Ken Takizawa

Case report of a 69-year-old woman with double cancers: Primary yolk sac tumor of the right ovary and primary serous surface papillary carcinoma of the peritoneum

This extremely rare case of a 69-year-old woman with yolk sac tumor of the right ovary and serous surface papillary carcinoma (SSPC) of the peritoneum is reported. Histological diagnosis for both tumors was done according to the classifications of the Japanese Society of Pathology and Japan Society of Obstetrics and Gynecology. To confirm the histological diagnosis, both immunocytochemical studies for alphafetoprotein (AFP) and carcinoembryonic antigen (CEA), and immunohistochemical studies for AFP, CEA, CA19-9, and CA125 were performed. Serum AFP and CA125 levels were serially determined. On hematoxylin and eosin staining an endodermal sinus pattern associated with Schiller-Duval bodies was observed in the right ovarian tumor. However, papillary serous carcinoma was found on the surface of the almost normal sized left ovary and in the omental metastatic nodules.

Pregnancies following conservative treatment of malignant ovarian tumors

SummarySixteen patients with malignant ovarian tumors were treated conservatively; 1 had a serous cystadenoma of low potential malignancy; 6 had a mucinous cystadenoma of low potential malignancy; 2 had a pure dysgerminoma; 2 had a mature solid teratoma; 3 had a mucinous cystadenocarcinoma; and 2 had an endodermal sinus tumor. Postoperative chemotherapy was given in 12 cases and 1 patient with a pure dysgerminoma had radiotherapy. Eighteen pregnancies occurred in 13 patients. One full-term and one 8 month premature infant died in utero, and 2 infants had malformations; the other 14 infants are all well. The patient with moderately differentiated mucinous cystadenocarcinoma who delivered a premature infant and 2 patients with endodermal sinus tumors died of recurrence.

Case of a 23-year-old woman with serous surface papilloma of borderline malignancy of the left ovary and mucinous cystadenoma of the right ovary

A rare case is reported of a 23-year-old woman with serous surface papilloma of borderline malignancy (SSPBM) of the left ovary associated with a foci of peritoneal “implant,” as well as the coexistence of mucinous cystadenoma of the right ovary. The histologic diagnosis of these tumors was classified according to the criteria of the World Health Organization. To confirm the histologic diagnosis, special staining was performed both with AIcian blue, periodic acid-Schiff (PAS), and PAS with diastase digestion, and with immunohistochemical staining for vimentin, cytokeratin, epithelial membrane antigen (EMA), neuron-specific enolase, and carbohydrate antigen 19-9 (CA 19-9). After hematoxylin and eosin staining of the tissue samples, the right ovarian tumor was diagnosed as benign mucinous cystadenoma, and the left ovarian tumor was identified as serous surface papilloma with no apparent stromal invasion, but showing proliferating activity and nuclear abnormality (SSPBM). The histologic features of the peritoneal lesion resembled those of the SSPBM of the left ovary, and showed no invasion of underlying normal tissue. Moreover, both the SSPBM and the peritoneal lesion showed similar patterns on special staining. The summary diagnosis was SSPBM of the left ovary associated with a foci of peritoneal noninvasive “implant” and coexistent mucinous cystadenoma of the right ovary. Regardless of whether or not the peritoneal loci represented an autochthonous multicentric tumor of the peritoneum or a secondary implant from the left SSPBM, the less aggressive histologic character of her tumors has allowed this patient to survive for 8 years after fertility-retaining surgery with no sign of recurrence.

The clinical evaluation of cytological diagnosis during pregnancy in the management of severe dysplasia, carcinoma in situ and invasive cancer complicating pregnancy.

最近9年間に当科で経験した妊娠に関連した異常細胞診と子宮頸部異形成・上皮内癌および浸潤癌について, 臨床的に検討した.1) 1984年から1992年までに実施した妊婦8012例の初診時細胞診は, ClassV2例, Class IV5例, Class IIIb7例, Class III13例, Class IIIa22例で要精密検診者は, 49例 (0.61%) であった.このうち35例 (71.4%) が精密検診を受け, 浸潤癌2例, 上皮内癌8例合計10例 (0.13%) の子宮頸癌と, ほかに2例の高度異形成が発見された.2) 妊娠が終了した9例の細胞診, 組織診の変遷をみると, 4例では組織診より細胞診断がより軽い判定であり, 標本採取不良がその原因と思われた.産褥時の組織診では, 妊娠中より, より進行した病変は認めなかったので, 上皮内癌以下の場合には保存的管理を行い得ること, 分娩方法も産科的適応に従って対処し得ることが判明した.3) 産褥1年以内に子宮頸部高度異形成以上の病変を認めた5症例は先行する妊娠時の細胞診が陰性であったが, その原因は, 標本採取不良であった可能性が考えられた.妊婦の癌検診では, 子宮腟部 (要すれば頸管部) の確実な擦過により, 適切な細胞診を行うことが重要だと思われた.