Kihyoe Ichinoe

Incidence of ovarian metastasis in patients with cancer of the uterine cervix

With the recent advances in general surgery, the treatment of cervical cancer has been markedly improved to increase the five-year survival rate after radical hysterectomy. Therefore, the operative main attention has recently been directed towards conservative surgery for the function of pelvic organs as well as towards the therapeutic improvement of cervical cancer. The most crucial point for the preservation of the ovary at the time of the operation is whether the cancer metastasizes to the ovaries or not. In order to answer this question, the factors influencing metastasis, such as; the clinical stages, the cancer cell types and the cancer extension to the uterine corpus, were studied. A total of 679 cases of cervical cancer stage 0 and stage Ia were treated surgically with a simple hysterectomy preserving the ovaries in orthotopic position during the period of 1970 to 1984. Three hundred eleven patients of invasive carcinoma in stage Ib to stage IIIb were operated on by a radical hysterectomy with lymphadenectomy from 1977 to 1985. Histopathological examination was performed on specimens of the ovaries to determine the metastasis. In order to study the incidence of the ovarian metastasis in advanced cancer patients, the data of the autopsied 674 cases who died of cervical cancer without surgical therapy were obtained from Annual of the Pathological Autopsy Cases in Japan (1965-1978). Follow-up observations on the 679 patients of stage 0 or stage Ia after the operation revealed no recurrence in these cases. This indicates that almost no ovarian metastasis occurs in the patients of early cervical carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Human lymphocyte antigen expression in hydatidiform mole: androgenesis following fertilization by a haploid sperm.

Thirteen hydatidiform moles (complete moles) and lymphocytes from each parent were analyzed for human lymphocyte antigen (HLA-A and HLA-B specificities). It was demonstrated that molar tissues expressed homozygous A and B specificities which were identical to those of the father and not those of the mother. It was concluded that androgenesis was responsible for the pathogenesis of most cases of complete mole. There was homozygous expression of paternal HLA specificities which were heterozygous for A locus and/or B locus in eight of nine cases of complete mole. This suggests that these hydatidiform moles developed from an egg which was fertilized by a haploid sperm which duplicated its own chromosomes after meiosis.

Nonsurgical therapy to preserve oviduct function in patients with tubal pregnancies.

Surgical treatment for tubal pregnancies greatly impairs the subsequent fertility of patients because of salpingectomy and its complicated adhesions. Nonsurgical methotrexate therapy was developed to avoid such complications. Although early detection was of prime importance, resolution of ectopic pregnancy was obtained in 22 patients (95.7%) with methotrexate administration alone. Patency of the oviducts was evaluated with hysterosalpingography and/or laparoscopy in 19 patients after termination of methotrexate treatment. In 10 of 19 patients (52.6%), complete patency of the involved oviduct confirmed the validity of this regimen. Severe side effects were not observed in any of the 23 patients.

Marker chromosomes of the long arm of chromosome 1 in endometrial carcinoma

Cytogenetic studies were performed on endometrial specimens of four patients with hyperplasia, six with adenocarcinoma, and one with a mixed mesodermal tumor. Except for one cell, all 65 cells from the hyperplastic specimens had a normal female karyotype. However, a total of 92 cells from the five adenocarcinoma specimens had chromosome abnormalities, though all 20 cells from a specimen of a well differentiated adenocarcinoma showed a normal karyotype. The chromosome number and morphology of the aneuploid cells had minimal changes. The modal number of chromosomes was pseudodiploid in one case and hyperdiploid in four cases. Three kinds of structural abnormalities involving chromosomes #1 were identified to be of clonal origin: del(1p21) in two cases, tdic(1;16)(p21;q24) in one case, and i(1q) markers in two cases. Because the carcinoma cells had two chromosomes #1 of normal morphology, the presence of the marker chromosome led to partial trisomy or tetrasomy of the long arm of chromosome #1. This involvement may be assumed to represent a karyotypic change characteristic of some adenocarcinomas of the endometrium. Complex karyotypes with many rearranged chromosomes were observed in cells from the mixed mesodermal tumor. The karyotypic differences between endometrial carcinoma and the mixed medodermal tumor suggest that the genesis (and its mechanism) of the former may differ from that of the latter.

The Propensity to Malignancy of Dispermic Heterozygous Moles

Complete hydatidiform moles may originate from either the fertilization of an empty egg by a haploid sperm followed by duplication (producing a monospermic, homozygous mole) or the fertilization of such an egg by 2 haploid sperm (producing a dispermic, heterozygous mole). This difference in the mechanism leading to the formation of complete moles raises the question of whether the risk of subsequent malignancy is influenced by the zygosity of the mole. In the research reported here, we compared the incidence of postmolar sequelae between patients with homozygous and heterozygous moles. Using chromosomal heteromorphism, HLA and PGM1 polymorphisms, we established the androgenetic origin of complete mole in 82 of 91 cases. Homozygosity was confirmed in 51 moles, and we found 10 heterozygous moles. Five of 10 patients with heterozygous moles developed postmolar trophoblastic disease, whereas only 2 of the 51 patients with homozygous moles had postmolar trophoblastic disease (an additional 5 patients showed signs of degenerating residual trophoblasts). A high incidence of sequelae after the expulsion of heterozygous moles suggests that the heterozygous constitution of allelic genes plays an important role in the process of malignant transformation of trophoblasts.

A further HLA study of hydatidiform moles

Abstract Five newly obtained hydatidiform moles (complete moles) and lymphocytes from each parent were analyzed for HLA antigen specificities of the A and B loci. The results obtained were not inconsistent with the results observed in 13 cases of complete moles in our first report that mole tissues expressed HLA antigens, and that those specificities were homozygous A and B specificities which were identical to one of the paternal specificities, not the maternal ones. Further, up to date in the literature, the number became 27 cases of complete and invasive moles by adding present ones, where HLA specificities were analyzed. Seventeen cases (22 loci) of the 27 moles had the heterozygous father on the A and/or B loci. These observations confirmed as we suggested in our first report that fertilization of the androgenetic diploid mole with a 46, XX karyotype occurred by a haploid sperm, not a diploid sperm, followed by duplication as a postmeiotic event.

Factors associated with clinical reactions to rubella vaccination in women

Two types of rubella vaccine were given to 272 seronegative healthy Japanese adult women. Clinical and laboratory studies on clinical reaction after vaccination were carried out on HI antibody response, HLA types, basal body temperature (BBT), menstrual cycles and serum progesterone levels of vaccinees. Clinical reactions were not associated with HLA types of vaccinees, but arthropathy occured significantly more often in women vaccinated at the progestational stage than in women vaccinated at the estrogenic stage.

Long arm deletion of the X chromosome, 46,X,del(X)(q21), associated with gonadoblastoma

SummaryA 28-year-old woman with short stature was found to have bilateral gonadoblastoma in the dysgenetic ovaries. Chromosome banding analysis of her cultured blood cells and skin fibroblasts revealed a terminal deletion of the long arm of the X chromosome, 46,X,del(X)(q21), as the sole karyotypic anomaly. None of the Xq- patients so far reported were associated with gonadoblastoma.

Serial monitoring of serum estradiol and progesterone levels during the HMG‐HCG therapy in six anovulatory women

Serum estradiol (E2) and progesterone (P) levels were radioimmunoassayed every or every other day for monitoring the HMG‐HCG therapy in six anovulatory patients, and the clinical significance of measuring steroid hormones as precautionary counter‐plot against the ovarian hyperstimulation syndrome and multiple pregnancies was evaluated.

The serum pregnancy-specific β1-glycoprotein to betahuman chorionic gonadotrophin ratio as an index of prognosis in patients with choriocarcinoma

Summary. The ratio of serum pregnancy‐specific β1‐glycoprotein (SP1) to the β‐subunit of human chorionic gonadotrophin (β‐hCG) before and after chemotherapy was measured in 12 patients with metastatic choriocarcinoma. The ratios before chemotherapy ranged between 0.03 and 0.75, with a mean value of 0.34 (SD 0.21). The ratio increased to over 1.0 (1.05–53.3) after one or two courses of chemotherapy in seven of the 12 patients. These women achieved complete remission. In the other five patients who died of the disease due to drug resistance of the tumour, the ratio after chemotherapy was low (0.04–0.74) and tended to decline. These data suggest that the serum SPl/β‐hCG ratio can be used to predict the prognosis of patients with choriocarcinoma.