Kensaku Teshima

Studies on the Histogenesis of Cervical Adenocarcinoma

The uterine cervices of 58 patients with cervical adenocarcinoma (seven in situ, 16 microinvasive, and 35 frank invasive) were studied along with 210 cervices that did not show any disease. Squamous metaplasia was confirmed in surface and cleft epithelium, but not in the deepest area of the gland-bearing portion of the cervix. Ectopic endometrial glands were observed in two of the 210 cases. The maximum extent of in situ and microinvasive endocervical adenocarcinoma was located in the area of the primary cleft; and that of endometrioid adenocarcinoma, in the deepest area of the gland-bearing portion. It is suggested that endocervical adenocarcinoma originates from the primary cleft and that neoplastic epithelium replaces normal gland epithelium starting from the shallow part of the cleft and spreading to the deep part of the cervical canal. Endometrioid adenocarcinoma is considered to originate mainly from the cells of the deepest tunnels, as well as from ectopic endometrial glands; its initial growth occurring by means of invasive proliferation into the stroma.

Immunotherapy using the streptococcal preparation OK-432 for the treatment of uterine cervical cancer. Cervical Cancer Immunotherapy Study Group.

The effectiveness of immunotherapy using a streptococcal preparation, OK-432, was evaluated for cervical cancer. The 382 eligible patients were stratified by presence/absence of surgical operation and clinical stage, and then, in each stratum, were randomly divided into two groups: an OK-432 treatment group and a control treatment group. The 3-year recurrence-free rates of 221 patients in the OK-432 group and 161 patients in the control group were 71.9% and 58.6%, respectively. The intergroup difference was statistically significant (P less than 0.05). Delayed skin reactions to phytohemagglutinin (PHA) and Su-polysaccharide extracted from Streptococcus pyogenes Su-strain (Su-PS) and peripheral lymphocyte counts were reduced within two months after the initiation of therapy in both groups. The observed immunological changes were apparently reversed by 3 months after the start of the therapy in the OK-432 group, but this took at least one year in the control group, with significant intergroup differences at 6 and 12 months of the therapy (P less than 0.01). These results indicate that OK-432 can be considered as one of the most effective and useful immunotherapeutic agents for cervical cancer.

Screening of the uterine cervical adenocarcinoma - Cytological analysis in cases of followed-up patients.

頸部腺癌は近年増加傾向が指摘されているが, その初期のものは細胞診上陰性と判定されやすい.本研究では, 集検における頸部腺癌のスクリーニング上の注意点を知るために, 集検初診時に発見された初期腺癌12例, 一定期間のfollowup後に発見された初期腺癌11例の細胞所見を詳細に検討した結果つぎの結論を得た.1.過半数 (13例) に扁平上皮型異型細胞の存在を認めた.したがって, 扁平上皮型異型細胞の存在する場合は, 同時に腺型異型細胞の有無に注目する必要がある.2.スクリーニング上癌の基準を満たさない腺型異型細胞に着目する必要があり, その所見は不規則重積性, 柵状配列, 核小体肥大である.3.腺型異型細胞が持続し生検陰性の場合は, 早い時期に円錐切除による確認を行わなければならない.

Diagnosis of Microinvasive Cervical Cancer

初期頸癌の細胞像と組織像を対比検討し, 次の結論を得た.1) 微小浸潤癌の細胞像は, 深層型悪性細胞の他に中表層型悪性細胞が出現し, また, 悪性細胞 相互に多彩性が認められ, さらに, 小数ながらbizarre cell, cellular detritusが出現する.2) 細胞診上出現するcellular detritusは, 組織像にみられるnecrotic substanceやparakeratosisと相関性がある.3) 細胞診上中表層型悪性細胞が出現していた症例のなかには, 組織学的に分化傾向を示さないが, 表層から離れてfocal differentiationを有するものがあり, スクレーパーによりかなり深部の細胞を擦過採取してくることが示唆された.4) 油浸観察の結果, 微小浸潤癌では, 粗顆粒状不均等分布クロマチンおよび核縁の全周にわたる不整所見が出現し, 悪性細胞のうち2μ以上の核小体が10%以上, インディアナインク状クロマチン10%以上, 核縁の一部不整のものが25%以上にみられた. このことは高倍率観察所見を加味することによって, 微小浸潤癌の細胞学的診断の精度をより向上させうることを示している.

A subclassification of cervical dysplasia according to the cytoplasmic differentiation

Sixty-four cases of dysplasia, high degree, of cervical epithelium were histologically classified into immature, premature and mature dysplasia according to their cytoplasmic maturation.Cytologic samples of the same cases were also classified into metaplastic, nonkeratinizing and keratinizing dysplastic cell type by the description of Dr. S. F. Patten.No keratinizing dysplastic cells were found in the immature dysplasia classified histologically.Metaplastic dysplastic cells were scarcely included in the mature dysplasia.The samples classed to the premature dysplasia had various cell types.