Atsushi Mori

Expression of steroid receptors, Ki-67, and p53 in uterine leiomyosarcomas

The expression of estrogen receptor (ER), progesterone receptor (PR), tumor suppressor oncogene p53, and Ki-67 was compared in uterine smooth muscle tumors, including leiomyosarcoma (LMS), tumor of uncertain malignant potential (UMP), cellular leiomyoma (CL), bizarre leiomyoma (BL), and usual leiomyoma (UL). ER and PR were expressed in all ULs. PR was expressed in UL irrespective of the phase of the menstrual cycle; this staining was also observed in CL, UMP, and BL, although BL showed variable staining for ER. Compared to these tumors, the expression of both ER and PR was markedly reduced in LMS. The results of ER and PR transcripts by reverse transcription-polymerase chain reaction were compatible with those of immunohistochemistry. The number of Ki-67 positive cells in LMS was significantly higher than in UMP, BL, CL, and UL. p53 immunoreactivity was seen in 10 of 14 LMSs, and missense mutation in the p53 gene was found in 4 of 10 LMSs. These results suggest that abnormal expression of ovarian steroid receptors, p53, and Ki-67 is frequently associated with LMS of the uterus.

Mast cells in smooth muscle tumors of the uterus

SummaryMast cells (MCs) have been reported in the myometrium and uterine smooth muscle tumors. We examined the number of MCs in various uterine smooth muscle tumors (including leiomyosarcomas) and assessed whether this feature might be of value in their pathologic diagnosis. The number of MCs in 95 uterine smooth muscle tumors, including 55 ordinary leiomyomas, 17 cellular leiomyomas, 8 bizarre leiomyomas, and 15 leiomyosarcomas, was counted using toluidine blue and immunohistochemical staining. The number of MCs that stained for tryptase was lowest in leiomyosarcoma and next lowest in ordinary leiomyoma; the number in each of these two groups was significantly lower than in the myometrium (p < 0.001). In cellular and bizarre leiomyomas, the number of MCs was significantly higher than in ordinary leiomyoma (p < 0.001 and p < 0.001, respectively) and leiomyosarcoma (p < 0.001 and p < 0.005, respectively). Statistical analysis revealed that counting the number of MCs and using a cut-off value of 16 MCs per high-power-field is useful for the differential diagnosis of leiomyosarcomas from cellular leiomyoma and bizarre leiomyoma, yielding 100% sensitivity and 96% specificity. The number of MCs was significantly lower in leiomyosarcomas at TNM stages III and IV than in those at stages I and II (p < 0.05), but there was no significant correlation between the number of MCs and patient survival. These results suggest that the number of MCs might be useful as part of a multivariate approach to the differential diagnosis of leiomyosarcoma from bizarre or cellular leiomyoma.

The case of invasive lobular carcinoma of the breast which appeared in ascites, which was indistinguishable from reactive mesothelial cell.

A 74-year-old wolnan was admitted becase of a large amount of ascites. The patient also pointed out the presence of a breast tumor. Aspiration cytology of the breast tumor and a cytology exalnination of the ascites were pcrformed.Cytologicaly, the tumor cells in the ascites were small. sized and uniform-In celis with a low N/C ratio, the chromatin pat. tern was fine and uniform. ICL was observed in the cytoplasm. The tulnor cells were individually dispersed.The cytological findings strongly suggested that these cells were reactive mesothelial cells.Histologlcally, the breast tumor was diagnosed as an invasive lobular carcinoma that was positive for CA19-9. The peritoneum biopsy was diagnosed as a metastasis of the invasive lobular carcinoma of the breast. Thus, the cells which had been regarded as reactivc mesothelial cells were in fact adenocarcinoma cells.

Is self-irrigation smear effective for the detection of intraepithelial lesions of the uterine cervix?

手術を予定した25例の子宮頸部上皮内病変を対象として, 自己採取法および通常の採取法の子宮頸部スメアを作製し, 自己採取スメアの細胞像を通常のスメアおよび組織診断と対比した. その結果, 自己採取スメアの細胞像は以下のような特徴を呈していた.1) 出現細胞の大部分が正常の表層・中層扁平上皮細胞であり傍基底細胞は少数であった.2) 頸管内上皮成分である頸管腺細胞や扁平上皮化生細胞はきわめて少数で, しばしば変性像を伴っていた.3) 異型細胞は全くみられないか, または通常の採取法と比較して非常に少数であった.4) 異型細胞のみられる標本では, 出現異型細胞は主として散在性に出現し, しかも変性像を呈しているものが多かった. このような異型細胞の多くは, 直接擦過されたものではなく, 自然剥離後に変性を伴ったものと考えられた.以上の結果から, 子宮頸部上皮内病変の検出法として, 自己採取法のスメアは誤陰性になる可能性が高いことが推察され, 自己採取法は頸部上皮内病変のスクリーニング法としては問題があると思われる.