Journal of International Obstetrics and Gynecology

Research Progress of Laparoscopic Lateral Suspension with Mesh and Its Modified Operation in the Treatment of Pelvic Organ Prolapse

LIU Shu-jie, ZHANG Hai-Yan

2024, 51 (2): 121-127. doi: 10.12280/gjfckx.20230639

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Pelvic organ prolapse is a disease prevalent in middle-aged and elderly women. Surgery is often the ultimate choice to eliminate the symptoms of prolapse. However, there is currently no uniform standard for the treatment of this disease, and the existing surgical methods have obvious advantages, disadvantages, and applicability. In recent years, clinicians have favored laparoscopic lateral suspension with mesh as a technique for preserving the uterus and achieving postoperative beauty for women. This surgery has proven to have good therapeutic results in both uterus preservation and hysterectomy, with short learning curve, low risk, minimal bleeding and low complication rate. The high success rate of this surgery and its modifications in the treatment of anterior and intermediate ventricular prolapses reflects the universality of the procedure and the high rate of complications. The universality and practicality of this procedure is expected to become a substitute for laparoscopic sacralcolpopexy. Among the different types of mesh materials, polypropylene synthetic mesh exhibits a lower incidence of complications and is the preferred extracorporeal repair material for laparoscopic surgery.

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Progress in Treatment of Bacterial Vaginosis

NIU Han-fei, HAN Qin

2024, 51 (2): 128-132. doi: 10.12280/gjfckx.20230733

Abstract ( 259 )

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Bacterial vaginosis (BV) is the most common lower reproductive tract infection among women of childbearing age, leading to an increasing risk of pelvic inflammatory disease, poor pregnancy outcomes, and multiple sexually transmitted infections. At present, the main clinical drugs used for BV treatment are antibiotics such as metronidazole and clindamycin, but it is difficult to solve the problems of treatment failure and high recurrence rate in some patients. The reason might be that the antibiotics have a single mechanism of bacterial inhibition, and the intensity is insufficient, which cannot rebuild the vaginal microbiota dominated by Lactobacillus, nor can they inhibit the production of pathogenic biofilms dominated by Gardnerella vaginalis. Therefore, there is an urgent need to develop new alternative drugs or combination therapies for BV treatment. This article reviews the recent research advances in new treatment for BV based on its microbiological foundation, especially lactobacillus preparations and biofilm inhibitors. Most of these therapies have good safety and high effectiveness, with great research value. Some of the applications have been available in clinic practice in these years.

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The Relationship between Melatonin and Premature Ovarian Insufficiency

SHOU Meng-na, HUANG Yi-zhou, ZHOU Jian-hong

2024, 51 (2): 133-136. doi: 10.12280/gjfckx.20230761

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Premature ovarian insufficiency (POI) is a clinical syndrome in women who develops ovarian insufficiency before the age of 40 years, which manifests itself as a weakening of reproductive and endocrine functions, and is one of the most important factors leading to female infertility, but the pathogenesis is unknown and the treatment is limited. Melatonin is a neuroendocrine hormone mainly synthesized and secreted by the pineal gland, which exerts effects in regulating circadian rhythms, antioxidant activity, and scavenging free radicals. Studies have shown that melatonin is involved in regulating ovarian steroid hormone synthesis, follicular development, ovulation and oocyte quality. Animal models for studies of POI have found that melatonin can alleviate oxidative stress, reduce apoptosis, regulate ovarian function and delay POI through the regulation of multiple signaling pathways. Clinical studies have shown that melatonin can improve ovarian function and pregnancy rate in POI patients. Its potential value in assisted reproduction provides a new direction to improve the fertility of POI patients.

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Research Progress of Premenopausal Endometrial Polyps, Postmenopausal Endometrial Polyps and Tamoxifen-Associated Endometrial Polyps

WANG Qi-qin, WANG Xiang-lian, PAN Si-yi, WANG Xiu-li

2024, 51 (2): 137-141. doi: 10.12280/gjfckx.20230805

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Endometrial polyp (EP) is a common lesion of the endometrium, which can be classified as premenopausal EP, postmenopausal EP, and Tamoxifen (TAM)-associated EP. Different types of EP have different clinical features and treatment. Ageing, menopause, and the use of TAM are high-risk factors for the development and malignancy of EP. The expression of steroid hormone receptors varies among the three types of EP due to the influence of different factors such as hormone levels in women. Premenopausal EP usually exhibits the classic pathological features of EP, postmenopausal EP has a richer mesenchymal stroma, and TAM-associated EP may be accompanied by atypical hyperplasia and carcinoma. Premenopausal EP is usually a homogeneous hypoechoic mass on ultrasound, while postmenopausal EP often shows multiple cystic foci of varying sizes, and TAM-associated EP often shows densely distributed honeycomb-like liquid dark areas. The treatment approaches for different types of EP are not entirely the same and should be personalized based on factors such as whether the patient is menopausal or not, with or without symptoms and fertility requirements, and risk of malignancy.

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Trend and Age-Period-Cohort Analysis of Gynecological Diseases in China from 1990 to 2019

LI Ni, WANG Yu-ping, REN Juan-juan, LI Shu-xi

2024, 51 (2): 142-147. doi: 10.12280/gjfckx.20230946

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Objective: To understand the changing trends of gynecological diseases burden and its age, period, and cohort effects among Chinese women from 1990 to 2019, and to provide a scientific basis for the development of prevention and control strategies for gynecological diseases. Methods: Using data from the Global Burden of Disease Study 2019 (GBD 2019), a Joinpoint regression model was used to analyze the incidence rate of gynecological diseases and disability adjusted life year (DALY) rate in China. Trends of gynecological diseases and DALY rate in China were investigated based on the age-period-cohort model to explore the effects of age, period and cohort effects on incidence and DALY rates, and to analyze the parity of incidence and DALY rates of premenstrual syndrome, genital prolapse, uterine fibroid tumors, endometriosis, and polycystic ovary syndrome. Results: The incidence rates of gynecologic diseases and DALY rates among Chinese women showed a decreasing trend from 1990 to 2019, with an average annual decrease of 0.63% (95%CI: -0.73% to -0.54%, P<0.05) and 0.34% (95%CI: -0.43% to -0.24%, P<0.05), respectively. The results of the age-period-cohort model showed that the longitudinal age curves of both the incidence of gynecological diseases and the DALY rate in Chinese women from 1990 to 2019 showed an increasing and then decreasing trend, peaking at the age of 30 to 34 years. The risk of female gynecological disease incidence and the risk of DALY both showed a decreasing trend as the period progressed, with 2000—2004 as the reference period (RR=1), and the risk of incidence declined to the lowest in the 2015—2019 period (RR=0.73, 95%CI: 0.74 to 0.71). The risk of incidence and the risk of DALY trended downward in the 1905—1909 to 1985—1989 birth cohorts and slightly upward in the 1990—1994 to 2000—2004 birth cohorts. 1990 and 2019 premenstrual syndrome incidence (7 245.53/100 000, 5 695.02/100 000) and DALY rate (222.21/100 000, 197.95/100 000) topped the list of common gynecological disorders in 1990 and 2019. Conclusions: China has made some progress in reducing the disease burden of female gynecological diseases, but disease burden is still serious, and health promotion and education on gynecological diseases in young women should be strengthened, targeted screening should be carried out, and diagnostic and treatment techniques should be improved to continue to reduce the burden of female gynecological diseases in China.

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A Case Report of Atypical Accessory Cavitated Uterine Malformation

WANG Xiao-li, CHEN Yi, ZHENG Xin-chun, CAO Yan-hua

2024, 51 (2): 148-151. doi: 10.12280/gjfckx.20230876

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Accessory cavitated uterine malformation (ACUM) is a rare obstructive organ malformation, often found in young women, with the main clinical manifestations of progressively aggravated dysmenorrhea and recurrent pelvic pain. It should be differentiated from cystic adenomyopathy, congenital uterine cyst and residual horn uterus. At present, surgery is the most effective treatment. We report a married female patient with dysmenorrhea for 4 years, paroxysmal lower abdominal pain radiating to the perineum and back, progressively aggravated, requiring oral painkillers. In August 2023, gynecological vaginal ultrasound showed that the right side of the uterus was about 3.5 cm×2.7 cm heterogeneity nodular echo, the visible range was about 1.1 cm×0.6 cm small echoless area, the nature of which was to be determined. Laparoscopic exploration was performed. The uterus was normal in size, centered, and rosy. The appearance of bilateral fallopian tubes and ovaries was normal. On the right side of the uterus near the uterine horn, there was a slightly outward protrusion between the fallopian tube and the right round ligament. A hard muscular mass of about 3 cm in diameter was exfoliated from the protrusion. After incision, a space was found with dark-red fluid flowing out. The tumor was completely resected for examination and the diagnosis was confirmed as ACUM by pathological analysis. The symptoms disappeared in the post-operative follow up.

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The Etiology of Fetal Growth Restriction and Its Effects on the Long-Term Health of the Child

WANG Ya-hui, WANG Yan, WANG Yan, PEI Fe

2024, 51 (2): 152-156. doi: 10.12280/gjfckx.20230840

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Fetal growth restriction (FGR) is one of the common and more complex complications of pregnancy, which refers to the inability of the fetus to reach its expected growth potential during pregnancy. The etiology of FGR is complex and varied, and may be caused by maternal, fetal or placental factors. Long-term follow-up studies of pediatric and adult patients with FGR have revealed adverse health outcomes. Fetuses with growth restriction lag significantly behind normal children in birth weight and length after delivery, and the vast majority of these children begin to experience significant growth catch-up early in life, but are at higher risk for metabolic problems. FGR is often associated with a range of long-term complications, such as neurologic deficits and abnormalities in skeletal muscle growth and metabolism, and is even associated with increased risk of metabolic syndrome and cardiovascular disease in adulthood. This has a serious impact on the physical health and quality of life of children with FGR. We summarize the pathogenic factors of FGR and its effects on the long-term health of children in order to provide theoretical support for the clinical prevention and treatment of FGR.

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The Relationship between Biological Rhythm and Preeclampsia

PENG Lan, BAI Ting, ZHOU Li-ping, YU Yan-xia

2024, 51 (2): 157-160. doi: 10.12280/gjfckx.20230756

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Preeclampsia (PE) is a common complication of pregnancy and serious international public health problem, which endangering maternal and infant health. Although risk factors for PE have been demonstrated to include obesity, diabetes, and pre-pregnancy hypertension, its pathogenesis has not been fully elucidated. The vast majority of physiological processes in mammals are regulated by biological rhythm, and the disruption of biological rhythm has been shown to be associated with numerous diseases, such as cardiovascular disease, diabetes and breast cancer. Although PE is characterized by a series of biological rhythm, such as 24-hour variability in blood pressure in PE patients, "reversed nocturnal" blood pressure is associated with more severe target organ damage of PE, and superior prophylactic protection with nocturnal aspirin administration. The question of whether variation in biological rhythm is a risk factor for PE, or PE is associated with abnormal biological rhythm has not yet been clarified. The correlation between biorhythms and PE through literature study, including the expression of clock genes in the placenta and its relationship with PE, the biological rhythm of blood pressure, chronotherapy in the prevention of PE and disruption of biological rhythm and the risk of PE, in order to enlighten the necessity of further study on the potential association between biorhythms/circadian clock gene and PE in the future.

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The Effects of TNF-α and IL-6 on Skeletal Muscle of Fetuses with Fetal Growth Restriction

WANG Yan, WANG Ya-hui, WANG Yan, PEI Fei

2024, 51 (2): 161-166. doi: 10.12280/gjfckx.20231050

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Fetal growth restriction (FGR) is a common obstetric condition and resulting in low birth weight and reduced muscle mass in newborns after birth. This may be closely related to the regulatory mechanisms of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Studies have found that these two inflammatory factors are expressed at abnormal levels in FGR fetuses, affecting the proliferation and differentiation of myoblasts, interfering with the normal development of skeletal muscle. Moreover, TNF-α and IL-6 can activate specific signaling pathways, such as nuclear factor-κB (NF-κB), Janus kinase/signal transducer and activator of transcription (JAK/STAT), mitogen-activated protein kinase (MAPK), and other signaling pathways that regulate myocyte metabolism and function. Using specific anti-inflammatory drugs or biological agents to reduce the activity of TNF-α and IL-6 may help improve the skeletal muscle development in FGR fetuses. Overall, the role of TNF-α and IL-6 in the skeletal muscle development of FGR fetuses is a multifaceted and complex process, requiring further in-depth research to clarify their specific mechanisms, aiding to the understanding of the pathophysiology of FGR, and providing new ideas for the treatment of FGR fetuses.

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Mechanism of Schisandrae Chinensis Fructus on Treating Missed Abortion Based on Network Pharmacology and Preliminary Verification

LIANG Jing, QIAO Lin-jing, HOU Hai-yan

2024, 51 (2): 167-175. doi: 10.12280/gjfckx.20230445

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Objective: To explore the potential mechanism of Schisandrae chinensis fructus on the treatment of missed abortion based on a network pharmacology approach and verified experimentally. Methods: The system pharmacology approach was used to find and screen the active components and targets of Schisandrae chinensis from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP, https://old.tcmsp-e.com/tcmsp.php), find the genes related to missed abortion, and identify the targets of Schisandra chinensis for prevention and treatment of missed abortion. The "drug component-target" network was constructed by using Cytoscape to screen key compounds. The protein-protein interaction (PPI) network was established by String, and the core targets were screened by the Cytoscape-CytoNCA topology analysis. Gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) analysis were performed on the target genes to predict their possible signal pathways and explore their molecular mechanisms. Finally, the mechanism was validated with the help of human chorionic villous trophoblast cell line (HTR-8/SVneo) using real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) detection and Western blotting assays. Results: Seven active compounds of Schisandra chinensis were identified from TCMSP database. Schisandrae chinensis has five potential targets for the prevention and treatment of missed abortion. The PPI network shows that androgen receptor (AR), estrogen receptor (ER), cyclooxygenase-2 (COX-2), nuclear receptor coactivator 2 (NCOA2) and acetylcholine esterase (ACHE) may be the core targets of Schisandrae chinensis for the prevention and treatment of missed abortion. Forty-four cell biological processes were obtained by GO enrichment analysis, and two related signal pathways were obtained by KEGG pathway enrichment analysis, mainly including thyroid hormone signal pathway and estrogen signal pathway. During the process of validating the mechanism using a cell model, it was found that the protein and/or mRNA levels of AR, ER, and COX-2 in cells treated with benzo(a)pyren-7, 8-dihydrodiol-9, 10-epoxide (BPDE) were higher than those of normal cells, while the protein and/or mRNA levels of AR, ER, and COX-2 were reduced in cells pretreated with Schisandrin B (Sch B) first and then tainted with BPDE compared with those not pretreated with Sch B. The NCOA2 and ACHE protein and/or mRNA levels did not change significantly. Conclusions: Schisandrae chinensis may exert its preventive and therapeutic effects on missed abortion through anti-inflammatory and hormonal receptor regulation, and this protective effect may be achieved through the estrogen signaling pathway.

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Analysis of Macrosomia Risk between Pregnancy Weight Gain and Glycolipid Metabolism among Normal Pregnant Women

GAO Jing, QIN Fei, CHEN Chao, XIONG Yao-xi, CHENG Wei-wei

2024, 51 (2): 176-180. doi: 10.12280/gjfckx.20230346

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Objective: To analyze the pregnancy weight gain and glycolipid levels during pregnancy in normal pregnant women who delivered macrosomia without pregnancy complications, obesity, and advanced age, and explore their influence on the risk of macrosomia. Methods: Normal pregnant women who underwent regular prenatal examination were selected as the research object in the International Peace Maternal and Child Health Hospital from September 2020 to December 2020, and divided into macrosomia group (104 cases) and normal control group (258 cases) according to neonatal weight. The difference of basic situation and the levels of glucose and lipid metabolism were compared, and Logistic regression models were adopted to explore the risk factors of macrosomia in normal pregnant women. Results: Compared with the normal control group, the macrosomia group had higher levels of fasting blood glucose, triglyceride (TG) and lower levels of high density lipoprotein (HDL) at all stages of pregnancy (P<0.05), there are lager difference of TG level and smaller difference of HDL level in macrosomia group (both P<0.05). Compared with those who gained proper weight during pregnancy, those who gained too much weight had 142% increased risk of delivery of macrosomia (OR=2.42, 95%CI: 1.34-4.39) and those who had adequate weight gain had 73% decreased risk of delivery of macrosomia (OR=0.27, 95%CI: 0.10-0.77). For every 1 mmol/L increase in HDL in late pregnancy, the risk of delivery of macrosomia decreased by 79% (OR=0.21, 95%CI: 0.08-0.57). Conclusions: Normal pregnant women should control their weight gain strictly during pregnancy to reduce the risk of macrosomia, and lipid metabolism needs to be paid attention to, in which the level and change of HDL in late pregnancy may assist in the screening of cryptogenic macrosomia.

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Analysis of Maternal and Infant Outcomes of Septate Uterus in Late Pregnancy by Cesarean Section

YANG Qiong, XU Xiao-yan

2024, 51 (2): 181-183. doi: 10.12280/gjfckx.20231002

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Objective: To analysis of maternal and fetal outcome of cesarean section in late pregnancy of the septate uterus. Methods: 160 pregnant patients ≥ 34 weeks with cesarean section were collected at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Research group are 80 pregnant pateints with septate uterus, while control group are randomly select 80 pregnant patients with normal uterus. The general condition, placental and fetal condition, intraoperative bleeding and neonatal condition of pregnant women in the two groups were compared. Results: The age, pregnancy times, prenatal body mass, assisted reproduction, maternal complications, placental abnormalities, premature rupture of membranes, umbilical cord around the neck for two cycles or more, intraoperative bleeding, neonatal asphyxia and low birth weight infants are compared between two groups, which show no statistically significant (P>0.05). The number of previous births, gestational weeks and birth weight of newborns in septate uterus group were lower than those in control group, and the proportion of fetal breech position was higher than that in control group, the difference was statistically significant (P<0.05). Conclusions: Pregnant patients with septate uterus ≥ 34 weeks always have clinical issues with fetal position. Appropriate cesarean section can result in a similar maternal and fetal outcome to that of pregnant women with a normal uterus.

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Study on the Predictive Value of Cervical Ultrasound Elastography Combined with Serological Markers and Cervical Bishop Score for Cervical Ripening

LIU Yuan-ying, ZHANG Ai-qing, WANG Yong-qing

2024, 51 (2): 184-188. doi: 10.12280/gjfckx.20230506

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Objective: To analyze the predictive value of cervical Bishop score combined with cervical ultrasound elastography and serological markers for cervical ripening. Methods: 178 pregnant women who were registered at Peking University Third Hospital from January 2022 to June 2022 and underwent induced labor were selected and divided into a successful labor induction group of 158 cases and a failed labor induction group of 20 cases. Cervical ultrasound elastography indexes, serological markers (relaxin, estradiol, estriol, progesterone), cervical Bishop score before induction of labor were collected and analyzed. Compare the differences in the above indicators between two groups, and use the receiver operator characteristic curve (ROC curve) to analyze the value of combined detection in evaluating cervical ripening. Results: The elastic contrast index (ECI), external cervical os (EOS) and relaxin levels of the failed labor induction group were lower than in the successful labor induction group, and the cervical length was longer than that in the successful labor induction group (P<0.05). There was no significant difference in the levels of progesterone, estradiol and estriol between the two groups (P>0.05). The combination of cervical Bishop score, ultrasound elastography indicators (ECI, EOS, cervical length), and serum relaxin had the highest evaluation value for cervical ripening, with an area under the ROC curve of 0.940. Conclusions: The cervical Bishop score combined with cervical ultrasound elastography and relaxin can improve the accuracy of predicting cervical ripening.

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Decision Tree Analysis of Influencing Factors of Fetal Pleural Effusion

DONG Yue, ZHANG Hui-fang, GUO Xiao-pei, LI Zhu-yin, JI Ruo-nan, LUO Xiao-hua

2024, 51 (2): 189-193. doi: 10.12280/gjfckx.20230951

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Objective: To analyze the influencing factors of fetal pleural effusion complicated with edema by using decision tree model. Methods: The patients with fetal pleural effusion admitted to the Third Affiliated Hospital of Zhengzhou University from January 2016 to January 2023 were selected for the study. The 148 patients were divided into the fetal hydrops group (83 cases) and the fetal no hydrops group (65 cases) according to whether the fetus was edema or not. The χ² test or t test was used for single factor test, and the factors with statistical difference between the two groups were screened out and incorporated into the decision tree model (classification regression tree, CRT). The factors influencing the prognosis of fetal pleural effusion were explored. Results: The results of univariate analysis showed that in the single-factor analysis, these factors for the first diagnosis of pregnancy week ( χ²=2.044, P=0.043), the location of fetal pleural effusion ( χ²=5.628, P=0.018), the severity of fetal pleural effusion ( χ²=12.955, P=0.001), the return of fetal pleural effusion during pregnancy ( χ²=11.704, P=0.001) between the two groups had statistically difference. The results of Logistic regression analysis suggested that late gestational week at first diagnosis (OR=0.909, 95%CI: 0.844-0.978, P=0.011) was a protective factor for hydrops fetalis, and severe pleural effusion (OR=6.045, 95%CI: 1.980-18.451, P=0.002) was a risk factor for hydrops fetalis. Decision tree analysis showed that the earlier the first gestational age, the severity of pleural effusion, and bilateral pleural effusion were the influencing factors for edema caused by fetal pleural effusion, and the strongest association was between the first gestational age and fetal pleural effusion leading to edema. Conclusions: Fetal pleural effusion is often accompanied with fetal edema. The earlier the first gestation week, the more serious the pleural effusion, and the bilateral pleural effusion of the fetus, the more likely it is to cause fetal edema and the worse the prognosis of the fetus.

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A Case Report of Hyperemesis Gravidarum Combined with Wernicke Encephalopathy

JIANG Long-huan, CHU Chun-yu, ZHANG Ying, ZHU Tong-yu

2024, 51 (2): 194-197. doi: 10.12280/gjfckx.20230827

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Hyperemesis gravidarum is a condition characterized by severe nausea and vomiting during pregnancy, which can cause various complications, such as dehydration, acidosis and other disorders of fluid and electrolyte metabolism, as well as complications caused by intractable vomiting, such as esophageal laceration and gastrointestinal hemorrhage, etc. Among them, the one with the higher risk of death is Wernicke encephalopathy, which can lead to serious consequences if the diagnosis and treatment are not timely. A case of pregnant woman with hyperemesis gravidarum and Wernicke encephalopathy was reported. The patient presented with typical clinical symptoms of Wernicke encephalopathy such as nausea, vomiting, dizziness and nystagmus, but did not show typical imaging manifestations. Upon admission, a routine intramuscular injection of 100 mg vitamin B₁ was administered. After diagnosis, high-dose vitamin B₁ was given timely and termination of pregnancy. The symptoms improved and no residual complications. This case suggests that the imaging abnormalities of Wernicke encephalopathy combined with hyperemesis gravidarum have a lagging effect, and that vitamin B₁ supplementation should be given immediately for the appearance of relevant symptoms and suspected diagnosis.

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Large Cell Neuroendocrine Carcinoma of the Uterine Cervix in Pregnancy Combined with Hyponatremia: A Case Report

WANG Fang, JIA Ze-nan, ZHENG Jing, WANG Hui-ling, ZHU Bao-yu, WU Zhen-zhen, LIU Qing

2024, 51 (2): 198-202. doi: 10.12280/gjfckx.20230757

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Retrospective analysis of a case of pregnancy complicated with cervical large cell neuroendocrine carcinoma stage ⅢC1(r) cesarean section after intravenous chemotherapy occurred hyponatremia. Chemotherapy and radiation were employed to treat the main tumor, and symptomatic treatment was utilized to deal with hyponatremia. After 6 months of complete remission, there was a recurrence of the disease. Through the chemotherapy combined with targeted and immunotherapy, the patient experienced distributed shock and electrolyte disorder, and the patient′s family to give up the treatment. The follow-up didn′t break off until the patient died in May 2023. The prognosis for cervical large cell neuroendocrine carcinoma is poor due to its high level of aggressiveness. Hyponatremia may be associated with a poor prognosis of the tumor, which in clinical practice is easily obscured by severe effects to chemotherapy in the clinic. Understanding the clinical signs of hyponatremia, improve the ability of early recognition, obtaining an early diagnosis and course of therapy, and actively enhancing patient prognosis are all important for clinicians.

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A Case Report of Triploid Stillbirth with Cyclopia

LUO Ting, LIU Bo, ZHOU Zhong-min, HOU Shu-hui, LIU Jin-yu, PENG Mei

2024, 51 (2): 203-205. doi: 10.12280/gjfckx.20230755

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Cyclopia typically arises from incomplete separation of the embryonic eye primordia or developmental disorders in the midline forebrain, leading to fusion of the original visual vesicles on both sides towards the midline. It represents the most severe facial manifestation within the holoprosencephaly spectrum. Here, we present a case of stillbirth at 16 weeks of pregnancy with cyclopia. At 14⁺³ weeks gestation, fetal nuchal translucency examination revealed a significant fluid-filled dark area within the skull. Following termination of pregnancy, only one orbit and an accompanying frontal nasal column were discernible on the face of the fetus. Copy number variation sequencing (CNV-seq) analysis demonstrated chromosomal triploid variation along with chimeric duplication involving the X chromosome at a ratio approximately equal to 32%, accompanied by chimeric deletion affecting the Y chromosome at a ratio approximately equal to 32%. The etiology underlying cyclopia is heterogeneous and its pathogenesis remains elusive. Prenatal diagnosis and medical imaging play crucial roles in identifying monocular malformations during pregnancy, enabling timely termination when detected early, thereby minimizing physical and psychological harm to pregnant women while alleviating healthcare costs.

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PARP Inhibitors Combined with Immune Checkpoint Inhibitors in the Treatment of Gynecological Malignant Tumors

ZHOU Lin, YUAN Lin, WAN Yi-cong, ZHANG Lin, CHENG Wen-jun, JIANG Yi

2024, 51 (2): 206-209. doi: 10.12280/gjfckx.20240102

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In recent years the progress of targeted therapy and immunotherapy has developed rapidly, such as poly (ADP-ribose) polymerase inhibitor (PARPi) and immune checkpoint inhibitors (ICI) have changed the traditional treatment pattern of gynecologic tumors, but some patients have limited efficacy or develop drug resistance. Preclinical studies have found that PARPi damages DNA repair process, results in increasing tumor mutation burden and tumor -specific antigen neoantigens, modulates the tumor microenvironment, and stimulates the production of tumor infiltrating lymphocytes (TIL) and promotes anti-tumor immune response, which providing a theoretical basis for the combination treatment of PARPi and ICI. Recently, many clinical studies have found that the combination of PARPi and ICI can significantly improve the prognosis of patients with gynecological malignant tumors.

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Role of E-Cadherin in Peritoneal Implantation and Metastasis of Ovarian Cancer

QI Qi, GAO Ya-ting, XU Fei-xu

2024, 51 (2): 210-214. doi: 10.12280/gjfckx.20230884

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Ovarian cancer is one of the important causes of cancer death in women, and the main reason for its poor prognosis is that ovarian cancer is prone to recurrence and metastasis in a short period of time. Metastasis of ovarian cancer involves many aspects, such as intercellular junction, angiogenesis, tumor microenvironment and so on. It has been found that epithelial cadherin (E-cadherin) is an important factor in the metastasis of ovarian cancer, which can participate in the metastasis of ovarian cancer by changing cell-cell adhesion, promoting angiogenesis, regulating the process of epithelial-mesenchymal transition, and promoting tumor invasion and infiltration. The structure and expression of E-cadherin in ovarian cancer will be described in detail, and the implantation and metastasis mechanism of ovarian cancer and the role of E-cadherin in ovarian cancer metastasis are reviewed, in order to provide new ideas for recurrence monitoring and follow-up treatment of ovarian cancer.

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Research Progress in Copper and Ovarian Cancer

ZOU Qiao-jian, YAO Shu-zhong, CHEN Yi-li, LIU Jun-xi

2024, 51 (2): 215-219. doi: 10.12280/gjfckx.20231088

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Ovarian cancer is one of the common gynecological malignant tumors, and most patients with ovarian cancer are discovered in their advanced stage, their prognosis and treatment effects are usually poor, which also seriously affects the quality of patients′ survival. Copper is an important trace element that participates in various important biological processes in human body and correlates closely with the progression of many malignant tumors. An increasing number of studies have explored the relationship between copper and ovarian cancer. Previous research has noticed that copper levels are apparently higher in the plasma, ascites, and tumor tissue of ovarian cancer patients than in healthy women, and the abnormal expressions of a variety of copper- transporting proteins is closely related to the resistance to platinum-based drug chemotherapy in ovarian cancer. Recently, anti-tumor therapy targeting copper metabolism has become a hot research topic. Many studies have demonstrated the significant inhibitory effect of copper chelators and ionophores on ovarian cancer in vitro and in vivo. To summarizes the close relationship between copper and ovarian cancer, and to gain a deeper understanding of the application of copper-metabolism-based drugs and therapies, which may provide new insight into the treatment of ovarian cancer.

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The Prognosis Factors Abdominal Wall Endometriosis Associated Clear Cell Carcinoma: A Pooled Analysis Based on Case Reports

YU Liang, YUAN Lin, MENG Huang-yang, YANG Yu-qin, ZHAO Ming-rui, ZHANG Lin, CHENG Wen-jun

2024, 51 (2): 220-227. doi: 10.12280/gjfckx.20231109

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Objective: To explore the prognostic factors associated with clear cell carcinoma of abdominal wall endometriosis (AWE-CCC). Methods: A systematic literature search for case reports on AWE-CCC was performed in PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library, Wanfang, VIP and China National Knowledge Infrastructure (CNKI) from January 1980 to September 2023. Kaplan-Meier univariate survival analysis and multivariate Cox analysis were utilized to screen for factors affecting prognosis, and clinical treatment rules were summarized using the Apriori algorithm. Results: A total of 68 patients with AWE-CCC were included in this analysis. age ≤46 years old, lesion diameter >8 cm, lesion recurrence and recurrence interval≤6 months might be poor prognostic factors for AWE-CCC (P<0.05). Lesion excision plus hysterectomy were a strong therapeutic association rule and hysterectomy could offer recurrence protection (HR=0.08, 95%CI: 0.01-0.81, P=0.03). Conclusions: In clinical practice, patient′s age and lesion size should be emphasized. The initial treatment should include lesion excision and hysterectomy-based combined surgical treatment to reduce postoperative recurrence.

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A Case Report of Cervical Perivascular Epithelioid Cell Tumor

XU Jia-rong, XIE Le, PANG Zhuo-chao

2024, 51 (2): 227-231. doi: 10.12280/gjfckx.20230974

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Perivascular epithelioid cell tumor (PEComa) is a group of clinically rare mesenchymal tumors, mainly occuring in perimenopausal and postmenopausal women. The primary tumors are mostly located in uterus, retroperitoneum and other sites. PEComa of uterus mostly occurs in the uterine body subserous membrane, and a few patients occur in cervix and submucosa, and malignancy is rare. A case of cervical PEComa was reported due to abdominal pelvic space occupying and multiple bone metastases. The patient underwent CT of the sacroiliac joint in a local hospital due to repeated pain of the left knee joint, and was found that abdominal pelvic space occupying lesions and multiple high density lesions of the iliac bone and lumbosacral coccygeal bone. After admission in July 2023, combined with imaging examination and pelvic mass biopsy, malignant myoma was considered, and abdominal total hysterectomy, double adnexectomy, pelvic lymph node biopsy and pelvic adhesion lysis were performed under general anesthesia after exclusion of surgical contraindications. Postoperative pathology indicated cervical PEComa and lymphangioleiomyomatosis. Regular outpatient follow-up after discharge, no recurrence was found 5 months after surgery. The clinical and imaging manifestations of cervical PEComa are lack of specificity, and it is easy to be misdiagnosed and missed clinically. Pathological diagnosis is the gold standard, and the main treatment method at present is surgical resection of tumor tissue.

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A Case Report of Primary DICER1 Associated Cervical Rhabdomyosarcoma

ZHANG Ming-jun, HUANG Ai-hua, GAO Lian

2024, 51 (2): 232-235. doi: 10.12280/gjfckx.20230702

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Rhabdomyosarcoma has a highly malignancy and rare. A 17-year-old patient who was admitted to the hospital for 2 years due to incomplete menstrual bleeding was reported，after perfecting the pelvic magnetic resonance imaging which revealed cervical and vaginal masses. Our hospital performed cervical biopsy, and rapid pathological examination revealed malignant tumors. Later, a walking radical surgery was performed in an external hospital. Postoperative pathology and molecular testing showed that it was DICER1-associated embryonal rhabdomyosarcoma. After surgery, we combined radiotherapy and chemotherapy. Follow up until August 2023 showed no clinical or imaging recurrence, and tumor markers were normal. The clinical symptoms of embryonal rhabdomyosarcoma of the female reproductive tract are atypical, and its occurrence is closely related to the mutation of DICER1 gene. Individualized treatment plans should be developed based on the patient′s age, tumor location, and fertility protection needs, and follow-up monitoring should be strengthened.

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Targeted Therapy for Pelvic-Abdominal Epithelioid Inflammatory Myofibroblastic Sarcoma: A Case Report

SUN Jia-fan, HAN Su-ping, WANG Cong, JIANG Min-bo, WANG Xiu-li

2024, 51 (2): 236-240. doi: 10.12280/gjfckx.20230820

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Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a specific subtype of inflammatory myofibroblastic tumor. It is a rare malignant mesenchymal tumor with clinical features such as anaplastic lymphoma kinase (ALK) positivity, high aggressiveness, and poor prognosis. ALK inhibitors (TKI) are targeted drugs for the treatment of these tumors. We report a case of pelvic-abdominal EIMS that was difficult to be resected by surgery. The patient was a young woman with clinical manifestations of left lower abdominal pain with fever, and was clearly diagnosed by pathology as EIMS with RANBP2-ALK fusion mutation of ALK gene, and the symptoms of abdominal pain and other symptoms were rapidly relieved after TKI-targeted therapy, and with the prolongation of the time of administration, the lesion in the pelvic-abdominal cavity progressively shrunken. The patient was treated with TKI for 3 years, and no signs of recurrence or metastasis of the tumor lesions were seen on any of the imaging examinations. A successful case of sustained response to targeted therapy is provide, and confirm the possibility of TKI targeted therapy for patients with unresectable, refractory ALK-positive EIMS.

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