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To evaluate the results of etoposide/ methotrexate/actinomycin D/etoposide/cisplatin (EMA/ EP) chemotherapy in patients with chemorefractory gestational trophoblastic tumor (GTT).Fifteen patients with chemorefractory GTT were treated with EMA/EP.Twelve of the 15 cases were choriocarcinoma, and the last 3 were metastatic placental site trophoblastic tumor (PSTT): International Federation of Gynecology and Obstetrics (FIGO) stage I, 2 cases; stage III, 10 cases; stage IV, 3 cases. Seven cases have FIGO score 7-10; the scores of the remaining 8 cases were10. Fifteen patients received a total of 93 cycles of the study regimen. The median number of courses for each patient was 6.2. Eleven cases (73.3%) achieved complete remission, while 3 (20%) had partial remission; 1 case (6.7%) showed no response. The main complications of EMA/EP chemotherapy were myelosuppression and gastrointestinal symptoms.The EMA/EP regimen is effective for chemorefractory GTT, and the chemotherapeutic results can be improved when combined with surgery and arterial infusion chemotherapy in selected patients. The EMA/EP regimen should be considered for primary management of metastatic PSTT.

To investigate the histological characteristics in uterine ligaments of stress urinary incontinence (SUI) and pelvic organ prolapse (POP); to detect the alteration of collagen ultrastructure in uterine ligaments that contribute to SUI and POP; to study the relationship between collagen alteration and SUI and POP.The cardinal ligament (Car lig.) and uterosacral ligaments (U-S lig.) samples were obtained from 73 subjects suffering from SUI, or normal controls who underwent hysterectomy. Collagen ultrastructure was examined with transmission electron microscopy (TEM).1) The smooth muscle fascicles in the patients with SUI and POP were thinner. Arrangement of smooth muscle fascicles was in disorder. 2) The collagen constituting the ligaments was active in metabolism. The mean collagen fibril diameters in the SUI and POP groups were about 25% larger than that in the control groups (por = 0.01). 3) Histological characteristics of the Car lig. and the U-S lig. were similar.1) The Car lig. and U-S lig. are homologous. Abnormalities in arrangement of smooth muscles and the collagen ultrastructure were obviously seen in SUI and POP 2) The collagen fibril diameter in the SUI and POP subgroups was significantly larger than that in the control groups. Those ligaments are probably less elastic and more likely to break. Predominance of collagen degradation during tissue repair may contribute to POP and SUI.

A 21-year-old virgin presented with abdominal discomfort and pelvic mass. Laparotomy revealed non-ruptured right ovarian tumour about 5 cm in diameter with no ascites. No extra-ovarian disease was noted intraoperatively. She underwent right salpingo-oophorectomy at a local hospital. Pathological diagnosis was right ovarian Sertoli–Leydig cell tumour with heterogeneous components. Subsequently, she received three courses of combined chemotherapy composed of bleomycin, etoposide and cisplatin, but the disease had been progressing. At the time of admission to our hospital just 4 months later from the initial operation, her serum β subunit of human chorionic gonadotropin (β-HCG) was 258.6 mIU/ml, and other tumour markers were normal. Her serum parathyroid hormone (PTH) was 88.6 pg/ml (normal 5∼70 pg/ml), but serum calcium level was normal. The pathology slides from her first operation were reviewed. The tumour was composed of two different components, most of which consisted of poorly differentiated medium to large tumour cells with enlarged round or oval nuclei arranged in solid cords and nests. On higher magnification, the tumours had abundant eosinophilic and granular cytoplasm, and the nuclei had coarse chromatin and prominent nucleoli (figure 1). The smaller component consisted of a strip of mucinous borderline …