Keita Matsukuma

Microscopic ovarian metastasis of the uterine cervical cancer

Six hundred forty-seven cases of carcinoma of the uterine cervix with FIGO stages Ib or more were initially treated with hysterectomy at Kyushu University Hospital from 1973 to 1987. In these, 597 cases could be pathologically reviewed for ovarian metastasis. In these 597 cases, 335 were stage Ib, 71 IIa, 185 IIb, and 6 IIIb. Only 3 (0.5%) of 597 showed ovarian metastasis. All 3 cases were stage IIb. None of stage Ib cancer cases had ovarian metastasis. One (0.19%) of 524 squamous cell carcinomas metastasized to the ovary, whereas 2 (5.5%) of 36 pure adenocarcinomas revealed ovarian metastasis. Interestingly, all ovarian metastatic lesions were microscopic in size and found in the ovarian hilus. As for the primary lesion, all cases with ovarian metastasis showed deep myometrial invasion, corpus invasion, and lymphatic permeation. Two cases showed pelvic lymph node metastases and positive peritoneal washing cytology. From the results of our study, it can be said that it is fairly safe to preserve the ovary at the time of radical operation in squamous cell carcinoma of the uterine cervix, but it may not be safe to preserve the ovary in pure adenocarcinoma of the uterine cervix.

A comparative analysis of human papillomavirus types 16 and 18 and expression of p53 gene and Ki-67 in cervical, vaginal, and vulvar carcinomas

UNLABELLED This study aimed to investigate the correlation between HPV positivity, p53 overexpression, and cell proliferative activity in cervical, vaginal, and vulvar squamous cell carcinoma. METHODS Sixteen vaginal and 31 vulvar squamous cell carcinomas were examined retrospectively for overexpression of p53 gene and Ki67 antigen by immunohistochemistry and for the presence of HPV types 16 and 18 DNA using a polymerase chain reaction (PCR) method. The results were compared with those obtained from 40 cervical squamous cell carcinomas. RESULTS HPV type 16 or 18 DNA was detected in 21 (52.8%) of 40 cases of cervical carcinomas and p53 overexpression in one (2.5%), while HPV DNA sequences were detected in seven (43.7%) of 16 cases of vaginal carcinoma and p53 overexpression in three (18.7%). With regard to vulvar carcinoma, HPV was harbored in four (12.8%) of 31 cases and p53 overexpression in 19 (61.2%). These results indicated statistically significant inverse correlations between HPV positivity and p53 overexpression (R = -0.999, P < 0.0001). Overexpression of Ki-67 was detected in 28 (70.0%) of 40, 12 (75.0%) of 16, and 21 (67.7%) of 31, cervical, vaginal, and vulvar carcinomas, respectively. There was no significant difference among the three groups. CONCLUSIONS In cervical carcinoma, HPV types 16 and 18 might play a common causal role, and in vulvar carcinoma, p53 gene mutations might be a main causal factor for carcinogenesis. Vaginal carcinoma, on the other hand, is considered to have transitional characteristics between cervical and vulvar carcinoma.

Preoperative CT study of lymph nodes in cervical cancer—Its correlation with histological findings

A study was conducted to retrospectively evaluate the accuracy of abdominopelvic computed tomography (CT) in the diagnosis of paraaortic and pelvic lymph node metastases from carcinoma of the uterine cervix. Seventy patients with a diagnosis of invasive carcinoma of the cervix had preoperative CT of abdomen and pelvis and subsequently underwent a radical hysterectomy with pelvic lymph node dissection and paraaortic lymph node biopsy or an exploratory laparotomy with paraaortic lymph node biopsy. Five of six patients with metastatic paraaortic lymph nodes larger than 15 mm in diameter on the histologic slides were diagnosed by CT scan to have enlarged nodes. CT diagnosis was true-positive in five of seven patients with paraaortic lymph node metastases (71.4%). Two patients with false-positive paraaortic lymph nodes had clusters of small lymph nodes less than 10 mm in diameter on the histologic slides. In contrast, only a small number of the metastatic pelvic nodes were diagnosed by CT as enlarged nodes. CT diagnosis was true-positive in 5 of 11 sites with pelvic lymph node metastases (45.5%).

The problem of stage Ia (FIGO, 1985) carcinoma of the uterine cervix

The FIGO definition of stage Ia (microinvasive) carcinoma of the uterine cervix had been vague and caused continued confusion. In 1985 FIGO revised the definition of stage Ia by including measurements in the definition and it also subdivided stage Ia into stages Ia1 and Ia2. One hundred and eighteen of eight hundred and sixty patients with stage 0 to IIb carcinoma, who retrospectively satisfied the new FIGO definition of stage Ia, were reviewed with respect to depth of invasion, horizontal spread, number of invasive foci, vascular space involvement, pattern of invasion, incidence of lymph node metastasis, and clinical outcome. There were three potentially high-risk patients: one with pelvic lymph node metastases, one with parametrial metastasis, and the third with recurrence 23 months after initial treatment. It was pointed out that the border between stages Ia1 and Ia2 is very vague in the 1985 FIGO definition. It was proposed that a lesion with 3-mm or less stromal invasion and without vascular space involvement and confluency be defined as stage Ia1 and be safely treated with simple means.

Endolymphatic stromal myosis : A case with positive estrogen and progesterone receptors and good response to progestins

This report describes a case of recurrent and metastatic endolymphatic stromal myosis (ESM), which showed good response to progestin therapy. Metastatic lung nodules regressed after medroxyprogesterone acetate (MPA) treatment, recurred while MPA was stopped, and disappeared again when MPA was restarted. The levels of estrogen and progesterone receptors measured in the resected tumor amounted to 79.5 and 310 fmole/mg protein, respectively. Sex steroid hormone dependency of ESM was reviewed in the literature.

Clinicopathologic study of squamous cell carcinoma of the ovary

Clinicopathologic study was performed on 10 squamous cell carcinomas of the ovary. All four patients with stage II or III lesions had deteriorated within 1 year after the operation, and four of six patients with stage I lesions had survived over 5 years. Clinical findings of the patients with ovarian SCC, including age, chief complaint, clinical stage, and outcome of the patients, were similar to those of common epithelial cancer. The effectiveness of chemotherapy was not shown in this study. Histopathologic study revealed that squamous cell carcinoma may arise not only from epidermis, but also from squamous metaplastic epithelium of respiratory gland.

Prophylactic chemotherapy for hydatidiform mole: five to 15 years follow-up

The effectiveness of the prophylactic chemotherapy was evaluated in 420 patients with molar pregnancy. All patients were followed for 5 to 15 years after the evacuation. Twenty‐two (7.5%) of 293 patients with prophylactic chemotherapy and 23 (18.1%) of 127 patients without prophylactic chemotherapy (control) developed secondary trophoblastic disease. The prophylactic chemotherapy could reduce the occurrence of secondary trophoblastic disease. In these secondary trophoblastic diseases, 5 (22.7%) of 22 patients in the prophylactic chemotherapy group and 5 (21.7%) of 23 in the control had metastatic trophoblastic disease. Choriocarcinoma after the molar pregnancy developed in two patients (0.7%) of the prophylactic chemotherapy group and two (1.6%) of the control. Prophylactic chemotherapy did not eliminate the occurrence of choriocarcinoma. The complication of the prophylactic chemotherapy was seen in 27.3% of the patients. Neither severe complication nor death were related to the toxicity. Cancer 58:624‐629, 1986.

Early adenocarcinoma of the uterine cervix—Its histologic and immunohistologic study

Eight cases of early adenocarcinoma selected from 101 adenocarcinomas of the uterine cervix were studied to establish the criteria of early adenocarcinoma. Lesions of these 8 cases were small in size. In 7 of 8 cases, these tumors originated in the area of the squamocolumnar junction (SCJ). Tumor cells consisted of two types of atypical columnar cells, i.e., tall columnar cells with enlarged and deeply eosinophilic cytoplasm and clear cells with enlarged and clear vacuoles. Tall columnar cells showed weak or negative reaction to high iron diamine (HID) stain and negative to Alcian blue (AB) stain. Clear cells showed negative reaction to HID stain and positive to AB stain. Although normal endocervical columnar cells showed markedly positive reaction to HID stain and negative reaction to AB stain, invasive adenocarcinoma cells showed similar reaction to early adenocarcinoma cells. From this study, it is surmised that early adenocarcinoma of the uterine cervix originates in the area of the SCJ and consists of tall cells in all cases and clear cells in 4 of 8 cases, and that HID-AB stain is useful in differentiating early adenocarcinoma cells from normal endocervical columnar cells.

Primary malignant melanoma arising in a cystic teratoma of the ovary

The 11th well-documented case of malignant melanoma, arising in a cystic teratoma of the ovary, is described. The melanoma which recurred 4 months after surgery responded completely to immunochemotherapy.

Malignant ovarian tumors associated with pregnancy: Report of six cases

Six cases of pregnancy associated malignant ovarian tumors, four epithelial cancers, one immature teratoma and one metastatic cancer of colon origin, are reported. One patient with mucinous cystadenocarcinoma had a history of persistent ovarian tumor during her past three pregnancies. Another patient was found to have mucinous cystadenocarcinoma after an emergency operation for twisted ovarian tumor. Immature teratoma associated with pregnancy is very rare and our case seems to be the 8th reported such case.