Akimasa Fukui

Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary

Aim:  The aim of this study was to investigate whether fertility preservation influences the clinical outcome in patients with malignant germ cell tumors of the ovary (MGCTO).

Validity of intraoperative diagnosis at laparoscopic surgery for ovarian tumors.

STUDY OBJECTIVE To evaluate the accuracy and usefulness of intraoperative diagnosis of ovarian tumor during laparoscopic surgery. DESIGN Retrospective cohort study (Canadian Task Force classification II-3). SETTING Tertiary care university hospital. PATIENTS We reviewed the cases of 262 patients who underwent laparoscopic surgery at our institution between January 2005 and December 2011 in whom a benign ovarian tumor was diagnosed intraoperatively. INTERVENTIONS Intraoperative pathologic assessment of frozen sections. MEASUREMENTS AND MAIN RESULTS Intraoperative diagnosis of ovarian tumors demonstrated sensitivity of 80%, specificity of 99.6%, positive predictive value of 80%, and diagnostic accuracy of 99.2%. Mucinous tumors diagnosed intraoperatively showed differing intraoperative and final pathologic diagnoses significantly more frequently than did other types of tumors. CONCLUSION Intraoperative pathologic assessment of benign ovarian tumors during laparoscopic surgery is reliable. However, clinicians should recognize that it is possible to make an incorrect diagnosis in some situations and should exercise caution accordingly.

Identification of B cell epitopes reactive to human papillomavirus type-16L1- derived peptides

BackgroundPersistent infection of human papillomavirus (HPV) types 16 and 18 causes cervical cancer. To better understand immune responses to the prophylactic vaccine, HPV 16/18 L1 virus-like particles (HPV-VLPs), we investigated B cell epitopes of HPV16 L1-derived peptides.MethodsSera from mice immunized with HPV-16/18 L1 VLPs were analyzed for their IgG titers against 10 different HPV16 L1-derived peptides (20-mer) that contain human leukocyte antigen (HLA)-class I A-2, A-24 and class II DR.ResultsOne 20-mer peptide at positions 300 to 319 was identified as a common B cell epitope in both Balb/c (H-2d) and C57BL/6 (H-2b) mice. Mapping analysis showed that the 10-amino-acid sequence at positions 304to 313 was an immunogenic portion. It is of note that the binding capability of this 10-mer peptide to the HLA-A2 and HLA-A24 molecules was confirmed by the HLA class I stabilization assay. In addition, one unique 20-mer was determined as a B cell epitope in each strain.ConclusionsThese results might provide new information for better understanding of immune responses to HPV 16 L1.

Enhancement of humoral and cell mediated immune response to HPV16 L1-derived peptides subsequent to vaccination with prophylactic bivalent HPV L1 virus-like particle vaccine in healthy females

Currently prophylactic HPV16/18 L1 virus-like particle (VLP) vaccines are employed with great success for the prevention of HPV infection. However, limited information is available regarding the immune responses against human papillomavirus (HPV) 16/18 L1 subsequent to HPV16/18 L1 VLP vaccination, primarily due to the lack of widely used assays for immune monitoring. The aim of the present study was to identify HPV16 L1-derived B and T cell epitopes for monitoring the immune responses after HPV16/18 L1 VLP vaccination in healthy females. The levels of immunoglobulin G (IgG), IgE, IgA and IgM reactive to HPV16 L1-derived peptides were measured by multiplex bead suspension assay. Following detailed B cell epitope mapping, T cell responses specific to HPV16 L1-derived peptides were evaluated by an IFN-γ ELISPOT assay. The levels of IgG, IgM and IgA reactive to 20-mer peptides (PTPSGSMVTSDAQIFNKPYW) at positions 293-312 and 300-319 of HPV16 L1 were significantly increased in the plasma after 2, 7, and 12 months after first vaccination. Detailed epitope mapping identified the amino acid sequence (TSDAQIFNKP) at position 301-310 of HPV16 L1 as an immunogenic B cell epitope. In addition, T cell responses to an HLA-A2- and HLA-A24-restricted epitope (QIFNKPYWL) at position 305-313 of HPV16 L1 were increased following immunization, suggesting that the HPV16/18 L1-VLP vaccination as able to induce specific immune responses in T and B cells simultaneously. The identified B and T cell epitopes may be useful as a biomarker for monitoring the immune responses subsequent to HPV16/18 L1 VLP vaccination. Thus, the present study may provide novel information to improve the understanding of the immune responses to HPV16 L1.

Long Survival in a Rare Case of Hepatocellular Carcinoma that Metastasizedto the Ovary: A Case Report

Hepatocellular carcinoma usually metastasizes to the lung, bone, adrenal glands, diaphragm and lymph nodes. In this study, we present a case of hepatocellular carcinoma that metastasized to the ovary. To the best of our knowledge, there are very few reports of such cases published in English and none in which the patient survived more over 7 years. A 72-year-old postmenopausal Japanese woman had been diagnosed with type C chronic hepatitis. Screening ultrasonography revealed a low echoic small nodular lesion located on S6 of the liver. Tiny hepatocellular carcinoma was diagnosed by needle biopsy and the patient was treated with percutaneous ethanol injection therapy. Two years later, she underwent a work-up because of an elevation in serum alpha-fetoprotein level, and whole body Computed Tomography scan revealed a large solid pelvic mass. At laparotomy, a large right ovarian tumor was revealed. No other lesion was found. A bilateral salpingo-oophorectomy was performed. On microscopic examination, the tumor showed predominantly solid and trabecular patterns. Pseudo-glandular patterns were also observed. The final pathological diagnosis was hepatocellular carcinoma metastatic to the right ovary. Postoperatively, the serum alphafetoprotein concentration decreased to within the normal range. Although, we resected an implantation in her right thoracic wall seven months post laparotomy, she did not show any evidence of recurrence during her 7 year follow up period. Metastatic hepatocellular carcinoma to the ovary is very rare. If a patient presents with findings similar to those describing our patient, the examining physician should be aware of the risk of potential ovarian metastases from hepatocellular carcinoma. Surgical resection may be the only effective treatment strategy for static ovarian cancer.

A case of minimal uterine serous carcinoma with distant lymph node metastasis without peritoneal dissemination.

A 61-year old woman underwent total abdominal hysterectomy and pelvic lymph node dissection under the diagnosis of endometrial cancer. Although pelvic lymph nodes were positive for adenocarcinoma with psamomma bodies, no other lesion that was a primary lesion was verified. A postoperative study revealed the existence of para-aortic lymph node and supraclavicular lymph node metastases. Therefore, the endometrial biopsy specimen was reviewed. With the findings of p53 positivity by immunohistochemistry in the papillary part, the final histopathological diagnosis was changed to endometrial serous adenocarcinoma. Postoperative chemotherapy followed by radiotherapy for supraclavicular lymph node metastasis achieved complete response. This type of tumor must be considered in a differential diagnosis when metastatic papillary serous carcinoma is detected, but the primary site remains unknown.