Kazuo Ohmi

Early stage adenocarcinoma of the uterine cervix histopathologic analysis with consideration of histogenesis

Thirty cases of early stage adenocarcinoma, 5 mm or less in depth, were selected from 1942 primary carcinomas of the uterine cervix for histologic analysis to clarify their histogenesis. There were 16 carcinomas of endocervical type, 12 of endometrioid type, and 2 clear cell carcinomas. There were 22 early invasive adenocarcinomas and 8 adenocarcinomas in situ. In 27 cases the carcinoma was adjacent to the transformation zone and in 3 it was separate from it. In 10 cases adenocarcinoma coexisted with in situ squamous cell carcinoma. Only one patient whose tumor was 3 mm in depth developed a pelvic recurrence after radical hysterectomy. All other patients remained disease‐free after treatment by hysterectomy. It is suggested that most adenocarcinomas of the uterine cervix originate from endocervical glands adjoining the transformation zone and that they may develop directly from normal‐appearing epithelium without passing through adenomatous or dysplastic changes.

High-dose-rate intracavitary irradiation in the treatment of carcinoma of the uterine cervix: Early experience with 84 patients☆

Eighty-four patients with previously untreated invasive carcinoma of the uterine cervix were treated by high-dose-rate intracavitary irradiation using a remotely controlled afterloading system (Ralstron) with or without external irradiation at the National Cancer Center Hospital, Tokyo, between 1977 and 1981. Survival rates and local control rates were comparable to those for 372 patients treated by low-dose-rate intracavitary irradiation with or without external irradiation from 1972 to 1981 at the hospital. The incidence of major complications was 5.1 and 2.4% for the patients treated by low-dose-rate intracavitary irradiation and by high-dose-rate irradiation, respectively. The results are comparable to those reported by other institutions. We have abandoned the conventional low-dose-rate intracavitary irradiation with the impression that the high-dose-rate remotely controlled afterloading system is a good alternative to the conventional one.

Prognostic Value of p53 Protein Accumulation in Cancer Cell Nuclei in Adenocarcinoma of the Uterine Cervix

Adenocarcinoma of the uterine cervix (CxAd) is one of the most distressing malignancies of the female reproductive system because of its tendency to spread aggressively and to be resistant to radiation and systemic therapies. To clarify the prognostic significance of p53 alteration in CxAd, we immunohistochemically examined the incidence of p53 nuclear accumulation, which is considered to be mostly parallel with p53 gene mutation, and its association with clinicopathological parameters in 26 patients with CxAd. The overall incidence of p53 nuclear accumulation was 46% (12 of 26), being higher in groups with clinically advanced disease, higher degrees of cellular atypia, and deeper myometrial invasion, but significantly lower in patients with integration of human papillomavirus (HPV) type 16 or 18 DNA. Nuclear p53 immunoreactivity as well as lymph node status, depth of invasion and the absence of HPV‐DNA integration were significant indicators of a poor prognosis. Examination of p53 nuclear accumulation could be applied to biopsy material, and would be of practical assistance in predicting the prognosis of CxAd both preoperatively and postoperatively.

Carcinoma of the uterine cervix treated with external irradiation alone

One hundred and four out of 2701 patients with carcinoma of the uterine cervix were treated with a curative intent by external irradiation alone at the National Cancer Center Hospital from 1962 to 1979. All patients were judged inappropriate for the combined treatment of intracavitary and external irradiation, which was the treatment of choice for patients with advanced carcinoma of the uterine cervix in the hospital. The 5-year survival rate was 17% overall and 36, 17, and 5% for patients with Stage II, III, and IV disease, respectively. The local control rate was 20%, at 2 years, for all patients. Major complications were observed in five patients. There were no major complications in patients given a total dose of less than 115 in the Time Dose Fractionation factor (TDF). External irradiation combined with interstitial irradiation and/or hyperthermia is being considered to improve the results.

Para-Aortic Nodal Irradiation in the Treatment of Carcinoma of the Uterine Cervix: A Report of 22 Cases

Twenty-two patients with previously untreated carcinoma of the uterine cervix were treated by para-aortic nodal irradiation for the macroscopical metastases found at the operation with or without pathological confirmation, at the National Cancer Center Hospital from 1962 to 1980. The irradiation was given with 6 MeV X rays. Total doses ranged from 42 to 99 with an average of 69 in Time Dose Fractionation factors. All of the patients died of the tumor within 42 months. The initial site of relapse was intrapelvic for two patients, extrapelvic for 18, and both intra- and extrapelvic for two. Of 12 patients upon whom autopsies were performed, only one of the patients who had multiple metastatic tumors of less than 1 cm in maximum diameter had the tumor controlled in the irradiated region.