Haruko Fujii

Adenocarcinomas arising from uterine adenomyosis: a report of four cases.

Adenocarcinomas arising from adenomyosis uteri are rare. This study reports four such cases and characterizes them clinically and microscopically. In all four patients, the endometrial cytology was negative, and MR imaging and ultrasound sonography did not detect the tumors preoperatively. The histological subtypes of the four tumors were endometrioid (one grade 1, one grade 3), serous, and clear cell. In three cases, the adenocarcinomas were present exclusively in the myometrium, and a transition between the carcinomas and the adenomyotic glands was observed in all cases. The eutopic endometrium was normal except in one case in which there was a small focus of invasive carcinoma. In two of four cases, pelvic or paraaortic lymph node metastases were present. In the carcinomas, ER immunoreactivity was not found in any tumor and PR positivity was found in only one tumor. In contrast, p53 immunopositivity was found in three of four carcinomas. Adenocarcinomas arising from adenomyosis are difficult to diagnose preoperatively, and their aggressive behavior in some cases seems to be related to the histological subtype.

Expression of multidrug resistance-associated protein in endometrial carcinomas: correlation with clinicopathology and prognosis.

The objective of the study reported here was to investigate the expression of multidrug resistance-associated protein (MRP) in endometrial carcinomas and to evaluate the relationship between its expression and clinical data. Using immunohistochemistry, we examined MRP expression in 15 normal endometria, 10 cases of endometrial hyperplasia, and 64 cases of endometrial carcinoma. The normal endometrial glands were weakly immunopositive throughout the menstrual cycle. In addition, we found a progressive increase in the MRP expression of the endometrial hyperplasias. Of the 64 cases of endometrial carcinoma, 62 (97%) expressed MRP. Of these 62 cases, 34 (55%) showed strong immunostaining (>/=50%) and 28 (45%) showed weak immunostaining (<50%). In particular, the intensity of the immunostaining was very strong in 25 (71%) of the 35 grade 1 carcinomas. There was a significant difference in MRP expression between the grade 1 carcinomas and the more poorly differentiated carcinomas (grade 2 or grade 3) (P <.01), especially at stages 1a and 1b (P <.001). However, beyond stage 1c, there was no significant difference in MRP immunoreactivity between the histologic differentiations. Furthermore, beyond stage 1c, those patients with strongly MRP-positive carcinomas had a relatively poorer survival rate than those with weakly MRP-positive carcinomas (P <.05). We concluded that MRP immunoreactivity was already present in normal endometrium and showed a progressive increase from endometrial hyperplasia to well-differentiated carcinoma. Beyond stage 1c, strongly MRP-positive carcinoma indicated a poorer survival rate.

Ovarian actinomycosis complicated by diabetes mellitus simulating an advanced ovarian carcinoma

A patient presented with a pelvic tumor which mimicked an advanced ovarian carcinoma with invasion into urinary bladder, rectum and uterus, as detected by MR imaging. After surgery, however, actinomycosis of the left ovary was diagnosed by pathological examination. Ovarian actinomycosis in this patient was complicated by diabetes mellitus.

Ovarian dysgerminoma showing high serum levels and positive immunostaining of placental alkaline phosphatase and neuron-specific enolase associated with elevation of serum prolactin level

We report a 35-year-old Japanese female patient with ovarian dysgerminoma showing elevated serum levels of placental alkaline phosphatase (PLAP), neuron-specific enolase (NSE) and prolactin (PRL). All elevated tumor markers improved dramatically after the removal of the tumor. Immunohistochemically examined, the tumor was stained positive for PLAP and NSE and negative for PRL. Our present case is the first report of dysgerminoma showing positive immunostaining for PLAP and NSE, and the association of high serum level of PRL followed by decrease accompanied by the tumor debulking.

Recurrent clear cell carcinoma of the ovary changing into producing parathyroid hormone-related protein (PTH-rP) with hypercalcemia

We experienced the case of a clear cell carcinoma of the ovary arising from an endometrial cyst, which started to produce parathyroid hormone-related protein (PTH-rP) in a recurrent tumor, thus inducing hypercalcemia. Using immunohistochemical analysis, we demonstrated that the primary carcinoma was immunonegative for PTH-rP, but that the recurrent carcinoma was strongly immunopositive for PTH-rP.

Intermittent, repetitive administrations of irinotecan (CPT-11) reduces its side-effects

To reduce the side-effects of irinotecan (CPT-11) while maintaining its anti-cancer effects against recurrent ovarian carcinomas, we devised a novel administration schedule for CPT-11 single chemotherapy. It consisted of an initial dose of 70 mg/m2, followed by increasing the dose to 100 mg/m2 every 10 days (three times per month) for 9 cycles. Nineteen patients with refractory or recurrent ovarian carcinomas were treated. In comparison with a late phase II study of single CPT-11 chemotherapy in Japan (100 mg/m2 every 7 days; four times per month), the number of patients who suffered from leukocytopenia and diarrhea higher than grade 3 was significantly lower with our new method (36.8 versus 57.1%; P < 0.01 and 0 versus 19.2%; P < 0.001, respectively). The total response rate was 26% (5/19). This rate was almost equal to a late phase II study. We suggest that our new protocol of single CPT-11 administration should be available clinically to all patients for reducing the side-effects while maintaining its anti-cancer effects. CPT-11 is useful in patients with refractory ovarian carcinomas as a second- or third-line chemotherapy.

Gynecologic malignancies accompanied by benign hormone-dependent diseases.

Objective To investigate the correlation between benign gynecologic diseases and hormone-dependent malignancies such as endometrial carcinoma in postmenopausal women. Design We retrospectively analyzed the prevalence of myoma uteri and adenomyosis uteri in 136 cases of endometrial carcinomas. We used 222 uterine prolapse cases as controls. Results The results showed that 21.6% and 9.9% of healthy postmenopausal women (control) had myoma uteri and adenomyosis uteri, respectively, after the cessation of menses. However, postmenopausal women with endometrial carcinomas had a 1.5-to 2-fold higher prevalence, respectively, for myoma uteri and adenomyosis uteri as compared with the postmenopausal control women. Conclusion There was a higher prevalence of myoma uteri and adenomyosis uteri in postmenopausal patients with endometrial carcinomas than in the control population.