Keizo Fujiyoshi

Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary

Aim:  The aim of this study was to investigate whether fertility preservation influences the clinical outcome in patients with malignant germ cell tumors of the ovary (MGCTO).

Desmoplastic small round cell tumor in the ovary: Report of two cases and literature review.

Desmoplastic small round cell tumor (DSRCT) is a rare intra‐abdominal tumor of uncertain histogenesis that occurs predominantly in young males. We report two cases of DSRCT in young women that presented clinically as ovarian tumor with extensive pelvic and abdominal dissemination. Both patients underwent debulking surgery and combined chemotherapy. After primary therapy, the tumors recurred and both women died of the disease. The clinical presentation and differential diagnosis, as well as the treatment, including surgical debulking and combined chemotherapy are discussed.

Long Survival in a Rare Case of Hepatocellular Carcinoma that Metastasizedto the Ovary: A Case Report

Hepatocellular carcinoma usually metastasizes to the lung, bone, adrenal glands, diaphragm and lymph nodes. In this study, we present a case of hepatocellular carcinoma that metastasized to the ovary. To the best of our knowledge, there are very few reports of such cases published in English and none in which the patient survived more over 7 years. A 72-year-old postmenopausal Japanese woman had been diagnosed with type C chronic hepatitis. Screening ultrasonography revealed a low echoic small nodular lesion located on S6 of the liver. Tiny hepatocellular carcinoma was diagnosed by needle biopsy and the patient was treated with percutaneous ethanol injection therapy. Two years later, she underwent a work-up because of an elevation in serum alpha-fetoprotein level, and whole body Computed Tomography scan revealed a large solid pelvic mass. At laparotomy, a large right ovarian tumor was revealed. No other lesion was found. A bilateral salpingo-oophorectomy was performed. On microscopic examination, the tumor showed predominantly solid and trabecular patterns. Pseudo-glandular patterns were also observed. The final pathological diagnosis was hepatocellular carcinoma metastatic to the right ovary. Postoperatively, the serum alphafetoprotein concentration decreased to within the normal range. Although, we resected an implantation in her right thoracic wall seven months post laparotomy, she did not show any evidence of recurrence during her 7 year follow up period. Metastatic hepatocellular carcinoma to the ovary is very rare. If a patient presents with findings similar to those describing our patient, the examining physician should be aware of the risk of potential ovarian metastases from hepatocellular carcinoma. Surgical resection may be the only effective treatment strategy for static ovarian cancer.

Successful treatment of two patients with recurrent endometrial cancer by weekly paclitaxel

OBJECTIVE The aim of this study was to evaluate the toxicity and efficacy of weekly paclitaxel in patients with recurrent endometrial cancer. METHODS Paclitaxel (70 mg/m(2) by 1-h infusion weekly) was administered to two patients with recurrent endometrial cancer of the lung. RESULTS After 5 cycles, both patients with platinum-resistant disease achieved clinical partial responses confirmed by computed tomography (CT) scan. The serum CA125 levels of case 1 decreased to cut-off level. The response duration of both patients was 4 months. The toxicity was acceptable and probably less pronounced than that characterize of the standard tri-weekly schedules. CONCLUSION Although conclusions regarding survival are premature, weekly paclitaxel might offer better quality of life during treatment.

An unusual endometrioid adenofibroma of the uterine cervix: a histologic and immunohistochemical study

An unusual adenofibroma of the uterine cervix is reported. The cervix was bulkily enlarged but did not have a polypoid appearance. The neoplastic epithelium was in continuity with the covering epithelium of the cervix and consisted predominantly of endometrioid cells which proliferated to form numerous glandular structures of irregular size and shape. The glandular component resembled an endometrial hyperplasia, and was set in an abundant fibrous stroma which was moderately cellular and hyalinized. Both the epithelial and mesenchymal cells lacked cytologic atypia. Despite its benign appearance, the tumor occupied almost all the uterine cervix and extended into the upper vaginal wall. The epithelial cells showed diffuse positive staining for CA19-9 and were focally positive for carcinoembryonic antigen. The presence of dense periglandular fibrosis distinguished the present case from a minimal deviation adenocarcinoma of endometrioid type.

Relation between risk factors for uterine endometrial carcinoma and the cellular cluster architecture in endometrial cytology. Focusing on stromal A.

目的:今回われわれは子宮内膜細胞診における細胞集塊の形態的特徴と, 子宮内膜癌の組織分化度や筋層浸潤の程度との関連性について, とくにStromalAに注目して検討を行った.方法:対象は当科において子宮内膜癌と診断され, 子宮摘出を受けた症例のうち術前に子宮内膜細胞診の直接塗抹および生食洗浄法により子宮内膜細胞を得た49例である.これらの検体に対し, プレパラートあたりのStrornal Aを有する樹枝状集塊の出現数, Stromal Aを構成する細胞束数, Stromal Aにおける分岐数を観察し, 組織分化度や浸潤度との関係について検討を行った.結果:(1) Stromal Aを有する細胞集塊の出現頻度とStromal Aの分岐数は, 組織分化度ならびに筋層浸潤の程度との相関はみられなかった.(2) Stromal Aを構成する細胞束は, 高分化型腺癌において層数の多い大きな細胞束が出現する傾向を認めた.(3) 筋層浸潤の程度が深いほど, 出現するStromal Aの細胞束が層数が大きい傾向を認めた.結論:子宮内膜細胞診における細胞集塊内のStromal Aの観察は, 組織の構造異型を反映する重要な情報であると考える.

Adenocarcinoma in situ of the uterine cervix.

背景: 今回子宮頸部細胞診で, 上皮内腺癌と診断しえた1例を経験したので報告する.症例: 症例は41歳で, 近医での子宮頸部細胞診で腺型細胞の異常を指摘され当科へ紹介となった.当科での細胞診でClassIV上皮内腺癌が疑われ, 円錐切除術を施行した.摘出病理組織診断では上皮内腺癌の診断であり, その後単純子宮全摘出術を施行した.結論: 子宮頸部の腺型病変が疑われる症例ではサイトブラシによる細胞診が有用であり, コルポ診での狙い病理組織生検では確定診断がつきにくく, 積極的な診断的円錐切除術が頸部腺癌の早期発見のために必要であると思われた.

Cytologic changes in cervical cancer due to intraarterial infusion chemotherapy primarily with a platinum preparation.

進行子宮頸癌症例に対しNeo-Adjuvant Chemotherapyとして白金製剤による動注化学療法を施行し, 子宮膣部剥離細胞の経時的変化を観察することにより, 治療効果判定の可能性を検討した.対象は1989年7月より1992年5月までに当科において診断された進行子宮頸癌患者14例である. 治療法は, シスプラチンもしくはカルボプラチンを左右の内腸骨動脈より注入した. 動注化学療法は3週ごとに2コース行い, 動注前および動注1コース後1週目, 2週目, 動注2コース後1週目, 2週目に子宮膣部病巣部より綿棒i擦過による細胞診を行った.細胞診では腫瘍細胞数および正常細胞数の推移, また, 細胞変化の個々の所見として, 腫瘍細胞における核腫大, 核濃縮, 空胞変性, 多角化の4つの所見の出現頻度に注目した.治療の経過に伴い腫瘍細胞数の減少および正常細胞数の増加傾向が認められ, 治療効果として治療開始後より核腫大, 核濃縮細胞の出現が著明で治療の経過に従い, 核濃縮細胞の出現頻度は減少した. また空胞変性細胞も治療開始後より認められたが増加傾向はみられず出現頻度は低かった. 多核細胞の出現頻度は治療の経過とともに増加し, 抗腫瘍効果を反映していると考えられ, 最も客観的な指標となりうると考えられた.