Hajime Sugimori

Histological study of microinvasive carcinoma of the uterine cervix

Abstract Fifty-three cases of microinvasive carcinoma, 107 cases of carcinoma in situ , and 52 cases of dysplasia were studied histologically. When the original squamocolumnar junction (SCJ) was defined as it was at the last cervical gland, most of the abnormal epithelia located in the zone between this SCJ and 10 mm proximal to SCJ. Concerning the spreading extent of abnormal epithelium there was an apparent tendency that the more severe the lesion, the wider was the extent. The circumferential extent of the lesions was closely correlated to the longitudinal extent. The type of invasion was classified into four groups: drop, fingerlike, bulky, and confluent type. Since many invasions which began from the surface epithelium remained within 1 mm in depth, and invasions from a cervical gland were initially noted in deeper areas, the depth of invasion measured from the surface epithelium may not directly reflect the progression of the lesions.

Cervical cancers in uterus didelphys

Two cases of cervical cancer in uterus didelphys are presented. One was extensive adenocarcinoma and one was squamous cell carcinoma in situ. In both cases the cancers appeared to have originated separately in each cervix.

Evaluation of the colposcopically directed biopsy and the cone biopsy

Abstract Cytology and colposcopically directed biopsy were performed in 110 cases of borderline lesions of the cervix, of which 90 cases had cone biopsy. The correct diagnosis rate of colposcopically directed biopsy and the role of cone biopsy were evaluated. The correct diagnosis rates of directed biopsy of dysplasia, carcinoma in situ (CIS), and microinvasive carcinoma were 73, 77, and 45%, respectively. Cone biopsy was considered necessary in making an exact diagnosis of borderline lesions, since there was a fair discrepancy between the results of cone biopsy and colposcopically directed biopsy. Seventy-five of 90 cases had hysterectomy following cone biopsy. Though there were residual lesions found in the cervices of the removed uteri, they were not more severe than those found by cone biopsy. The frequency of the residual lesion in the removed uteri was 35% in total, 26% in CIS, and 52% in microinvasive carcinoma. There was a trend that, the more progressive the lesion, the more residual lesions were found. It is therefore very dangerous to perform conization as a definitive therapeutic method.

Angiography of trophoblastic tumors: Analysis of pelvic angiography correlated with microangiography and histopathological examination of uterine specimens

Abstract Pelvic angiography of 61 patients with trophoblastic disease was studied. Twenty-four patients were studied in detail correlating direct 4-fold magnification angiography, microangiography, and histopathological examination. Increased myometrial vessels, central vascular pooling, and central avascularity on pelvic angiograms were confirmed by magnification angiography or microangiography, but the diagnosis of tumor vessels by pelvic angiography was often disproved by microangiography. It is usually possible to detect and diagnose established malignant tumors with pelvic angiography, but there were exceptions which impose limitations to pelvic angiography. Differential diagnosis of chorionepithelioma and destructive mole is not always possible. Central vascular pooling is more suggestive of destructive mole than chorionepithelioma, because diffuse infiltration of contrast media into intervillous spaces which were found on destructive mole were represented as central vascular pooling on pelvic angiograms.

Cytological and histopathological study of HPV infection of the uterine cervix.

子宮頸部のHPV感染症について細胞学的ならびに組織学的診断を比較検討した.1. 佐賀県総合保健協会における1985～86年の2年間に取り扱った子宮がん集団検診受診者81,995名のうち, koilocytotic atypiaを示したものは48名 (0.06%) であった.2. 佐賀医科大学産科婦人科学教室において治療した頸部境界病変41例中, 組織標本に, koilocytosisを認めたものは21例 (51%) であり, 軽度異形成から上皮内癌へと病変が進行するにつれて, koilocytosisの出現頻度は少なくなっていた.3. HPV感染症の細胞学的表現としてdyskeratosisは組織標本よりも細胞診標本に, koilocytosisは細胞診標本よりも組織標本の方により多く出現する傾向が認められた. したがって, 細胞診におけるkoilocytosisを指標としてHPV感染症を検出しようとすると, その検出率は必ずしも高くなり得ないことが推定された.

Detection of the cervical cancer in mass-screening.

福岡県対ガン協会では, 昭和51～55年に204,186名の頸癌検診を行った.これより扁平上皮癌166例, 上皮内癌102例, 腺癌4例, 体部腺癌1例を発見したが, 上皮内癌を含む頸癌発見率は初診者群で0.24%, 再診群で0.09%であった.年齢別にみると, 初診群では高齢者における発見率が高いが, 再診群では必ずしもこの傾向はなく, 高齢者の集検受診は自覚症状が全くない人ばかりではないことを推測させた.再診癌患者130例について過去の受診歴を調べると, 1回受診57例, 2回受診31例, 3回受診18例, 4回以上受診24例であった.このうち, 26例 (20%) は過去に細胞診異常を示しており, 二次精検に問題があったと考えられる.癌発見直前回の陰性スメアを再検すると, 扁平上皮癌で30例中7例, 上皮内癌で21例中7例に異常細胞が発見された.これより, われわれの検査室における誤陰性率は9.8～12.5%と推定された.前回受診との間隔が4年以上あくと上皮内癌が浸潤癌に比して極めて少なくなり, 早期発見の実はあげられないと考えられた.またclassIII例の追跡が重要であることが示された.

Cytologic Studies of Endometrial Adenocarcinoma

子宮体癌患者38例について, 治療前細胞診と病理組織診との関連性を検討した. 内膜スメアでは癌の分化度と異型細胞出現率との間に関連性はなく, 高分化型腺癌, 低分化型腺癌いずれにも高い出現率が認められたが, 頸管スメアでは低分化型腺癌ほど異型細胞出現率が高いという結果が得られた.癌の筋層浸潤度による異型細胞出現率の違いでは, 頸管スメア, 内膜スメアいずれにおいても筋層浸潤度と異型細胞出現率との問に関連性は認められなかった. しかし頸管浸潤のあるものでは, 高い異型細胞出現率が頸管スメアで得られた.体癌細胞診の特徴について, 細胞診の背景と正常内膜細胞の出現状態という点から検討を行った. 腫瘍性背景は頸管スメアよりも内膜スメアにおいて高い頻度でみられ, また頸管スメアでは腫瘍性背景を示しながら異型細胞が認められないものもあった. 閉経後体癌患者の頸管スメアでは, 比較的高頻度に正常内膜細胞が認められるものがあり, このなかには異型細胞が認められないものもあった.