Hideaki Yamauchi

Basement membrane material and tigroid background in a fine needle aspirate of clear cell adenocarcinoma of the cervix : A case report

BACKGROUND Although cytologic findings of clear cell adenocarcinoma of the female genital tract have been reported sporadically, the background on the smear has received little attention. CASE A 16-year-old female had a large, necrotic mass in the cervix. As cervical brushing cytology and a punch biopsy of the mass could not make a definitive diagnosis, fine needle aspiration cytology was performed from the mass. The smears revealed loose, three-dimensional clusters and sheet arrangements of atypical cells. Dispersed atypical cells were also seen. The atypical cells were large and had abundant, weakly stained cytoplasm and round or oval nuclei with large nucleoli. There were a few tumor cells with clear cytoplasm and distinct cell borders in Papanicolaou-stained smears. The background in Diff-Quik-stained smears revealed a tigroid background and basement membrane material. CONCLUSION The malignant tumor, revealing both a tigroid background and basement membrane material, seems to have been clear cell adenocarcinoma. Both features are diagnostic clues to clear cell adenocarcinoma in the female genital tract. Our case indicates that aspiration cytology is also an effective method of diagnosing a cervical tumor when the tumor is polypoid and the surface is extensively necrotic.

Papillary squamous cell carcinoma of the uterine cervix: diagnostic pitfalls

A case of papillary squamous cell carcinoma (PSCC) of the uterine cervix is reported. The patient was a 73‐year‐old Japanese woman with acute renal failure and bilateral hydronephrosis. A cauliflower‐like mass was found in the uterine cervix. A uterine cervical biopsy specimen revealed PSCC in situ, while clinically it was an invasive carcinoma. Uterine cervical biopsy was performed a second time to confirm its stromal invasion. However, only small fragments were obtained because of heavy bleeding from the tumor and they showed PSCC in situ again. Following this, computed tomography of the pelvis revealed a 5 cm mass in the uterine cervix, invading the vagina and urinary bladder. Though deep‐wedge biopsy, loop electrosurgical excision, or cone biopsy is recommended to evaluate PSCC, it may be impossible to perform any of these procedures because of bleeding such as that seen in our case. In these circumstances, good communication between pathologists and clinicians is important since lack of communication may cause PSCC to be microscopically misinterpreted as in situ carcinoma rather than invasive carcinoma.

Subcutaneous transposition of the ovary following hysterectomy

Objectives: Preservation of ovarian function at hysterectomy in pre‐menopausal women is desirable. A possibly malignant tumor from retained ovary is a concern. We demonstrate a new technique for exteriorization of the ovaries. Method: In 27 patients, the infundibulopelvic ligament was mobilized. The retroperitoneal space was then widely opened. The ovary was gently pulled through a fascial incision and fixed on the fascia followed by skin closure. Results: Cystic formation was common (66.7%). Four patients had extreme enlargement of the transposed ovary. A needle puncture revealed intra‐ovarian hematomas or fluid retention. One had puncture of the translocated ovary for in vitro fertilization more than two years following transposition. Conclusions: Possible advantages are (1) early detection and diagnosis of ovarian cysts, (2) easy surgical access to remove ovarian cysts, (3) transposition of ovaries outside the radiation field and (4) in vitro fertilization is facilitated. Comparative study for ovarian function is ongoing.

Relationship between calculated carboplatin area under the curve, using the Cockcroft-Calvert formula and the Chatelut formula, and thrombocytopenia induced by intraperitoneal carboplatin in combination with intravenous cyclophosphamide

AbstractBackground. There is no standard formula to estimate doses for the intraperitoneal (IP) administration of carboplatin. We evaluated a combination of the Cockcroft and the Calvert (Cockcroft-Calvert) formula to determine the area under the curve (AUC) for IP carboplatin co-administered with intravenous (IV) cyclophosphamide (CPM). We also evaluated the correlation of carboplatin clearance determined by the Chatelut formula with carboplatin clearance determined by the Cockcroft-Calvert formula. Methods. We performed a retrospective study of the records of 149 treatments in 30 patients who received IP carboplatin and IV CPM for ovarian carcinoma. The glomerular filtration rate was calculated with the Cockcroft formula. Carboplatin doses were determined based on the body surface area. The Cockcroft-Calvert formula was used to calculate the AUC. The Chatelut formula was also used to calculate the clearance of carboplatin and the AUC. Results. The AUC calculated with the Cockcroft-Calvert formula was well correlated to the AUC calculated with the Chatelut formula (r2 = 0.965). During the first four courses of IP carboplatin combined with IV CPM (300–500mg/m2), the correlation between the percent decrease in platelet count and the calculated carboplatin AUC varied among methods: Cockcroft-Calvert formula AUC:r2 = 0.460; Chatelut formula AUC:r2 = 0.431; body surface area dose:r2 = 0.204; total dose:r2 = 0.143. Conclusion. To decrease patient platelet count by 67%, the optimal target AUC following IP administration of carboplatin in combination with 300–500mgCPM/m2IV was calculated as 6.5, using the Cockcroft-Calvert formula, and as 7.5, using the Chatelut formula. Considerable modification of the IP carboplatin dose is required after the fourth course. A prospective study is ongoing to confirm these results.