BACKGROUND: A study was carried out to determine the functional attributes of CD4 þ CD25 þ regulatory T cells in cancer progression by suppressing antitumor immunity. METHODS: Triple-color flow cytometry was used to study the phenotype expression of CD4 þ CD25 þ regulatory T cells and CD8 þ T cells in the peripheral blood lymphocytes (PBLs) and tumor-infiltrating lymphocytes (TILs) of 57 cases of stage I to IV endometrial carcinoma. The expression of T cell subsets was correlated with clinical prognostic parameters. RESULTS: The prevalence of CD4 þ CD25 þ T cells was significantly higher in the TILs than PBLs. The expression of CD4 þ CD25 þ regulatory T cells in cancer milieu correlated with the tumor grade, stage, and myometrium invasion. The expression of FOXP3 and GITR in CD4 þ CD25 þ regulatory T cells was lower in PBLs than TILs. Most tumor-infiltrating CD8 þ T cells were CD28 À CD45RA À CD45RO þ CCR7 À , suggesting good terminal differentiation. Most of them had an activated role with CD69 þ CD103 þ CD152 þ . Functionally, both granzyme B and perforin were scarcely expressed in peripheral regulatory T cells but were highly expressed in peripheral regulatory T cells in the tumor microenvironment. In contrast, CD8 þ cytotoxic T cells derived from PBLs expressed both granzyme B and perforin, and at significantly higher levels than in TILs. Further functional assays demonstrated that Th1 cytokines and cytotoxic molecules can be synchronously up-regulated in CD8 þ cytotoxic T cells. CONCLUSIONS: Regulatory T cells in the tumor microenvironment may abrogate CD8 þ T cell cytotoxicity in a granzyme B-and perforin-dependent conduit. Decreases in both Th1 cytokines and cytotoxic enzymes are relevant for regulatory T cell-mediated restraint of tumor clearance in vivo. Of clinical significance, the expression of regulatory T cells in TILs may mediate T cell immune repression within cancer milieu and thus greatly correlate with cancer progression. Cancer 2010;116:5777-88.

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We describe a technique for laparoscopically assisted extracorporeal cystectomy or adnexectomy of large adnexal cysts without spillage of the cyst contents. At open laparoscopy, a suction tube decompressed the adnexal cyst from the 2-cm umbilical incision and the puncture hole was closed by the purse string tie, which was followed by extra-corporeal excision of the cyst. With this method, we prevent cyst spillage in three ways. Firstly, the cyst is aspirated extracorporeally. Secondly, when the cyst is totally collapsed, the puncture point is closed with a 1-o Vicryl purse suture and pulled to the umbilicus. Thirdly, as soon as a part of the mass is delivered from the abdomen, it is lined with moist gauze. This method provides excellent visualization and control of the penetration site during aspiration, and minimizes the chances of the cyst contents leaking into the peritoneal cavity. This method was successfully used with 12 patients, including four cystadenomas, one serous cystadenoma, three dermoid cysts (with one pregnant woman who successfully spontaneously delivered a normal baby at term), two low malignant potential ovarian tumors and one grade I endometrioid adenocarcinoma. The cancer patient has shown no recurrence after a follow-up of three years.

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TM is efficacious in treating voiding difficulty after the TVT procedure.