正しい方法がわかる臨床基本手技 : from the New England journal of medicine

Gestational Trophoblastic Disease

2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy.

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease.

Inflammasomes are large intracellular multi-protein signalling complexes that are formed in the cytosolic compartment as an inflammatory immune response to endogenous danger signals. The formation of the inflammasome enables activation of an inflammatory protease caspase-1, pyroptosis initiation with the subsequent cleaving of the pro-inflammatory cytokines interleukin (IL)-1β and proIL-18 to produce active forms. The inflammasome complex consists of a Nod-like receptor (NLR), the adapter apoptosis-associated speck-like (ASC) protein, and Caspase-1. Dysregulation of NLRP3 inflammasome activation is involved tumor pathogenesis, although its role in cancer development and progression remains controversial due to the inconsistent findings described. In this review, we summarize the current knowledge on the contribution of the NLRP3 inflammasome on potential cancer promotion and therapy.

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Role of the NLRP3 inflammasome in cancer

Cancer of the cervix is the second most common life-threatening cancer among women worldwide and both incidence and mortality rates are likely to be underestimated in developing countries. HPV high risk strains play at least the major if not an absolutely necessary role in the etiology. The concept of cervical intraepithelial neoplasia (CIN) was introduced in 1968 as an equivalent to the term dysplasia, which means abnormal maturation. Cervical cancer progresses slowly from preinvasive CIN to invasive cancer and therefore screening for dysplasia is an important public health effort worldwide, given the accessibility of the primary organ site, the acceptability of current screening methods, and the long preinvasive period in which to detect disease and successfully intervene. It is widely accepted that detection and treatment of HPV-related dysplastic epithelial change in the form of CIN-2 and CIN-3 can prevent the development of invasive cervical cancer in individual patients. The mainstay of screening programs has been the Pap smear, introduced originally by George Papanicolaou in 1941. However, considerable numbers of false-negative Pap smears may occur with the traditional Pap technique, mostly due to sampling error. More recently, the use of liquid-based technologies such as ThinPrep and AutoCyte Prep have gained popularity, in part because of evidence suggesting reduction in the incidence of inadequate smears. It is also hoped that the ability to identify patients with oncogenic HPV types will lead to improved detection in women more likely to have squamous intraepithelial lesions. Hybrid Capture 2 is the latest refinement of HPV tests and has been described as having enhanced sensitivity. HPV DNA testing can be used as an adjunct to cytology in routine cervical disease screening programs. Establishment of the link between HPV and cervical cancer has further provided the impetus for research into prophylactic vaccination against the most common HPV types associated with the disease, HPV 16 and 18. Initial studies have provided evidence that L1 virus-like particle vaccines against HPV types (as monovalent, bivalent, or quadrivalent vaccines) prevent at least 90% of incident and persistent infections and their associated precursors of cervical cancer. This vaccine has sustained long-term vaccine efficacy against incident and persistent infections and in the long term should provide an answer to the cervical cancer problem. For the vast majority of women who have already been infected, however, continued screening and resection need to be emphasized.

Cervical cancer: screening and prevention.

Background The efficacy of neoadjuvant chemotherapy before surgery (NCS) has not been well-established in FIGO stage IB1 to IIA cervical cancer when compared with primary surgical treatment (PST). Thus, we performed a meta-analysis to determine the efficacy of NCS in patients with FIGO stage IB1 to IIA cervical cancer when compared with PST. Methods We searched Pubmed, Embase and the Cochrane Library between January 1987 and September 2010. Since there was a relative lack of relevant randomized controlled trials (RCTs), we included 5 RCTs and 4 observational studies involving 1784 patients among 523 potentially relevant studies. Results NCS was related with lower rates of large tumor size (≥4 cm) (ORs, 0.22 and 0.10; 95% CI, 0.13–0.39 and 0.02–0.37) and lymph node metastasis (ORs, 0.61 and 0.38; 95% CI, 0.37–0.99 and 0.20–0.73) than PST in all studies and RCTs. Furthermore, NCS reduced the need of adjuvant radiotherapy (RT) in all studies (OR, 0.57; 95% CI, 0.33–0.98), and distant metastasis in all studies and RCTs (ORs, 0.61 and 0.61; 95% CI, 0.42–0.89 and 0.38–0.97). However, overall and loco-regional recurrences and progression-free survival were not different between the 2 treatments. On the other hand, NCS was associated with poorer overall survival in observational studies when compared with PST (HR, 1.68; 95% CI, 1.12–2.53). Conclusions Although NCS reduced the need of adjuvant RT by decreasing tumor size and lymph node metastasis, and distant metastasis, it failed to improve survival when compared with PST in patients with FIGO stage IB1 to IIA cervical cancer.

Efficacy of neoadjuvant chemotherapy in patients with FIGO stage IB1 to IIA cervical cancer: an international collaborative meta-analysis.

Background
The aim of this study was to analyze and describe cases of ovarian cancer in pregnant women treated at our center and to review the literature concerned, and to discuss the rationale for therapy.

https://link.springer.com/content/pdf/10.1186%2F1471-2393-8-3.pdf

Ovarian carcinoma associated with pregnancy: A clinicopathologic analysis of 23 cases and review of the literature

Endometrial stromal sarcoma (ESS) is a rare disease with probably less than 700 new cases in the USA or Europe per year. The aim of this study was to evaluate the behavior of low-grade endometrial stromal sarcoma (LGESS) in relation to their clinical and pathological features and to identify possible prognostic factors. Fourteen patients with histologically proven ESS were included in the analysis. Endometrial stromal sarcoma is characterized by proliferations composed of cells with Endometrial stromal cell differentiation. Low-grade endometrial stromal sarcoma has an infiltrating margin and typically show extensive worm-like vessel invasion. The median age was 44.35 ± 6 years. The most common presenting symptom was vaginal bleeding, occurring in twelve patients (86%). Diagnosis was made through Fractional dilatation and curettage in four patients (28.5%). Eight patients had a total abdominal hysterectomy and salpingo-ophorectomy (57%). Radiotherapy as adjuvant therapy was administered to four patients (28.5%). The median follow-up time was 45.6 months (range 24–84). The median overall survival of the 14 patients was 45.35 ± 21 months (range 20–83). Three of 14 patients demonstrated a recurrence of disease at 9, 72, and 96 months respectively. The recurrent diseases were treated with surgery, chemotherapy, and radiotherapy. No patient died of the disease. Clinico-pathological parameters did not significantly differ between patients with and without recurrence, but patients with no myometrial invasion and low mitotic count <= 5/HPF showed longer disease-free survival. Five-year survival rate was 93%. Survival probabilities were calculated by the product limit method of Kaplan and Meier that showed, patients with no myometrial invasion and low mitotic count <= 5/HPF have longer disease-free survival, but P value was not significant.

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Low grade endometrial stromal sarcoma of uterine corpus, a clinico-pathological and survey study in 14 cases.

Dysgerminoma is the most common malignant germ cell tumor of the ovary. This malignancy can be associated with pure gonadal dysgenesis or Swyer syndrome, mixed gonadal dysgenesis and partial gonadal dysgenesis. Dysgerminoma developed in 3 phenotypic female patients with 46 XY pure gonadal dysgenesis. All patients presented first with abdominopelvic mass. Laparatomy was done. 46 XY karyotype was made by lymphocyte culture. Then these patients underwent gonadectomy that histopathology results were streak ovaries without evidence for malignancy. Two patients received postoperative adjuvant therapy. In Patients with Swyer syndrome the risk of dysgerminoma is high and gonadectomy is recommended. Also 5% of dysgerminomas are discovered in phenotypic female and 46 XY karyotype, thus in adolescent with dysgerminoimas and amenorrhea, karyotype should be done.

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Nadereh Behtash

Papers

Cervical cancer: screening and prevention.

Efficacy of neoadjuvant chemotherapy in patients with FIGO stage IB1 to IIA cervical cancer: an international collaborative meta-analysis.

Ovarian carcinoma associated with pregnancy: A clinicopathologic analysis of 23 cases and review of the literature

Low grade endometrial stromal sarcoma of uterine corpus, a clinico-pathological and survey study in 14 cases.

Dysgerminoma in three patients with Swyer syndrome