Kazumasa Masubuchi

Second cancer after radiation therapy for cancer of the uterine cervix

Radiation‐induced cancers after radiation therapy for cancer of the uterine cervix were investigated on 11,855 patients including 5725 patients treated with radiation therapy alone, 1969 postoperative radiation therapy and 4161 surgery alone. The observed‐to‐expected ratios of the second primary cancer was 0.933 for the patients with radiation therapy alone and 1.074 for the patients with postoperative radiation therapy, respectively. No significant increase was observed in the risk of second primary cancers when all sites were combined. However, assessing on site by site basis, significant excess was noted for the rectum cancer, leukemia, and bladder cancer for the radiation therapy group but not for the surgery group. A significant excess of lung cancer was observed in both radiation therapy and surgery groups, which was attributed to some other causative factors. Radiation‐induced cancers were suggested to develop apparently in organs involved in the irradiated field.

Circumscribed carcinoma of the uterine cervix, with marked lymphocytic infiltration.

The present study was carried out to investigate a distinctive type of carcinoma of the uterine cervix categorized under the designation as circumscribed carcinoma with lymphocytic infiltration. Grossly this carcinoma is characterized by defined circumscription with a superficial ulceration. A microscopic feature characteristic of this tumor is the presence of a loose fibrillary stroma infiltrated densely and uniformly by lymphocytes throughout the tumor mass. The tumor is arranged in solid cords separated by a lymphoid stroma with evidence of minimal squamous differentiation. The authors picked up 709 patients with carcinoma of the uterine cervix who underwent radical hysterectomy and pelvic lymphadenectomy at the Cancer Institute Hospital, Tokyo, between 1956–1967, without preoperative radio‐ or chemotherapy. Among them, 39 or 5.5% were identified as this type of carcinoma. Patients with this types of carcinoma had a significantly better prognosis than those with other types of cervical carcinoma of the same stage (p < 0.05). This favorable prognosis is probably due to the less regional node metastases found in the group. A proposal was made to segregate this particular type of carcinoma from other types of cervical carcinoma on the basis of its morphologic and prognostic distinctiveness.

Primary malignant melanoma of the vagina: study of four autopsy cases with ultrastructural findings.

Four cases of primary malignant melanoma of the vagina in women aged 23, 44, 51 and 65 years are presented. In these 4 cases, thorough clinical and postmortem examinations ruled out the possibility of a primary melanoma elsewhere. The primary tumors showed exophytic growth with superficial ulceration. Three of the melanomas arose from the middle third of the vagina and one from the upper third. Melanin was visible in sections stained with hematoxylin and eosin in 3 of the tumors. In the other one, the first biopsy failed to reveal melanin. However, the second biopsy performed following irradiation showed abundant melanin pigment. Electron microscopic examination of 3 tumors revealed premelanosomes and melanosomes in the tumor cells, thus confirming the diagnosis. Two neoplasms showed atypical histologic features, and only the presence of melanin enabled us to make diagnosis of malignant melanoma. One melanoma was associated with an adjacent widespread intraepithelial component of superficial spreading type indicating its probable mode of origin. All 4 patients died of widespread metastases within 13 months after initial treatment. These 4 cases, in which clinical diagnosis was confirmed by thorough autopsy, strongly indicate that malignant melanoma can arise directly from the vagina. Cancer 42:2675–2686, 1978.

Effective chemotherapy consisting of bleomycin, vincristine, mitomycin C, and cisplatin (BOMP) for a patient with inoperable vulvar cancer

Combination chemotherapy consisting of bleomycin, vincristine, mitomycin C, and cisplatin (BOMP) was first applied to an inoperable case (57-year-old) with FIGO stage IV (T3N3 + M1B) squamous cell carcinoma of the vulva. After three courses of BOMP therapy, the patient achieved a complete response with few toxic effects and subsequently could undergo radical vulvectomy with bilateral inguinal and pelvic lymphadenectomy. On microscopic examination, only a minute focus of viable squamous cell carcinoma was observed in the vulvar lesion and regional lymph nodes, which was surrounded by fibrotic or necrotic tissues. The patient received a further two courses of BOMP as postoperative chemotherapy. Five courses of BOMP were extremely tolerable and did not require special care. She has been free of disease for 20 months and her present performance status is 0. The encouraging result warrants the use of this combination chemotherapy regimen in other patients with advanced squamous cell carcinoma of the vulva.

Increasing incidence of endometrial carcinoma in Japan

Abstract Incidence of corpus cancer has been increasing in the Gynecology Clinic of the Cancer Institute Hospital, Tokyo, in recent years, and this tendency has become very marked since 1966. This tendency for increased incidence of corpus cancer has been observed among relatively young age groups. There was no evidence that the age of outpatients was getting higher in recent years or that the number of outpatients with higher risk age for corpus cancer was increasing. Increased incidence of corpus cancer could not be correlated to the improvement in diagnostic technique or to increase in the number of endometrial biopsy. Correlation between increased incidence of corpus cancer and socioeconomic factors must await further detailed examinations. Precancerous changes responsible for corpus cancer may have been on the increase in recent years.

Clinical study of primary carcinoma of the fallopian tube: Experience with 15 cases

Between 1950 and 1986, fifteen cases of primary carcinoma of the fallopian tube were diagnosed and treated at the Cancer Institute Hospital, Tokyo. These cases constituted 0.14% of the total number of gynecologic malignancies at the hospital during that period. The average age of the 15 patients was 55.7 years. The most frequent symptom was atypical genital bleeding, seen in 12 cases (80%). Massive watery discharge was seen in 4 cases (27%). In preoperative cytologic examination, 6 cases (40%) were positive for cancer. All cases underwent operation as therapy. Postoperative irradiation, adjuvant chemotherapy, and/or second- or third-look operations were also performed. Histopathologically, all materials were found to be adenocarcinoma. Four cases were well differentiated, eight were moderately differentiated, and three were poorly differentiated. As for the prognosis, 7 patients were followed more than 5 years postoperatively. The 5-year survival rate was 57% (4/7). In stage I cancers, the 5-year survival rate was 80% (4/5). The prognosis of stage I cancer patients was estimated to be rather good.

Immunotherapy of tumor-bearing mice utilizing virus help.

SummaryUtilizing vaccinia virus (VV), a tumor-specific immunotherapy model was established in which a growing tumor regressed. C3H/HeN mice were primed with VV after low dose irradiation to generate amplified VV-reactive T cell activities. Then 4 weeks later, the mice were inoculated i. d. with syngeneic MH134 hepatoma cells, and 6 days after the tumor cell inoculation, live VV was injected into the tumor mass 3 times at 2-day intervals. Of 10 mice which had received VV priming and subsequent VV injection into the tumor mass, 8 exhibited complete tumor regression. On the contrary, mice which had received only intratumoral VV injection without VV priming failed to exhibit appreciable tumor regression. Mice whose tumor had completely regressed following the VV immunotherapy were shown to have acquired systemic antitumor immunity, which was confirmed by a challenge with syngeneic tumor cells after immunotherapy. In vitro analysis of these immune mice revealed that potent tumor-specific antibody responses were preferentially induced, but with no detectable antitumor cytotoxic T lymphocyte (CTL) responses. Such a potent tumor-specific immunity was not observed in mice which had received intratumoral VV injection in the absence of VV priming. Thus, the results clearly indicate that tumor regression was accompanied by the concurrent generation of a potent tumor-specific immunity, suggesting that cellular cooperation between VV-reactive T cells and tumor-specific effector cells might be functioning in this VV immunotherapy protocol. Therefore, the present model provides an effective maneuver for tumor-specific immunotherapy. This system is, in principle, applicable to the human situation.

Lymph node metastasis and prognosis of endometrial carcinoma

Abstract Recently there has been much discussion about the choice of surgical treatment for carcinoma of the body of the uterus. From the study of the literature, it is concluded that there is a high incidence of lymphatic metastases in cases with cervical involvement, so Wertheims hysterectomy with pelvic lymphadenectomy has been carried out for such cases. Deep myometrial infiltration and involvement of lymphatic vessels within myometrium are also very important factors for pelvic lymph node involvement, but it is quite impossible to examine these two factors preoperatively. As to the sites of spread, paraaortic lymph node involvement seems not so important as was said in the literature. In the case with cervical involvement, the external iliac lymph node is the most often affected, just as in the case of cervical carcinoma. Without cervical involvement, the obturator lymph node and hypogastric lymph node seem to be a primary site for lymphatic spread. The prognosis is poor in patients with involvement of the pelvic lymph node. Radical hysterectomy should be carried out as the general condition permits.

Interferon-α, interferon-γ and sizofiran in the adjuvant therapy in ovarian cancer — a preliminary trial

The study included 24 cases of negative second-look laparotomy (SLL) after operation on ovarian cancer. 12 cases were treated with sizofiran and recombinant interferon-γ before and after SLL and then with human lymphoblastoid interferon-α. The remaining 12 cases (controls) were followed up without any drug therapy after SLL.There were no recurrences in the treated group, but in 3 cases of the control group.Also significant difference in survival was noted in the treated group.

Epidemiologic studies on uterine cancer at Cancer Institute Hospital, Tokyo, Japan

Five hundred and seventy‐two patients with uterine carcinoma, treated at the Department of Gynecology, Cancer Institute Hospital, Tokyo, were interviewed, and 200 healthy women were also interviewed as controls. The results are as follows: 1. the age at first intercourse is lower in the carcinoma group; 2. the carcinoma group showed increasing parity; 3. all the unmarried patients in the cervical carcinoma group have had sexual intercourse; 4. patients having had syphilis were more numerous in the uterine carcinoma group, and the Wasser‐mann‐positive patients were also significantly higher in this group; 5. the proportion of patients whose husbands had phimosis was higher in the cervical carcinoma group, and 6. the proportion of patients with uterine carcinoma who had mothers with uterine carcinoma was higher than the control group. It is concluded that uterine carcinoma has some genetic background and that early age at first intercourse and other cervical tissue contaminant factors are important.