Journal of International Obstetrics and Gynecology

Progress in Diagnosis and Treatment of Leiomyomatosis Peritonealis Disseminate

XU Qian, YUAN Jing

2023, 50 (4): 361-365. doi: 10.12280/gjfckx.20230036

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Leiomyomatosis peritonealis disseminate (LPD) is a rare and specific type of smooth muscle tumor disease that presents as multiple smooth muscle myoma nodules on the surface of peritoneal, pelvic and abdominal organs. The pathogenesis of the disease is still unclear, but there are mainly theories, including subperitoneal mesenchymal stem cells theory, the iatrogenic theory, the sex hormone theory and the genetic theory. It occurs in pre-menopausal women and has an asymptomatic clinical presentation, with incidental findings on imaging or during surgery. Diagnosis depends on intraoperative exploration and postoperative pathology, and differentiation from benign metastasizing leiomyomatosis, intravenous leiomyomatosis and metastatic smooth muscle sarcoma based on history, the extent of intraoperative smooth muscle tumour spread and pathology, etc. Surgery is currently the preferred treatment method. The surgical approach needs to be considered in relation to the patient′s age, fertility requirements and symptoms, and endocrine therapy can be used as adjuvant treatment. Although the disease is benign, it has the potential for recurrence and malignancy and requires close long-term follow-up.

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Advances in Diagnosis and Treatment of Cervical Mucinous Adenocarcinoma

SONG Xiao-xing, TIAN Ting-ting, SHI Hui-rong, JIA Yan-yan

2023, 50 (4): 366-371. doi: 10.12280/gjfckx.20230139

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Cervical mucinous adenocarcinoma is a rare and special histological type of cervical malignant tumor, which mainly includes adenocarcinoma of the cervix gastric type, adenocarcinoma of the cervix and intestines, and primary cervical signet-ring cell carcinoma. Due to the uncertainty between the pathogenesis of cervical mucinous adenocarcinoma and human papillomavirus (HPV) infection makes it difficult to be suggested by routine cervical cancer screening. Meanwhile, the etiology and pathogenesis of cervical mucinous adenocarcinoma are not clear, and there is a lack of typical clinical manifestations and early diagnosis methods, and the clinicopathological features and treatment are different from those of cervical common adenocarcinoma, resulting in patients being prone to miss the best treatment time, so the prognosis of cervical mucinous adenocarcinoma is worse than that of cervical common adenocarcinoma. In recent years, due to the popularization of HPV vaccine, the relative incidence of cervical mucinous adenocarcinoma has slightly increased compared with before, and the research on cervical mucinous adenocarcinoma has received more and more attention. The relevant research on cervical mucinous adenocarcinoma at home and abroad is reviewed, and the relevant pathogenesis, clinical features and treatment of cervical mucinous adenocarcinoma are discussed, in order to provide a reference for the clinical diagnosis and treatment of cervical mucinous adenocarcinoma.

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Progress in Diagnosis and Treatment of Cervical Large Cell Neuroendocrine Carcinoma

XI Ling, ZHOU Shun-qing, HAN Li-ying

2023, 50 (4): 372-376. doi: 10.12280/gjfckx.20230266

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Cervical large cell neuroendocrine carcinoma (LCNEC) is a special type of cervical cancer with characteristics of high malignancy and aggressiveness, and shows a tendency to metastasize systemically at an early stage. The development of cervical LCNEC is closely related to high-risk HPV infection. The diagnosis of cervical LCNEC is mainly based on typical pathological features and detection of specific neuroendocrine markers because of the lack of specificity of clinical manifestations. Due to the low incidence of cervical LCNEC and limited case data, there is no standardized treatment protocol, and its treatment is mainly based on small cell lung cancer, with radical surgery combined with chemotherapy and radiotherapy. However, genomic data suggest that cervical LCNEC is genetically more similar to common types of cervical cancer rather than to small cell neuroendocrine carcinoma outside the cervix, such as lung or bladder, which questions the ideas of adopting similar treatment regimens because of similar morphological manifestations among tumor tissues. This article focuses on a review of recent research advances regarding cervical LCNEC, with the aim of providing references and lessons for clinical work.

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The Relationship between ProMisE Molecular Typing and Lymph Node Metastasis and Other Clinical Features in Endometrial Cancer

LI Yuan-yuan, LI Qian, HE Lian, ZHU Yan-mei, ZHANG Xin

2023, 50 (4): 377-381. doi: 10.12280/gjfckx.20230211

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Objective: To explore the correlation between ProMisE molecular typing and lymph node metastasis and other clinical features in endometrial cancer. Methods: 74 patients with endometrial cancer who underwent surgical treatment at Cancer Hospital Affiliated of Dalian University of Technology from December 2014 to December 2018 were selected. Clinical data were collected and molecular typing was performed using the ProMisE method. The clinical characteristics of patients with different subtypes were compared, and the influencing factors of lymph node metastasis in endometrial cancer were analyzed. Results: Among 74 patients with endometrial carcinoma, 20 patients (27.0%) were mismatch repair defective, 2 patients (2.7%) were POLE mutant, 34 patients (46.0%) were p53 wild-type, and 18 patients (24.3%) were p53 mutated. There were statistically significant differences in lymph node metastasis (P=0.004), clinical stage (P=0.018), and pathological grading (P=0.036) among the four molecular subtypes of patients. Binary Logistic regression analysis revealed that p53 mutated (OR=27.669, 95%CI: 3.224-237.480, P=0.002) and muscle infiltration≥1/2 (OR=22.046，95%CI：4.185-116.146，P<0.001) as risk factors for lymph node metastasis. Conclusions: Molecular typing can provide an important reference for preoperative decision-making, that is, ProMisE molecular typing is performed on preoperative diagnostic uterine curettage specimens. If p53 mutant is found, the risk of lymph node metastasis is high and may need to be expanded intraoperatively.

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A Case of Endometrial Cancer Found in Postmenopausal Severe Lower Abdominal Pain and Literature Review of Postmenopausal Abdominal Pain Related Diseases

TANG Yi-lan, LOU Jiao-ying

2023, 50 (4): 382-386. doi: 10.12280/gjfckx.20220841

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Severe post-menopausal abdominal pain is commonly seen in advanced endometrial cancer, ovarian cancer and cervical cancer, but rare in malignant transformation of adenomyosis, endometriotic cysts, gastrointestinal stromal tumors (GIST), and endometrial tuberculosis. The gold standard for the diagnosis of almost all of the above-mentioned diseases is pathological examination, and imaging examination can serve as a reference and auxiliary diagnosis. When patients do not have typical clinical symptoms or B-ultrasonography and magnetic resonance imaging do not have typical imaging features, the imaging findings may influence the doctor′s diagnosis and delay treatment. A adenomyosis patient presented with post-menopausal abdominal pain without typical clinical manifestations such as endometrial thickening, hydrops of uterus and vaginal bleeding, the clinical data of the patient with stage ⅢC endometrial serous carcinoma diagnosed after operation were analysed, and the related literatures about post-menopausal abdominal pain related diseases were reviewed, and the diagnostic strategies of the patients with recurrent abdominal pain after menopause were discussed, in order to prevent misdiagnosis and mistreatment.

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A Case of Mature Teratoma with Liver Metastasis after Surgery for Ovarian Immature Teratoma

YANG Lin, GUO Hong-yan

2023, 50 (4): 387-391. doi: 10.12280/gjfckx.20230100

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Ovarian immature teratoma is a common ovarian germ cell malignant tumor that occurs in adolescent females. Surgical resection is the main treatment, and postoperative adjuvant chemotherapy is required if necessary. This case is an immature differentiated teratoma in the left ovary found during cesarean section. After 3 courses of chemotherapy with BEP regimen, the liver teratoma metastasis occurred. The pathological results after the second tumor resection suggest that mature teratoma is considered as growing teratoma syndrome (GTS). During the course of follow-up, the liver lesions were suspicious and reappeared, but gradually disappeared. Follow-up for 1 year showed no recurrence. During the treatment of ovarian immature teratoma, GTS is rare, has a special pathogenesis, and is easily misdiagnosed as recurrence or progression of ovarian immature teratoma. Therefore, it is necessary to understand GTS and pay attention to it in clinical practice.

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Giant Uterine Myoma: A Case Report

WEI Xiao-yu, GUO Qiu-yan, ZHANG Guang-mei

2023, 50 (4): 392-395. doi: 10.12280/gjfckx.20220886

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Uterine myomas, composed of smooth muscle and fibrous connective tissue, are the most common benign tumors in women, and can be classified according to their size and location of growth site. In China, giant uterine myoma is defined as leiomyoma with a diameter greater than 12 cm, which is rare clinically. A case of patient diagnosed with a giant uterine myoma, whose diameter was more than 20 cm, admitted to the First Affiliated Hospital of Harbin Medical University in 2021 was reported. This patient had found out about her uterine myomas many years ago, with the preoperative auxiliary examinations indicating that the uterus was large and compressed the surrounding organs. The giant uterine and bilateral fallopian tubes were removed with the assistance of urologists, and the patient recovered well after surgery. Through analyzing this case, we aim to summarize the clinical characteristics, study the perioperative management of the patient, and discuss the surgical and non-surgical treatment options of this disease.

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Uterine Mammary-Type Myofibroblastoma: A Case Report and Literature Review

XI Xin-xin, ZHANG Lin-feng, LI Jia

2023, 50 (4): 396-399. doi: 10.12280/gjfckx.20220933

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Mammary-type myofibroblastoma (MTMF) is a rare benign mesenchymal-derived tumor that occurs outside of the breast and is composed of diffusely distribution of spindle cells, varying numbers of mature fat cells and coarse collagen fiber bundles. Immunophenotypically, the spindle cells in MTMF diffusely express CD34 and Desmin. Once diagnosed, regardless of its size or location, it should be surgically excised and regularly monitored postoperatively. This article reports a case of a 51-year-old postmenopausal woman with uterine MTMF, who was misdiagnosed as uterine leiomyoma preoperatively and intraoperatively. Based on the condition and patient′s wishes, total abdominal hysterectomy with bilateral salpingo-oophorectomy were performed, and MTMF was finally diagnosed by postoperative immunohistochemical staining and was followed up for 18 months with no specific discomfort. Through a retrospective analysis of the diagnosis and treatment process and experience of this case, this study aims to provide clinical reference for diagnosis and treatment.

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Research Progress of Fibroblast Growth Factor 21 and Gestational Metabolic Diseases

LI Jing-jing, SUN Xiao-tong, LIU Ting-ting, LI Zhen-ying, ZHANG Yi-fan, SU Yan

2023, 50 (4): 400-404. doi: 10.12280/gjfckx.20230156

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Gestational metabolic diseases (GMD) are the most common cause of maternal and neonatal outcomes, but the mechanism remains unclear. Fibroblast growth factor 21 (FGF21) is a polypeptide hormone synthesized by a variety of organs. Its mechanism of action is complex. It regulates a series of metabolic processes in vitro and in vivo, and mainly participates in metabolic activities such as glucose, lipid, energy regulation and hepato-intestinal circulation of bile acid by means of endocrine. It also plays a key role in cell proliferation and differentiation, neuronal development, angiogenesis and wound healing. Therefore, FGF21 release disorders, signal dysregulation, and abnormal function are closely associated with GMD such as gestational diabetes mellitus, gestational hypertension disease, and intrahepatic cholestasis of pregnancy. This article reviews the latest research progress on the mechanism of FGF21 in GMD, so as to identify GMD and its hidden disease as early and accurate as possible, achieve the purpose of early diagnosis and intervention, and ultimately improve the prognosis of mothers and infants.

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Research Progress on the Pathogenesis of Preeclampsia

LIANG Jie-ming, LIU Guo-cheng

2023, 50 (4): 405-408. doi: 10.12280/gjfckx.20230106

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Preeclampsia is a multi-system hypertensive disorder in pregnancy with high morbidity and rapid progress. According to the statistics, preeclampsia causes more than 70 000 maternal deaths and 500 000 fetal deaths in the world annually, imposing a serious burden to the global health care system. However, the pathogenesis of preeclampsia is still unclear. It is generally believed that the development of preeclampsia is related to abnormal uterine-placental vascular remodeling caused by insufficient invasion of placental trophoblast cells and activation of maternal systemic inflammatory response. Numerous studies have demonstrated that placenta ischemia and hypoxia, oxidative stress, angiogenesis and function imbalance, immune disorder, inflammation, maternal cardiovascular dysfunction are important components of the pathogenesis of preeclampsia. This review introduces the research progress on the pathogenesis of preeclampsia from these aspects in an effort to understand the occurrence and development of preeclampsia, provide help for early diagnosis and intervention, and improve the maternal and fetal outcomes.

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The Relationship between Inflammatory Cytokines and Embryo Arrest

LIU Bing-bing, XU Yan-ning, CHEN Ling

2023, 50 (4): 409-415. doi: 10.12280/gjfckx.20230007

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Embryo arrest is a common early pathological pregnancy in which is caused by defects of fertilized eggs or adverse pregnancy factors of the mother, resulting in the embryo to stop developing during pregnancy. The incidence of embryo arrest has increased year by year, becoming the most common complication of pregnancy. It may eventually lead to spontaneous abortion and missed abortion. Many factors are related to the occurrence of embryo arrest and about half of them are related to immune factors. Cytokines are a class of biologically active molecules that modulate immune response, among which inflammatory cytokines are related to inflammation. Uterine decidua and trophoblast cells can secrete a variety of inflammatory cytokines. Recent studies have shown that in the process of embryonic development, different cytokines cooperate, depend on and antagonize each other to form a cytokine network and participate in the maternal fetal interface immune response. But the exact mechanism of inducing embryo arrest is still unclear. This review focused on the relationship between inflammatory cytokines and embryo arrest and the related mechanism, in order to laying a theoretical foundation for the prevention of embryonic abortion and the development of targeted therapeutic agents.

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The Role of Reproductive Tract Flora in Pregnancy

MU Xin-dan, GUO Jie

2023, 50 (4): 416-420. doi: 10.12280/gjfckx.20230168

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There are many kinds of reproductive tract flora, which are symbiotic and antagonistic to each other. They play an important role in defending infection, promoting pregnancy and maintaining a normal intrauterine environment. The metabolites produced by the interaction between the reproductive tract flora and the host are not only related to flora imbalance and host immunity, but also related to adverse pregnancy outcomes. In recent years, the research on the correlation between the role of reproductive tract flora in pregnancy has gradually attracted the attention of the academic community. Therefore, this article attempts to explain the complex interaction between the reproductive tract flora and the host from the aspects of the role of vaginal and cervical flora, uterine cavity flora, fallopian tube and follicular fluid flora in normal pregnancy, as well as the correlation between common microorganisms in the reproductive tract and adverse pregnancy outcomes, in order to provide a basis for studying the mechanism and treatment of adverse pregnancy outcomes.

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Construction and Validation of the Nomogram Prediction Model for Postoperative Infection after Cesarean Section

ZHANG Yan-fei, WANG Yi-xuan, ZHANG Shao-hua, CHU Ying, WANG Zan-hong

2023, 50 (4): 421-427. doi: 10.12280/gjfckx.20220806

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Objective: To investigate the influencing factors of postoperative infection in cesarean section patients and construct a nomogram prediction model. Methods: The clinical data of patients undergoing cesarean section in Shanxi Bethune Hospital from January 2021 to December 2021 were retroanalyzed and devided into infection group (n=60) and no infection group (n=1 086). The influencing factors of postoperative infection in cesarean section patients were selected into the nomogram risk prediction model. The discrimination, calibration, and prediction efficacy of the nomograms prediction model were evaluated. Results: The results of the multivariate Logistic regression analysis showed that having stable work was a protective factor for postoperative infection in cesarean section patients (OR=0.570, 95%CI: 0.331-0.983, P=0.043). Hypertensive disorders in pregnancy (OR=2.356, 95%CI: 1.324-4.192, P=0.004), GBS colonization (OR=3.154, 95%CI: 1.118-8.897, P=0.030), times of vaginal examinations >5 (OR=2.470, 95%CI: 1.146-5.324, P=0.021) and oxytocin induction (OR=2.457, 95%CI: 1.230-4.907, P=0.011) were independent risk factors of postoperative infection in cesarean section patients. The nomogram prediction model was established based on the above factors, whose consistency index (C-index) was 0.721 (95%CI: 0.651-0.791), and 0.051 was selected as the cut-off value, with a sensitivity of 66.7% and a specificity of 72.5%. The Homer-Lemeshow goodness-of-fit test suggested that the prediction model had a better calibration ability ( χ²=2.169, P=0.825). Conclusions: The nomogram prediction model constructed based on work, gestational hypertensive diseases, GBS colonization, times of vaginal examinations, and oxytocin labor induction has good accuracy and differentiation. It can identify the high-risk group after cesarean section to be infected in the early stage according to the predicted risk value, and corresponding preventive measures should be taken to reduce the occurrence of infection. However, further external verification and prospective comparative trials are needed to confirm the reliability of the predictive ability of the model.

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Effect of COVID-19 Vaccine Inoculation on Pregnancy Outcome during Peri-Pregnancy

YU Yi-xiang, WEN Ming

2023, 50 (4): 428-432. doi: 10.12280/gjfckx.20230096

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Objective: To explore the effect of peri-pregnancy vaccination with a novel coronavirus disease 2019 (COVID-19) vaccine on pregnancy outcome and to provide a reference basis for the immunization strategies for peri-pregnant women with COVID-19 vaccine. Methods: The clinical and pregnancy outcome data of 1 987 pregnant women who were hospitalized in the First People′s Hospital of Wuhu and Medical Association Hospital from May 2021 to November 2022 were retrospectively analyzed. According to whether they were vaccinated with COVID-19 vaccine, they were divided into vaccinated group (n=1 346) and unvaccinated group (n=641). The clinical data, pregnancy outcomes, maternal complications and neonatal outcomes of the two groups were analyzed. Results: 1 346 pregnant women were vaccinated with inactivated vaccine in 913 cases (67.83%), recombinant subunit vaccine in 417 cases (30.98%) and adenovirus vector vaccine in 16 cases (1.19%). The proportion of postpartum women in the vaccinated group was higher than that in the unvaccinated group (60.18% vs. 35.22%, P<0.001), and the incidence of hypertension disorder in pregnancy was lower than that in the unvaccinated group (4.61% vs. 7.49%, P=0.009). There was no significant difference between the two groups in the incidence of diabetes in pregnancy, anemia in pregnancy, premature rupture of membranes, amniotic fluid pollution, postpartum hemorrhage, puerperal infection, preterm infants, neonatal malformations, low birth weight infants, admission to the NICU, and the incidence of Apgar score ≤7 points 5 minutes after delivery (all P>0.05). Conclusions: The COVID-19 vaccination in peri-pregnant women is not associated with adverse maternal and infant pregnancy outcomes.

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Pregnancy Complicated with Severe Homozygous Hereditary Coagulation FactorⅤDeficiency and Postpartum Massive Hemorrhage: A Case Report

FAN Qian-qian, HE Rong-xia

2023, 50 (4): 433-436. doi: 10.12280/gjfckx.20230138

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Coagulation factor Ⅴ(FⅤ) deficiency is a rare genetic disorder that is primarily characterized by decreased FⅤ activity(FⅤC) and extensive clinical bleeding symptoms. Pregnancy combined with FⅤ deficiency is even more rare, and the risk of poor prognosis is higher. In this article, we report a case of severe homozygote hereditary FⅤ deficiency and postpartum hemorrhage occurring simultaneously. The patient was treated with ongoing high-dose blood product transfusions after being admitted to the hospital with a clear diagnosis of FⅤ deficiency, but the FⅤC did not improve adequately. Later, a live infant was delivered by cesarean section for acute fetal distress, bilateral uterine artery embolization was done for combined postpartum hemorrhage, and postoperative review revealed that the FⅤC had not returned to the normal level, and the patient was discharged with stable condition after symptomatic treatment. We now go over the medical history, the clinical course of this case, and the pertinent literature, with the aim of increasing clinicians′ understanding of this disease and accumulate more clinical experience.

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A Case of Colon Cancer in Pregnancy with Ovarian and Abdominal Metastasis

ZHU Yuan-yuan, XU Ye-tao, SUN Li-zhou

2023, 50 (4): 437-435. doi: 10.12280/gjfckx.20230051

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The incidence of colorectal cancer in pregnancy is low and rare in clinical practice. There is no consensus on the diagnosis method, timing of pregnancy termination and treatment options for colorectal cancer in pregnancy. This article reports a case of colon cancer in pregnancy with ovarian and abdominal metastases, who presented to the clinic with abdominal distension in mid-pregnancy, and a large amount of ascites were seen in ultrasound examination. Combining MRI, tumor index and multi-disciplinary team suggestions, it was considered that possibility of malignancy was high and recommended that abdominal puncture be performed to examine ascites for a clear diagnosis. Based on the pathological findings of ascites, a diagnosis of pregnancy with malignant tumors (poorly differentiated adenocarcinoma of the digestive tract) was made. After seeking the consent of the patient and her family members, she was induced with Levanon amniotic cavity injection midterm. Postpartum enteroscopy revealed poorly differentiated adenocarcinoma of the sigmoid colon and chemotherapy for the primary disease was administered one month after delivery. Meanwhile, the relevant literature was reviewed to provide experience for the diagnosis and treatment of colorectal cancer in pregnancy.

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Molecular Diagnosis and Analysis of A Fetus with Chimeric Beckwith-Wiedemann Syndrome

GUO Jing, ZHU Chong-yang, LI Peng-yun, WANG Han-duo, LIU Ling

2023, 50 (4): 442-445. doi: 10.12280/gjfckx.20221010

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A pregnant woman with left renal cyst and excessive amniotic fluid diagnosed by prenatal ultrasound was reported. After consultation, genetic testing of the fetus was requested to clarify the clinical diagnosis. Subsequently, chromosomal microarray analysis (CMA) and whole exome sequencing (WES) were used to analyze the DNA of fetal amniotic fluid cells. CMA results showed that there was a chimeric uniparental disomy (UPD) with a fragment size of about 18.6 Mb in the 11p15.5p15.1 region of the fetal chromosome. Simultaneously, no clear pathogenic gene mutations were found within the WES detection range. To clarify the parental origin of fetal chimeric UPD, the methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) for Beckwith-Wiedemann syndrome (BWS) was further used to detect abnormal methylation in the fetal imprinted region. The MS-MLPA results demonstrated that the methylation level in the imprinting center region 1 (ICR1) region of the fetus increased, while the methylation level in the ICR2 region decreased. Therefore, it can be determined that the fetal 11p15.5p15.1 region is a paternal chimeric UPD, thereby confirming that the fetus is BWS. Prenatal ultrasound of BWS is often a non-specific manifestation, which easily leads to missed diagnosis and misdiagnosis. Therefore, it is extremely important to carry out correct and targeted molecular diagnostic techniques to avoid the birth of defective children.

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Application of Organoids in Research of Endometrium and Endometrium-Related Diseases

ZHANG Xiao-lei, DENG Dan-ni, GAO Yan, ZHANG Hui-min

2023, 50 (4): 446-449. doi: 10.12280/gjfckx.20230197

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Organoids are three-dimensional cellular models cultured in vitro that retain the histological, physiological, and genetic characteristics of original tissues in vivo. They have the advantages of short culture time and high proliferative efficiency. In recent years, organoids have been widely applied in the field of life sciences, particularly in the endometrial research. By overcoming the limitations of conventional cell and animal models, organoids provide a more accurate simulation of the cyclic physiological changes of the endometrium and the characteristics of embryo implantation. Additionally, they show significant potential in disease modeling, precision medicine, drug screening for endometrium-related diseases such as endometriosis, endometrial tumors, and infertility. This review summarizes the progress in the application of organoids in translational research of basic endometrial and related diseases.

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Research Progress of Fanconi Anemia Related Genes and Premature Ovarian Insufficiency

WEN Xing-xing, CHAI Meng-han, YANG Ni, YANG Dan-dan, ZOU Hui-juan, ZHANG Wen-xiang, CHEN Bei-li

2023, 50 (4): 450-455. doi: 10.12280/gjfckx.20230003

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Premature ovarian insufficiency (POI) is an important cause leading to female infertility with a prevalence of >1%. Fanconi anemia (FA) is a disease characterized by bone marrow failure, birth defects, cancer predisposition, and increased sensitivity to DNA interstrand cross-link agents. The FA related genes, known for their important role in the repair of DNA interstrand cross-links, have been shown to be involved in germ cell development. Approximately half of FA females have impaired fertility, whereas almost FA males are infertile. Up to now, at least 22 FA related genes have been found and identified. The FA gene-deficient mouse models show different effects on reproductive function. In mild cases, the mice could have their offspring despite the fertility being reduced, while in severe cases, the fertility of mice is completely lost with the abnormal gonads congenitally. There are also increasing reports of infertility caused by FA gene defects. Abnormalities in primordial germ cells proliferation and meiosis are considered to be the main causes of infertility in FA patients. Studies have shown that genes involved in meiosis, DNA damage repair and mitosis are a large family of genes that cause POI. Therefore, the role of FA genes in follicle development and fertility maintenance needs to be paid more attention.

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Research Progress in the Diagnosis of Pelvic Tuberculosis

WANG Huan-huan, WANG Yu-xian

2023, 50 (4): 456-460. doi: 10.12280/gjfckx.20230137

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Pelvic tuberculosis is an inflammatory disease of the female reproductive system caused by Mycobacterium tuberculosis and is one of the important causes of infertility in women of childbearing age. The incidence rate of pelvic tuberculosis has increased significantly in recent years. The onset of this disease is hidden, and there is a lack of typical symptoms and signs. The commonly used medical tests have a low specificity and sensitivity for this disease. At present, there is no single standard that can be used for diagnosis. The conventional diagnosis mainly depends on the pathological results during and after operation, so the clinical diagnosis is difficult, and it is prone to missed diagnosis and misdiagnosis, resulting in delay in treatment. Advances in medical technology and improved awareness of pelvic tuberculosis among clinicians have made early diagnosis possible, but more convenient and rapid diagnostic methods still need to be explored. At present, the diagnostic methods of pelvic tuberculosis include serological examination, imaging examination, endoscopy, bacteriological examination, immunological examination, molecular biology examination, etc. The above methods have their own advantages and disadvantages, and the diagnostic methods of pelvic tuberculosis are still the focus of current research. Therefore, in order to provide reference for the establishment of clinical diagnostic thinking, we reviewed the above diagnostic methods and the latest research progress, analyzed and compared the advantages and disadvantages of different diagnostic methods, made a brief review of the existing diagnostic methods and summarized their diagnostic processes.

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Research Progress on Ovarian Function Protection of Ovarian Endometriosis Cyst

YAN Zhen-zhen, ZHANG Qi, ZHAO Ye

2023, 50 (4): 461-465. doi: 10.12280/gjfckx.20230111

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Ovarian endometriosis cyst are a common manifestation of endometriosis in women of childbearing age, which seriously threatens women′s reproductive health, reduces patients′ fertility and causes great psychological and economic burden to patients. Currently, ovarian endometriosis cyst still face problems such as delayed diagnosis, disease progression and subsequent treatment that impair ovarian reserve function, and high recurrence rate after surgery, all of which directly or indirectly reduce female fertility. However, there is no uniform standard clinical treatment scheme for the protection of ovarian reserve function of ovarian endometriosis cysts. In this paper, the latest research progress on the protection of ovarian reserve function in ovarian endometriosis cyst is reviewed from the aspects of evaluation of ovarian reserve function, early diagnosis and drug treatment of ovarian endometriosis cysts, selection of suitable surgical methods and fertility preservation methods, and postoperative management, with the aim of selecting appropriate treatment options for women with ovarian endometriosis cysts based on the maximum protection of ovarian reserve function.

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Research Progress of Diagnosis and Treatment of Adolescent Endometriosis

PAN Yong-chao, WANG Yin-feng, MAO Jing-xia, WU Rui-jin

2023, 50 (4): 466-471. doi: 10.12280/gjfckx.20230121

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Endometriosis (EMs) is a group of gynecologic disease defined by the presence of endometrial glandular epithelium and stroma outside the uterine lining. Recent studies suggest that EMs can affect women throughout their life cycle. Adolescent EMs is a special type of EMs which has attracted increasing attention in recent years. Among the most important risk factors for adolescent EMs are include genetic predisposition, co-presence of obstructive Müllerian anomalies, and higher levels of endogenous estrogens. There are many hypotheses for the pathogenesis of adolescent EMs, including retrograde menstruation theory, somatic epithelial metaplasia, hematogenous spread, lymphatic spread, neonatal uterine bleeding, immunologic theory and so on. Diagnosis depends on clinical symptoms, body sign, serology, imaging, surgery and pathology. Individualized medical and surgical treatment is considered the most effective strategy to relieve symptoms, inhibit disease progression, and protect future fertility. This article reviews the risk factors, pathogenesis, clinical manifestations, diagnosis and treatment of adolescent EMs, in order to provide clinicians with a reference for the understanding and treatment of this disease.

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Clinical Analysis of 27 Cases of Isolated Fallopian Tube Torsion

SHAO Hui, GUO Xiao-yue, LU Shan, ZHAO Yang-yu

2023, 50 (4): 472-476. doi: 10.12280/gjfckx.20230220

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Objective: To investigate the clinical characteristics of isolated fallopian tube torsion (IFTT). Methods: The clinical data of 27 IFTT patients, admitted to Peking University Third Hospital during January 2017 to December 2021, were retrospectively analyzed. Results: ①Clinical characteristics: 22 women of childbearing age, and 7 women experienced the onset of IFTT during pregnancy. Twenty-four patients presented with abdominal pain as the primary symptom, and 3 patients were diagnosed IFTT during surgery.②Examination, surgery and pathology: All patients underwent preoperative ultrasound examination, suggested tortuosity or cystic anechogenicity in the adnexal area. More specifically, 21 patients were operated laparoscopic surgery, while 6 patients underwent laparotomy. The choice of whether to preserve the fallopian tube depends on patient′s fertility requirements and where the torsion site. Of the 16 patients who had given birth, 2 cases of mesosalpinx cyst torsion preserved fallopian tubes, and the rest of them underwent salpingectomy. In the 11 cases who did not give birth, salpingectomy was performed in 3 patients of hydrosalpinx who scheduled to undergo assisted reproductive technology assisted pregnancy, and the rest of them were preserved fallopian tubes. The pathological findings were consistent with preoperative ultrasonography, suggesting hydrosalpinx or benign cysts in the fallopian tubes. ③There were seven IFTT patients during pregnancy, two were diagnosed during the second trimester pregnancy and five in the third trimester pregnancy. One patient was operated laparoscopic surgery, while the other six underwent laparotomy. However, all seven patients presented mesosalpinx cyst torsion. Three patients were treated with mesothelial cystectomy, with the fallopian tube retained, while four patients were treated with salpingectomy. All neonates showed good outcome. Conclusions: If women of childbearing age with hydrosalpinx and mesosalpinx cysts report sudden abdominal pain, the possibility of IFTT should be considered. Early diagnosis and treatment can avoid fallopian tube torsion and necrosis to preserve the patient′s ability to conceive naturally. The decision to keep the fallopian tube should be determined according to the patient′s fertility requirements and the site and degree of fallopian tube torsion.

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Non-Puerperal Uterine Inversion in Adolescent: A Case Report and Literature Review

WANG Ya-dong, GUO Yan, DING Yuan-yuan, ZHANG Xu, SHI Xiao-rong

2023, 50 (4): 477-480. doi: 10.12280/gjfckx.20221025

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Uterine inversion refers to the plunging of the uterine fundus into the uterine cavity and the protrusion of the endometrium towards the vagina, which is mostly seen in the third postpartum stage, while non-puerperal uterine inversion is rare in clinical practice. We report the diagnosis and treatment of an adolescent patient with non-puerperal uterine inversion. The patient had massive vaginal bleeding with vaginal drainage before surgery, and after symptomatic treatment such as correction of anemia and anti-infection, the patient improved the relevant examination to indicate uterine inversion or uterine malformation, which was confirmed to be uterine inversion during operation. We had performed uterine reset surgery first. Considering the possibility of uterine malignancy during the surgery, it was suggested to send it to frozen pathology to decide the scope of operation. The family refused and requested direct hysterectomy. Therefore, we performed laparoscopic subtotal hysterectomy+bilateral salpingectomy. The postoperative pathological examination confirmed malignant mesenchymal tumor of the uterus. By reviewing the relevant literature on non-puerperal uterine inversion in the past 30 years at home and abroad, we summarize the diagnostic and treatment experience, improve clinicians′ understanding of the disease, avoid misdiagnosis and guide the clinic.

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