrium/pathology ; Carcinoma, Ductal, Breast/complications/pathology ; Breast Neoplasms/complications/*pathology ; Adult ; Adenocarcinoma/complications/pathology

No abstract available.
Aged ; Chronic Disease ; Colitis/complications/*diagnosis/pathology ; Colonoscopy ; Female ; Fistula/complications/diagnosis ; Humans ; Intestinal Perforation/diagnosis/surgery ; Tomography, X-Ray Computed ; Uterine Cervical Neoplasms/*radiotherapy

Female ; Human papillomavirus 18 ; physiology ; Humans ; Papillomavirus Infections ; complications ; Risk Factors ; Uterine Cervical Neoplasms ; epidemiology ; etiology ; pathology ; virology ; Virus Integration ; genetics ; physiology

OBJECTIVETo study the expression of Skp2 in cervical squamous cell carcinoma (SCC) and its precancerous lesions, and to investigate its relationship with human papillomavirus (HPV) infection.

METHODSThe expression of Skp2 protein and HPV16/18 DNA was determined using immunohistochemistry and in-situ hybridization in 30 cases of normal cervical squamous epithelium, 29 cases of low-grade intraepithelial neoplasia, 31 cases of high-grade intraepithelial neoplasia and 31 cases of cervical SCC.

RESULTSSkp2 expression was not detected in normal cervical squamous epithelium and no significant difference was obtained statistically on Skp2 expression between normal cervical squamous epithelium and low-grade intraepithelial neoplasia (P > 0.05). However, the expression of Skp2 gradually increased with elevation of epithelial lesion grading in an order from low to high grade and to cervical SCC (P < 0.01). The positive rate of HPV16/18 DNA in cases of normal cervical squamous epithelium, low-grade, high-grade intraepithelial neoplasia and cervical SCC was significantly different (P < 0.01), although both high-grade intraepithelial neoplasia and cervical SCC had a similar high HPV infection rate up to 96.8%. There was no correlation obtained between Skp2 expression and HPV16/18 infection in low-grade intraepithelial neoplasia. In contrast, expression of Skp2 and HPV infection were significantly correlated in both high-grade intraepithelial neoplasia and cervical SCC (gammaH = 0.373, gammaC = 0.416, P < 0.05).

CONCLUSIONSAbnormal expression of Skp2 is present mainly in high-grade cervical intraepithelial neoplasia and invasive carcinoma, which may be considered as a surrogate marker for the high-grade lesions. Skp2 may play a key role in the development of cervical squamous carcinoma induced by HPV16/18 infection, through E7-Skp2-Rb signaling pathway.

Carcinoma ; pathology ; virology ; Carcinoma, Squamous Cell ; etiology ; virology ; Cervical Intraepithelial Neoplasia ; Female ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans ; Immunohistochemistry ; Papillomaviridae ; Papillomavirus Infections ; complications ; Uterine Cervical Neoplasms ; pathology ; virology

OBJECTIVE: We conducted a pooled analysis of published studies to compare the performance of human papillomavirus (HPV) testing and cytology in detecting residual or recurrent diseases after treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3). METHODS: Source articles presenting data on posttreatment HPV testing were identified from the National Library of Medicine (PubMed) database. We included 5,319 cases from 33 articles published between 1996 and 2013. RESULTS: The pooled sensitivity of high-risk HPV testing (0.92; 95% confidence interval [CI], 0.90 to 0.94) for detecting posttreatment CIN 2 or worse (CIN 2+) was much higher than that of cytology (0.76; 95% CI, 0.71 to 0.80). Co-testing of HPV testing and cytology maximized the sensitivity (0.93; 95% CI, 0.87 to 0.96), while HPV genotyping (detection of the same genotype between pre- and posttreatments) did not improve the sensitivity (0.89; 95% CI, 0.82 to 0.94) compared with high-risk HPV testing alone. The specificity of high-risk HPV testing (0.83; 95% CI, 0.82 to 0.84) was similar to that of cytology (0.85; 95% CI, 0.84 to 0.87) and HPV genotyping (0.83; 95% CI, 0.81 to 0.85), while co-testing had reduced specificity (0.76; 95% CI, 0.75 to 0.78). For women with positive surgical margins, high-risk HPV testing provided remarkable risk discrimination between test-positives and test-negatives (absolute risk of residual CIN 2+ 74.4% [95% CI, 64.0 to 82.6] vs. 0.8% [95% CI, 0.15 to 4.6]; p<0.001). CONCLUSION: Our findings recommend the addition of high-risk HPV testing, either alone or in conjunction with cytology, to posttreatment surveillance strategies. HPV testing can identify populations at greatest risk of posttreatment CIN 2+ lesions, especially among women with positive section margins.
Cervical Intraepithelial Neoplasia/pathology/surgery/*virology ; Female ; Humans ; Neoplasm Recurrence, Local/*virology ; Neoplasm, Residual ; Papillomaviridae/*isolation & purification ; Papillomavirus Infections/complications/*diagnosis ; Predictive Value of Tests ; Risk Assessment/methods ; Sensitivity and Specificity ; Uterine Cervical Neoplasms/pathology/surgery/*virology

BACKGROUNDPelvic lymph node metastasis (LNM) is an important prognostic factor in cervical cancer. Cervical squamous cell carcinoma accounts for approximately 75-80% of all cervical cancers. Analyses of the effects of the number of positive lymph nodes (LNs), unilateral versus bilateral pelvic LNM and a single group versus multiple groups of pelvic LNM on survival and recurrence of cervical squamous cell carcinoma are still lacking. The study aimed to analyze the effects of the number of positive pelvic LNs and a single group versus multiple groups of pelvic LNM on survival and recurrence.

METHODSWe performed a retrospective review of 296 patients diagnosed with Stage IA-IIB cervical squamous cell carcinoma who received extensive/sub-extensive hysterectomy with pelvic lymphadenectomy/pelvic LN sampling at Peking University People's Hospital from November 2004 to July 2013. Ten clinicopathological variables were evaluated as risk factors for pelvic LNM: Age at diagnosis, gravidity, clinical stage, histological grade, tumor diameter, lymph-vascular space involvement (LVSI), depth of cervical stromal invasion, uterine invasion, parametrial invasion, and neoadjuvant chemotherapy.

RESULTSThe incidence of pelvic LNM was 20.27% (60/296 cases). Pelvic LNM (P = 0.00) was significantly correlated with recurrence. Pelvic LNM (P = 0.00), the number of positive pelvic LNs (P = 0.04) and a single group versus multiple groups of pelvic LNM (P = 0.03) had a significant influence on survival. Multivariate analysis revealed that LVSI (P = 0.00), depth of cervical stromal invasion (P = 0.00) and parametrial invasion (P = 0.03) were independently associated with pelvic LNM.

CONCLUSIONSPatients with pelvic LNM had a higher recurrence rate and poor survival outcomes. Furthermore, more than 2 positive pelvic LNs and multiple groups of pelvic LNM appeared to identify patients with worse survival outcomes in node-positive IA-IIB cervical squamous cell carcinoma. LVSI, parametrial invasion, and depth of cervical stromal invasion were identified as independent clinicopathological risk factors for pelvic LNM.

Adult ; Aged ; Carcinoma, Squamous Cell ; complications ; mortality ; pathology ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis ; pathology ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms ; complications ; mortality ; pathology

Adenocarcinoma ; complications ; metabolism ; pathology ; Adult ; Carcinoembryonic Antigen ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; metabolism ; Ovarian Neoplasms ; complications ; metabolism ; pathology ; Peutz-Jeghers Syndrome ; complications ; metabolism ; pathology ; Proliferating Cell Nuclear Antigen ; metabolism ; Sex Cord-Gonadal Stromal Tumors ; complications ; metabolism ; pathology ; Uterine Cervical Neoplasms ; complications ; metabolism ; pathology

OBJECTIVETo analyze the causes and therapeutic approaches for the complications of radical hysterectomy plus pelvic lymphadenectomy in cervical cancer patients.

METHODSFrom Jan. 1995 to Dec. 2003, 219 such patients were treated by radical hysterectomy plus pelvic lymphadenectomy. The stages were: 26 stage IA (17 stage IA1 and 9 stage IA2) (11.9%); 142 stage IB (78 stage IB1, 64 stage IB2) (64.8%); 40 stage IIA (18.3%) and 3 stage IIB (1.4%). 204 patients in this series were treated by radical hysterectomy plus pelvic lymphadenectomy and 15 by modified radical hysterectomy with pelvic lymphadenectomy.

RESULTSa total of 49 patients (22.4%) developed postoperative complications. The major complications included: bladder dysfunction (10.0%); formation of lymphocysts (7.8%); wound infection (6.8%); hydronephrosis (1.4%) and formation of ureteral fistulas (0.5%). The patients in the group treated by radical hysterectomy plus pelvic lymphadenectomy was likely to develop postoperative complication compared with the patients in the group by modified radical hysterectomy plus pelvic lymphadenectomy (24.0% versus 0, P = 0.067). The postoperative complication incidence in the patients who had preoperative neoadjuvant chemotherapy through intra-arterial catheter or radical radiotherapy in the other hospitals were 50.0% (2/4) and 100.0% (1/1), which were higher than that of the patients treated primarily in our hospital (21.3%, 25.3%) though without statistically significant difference among the groups. Of 52 patients who had previous abdominal surgery history, 13 developed posoperative complications, there was no significant difference between the patients with or without previous abdominal surgery history. The complication incidence of 87 patients treated with preoperative afterloaded radiotherapy was higher than that of 124 patients primarily treated by surgery (25.3% versus 19.4%), but the difference between two groups was statistically not significant (P = 0.239).

CONCLUSIONThe complication of radical hysterectomy with pelvic lymphadenectomy is correlated with the surgery mode. Preoperative afterloaded radiotherapy may not increase postoperative complication incidence. Properly reducing the extent of surgery may decrease incidence of complications.

Adolescent ; Adult ; Aged ; Brachytherapy ; adverse effects ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Humans ; Hysterectomy ; adverse effects ; methods ; Lymph Node Excision ; Lymphocele ; etiology ; Middle Aged ; Neoplasm Staging ; Postoperative Complications ; Radiotherapy, Adjuvant ; adverse effects ; Urinary Retention ; etiology ; Uterine Cervical Neoplasms ; pathology ; surgery