Objective To explore the clinical characteristics and management of ovarian tumor complicated by pregnancy and its influence on the pregnancy outcome, so as to provide diagnostic and therapeutic experiences. Methods A total of 248 cases were surgically and pathologically diagnosed as ovarian tumor complicated by pregnancy in The 202 Military Hospital from January, 2003 to December, 2009, and their clinical data were analyzed retrospectively. Results The incidence rate of ovarian tumor complicated by pregnancy was 0.49%. Among total 248 cases, 131 (52.82%) were benign tumors, of which 22.18% were ovarian mature teratomas; 113 (45.57%) were tumourlike lesions, of which most were ovarian chocolatecyst and lutealcyst, and 4 (1.61%) were malignant tumors. There were 212 cases treated by tumorectomy or salpingo-oophorectomy, and 3 of 4 cases with malignant tumors took postoperative chemotherapy. A total of 192 cases were diagnosed by regular antenatal care and ultrasound examination, accounting for 77.42% of the total sample size found during pregnancy. Among 14 cases receiving emergency operations, 9 were complicated by torsion, and the other 5 were by rupture. There were 67 cases receiving operation from the 14th to 18th gestational week, and 57 cases had full-time pregnancy. Conclusion Ultrasonography and pelvioscopy are of principal importance in the diagnosis and detection of ovarian tumor complicated by pregnancy which should be treated by tumorectomy, and suitable surgery intervention during second trimester is safe.
目的:研究TRAIL对卵巢癌COC1/DDP细胞生长的影响，以及化疗药物DDP等对TRAIL受体（DR4、DR5）表达的影响，揭示TRAIL与COC1/DDP细胞顺铂耐药性的关系。方法:用MTT法检测不同浓度TRAIL蛋白和TRAIL与DDP联合用药对COC1/DDP细胞生长的影响，用RTPCR方法检测DDP对TRAIL受体（DR4、DR5）表达的影响。结果:①TRAIL蛋白对COC1/DDP细胞生长有抑制作用，且随着TRAIL蛋白浓度升高，细胞抑制率逐渐上升。②DDP（2.5μg/mL）对COC1/DDP细胞生长抑制作用较弱（抑制率为3.31%），DDP在加入TRAIL蛋白后对细胞生长抑制率显著升高（Plt;0.05）。③DDP使COC1/DDP细胞的DR5表达水平显著增强为正常对照组的3.54倍（Plt;0.001）。结论:TRAIL蛋白对COC1/DDP细胞生长有抑制作用，DDP与TRAIL联合使用COC1/DDP细胞生长抑制更明显，TRAIL可逆转COC1/DDP细胞对DDP的耐药性，耐药性的逆转可能与DDP导致TRAIL受体DR5水平增高促进了肿瘤细胞的凋亡有关。
【Abstract】Objective To study the CT features of peritoneal Metastasis in postoperative patients of ovarian carcinomas. Methods CT appearance of peritoneal metastasis of ovarian carcinomas proved by surgery and pathology in 33 postoperative patients were reviewed. The CT features of the foci were recorded and analyzed, especially on the location, quantity, density and size.Results In the peritoneal cavity, 186 implant foci and 10 recurrent foci were found. metastasis often occurred in the right upper abdomen, especially the right subphrenic spaces. The most frequent locations were the right suprahepatic and subhepatic spaces, the small bowel mesentery, the gastrocolic ligament and the omentum. The density of the foci was most of solid. The size was ranged from 0.5~13 cm. Conclusion Peritoneal metastasis is the most frequent route of metastases for ovarian carcinomas. It is frequently found in upper abdomen, especially in the subphrenic spaces. Localized ascites in the peritoneal cavity is another important sign suggesting peritoneal implants. CT scan from the diaphragm to the pelvic floor will be helpful to diagnose peritoneal implants in cases of postoperative ovarian carcinomas.
ObjectiveTo explore the prevalence rate of gynecologic diseases and its character of age distribution of women in Chengdu, China. MethodsWe retrospectively analyzed gynecologic examination reports of women who underwent physical examination from December 2011 to November 2012. ResultsThis study included 23 389 women; the overall detection rate of cervix erosion was 20.98%. The detection rate of cervix erosion of women aged from 20 (included) to 30 was 44.81%, ranking first. The overall rate of abnormal cervical cytology was 0.93%, and the rate of women aged 41 to 50 was 1.20%, ranking first. The overall detection rate of uterine myoma, uterine adenomyosis, and ovarian tumor was 11.12%, 1.33%, and 3.60%, respectively. Fourty-one to 50 was the peak age of uterine myoma, uterine adenomyosis, and ovarian tumor; the detection rate was 19.95%, 2.46%, and 4.76%, respectively. The difference was significant in different age (P<0.05). ConclusionThe detection rate of gynecological common disease is high in childbearing aged women. Women aged 41-50 is the high-risk population of gynecological common disease.
ObjectiveTo explore the value of ultrasonic score, blood vessels and vascular resistance index in predicting and diagnosing benign and malignant ovarian tumor. MethodsA total of 157 patients with ovarian tumors (77 benign and 80 malignant) aged from 19 to 68 years old (average 56 years) between January 2008 and June 2012 were enrolled in the research. The ultrasonic score, blood vessels and vascular resistance index were recorded, and the differences between benign and malignant tumor were compared according to the pathological diagnosis; Their sensitivities and specificities were analyzed with the preoperative prediction. ResultsIn benign ovarian tumor, ultrasound scores and blood vessels index were obviously lower than that in the malignant tumor (P<0.05); the vascular resistance index was much higher than that in the malignant tumor (P<0.05). The sensitivities and specificities in diagnosing malignant tumor were high when the ultrasonic score was ≥ 2, vascular index was>0.02/cm3, and blood flow resistance index was ≤ 0.6. The sensitivities were 92.5%, 90.0%, 87.5%, respectively; while the specificities were 90.9%, 89.6%, 84.4%, respectively. ConclusionUltrasonic score, blood vessels and vascular resistance index have significance for identifying benign and malignant ovarian tumors; ultrasonic score is more accurate which has high value of clinical application and popularization.
ObjectiveTo systematically review the effect of laparoscopy versus laparotomy for borderline ovarian tumors (BOTs) on postoperative recurrence. MethodsWe searched PubMed, The Cochrane Library (Issue 11, 2015), EMbase, Web of Science, CNKI, WanFang Data and CBM databases from inception to Nov. 2015, to collect relevant clinical studies comparing laparoscopy and laparotomy for BOTs. Two reviewer independently screened literature, extracted data and assessed the risk of bias of include studies by using NOS scale. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsNineteen cohort studies were included. The scores of NOS scale showed that 10 studies were < 7 points, while the other 9 studies were≥7 points. The results of meta-analysis showed that: the recurrence rate of tumor (OR=1.75, 95%CI 1.05 to 2.91, P=0.03) in the laparoscopy group was higher than that in the laparotomy group, but no significant differences were found in further subgroup analysis according to type of operations (conservative surgery: OR=1.22, 95%CI 0.71 to 2.08, P=0.47; non-conservative surgery: OR=4.38, 95% CI 0.85 to 22.68, P=0.08). The diameter of tumor in the laparoscopy group was significant smaller than that in the laparotomy group (MD=-6.88, 95% CI-8.15 to-5.61, P < 0.000 01), and the rate of rupture of tumor in the laparoscopy group was significant higher than that in the laparotomy group (OR=3.99, 95% CI 2.54 to 6.26, P < 0.000 01). ConclusionCurrent evidence shows, compared with laparotomy, laparoscopy has similar effect on postoperative recurrence and smaller diameter of tumor, but laparoscopy could increase the rate of rupture of tumor. Due to the limited quality and sample size of included studies, more high quality and large sample size studies are need to prove the above conclusion.
Objective To systematically review the relationship between the expression of Survivin mRNA and ovarian cancer. Methods PubMed, The Cochrane Library (Issue 11, 2016), CBM, CNKI, VIP and WanFang Data databases were searched to identify case-control studies concerning the association between the expression of Survivin mRNA and ovarian cancer up to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 10 studies were included. The positive of Survivin mRNA in ovarian cancer group was significantly higher than that in control group (OR=24.63, 95% CI 13.44 to 45.15,P<0.000 01). The positive of Survivin in low differentiated group was significantly higher than that in high differentiation group (OR=3.69, 95% CI 2.29 to 5.93,P<0.000 01). The positive of Survivin in clinical stage of Ⅲ-Ⅳ was significantly higher than that in clinical stage of Ⅰ-Ⅱ (OR=4.76, 95% CI 2.99 to 7.57,P<0.000 01), respectively. However, the expression of Survivin mRNA was not associated with lymph node metastasis, ascites and histological type. Conclusion The current evidence indicates that the expression of Survivin mRNA is significantly correlated with ovarian cancer and its clinicopathologic features. Due to the limited quantity and quality of includes studies, the above conclusions are needed to be verified by more high quality studies.
ObjectiveTo improve clinicians' understanding of severe cytokine release syndrome (CRS) through reporting the clinical manifestation, diagnosis, treatment, and prognosis of CRS after chimeric antigen receptor T (CAR-T) cell therapy in a patient with solid tumor. Methods A patient with ovarian cancer who suffered severe CRS after CAR-T cell therapy in the Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University was reviewed. Relevant studies were searched for literature review. Results The patient, a 55-year-old woman, was diagnosed with ovarian cancer in early 2016 and continued to progress despite multiple lines of treatment, so she received CAR-T cell therapy on September 16, 2022. The patient developed a fever 2 days after infusion, and developed dyspnea and shortness of breath with oxygen desaturation 2 days later. Her condition kept deteriorating with respiratory distress and severe hypoxia 6 days after infusion, and the level of interleukin-6 and interferon-gamma continued to be elevated. Chest CT showed pleural effusion and massive exudation of both lungs. Considered to have acute respiratory distress syndrome (ARDS) due to severe CRS, she was transferred to the intensive care unit (ICU). The patient was treated with tocilizumab, high-dose intravenous glucocorticoid pulses, mechanical ventilation, and sivelestat sodium for ARDS. Her symptoms were gradually relieved, and the results of laboratory tests were gradually stabilized. The patient was extubated 6 days after ICU admission and discharged from ICU a week later. Six patients were screened out with ARDS or acute respiratory failure caused by CRS after CAR-T cell therapy, whose treatments were mainly anticytokine agents combined with high-flow oxygen therapy or invasive mechanical ventilation. One of them died. ConclusionsClinicians should be alert to severe CRS during the administration of CAR-T cell. Rapid interruption of the inflammation development is the key to all treatments. If respiratory and/or circulatory dysfunction occurs, patients should be transferred to ICU in time for organ support therapy.
Objective To construct and verify the diagnostic model of preoperative malignant risk of ovarian tumors, so as to improve the diagnostic efficiency of existing test indexes. Methods The related serological indicators and clinical data of patients with ovarian tumors confirmed by pathology who were treated in the Affiliated Hospital of Southwest Medical University between January 2019 and September 2023 were retrospectively collected, and the patients were randomly divided into a training set and a verification set at a 7∶3 ratio. Logistic regression was used to construct a diagnostic model in the training set, and the diagnostic efficacy of the model was verified through discrimination, calibration, clinical benefit, and clinical applicability evaluation. Results A total of 929 patients with ovarian tumors were included, including 318 cases of malignant ovarian tumors and 611 cases of benign ovarian tumors. The patients were randomly divided into a training set of 658 cases and a validation set of 271 cases. A diagnostic model was constructed using logistic regression in the training set, containing 5 factors namely age, percentage of neutrophil (NEU%), fibrinogen to albumin ratio (FAR), carbohydrate antigen 125 (CA125), and human epididymis protein 4 (HE4): modelUAM=−3.211+0.667×age+2.966×CA125+0.792×FAR+1.637×HE4+0.533×NEU%, with a Hosmer-Lemeshow test P-value of 0.21. The area under the receiver operating characteristic (ROC) curve measured in the training set was 0.927 [95% confidence interval (0.903, 0.951)], the sensitivity was 0.947, and the specificity was 0.780. The area under the ROC curve of the validation set was 0.888 [95% confidence interval (0.840, 0.930)], the sensitivity was 0.744, and the specificity was 0.901. Conclusion A new quantitative tool based on age, NEU%, FAR, CA125 and HE4 can be used for the clinical diagnosis of ovarian malignant tumors, and it is helpful to improve the diagnostic efficiency and is worth popularizing.