Gynecology and Obstetrics Clinical Medicine最新文献

Aims

Neuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer. This study aims to investigate the clinicopathological features and prognosis of NECC.

Methods

A retrospective analysis was conducted on twenty-one patients diagnosed with NECC between May 2008 and September 2021 ​at Peking University People's Hospital. The study involved histopathological examination, immunohistochemistry, ThinPrep cytology test (TCT), and high-risk HPV hybrid capture 2 (HC2) assay. Follow-up was conducted through telephone interviews and medical records for a range of 3–160 months, with an average follow-up period of 49.8 months.

Results

The average age of the patients was 48.6 years (range: 33–69 years). Seventeen patients were diagnosed with neuroendocrine carcinoma through biopsy. Nine cases underwent TCT and HC2 tests before biopsy, and TCT results of four cases showed high-grade squamous intraepithelial lesion (HSIL). High-risk HPV(HR-HPV) positive was detected in seven cases. The cancer cells exhibited consistent morphological features, including sparse cytoplasm, intensely stained nuclei, and extensive neoplastic necrosis. Thirteen cases were classified as pure NECC (61.9%), while eight cases were mixed types (38.1%). Three cases were associated with squamous cell carcinoma (SCC), and five cases were associated with adenocarcinoma. Prognosis varied significantly among these subtypes (p ​< ​0.05). The overall survival rate in the follow-up period was 66.7% (12/18).

Conclusions

NECC is an extremely rare and highly aggressive tumor with a poor prognosis, particularly in cases of mixed histology. It is strongly associated with HPV infection. TCT and HPV testing significantly enhance the detection rate before the biopsy. The diagnosis of NECC relies on histological and immunohistochemical examinations. This study provides valuable clinical observations on NECC and emphasizes the importance of early detection and accurate diagnosis for improved patient outcomes.

Objective

To assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran.

Methods

We retrospectively assessed women who gave birth between January 1st, 2020, and January 1st, 2022. These pregnant women were separated into two groups: (1) women aged 19 and younger; (2) women aged 20–34 years. Main outcome measures include preterm birth, maternal comorbidities, preeclampsia, eclampsia, low birth weight (LBW), intrauterine growth restriction (IUGR), placenta abnormalities, placenta abruption, chorioamnionitis, meconium fluid, fetal distress, methods of delivery, rate of cesarean section (CS), perineal lacerations, postpartum hemorrhage, childbirth trauma, shoulder dystocia, congenital malformation, and unfavorable maternal and neonatal outcome. Logistic regression models were used to determine the influence of teenage pregnancy on adverse pregnancy and childbirth outcomes.

Results

Of 7033 deliveries, 92.4% of women were adults, and 7.6% were adolescents. Adolescents residing in rural districts were more common than adults (42.3% vs. 33.7%). However, access to prenatal facility care was the same as the majority of women had 6-10 prenatal care visits during their pregnancy. There was no difference in the risk of preeclampsia, placenta abruption, placenta previa, fetal distress, preterm labor, shoulder dystocia, perineal lacerations, childbirth trauma, congenital malformation, postpartum hemorrhage, intensive care unit admission, maternal death, and unfavorable neonatal outcome including stillbirth, neonatal intensive care unit admission, neonatal death in adolescent pregnancies compared to adults. Adolescents had a significantly higher risk of LBW (OR: 1.47, 95%CI: 1.01–2.73), IUGR (OR: 1.96, 95%CI: 1.31–2.45), and meconium fluid (OR: 1.74, 95%CI: 1.41–2.32), however, there was no statistically significant difference after adjusting the confounding factors. Compared with adults, adolescents had a significantly lower risk of CS (aRR: 0.67, 95%CI: 0.51–0.77) and a lower risk of gestational diabetes (aRR: 0.78, 95%CI: 0.51–0.95).

Conclusions

Although we found no serious consequences of adolescent pregnancy, more research is needed to reach a more accurate conclusion about teenage pregnancy.

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