2016年 · 第51卷第09期

Although adenomyosis (AM) has many puzzles and unclear disputes in terms of its occurrence, development, naming and classification, people are more and more inclined to believe that AM and endometriosis (EM) should belong to the same disease, and different types are formed only because the locations of "ectopic lesions" are different. More studies have shown that the pathogenesis and clinical manifestations of EM and AM are basically the same.

A colposcope is a magnifying endoscope between the naked eye and a low-power microscope. It uses a strong light source to illuminate and magnify the cervix and lower genital tract lesions to locate the biopsy and guide treatment and follow-up. Colposcopy is one of the important methods for the early diagnosis of cervical intraepithelial neoplasia (CIN) and cervical cancer. In recent years, its role in the early diagnosis and early treatment of lower genital tract diseases has been paid more and more attention. Colposcopy has long been used to identify the most severe areas of the cervix and guide biopsies in that area. However, with the deepening of understanding, scholars gradually realize that pathological diagnosis only indicates whether patients need treatment, and the real clinical decision-making, such as how to treat it, depends on colposcopic images and the type of transformation area to assist in the decision. The term of colposcopy is to name the colposcopic images of important anatomical sites or tissues (epithelium, blood vessels) observed in colposcopy, so as to achieve the purpose of standardizing the terminology used in the diagnosis and treatment process. The International Federation for Cervical Pathology and Colposcopy (IFCPC) was founded in 1972. It is composed of Cervical Pathology experts and Colposcopy experts representing different countries and institutions around the world. It is committed to forming and promoting the internationally unified Colposcopy terminology and norms. It is currently the authoritative International organization for Cervical Pathology and Colposcopy.

The etiology of preeclampsia is complex, with a global incidence of 5% to 10%^[1]Seriously threaten the health of mothers and children. It is reported in the literature that preeclampsia is a placental ischemic disease, which is caused by uterine-placental blood circulation disorders and placental function defects, resulting in persistent placental hypoxia and releasing a large amount of cytokines into the blood circulation, which eventually leads to various disease manifestations in the mother^[2]。 The pathological study found that in addition to the abnormal recasting of the uterine spiral artery, the number of placental villi decreased and the formation of interstitial vascular network decreased, which was also an important cause of placental ischemia and hypoxia^[3]。 Notch signaling pathway affects embryonic development and plays an important role in cell proliferation, differentiation, apoptosis and vascularization^[4]。 Jagged1 is highly expressed as a ligand of the Notch signaling pathway in a variety of tumors and plays an important role in tumor angiogenesis^[5]However, there are many similarities between the development of placenta and the biological behavior of its cells during tumorigenesis. Whether Jagged1 gene is involved in the formation of placental blood vessels is still unknown. Many domestic and foreign studies suggest that Jagged1 is expressed in placental tissue of normal pregnancy, but there are few studies on its expression in placental tissue of preeclampsia, and the research results are inconsistent, and the relationship with angiogenesis is rarely studied. This study was conducted by CD₃₄Placental vascular endothelial cells were labeled, micro-vessle density (MVD) was counted, and the relationship between MVD and Jagged1 gene expression in placental tissues of preeclampsia was discussed, which provided a basis for deeper understanding of the pathogenesis of preeclampsia.

pre-eclampsia (PE) is an obstetric disease that seriously threatens maternal and fetal health, and its pathogenesis is still unknown. Studies showed that the expression level of Rho associated protein kinase (ROCK) in placental tissue of PE pregnant women was significantly upregulated^[1]It suggests that ROCK protein may be involved in the pathogenesis of preeclampsia. ROCK protein is a member of serine/threonine protein kinase family and is a downstream target effector molecule of Rho protein. ROCK protein has two isoforms, namely ROCKⅠ and ROCKⅡ. The sequence homology of the two isoforms reaches 64%, and the kinase activity region reaches 89%. Both isoforms are expressed in the placental tissues of normal and PE pregnant women^[2]。 ROCK protein mainly regulates cell shape and cell functions such as motility, secretion, proliferation, differentiation and apoptosis^[3]。 In recent years, it has been suggested that the pathogenesis of PE is related to placental hypoxia, and hypoxia is the key factor in the pathogenesis of PE. However, the changes and effects of ROCK protein in hypoxic state are still unclear. In this study, the effects of hypoxia on the expression of ROCK protein in placental tissue of normal pregnant women were further clarified by observing the changes of ROCK protein expression in placental tissue of normal pregnant women under hypoxia state.

intrauterine device (IUD) is one of the commonly used contraceptive measures for women of childbearing age in China. The incidence of ectopic IUD is not high, but it can cause different degrees of complications. A rare case of gastric ectopia of IUD was reported in this paper. Combined with the literature review, the causes, diagnosis and treatment of ectopia of IUD were discussed.

The number of patients with cervical intraepithelial neoplasia (CIN) is increasing year by year and the trend is getting younger. The management and active intervention of CIN are important links to block the occurrence of cervical invasive carcinoma. In 2013, the American Society for Colposcopy and Cervical Pathology (ASCCP) issued guidelines for cervical cancer screening and precancerous lesion management^[1]The management of CIN has been re-standardized, and it is recommended that the conservative treatment of CIN include physical therapy and surgical resection of local lesions, the latter including cervical circular electrode resection (LEEP) and other methods of cervical conization [such as cold knife conization (CKC), laser conization (CLC)], etc. With the advancement of initial treatment of CIN and the increase of reproductive population after CIN treatment, the impact of CIN surgery on fertility and subsequent adverse outcome of pregnancy has received more and more attention. Several meta-analyses suggest that a previous history of cervical conization is associated with an increased risk of preterm birth^[2,3]The predictive role of cervical canal length in the second trimester of pregnancy on premature birth has been clarified in the guidelines relating to premature birth issued in the United States and China^[4,5]。 Therefore, the purpose of this study is to analyze the correlation between the history of cervical conization, the length of cervical canal in the second trimester of pregnancy and premature birth, and analyze its possible influencing factors, so as to play a certain guiding role in the choice of treatment options for CIN patients with fertility requirements and the gestational management of pregnancy after their treatment.

gestational trophoblastic neoplasia (GTN) mostly occurs in women of childbearing age. Chemotherapy is the first choice and main method for treating GTN, which can not only effectively kill tumor cells, but also not change the anatomical structure of female reproductive system. At present, the cure rate of GTN is over 90%^[1]However, chemotherapy drugs have poor selectivity for target cells, which directly kill tumor cells and damage ovarian function, resulting in low ovarian function and infertility^[2], seriously affecting the quality of life of patients. Therefore, it is necessary to pay attention to the ovarian function and fertility status of GTN patients after chemotherapy. In this study, the age of admission to the Department of Gynecology of the First Affiliated Hospital of Zhejiang University School of Medicine between January 2013 and June 2015 was investigated<The effects of chemotherapy on menstruation, sex hormone levels and fertility were observed in 45 patients aged 40 years with GTN, and the related factors were discussed.

The patient was 27 years old due to "20 weeks of intrauterine pregnancy⁺³", vaginal intermittent watery leucorrhea for 1 month" was admitted to the hospital on May 30, 2015. The patient consciously had a small amount of vaginal intermittent discharge at more than 15 weeks of pregnancy, and the local hospital suspected premature rupture of membranes. This visit to our hospital for further examination. Gynecological examination: there was no abnormality in the vulva, the vagina was unobstructed, there was a small amount of watery leucorrhea, the vaginal dome was accessible, and an exogenous cauliflower-like mass was visible at the outer cervical opening, 4.0 cm ×3.5 cm in size, extending towards the vagina, with a crisp texture, contact bleeding, and soft parauterine tissue; There were no abnormalities in obstetric conditions. Pathological examination after cervical biopsy under colposcopy, the diagnosis of cervical squamous cell carcinoma stage IB 2. The patient was pregnant 2 and gave birth 1, and requested to keep the fetus. In view of the exophytic growth of the cervical tumor, it was decided to undergo local tumor resection combined with chemotherapy, and the time to terminate the pregnancy was decided according to the treatment situation. After adequate communication with patients and family members, at 20 weeks of pregnancy⁺⁵Local resection of cervical tumor was performed. Postoperative pathological examination: Cervical squamous cell carcinoma, moderately differentiated, infiltrating interstitial, with microscopic intravascular tumor thrombus in focus. Immunohistochemical detection: p16, CD₃₁, lymphatic marker D2-40 positive (+), cytokeratin (CK) 7 focal (+), cell proliferation-associated nuclear antigen (Ki-67) 90% (+), CK20 negative (-).

From 1860, when German pathologists first described the pathological manifestations of adenomyosis to today, for more than 100 years, medical scientists have conducted extensive research on the pathogenesis, diagnosis and treatment of adenomyosis. Despite our unremitting efforts, we don't know enough about adenomyosis. Adenomyosis has become a "modern disease" with an increasing incidence; Moreover, it seriously affects women's health and quality of life, and is also a "difficult to cure disease".

The concept of proteome was proposed by two Australian scientists Wilkins and Williams in 1994. It refers to the existence and activity of all proteins in cells, and later extended to all proteins expressed in the genome^[1]。 By comparing and analyzing the proteomes of normal and pathological individuals, we can find the changes of specific proteins associated with disease at the molecular level. proteomics allows large-scale studies of protein expression levels. hypertensive disorder complicating pregnancy (HDCP) is a systemic multi-system dysfunction of pregnant women, with an incidence rate of 8% ~10% in European and American countries^[2]； In China, the incidence of HDCP is 5.22%^[3]。 This type of disease is one of the main causes of high prevalence and mortality in pregnant women and perinatals, and its etiology and pathogenesis are still unclear.

pelvic floor dysfunction (PFD) includes pelvic organ prolapse (POP), urinary incontinence, defecation dysfunction, lower urethral sensation and urine emptying abnormalities, sexual dysfunction and chronic pain syndrome, among which POP and urinary incontinence are more common. PFD has a high incidence and complex etiology, involving one or more pelvic organs. MRI has been widely used in PFD because of its high resolution of soft tissue, no ionizing radiation, and the ability to display the whole pelvic cavity and pelvic floor supporting structure simultaneously. Static MRI examination only requires the patient to lie down without holding breath to perform Valsalva movement, and can perform a thin-layer scan of the whole pelvic cavity to observe the anatomical abnormalities of pelvic organs, muscles, ligaments, etc. in detail. Dynamic MRI can assess both resting state and breath-holding force state in one examination, and can find potential abnormalities that may cause the patient's symptoms^[1]； Through static and dynamic evaluation, we can understand the anatomical and functional abnormalities of pelvic floor supporting structures. The application of dynamic MRI in the diagnosis and post-treatment follow-up of PFD is reviewed below.

Endometrium, fallopian tube epithelium and ovary have the same origin of embryonic development. Fully understanding them will help to determine the true origin of gynecological malignant tumors, and provide new help for the occurrence, development, diagnosis and treatment of tumors. In addition to directly infiltrating the myometrium and lymph node metastasis, the exfoliated cells of endometrial cancer may also reach the pelvic and abdominal cavity through the lumen of the fallopian tube, causing dissemination outside the uterus. The pathogenesis of endometrial serous carcinoma (ESC) has the possibility of fallopian tube origin^[1]。 At present, the theory that high-grade ovarian serous adenocarcinoma originates from the fallopian tube has been widely recognized, that is, high-grade ovarian serous adenocarcinoma originates from the secretory cells of the fallopian tube epithelium, and its origin evolution process is: the secretory cells of the fallopian tube proliferate excessively and appear p53 blotting (p53 protein is strongly expressed), and further develop into serous tubal intraepithelial carcinoma (STIC), which eventually leads to the occurrence of high-grade ovarian serous adenocarcinoma^[2]。 With the understanding of the theory that high-grade ovarian serous adenocarcinoma originates from fallopian tube, many scholars have paid attention to the close relationship between fallopian tube and the occurrence and development of endometrial cancer and ovarian epithelial cancer (ovarian cancer). Therefore, it is believed that fallopian tube ligation may have a certain influence on the occurrence and development of endometrial cancer and ovarian cancer because it blocks the passage between uterine cavity and abdominal cavity.