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15 November 2023, Volume 42 Issue 6
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Case Report
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Original Article

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Investigation on the Cognitive Attitude of Perimenopausal and Postmenopausal Women to Menopause-Related Sexual Dysfunction ZUO Sheng-lan, WEN Yu-juan, XU Xiao-fang, JIN Long-mei, GU Xiao-qing, WANG Ying, WANG Bai-song, XU Hong, ZHOU Qian 2023, 42 (6):  441-445.  doi: 10.12280/gjszjk.20230136 Abstract ( 723 )   HTML ( 69 )   PDF (1275KB) ( 965 )   Objective: To investigate the cognition, views and attitudes of perimenopausal and postmenopausal women to menopause-related sexual dysfunction, and to provide guidance for sexual health care for middle-aged women. Methods: A total of 1 002 women who went to Maternity and Child Healthcare Hospital and Community Health Service Center of Xuhui, Minhang and Fengxian District for medical treatment or physical examination were screened from March 2021 to June 2022. 870 women who met the inclusion criteria were investigated by questionnaire in a cross-sectional way, and their population socio-economic status, cognition, views and attitudes towards menopause-related sexual dysfunction were collected. Results: A total of 831 completed questionnaires were collected, with an effective rate of 95.5%(831/870). 291(35.0%) of the respondents knew female sexual dysfunction, and 255(30.7%) of the respondents knew that menopause-related sexual dysfunction was mainly caused by the decline of menopause-related sex hormone levels. There was a statistically significant difference in the awareness rate among respondents of different ages, educational levels, occupations, family income, household registration types, and household registration locations(all P<0.05). Logistic regression analysis showed that education level of junior college degrees or above (OR=5.237, 95%CI: 3.071-8.928, P<0.001) and professional technical personnel (OR=3.291, 95%CI: 1.184-9.125, P=0.022) have a higher awareness rate of menopause-related sexual dysfunction. Only 141(17.0%) respondents reported having talked to doctors about their experience of menopause-related sexual dysfunction symptoms, 747(89.9%) stated that they do not have sufficient sources of information. 83.8%(696) of the surveyed respondents reported never receiving treatment. Conclusions: Perimenopausal and postmenopausal women have a low awareness and treatment rate of menopause-related sexual dysfunction. Therefore, the personnel engaged in women′s health care should strengthen sexual health science popularization and health education for middle-aged women to improve their medical and treatment rates, thereby improving their quality of life. Figures and Tables | References | Related Articles | Metrics

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Pathological Characteristics of 6 Cases of Ovarian Brenner Tumor MA Yan-hong, ZHAN Rui 2023, 42 (6):  446-449.  doi: 10.12280/gjszjk.20230327 Abstract ( 956 )   HTML ( 45 )   PDF (4104KB) ( 987 )   Objective: To investigate the clinicopathological and immunohistochemical characteristics of ovarian Brenner tumor. Methods: The clinical data, pathological features, immunophenotypes, and molecular characteristics of six patients with ovarian Brenner tumor between January 2019 and February 2023 at Suzhou Ninth Hospital Affiliated to Soochow University (our hospital) were retrospectively analyzed. Results: The age of the six patients varied from 54 to 73 years, with a median age of 66 years. Among these patients, four were diagnosed with benign ovarian Brenner tumor, while two were malignant. Biochemical indicators of 4 patients with benign ovarian Brenner tumor and one with malignant ovarian Brenner tumor were within normal ranges, while the level of carbohydrate antigen 125 (CA125) in another one patient with malignant ovarian Brenner tumor was significant increased. Microscopic examination revealed that the tissue of benign ovarian Brenner tumor was consisted of transitional cell epithelial nests, accompanied by fibrous stroma. These cells did not display any atypia and had oval nuclei with small nucleoli. In contrast, the tissue of malignant ovarian Brenner tumor exhibited clear stromal infiltration, evident atypia, a high nuclear plasma ratio, and increased mitotic activity, which was accompanied by benign ovarian Brenner tumor and borderline ovarian Brenner tumor components. Immunohistochemical staining showed that the tumor cells were positive for cytokeratin 7 (CK7), P63 and GATA binding protein 3 (GATA3), but negative for paired box 8 (PAX8), Wilm′s tumor gene 1 (WT1) and CK20. Ki-67 proliferation index was lowered 1% in benign ovarian Brenner tumor and about 20%-60% in malignant ovarian Brenner tumor. Four patients with benign ovarian Brenner′s tumor underwent adnexectomy on the affected side, with a good prognosis. One case of malignant ovarian Brenner′s tumor underwent laparoscopic ovarian staging surgery, and no recurrence or metastasis was found after 11 months of follow-up. Another case of ovarian malignant ovarian Brenner tumor was lost due to not undergoing surgery in our hospital. Conclusions: The diagnosis of ovarian Brenner tumor depends on the histopathological characteristics and immunohistochemistry. The differential diagnosis of benign and malignant ovarian Brenner tumor is based on the degree of cell atypia and stromal invasion. In addition, Ki-67 proliferation index can be used as a reference index. Figures and Tables | References | Related Articles | Metrics

Case Report

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Prenatal Diagnosis and Genetic Analysis of A Fetus with 46,X?,+der(13)t(13;21)(q32;q21)dmat,-21 WANG Li, LU Jun-jie, ZHOU Peng, HU Hua 2023, 42 (6):  450-453.  doi: 10.12280/gjszjk.20230182 Abstract ( 874 )   HTML ( 49 )   PDF (3463KB) ( 962 )   13-trisomy syndrome is a serious and rare chromosomal disease caused by complete or partial trisomy of chromosome 13. The prevalence is about 1.68/10 000, of which 13-trisomy syndrome caused by partial trisomy 13q accounts for 1%. The maternal partial trisomy 13q and partial monosomy 21q are even less. We reported a pregnant woman undergoing further prenatal diagnosis and genetic analysis in the Second Hospital Affiliated to Army Medical University, due to the abnormal fetal development indicated by ultrasound at 23+1 weeks of gestation. Ultrasound showed the subvalvular aortic ventricular septal defect, double superior vena cava and abnormal ossification of vertebral body. The karyotype of amniotic fluid was 46,X?,+der(13)t(13;21)(q32;q21)dmat,-21. Copy number variation sequencing (CNV-seq) showed seq[hg19]dup(13)(q11q32.1)chr13:g.19440000_ 97680000dup and seq[hg19]del(21)(q11.2q21.1)chr21:g.15060000_22020000 del. The maternal karyotype was 46,XX,t(13;21)(q32;q21). Fetal chromosomal abnormalities were caused by the mother′s chromosomal balance translocation, which was the main reason of fetal heart development abnormalities. The comprehensive application of chromosome karyotype analysis and CNV-seq can identify the origin and nature of chromosome abnormalities, and provide a basis for genetic counseling and reproductive guidance. Figures and Tables | References | Related Articles | Metrics

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SRY Negative 46, XX Male Syndrome with Normal Secondary Sexual Characteristics: A Case Report and Literature Review CUI Ling-bing, TIAN Wen-yan 2023, 42 (6):  454-456.  doi: 10.12280/gjszjk.20230292 Abstract ( 823 )   HTML ( 39 )   PDF (1316KB) ( 1007 )   46, XX male syndrome is a rare disorder of sex development, which usually has a 46, XX chromosome karyotype and positive sex-determining region Y gene (SRY), normal external genitalia and male phenotype. Most of them come to hospital due to adult infertility. The patients with SRY negative 46, XX male syndrome are often accompanied by external genital malformations, and most of them seek the treatment because of abnormal sexual development at young age. A case of SRY negative 46, XX male syndrome was reported in this paper. The development of external genitalia and secondary sexual characteristics in this patient were normal male type. The chromosome karyotype was 46, XX, while SRY was negative and AZF region was deleted. The hypergonadotropin hypogonadism and azoospermia were diagnosed. As for the fertility requirement of this patient, artificial insemination by donor was recommended. Figures and Tables | References | Related Articles | Metrics

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Perivascular Epithelioid Cell Tumor of Broad Ligament: A Case Report and Literature Review YU Ping-yuan, WAN Tao, HU Dan, YAO Zhi-qiang, YANG Yong-xiu 2023, 42 (6):  457-461.  doi: 10.12280/gjszjk.20230156 Abstract ( 799 )   HTML ( 36 )   PDF (1954KB) ( 1061 )   Perivascular epithelioid cell tumor (PEComa), a rare mesenchymal tissue-derived tumor, occurs mainly in women of child-bearing age. PEComa mainly occurs in the kidney, liver, gastrointestinal tract, etc. Rare cases occur in broad ligament, which is easily confused with broad ligament myoma in clinical practice. Definitive diagnosis depends on histopathological morphology and immunohistochemical detection. A patient was admitted to our hospital due to lower abdominal pain for 1 week. Imaging examination showed right pelvic mass. Laparoscopic exploration revealed a solid mass of 9 cm×8 cm in the right broad ligament. Intraoperative pathology revealed spindle cell tumor with abundant tumor cells. Laparoscopic mass resection, hysterectomy and bilateral salpingectomy were performed. After the postoperative pathological examination, the patient was confirmed as broad ligament PEComa. There was no recurrence after 10 months of operation. Figures and Tables | References | Related Articles | Metrics

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Small Cell Neuroendocrine Carcinoma of the Cervix: A Case Report and Literature Review ZHANG Ting-ting, WANG Li, YU Ping-yuan, CHEN Xi, YANG Yong-xiu 2023, 42 (6):  462-466.  doi: 10.12280/gjszjk.20230139 Abstract ( 1013 )   HTML ( 29 )   PDF (2673KB) ( 1004 )   Small cell neuroendocrine carcinoma of the cervix (SCNCC) is prone to lymphatic metastasis in the early stage, unique pathological manifestations, easy to recur, and poor prognosis. Data from one case of SCNCC (stage ⅢC1r) is reported. The patient presented with intermittent vaginal bleeding with lower abdominal pain for more than 1 month. Combined with the results of pelvic magnetic resonanace imaging (MRI), total abdominal CT and hysteroscopy with endometrial biopsy, it was diagnosed as SCNCC at ⅢC1r stage. According to the 2022 National Comprehensive Cancer Network (NCCN) guidelines, the patient was given 3 cycles of neoadjuvant chemotherapy (carboplatin plus etoposide neoadjuvant), followed by laparoscopic extensive hysterectomy plus bilateral oophorectomy plus bilateral salpingectomy plus pelvic lymph node dissection plus abdominal para-aortic lymphadenectomy plus antitumor drug intraperitoneal perfusion therapy (nidaplatin flushing the abdominal cavity) plus bilateral ureteral stent implantation. After surgery, the patient was given 3 cycles of chemotherapy again. No recurrence was seen in 13 months of postoperative follow-up. Figures and Tables | References | Related Articles | Metrics

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Perforation of Colon Due to Ectopic Intrauterine Device: A Case Report HE Yu-hua, WANG Yong-sheng, WU Hua-bin 2023, 42 (6):  467-470.  doi: 10.12280/gjszjk.20230122 Abstract ( 761 )   HTML ( 24 )   PDF (1023KB) ( 1231 )   Ectopia of intrauterine device (IUD) is a complication of contraception. The case was reported that a 33-year-old woman who had been placed with an IUD for 6 years and had a sudden acute abdominal pain after sex life. Acute pelvic inflammatory disease was initially considered. After 4 days of anti-infection treatment after admission, abdominal pain was not relieved. The imaging examination indicated the enlargement of pelvic mass, so exploratory laparotomy was performed. The final diagnosis was ectopic IUD, uterine perforation, intestinal perforation, and endometrioid cyst of ovarian. Combined with the literature review on ectopic IUD and gynecological acute abdominal pain, the clinical data of this case was presented in order to improve the attention and understanding of clinicians on acute abdominal pain and to treat timely these patients. Figures and Tables | References | Related Articles | Metrics

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Advances and Prevention Strategies for Mitochondrial Genetic Diseases Caused by the Mitochondrial DNA 8344A>G Mutation SHEN Ling-chao, WANG Xin, JI Dong-mei 2023, 42 (6):  471-475.  doi: 10.12280/gjszjk.20230358 Abstract ( 912 )   HTML ( 30 )   PDF (784KB) ( 1005 )   Mutations in mitochondrial DNA (mtDNA) may lead to a range of mitochondrial diseases that are related to the damage of the mitochondrial respiratory chain. These mitochondrial diseases are characterized by early onset, difficult-to-cure and maternal inheritance. Mutations at site 8 344 in the mitochondrial tRNA lysine gene can result in the reduced translation of the protein encoded by mtDNA and an inadequate energy supply, leading to myoclonic epilepsy associated with ragged red fiber (MERRF) syndrome, with severe myoclonic symptoms, seizures and ataxia. Another characteristic lesion is multiple symmetric lipomatosis (MSL) in the posterior neck and upper back. Among all of pathogenic mtDNA mutations, m.8344A>G mutations were accounted for about 4%. Nuclear gene modification and environmental factors may be involved in the pathogenesis of m.8344A>G mutation. At present, the specific treatment methods for MERRF are lacking. Preimplantation genetic diagnosis and mitochondrial transplantation based on assisted reproductive technology are expected to be new methods for the treatment of this kind of mitochondrial genetic diseases, but the safety and effectiveness still need to be further verified. References | Related Articles | Metrics

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Safety Monitoring of Gender-Affirming Hormone Therapy in Transgender Men SU Ling, CAI Wei-yao, HE Jia-xin, GAO Lyu-fen 2023, 42 (6):  476-480.  doi: 10.12280/gjszjk.20230329 Abstract ( 1274 )   HTML ( 30 )   PDF (766KB) ( 1002 )   Gender-affirming hormone therapy (GAHT) is the inevitable and most important way for transgender people to undergo gender transition, while the safety of hormone therapy needs more attention. For transgender men, the use of androgen (male hormone) will undoubtedly affect their physiological indicators, and even lead to some adverse reactions. For transgender men, intramuscular injection of testosterone undecanoate (TU) 1 000 mg every 12 weeks is currently the mainstream GAHT program in the world, with the best safety, effectiveness, economy and convenience. The GAHT of transgender men should be monitored for hematocrit, liver function, blood lipids, blood pressure, lean body mass, body mass index, bone mineral density, etc., to avoid the possible adverse events caused by excess androgen. This paper reviewed the GAHT of transgender men and its safety monitoring, and provided a reference for safe and rational use of GAHT for Chinese transgender men. Figures and Tables | References | Related Articles | Metrics

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Assessment of Psychological State in Patients with Polycystic Ovary Syndrome, and Psychological Management XU Si-liang, MA Xiang, LIU Jia-yin, GAO Yan 2023, 42 (6):  481-486.  doi: 10.12280/gjszjk.20230325 Abstract ( 856 )   HTML ( 22 )   PDF (828KB) ( 1113 )   Polycystic ovary syndrome (PCOS) is one of the most common ovulatory disorders among women of reproductive age. Due to the endocrine and metabolic disorders, dissatisfaction for shape and appearance, infertility and other factors, women with PCOS have decreased life satisfaction and are more susceptible to the mood disorders such as anxiety and depression. Maternal excessive androgen and metabolic disorders are common features of PCOS, and cause an unfavorable intrauterine environment that disturb the development of hypothalamic neuroendocrine system and contribute to long-term behavioral, cognitive, and emotional disorders in their offspring. We summarized the psychological traits of PCOS, analyzed the methods for psychological assessment for PCOS. The cause and origin of psychological characteristics of PCOS women and their offspring were also discussed. We then summarized and analyzed related researches of psychological disorders in PCOS offspring. Finally, we outlined the therapeutic methods for psychological disorders of PCOS. Early diagnosis and intervention for PCOS-related psychiatric problems deserve keen attention in the future. It is recommended that PCOS patients should undergo screening for anxiety and depression. Timely diagnosis and follow-up management should be taken for patients with positive results. Through psychotherapy, lifestyle intervention, metabolic regulation, menstrual cycle adjustment and ovulation treatment, psychological problems and life quality can be improved. References | Related Articles | Metrics

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Research Progress of GDF-9 and BMP-15 on Follicular Development and Insulin Resistance in PCOS ZHANG Yu-jie, WANG Wen-cheng, ZHANG Ning 2023, 42 (6):  487-491.  doi: 10.12280/gjszjk.20230290 Abstract ( 903 )   HTML ( 22 )   PDF (774KB) ( 1024 )   Growth differentiation factor-9 (GDF-9) and bone morphogenetic protein-15 (BMP-15) are two members of the transforming growth factor-β (TGF-β) superfamily, which participate in the proliferation and differentiation of granulosa cells and oocytes in the ovary. The GDF-9 and BMP-15 secreted by oocyte affect the development and quality of oocytes, and regulate ovarian function, by the interaction between oocyte and cumulus cells. The abnormal expressions of GDF-9 and BMP-15 affect follicular development and zona pellucida structure, which may be an important link leading to infertility in women with polycystic ovary syndrome (PCOS). BMP-15 activates the Smad1/5/8 signaling pathway, which is closely related to insulin resistance (IR) in PCOS patients. However, the precise quantification of serum GDF-9 and BMP-15 levels is difficult, and the levels of serum GDF-9 and BMP-15 are difficult to be used as specific markers for the diagnosis and treatment evaluation of PCOS. This article reviews the roles of GDF-9 and BMP-15 in follicular development, the effects of abnormal expression of GDF-9 and BMP-15 on follicular development and IR in PCOS patients, and discusses the potential application value of GDF-9 and BMP-15 in the diagnosis and treatment of PCOS. References | Related Articles | Metrics

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Clinical Studies of MSCs and MSCs-Derived Exosomes in Premature Ovarian Insufficiency, and Research Progress XIANG Chun-rong, DENG Zhi-min, DAI Fang-fang, CHENG Yan-xiang 2023, 42 (6):  492-497.  doi: 10.12280/gjszjk.20230216 Abstract ( 766 )   HTML ( 22 )   PDF (825KB) ( 1129 )   Premature ovarian insufficiency (POI) is one of the common causes of infertility in women of reproductive age, which has a serious impact on women′s physiological and psychological health. The incidence of POI is increasing year by year, and the etiology and mechanism of POI are diverse and complex. The existing therapeutic methods in clinic are limited. Hormone replacement therapy, the most commonly used method, focuses on improving patients′ symptoms and fails to fundamentally restore the ovarian function. With the development of regenerative medicine, the transplantation of mesenchymal stem cells (MSCs) and MSCs-derived exosomes (MSCs-EXOs) has been found to be able to repair the ovarian function and improve the fertility of POI patients by promoting granulosa cells (GCs) proliferation, inhibiting GCs apoptosis, anti-inflammation, anti-oxidation, anti-fibrosis, and by promoting angiogenesis and follicle development, as well as regulating immunity and other mechanisms, which brings new prospects for POI treatment. However, its safety and effectiveness still need to be further studied and verified. References | Related Articles | Metrics

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Application of Oocyte Cryopreservation in Patients with Iatrogenic Diminished Ovarian Reserve YE Ming-zhu, ZHENG Jie, LI Jie-peng, XU Li-xin 2023, 42 (6):  498-502.  doi: 10.12280/gjszjk.20230306 Abstract ( 834 )   HTML ( 19 )   PDF (766KB) ( 1140 )   Since the first successful use of oocyte cryopreservation and resuscitation, to obtain twin pregnancies, in 1986, oocyte cryopreservation has gradually become an intervention measure for iatrogenic ovarian dysfunction. In recent years, the number of patients with diminished ovarian reserve (DOR) has shown an increasing trend, and the preservation of their fertility is receiving increasing attention. The iatrogenic influencing factors of DOR mainly include reproductive system surgery, tumor radiotherapy and chemotherapy, etc. Oocyte cryopreservation is a first-line treatment option for fertility preservation, and its safety, applicability, utilization rate, and egg donation treatment in the clinical application of iatrogenic DOR patients have been confirmed by clinical data and relevant literature. However, the issues related to the timing of oocyte cryopreservation, limitations of clinical application and ethical policies cannot be ignored. Oocyte cryopreservation is of great significance for improving the pregnancy outcomes of unmarried patients with iatrogenic DOR and the reproductive autonomy of married patients. After clarifying the iatrogenic influencing factors of DOR, it is recommended to seek consultation from multiple disciplines such as oncology, gynecology and reproductive health as soon as possible to develop the personalized oocyte cryopreservation plans. References | Related Articles | Metrics

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Clinical Research Status of Mosaic Embryo Transfer YAN Hui-hui, ZHANG Yun-shan 2023, 42 (6):  503-506.  doi: 10.12280/gjszjk.20230248 Abstract ( 1037 )   HTML ( 17 )   PDF (729KB) ( 1145 )   Mosaic embryo is the third type of embryo between euploid embryo and aneuploid embryo, which contains two or more genetically different cell lines. With the development of genetic technology, the next generation sequencing technology has a higher detection accuracy for mosaic embryos. The outcome of mosaic embryo transplantation is uncertain, and the rates of implantation failure and abortion are significantly higher than those of euploid embryo transplantation. There is still a great debate on whether mosaic embryo can be transferred. However, mosaic embryo transfer provides the possibility of fertility for patients with aneuploid embryos, so the studies with large sample and long-term follow-up will be the research hotspot. Although the Reproductive Medicine Branch of the Chinese Medical Association issued preimplantation genetic diagnosis / preimplantation genetic screening (PGD/PGS) guidelines in 2017-2018, there is still a lack of guidance on mosaic embryo transfer. This article reviews the current research status of mosaic embryo transfer. References | Related Articles | Metrics

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Research Progress on Analgesic Methods for Transvaginal Ultrasound-Guided Oocyte Retrieval NIU Guo-yan, XIONG Zheng-fang 2023, 42 (6):  507-512.  doi: 10.12280/gjszjk.20230195 Abstract ( 867 )   HTML ( 30 )   PDF (798KB) ( 961 )   Transvaginal ultrasound-guided oocyte retrieval (TUGOR) is an important step of in vitro fertilization-embryo transfer (IVF-ET). The analgesia methods of TUGOR include general anesthesia, conscious sedation and analgesia, patient self-controlled analgesia, regional anesthesia, paracervical block, and acupuncture and moxibustion. Among them, intravenous general anesthesia is the most widely used, with the fast effect, strong efficiency and helps to increase the number of eggs obtained. Propofol is the most commonly used as an intravenous anesthetic drug at present. However, the possible toxic effect of propofol on oocytes should not be ignored, and some studies suggest that the oocyte extraction process should be as short as possible so as to decrease the accumulation of anesthetic drugs in follicular fluid. As a characteristic treatment of Chinese traditional medicine, acupuncture and moxibustion needs to be explored further the nerve pathway and the molecular mechanism of pain relief in TUGOR to determine the best acupuncture and moxibustion analgesia method. Some female patients with fewer follicles have voluntarily chosen the non-anesthetic oocyte retrieval, but its safety and overall acceptability need to be further studied. References | Related Articles | Metrics

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Research Progress of Focal Segmental Glomerulosclerosis and Neurodevelopmental Syndrome Caused by the Mutation of TRIM8 Gene DENG Quan-feng, XIN Min, XIA Lai-shuo, WANG Yi-fan, LIU Jin-xiu 2023, 42 (6):  513-518.  doi: 10.12280/gjszjk.20230263 Abstract ( 781 )   HTML ( 15 )   PDF (3469KB) ( 971 )   Focal segmental glomerulosclerosis and neurodevelopmental syndrome (FSGSNEDS) is a rare autosomal dominant disease caused by the mutation of TRIM8 gene encoding tripartite motif protein 8 on chromosome 10q24.32, which is characterized by developmental delay, renal diseases and epilepsy. FSGSNEDS often progresses to end-stage renal disease after the illness sets in. The phenotype of patients varies greatly, while there are few related studies. A total of 24 cases have been described until September 15, 2023. The definite diagnosis mainly depends on gene testing. At present, there is no specific therapy for FSGSNEDS, and the treatment methods are mainly targeted in the supportive care. Patients usually presented pharmaco-resistant epilepsy, and renal abnormalities were resistant to steroid therapy, whereas optimistic prognosis was expected undergoing early renal transplantation. This article reviews the advances in FSGSNEDS, in order to further improve the understanding of this disease. Figures and Tables | References | Related Articles | Metrics

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Menopausal Hormone Therapy and the Risk of Gynecological Malignancy ZHANG Zhe, ZHANG Wei 2023, 42 (6):  519-523.  doi: 10.12280/gjszjk.20230261 Abstract ( 734 )   HTML ( 21 )   PDF (774KB) ( 1006 )   Menopausal hormone therapy (MHT) is an effective treatment for alleviating menopausal syndrome, and 18.16% of perimenopausal women are receiving MHT treatment at present. Most gynecological malignancies are hormone-dependent, so the safety and efficacy of MHT in women with menopausal syndrome and those women with gynecological malignancies combined with menopausal syndrome are still controversial. For the menopausal syndrome patients without gynecological malignancies, reasonable selection of estrogen therapy may reduce the risk of ovarian cancer, and selection of MHT containing progesterone may reduce the risk of endometrial cancer and cervical cancer. As for epithelial ovarian cancer, early endometrial cancer, cervical squamous cell carcinoma, vaginal squamous cell carcinoma and vulvar squamous cell carcinoma, reasonable selection of MHT regimen may not increase the risk of recurrence, while may prolong the survival. By reviewing the MHT guidelines and the related clinical studies issued globally in recent years, we discuss how to rationally select MHT regimens to reduce the risk of gynecological malignancies in women with menopausal syndrome, how to reduce the recurrence risk of patients with gynecological malignancies combined with menopausal syndrome, and how to improve the survival rate of patients with gynecological malignant tumors. References | Related Articles | Metrics

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Research Progress of Atypical Polypoid Adenomyoma of the Uterus XIAO Wan-ting, ZOU Qian 2023, 42 (6):  524-528.  doi: 10.12280/gjszjk.20230276 Abstract ( 808 )   HTML ( 33 )   PDF (791KB) ( 1028 )   Atypical polypoid adenomyoma (APA) is a rare uterine epithelial and stromal tumor. The pathogenesis of APA is not clear, and it may be related to the increased level of estrogen. The main clinical manifestations were irregular vaginal bleeding and infertility. The characteristics of imaging examination of APA are atypical, the diagnosis depends on histopathology. The tissue structure under the microscopy is often complex and diverse. Immunohistochemistry is an important method to assist the diagnosis. APA is a benign tumor, but with malignant potential, there is a risk of progression into endometrial cancer. It is easy to miss diagnosis or misdiagnosis clinically. At present, the clinical treatment strategy of APA is to select the individualized treatment according to the fertility requirements, age and postoperative pathological diagnosis. The pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of APA were reviewed. References | Related Articles | Metrics