Masashi Imachi

Pulmonary metastasis from carcinoma of the uterine cervix

Of 817 patients with carcinoma of the uterine cervix that were treated and followed-up, 50 (6.1%) developed pulmonary metastases. The incidence of pulmonary metastasis was 3.2% in stage I, 5.0% in stage II, 9.4% in stage III, and 20.9% in stage IV disease. The incidence of pulmonary metastasis in patients with adenocarcinoma and undifferentiated carcinoma was higher. Of the patients in whom lung metastases were detected, 41.7% had no symptoms; 96% was diagnosed within 2 years from the initiation of treatment. All patients had abnormal shadows in chest X rays. We recommend that chest X rays be obtained every 2 months within the 8 months after treatment and every 6 months thereafter. Eighty-one percent of the patients had local recurrence or other distant metastatic lesions. The main treatment for these patients was chemotherapy, and CAP was effective for the patients with adenocarcinoma. Surgical resection of the pulmonary lesion may be an effective treatment for the patients who have no lesions in other sites.

Metastatic adenocarcinoma to the uterine cervix from gastric cancer. A clinicopathologic analysis of 16 cases

Background. Metastatic adenocarcinoma to the uterine cervix from gastric cancer is rare, and the clinicopathologic features of this metastasis are unclear.

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.

Peritoneal cytology in patients with endometrial carcinoma

Peritoneal cytology was obtained in 61 patients with carcinoma of the endometrium at the time of laparotomy. The incidence of positive peritoneal cytology was 23.0%. It increased as the clinical stage advanced. The incidence of positive peritoneal cytology in patients with well-differentiated carcinoma or superficial myometrial invasion was low. The rate of paraaortic lymph node metastasis was higher in patients with positive peritoneal cytology than in patients with negative peritoneal cytology. However, this trend was not recognized in pelvic lymph node metastasis. In the positive peritoneal cytology group, 64.3% had disease outside of the uterus, while in the negative group only 12.8%. The 2-year survival rate in patients with positive peritoneal cytology was 57.1% and it was 86.4% in patients with negative peritoneal cytology. It is concluded that the findings of positive peritoneal cytology is an important prognostic factor and routine peritoneal cytology should be obtained at the time of laparotomy in patients with carcinoma of the endometrium.

Bone metastasis from cervix cancer

Among 713 patients followed after treatment for cancer of the uterine cervix, 48 (6.6%) had a metastasis to the bone. The rates of metastasis in each of the four clinical stages were 11/273 (4.0%) in stage I, 16/243 (6.6%) in stage II, 13/162 (8.0%) in stage III, and 8/35 (22.9%) in stage IV, respectively. The most frequent site of metastasis was the vertebral column, particularly the lumbar spine (23 cases, 48%) followed by the pelvic bones. Pulmonary metastasis also frequently occurred. For 32 (67%), lesions of the bone were detected within 1 year after completion of the initial treatment, and 36 (75%) died within 1 year after detection of the metastasis. Those patients who survived over 2 years were those for whom the lesions of the bone had been treated by radiotherapy followed by chemotherapy.

Peritoneal cytology in patients with carcinoma of the uterine cervix

Peritoneal cytology was obtained in 125 patients with carcinoma of the uterine cervix at the time of laparotomy. The incidence of positive peritoneal cytology was 11.2%. Positive peritoneal cytology was found four times more frequently in adenocarcinoma than in squamous cell carcinoma. The incidence of pelvic lymph node and paraaortic lymph node metastasis was higher in patients with positive peritoneal cytology than in patients with negative peritoneal cytology. The 2-year survival rate in patients with positive peritoneal cytology was 30.0% and it was 82.7% in patients with negative peritoneal cytology. Some patients (28.6%) with positive peritoneal cytology developed peritonitis carcinomatosa. It was concluded that it is very important to obtain peritoneal cytology routinely at the time of laparotomy in patients with carcinoma of the cervix.

Malignant mixed müllerian tumor of the fallopian tube: Report of two cases and review of literature

Malignant mixed Müllerian tumors are usually found in the endometrium, vagina, cervix, and ovary. It is extremely rare for this tumor to arise in the fallopian tube, and to date only 37 tubal cases have been reported. We recently experienced 2 such cases. The clinical features, pathologic findings, diagnosis, therapy, and outcome of these 39 cases were reviewed. The clinical features and diagnosis were similar to those of primary carcinoma of the fallopian tube. Correct preoperative diagnosis was difficult. Histologically, 18 patients had homologous elements and 21 had heterologous elements in the sarcomatous components. The most common type of heterologous element was cartilage, followed by striated muscle and bone. The clinical stage (FIGO staging of ovarian carcinoma) was stage I in 15 cases, stage II in 11 cases, stage III in 8 cases, stage IV in 3 cases, and unknown in 2 cases. In all the patients except 1, the tumor was surgically removed. Postoperatively, radiotherapy was given to 9 patients, chemotherapy to 9 patients, and both to 2 patients. Sixteen patients died of the disease, after a mean period of 16.1 months. Of the 15 stage I patients, 10 survived more than 12 months. The most important prognostic factor was spread of the tumor at diagnosis.

Endometrial carcinoma in women aged 40 years or younger: a Japanese experience

We report on the clinical and pathologic findings in 17 cases of endometrial carcinoma in Japanese women aged 40 years or younger. Age of the patients ranged from 16 to 40 years, with a median of 35 years. Nine of 17 tumors (52.9%) were stage I or II (FIGO 1988) but 8 (47.1%) were stage III. Four of the 8 patients with stage III disease had pelvic lymph node metastases and one also had para-aortic lymph node metastasis. One patient had metastasis to the ovary and peritoneal cytology was positive in 4 patients. Histologically, 13 of these 17 patients had endometrioid adenocarcinoma, 3 had adenoacanthoma and 1 had an undifferentiated carcinoma. Ten were well differentiated tumors (G1), 3 were moderately differentiated tumors (G2), and 4 were poorly differentiated tumors (G3). Nine of 17 (52.9%) showed deep myometrial invasion (more than a half of the myometrium) and 5 of 17 (29.4%) demonstrated lymphatic/vascular space invasion. Pelvic and para-aortic lymph node metastases were seen in 4 of 15 (26.7%) and 1 of 15 (6.7%), respectively. Two of these 17 patients died of disease in a relatively short follow-up period. In our experience there is no difference in the survival rates between patients aged 40 years or younger and those over 40 years.

Cyclophosphamide-induced interstitial pneumonitis in a patient with ovarian carcinoma

A 40-year-old female with ovarian cancer being treated with daily oral cyclophosphamide developed fatal interstitial pneumonitis. Autopsy did not show any evidence of ovarian cancer. The review of the literature revealed eight reported cases of cyclophosphamide-induced interstitial pneumonitis and fibrosis. The case is reported to alert gynecologists to this rare but lethal complication of cyclophosphamide.

Malignant hemangiopericytoma of the omentum presenting as an ovarian tumor

Malignant hemangiopericytomas are usually found in the musculature of the extremities, the retroperitoneum, and the pelvis. Malignant hemangiopericytoma arising in the omentum is extremely rare. We recently experienced such a case, in which a malignant ovarian tumor was suspected preoperatively on the basis of the sonogram, CT scan, magnetic resonance image, and increased CA-125 value. Microscopically, the tumor showed many mitoses, increased cellularity, and cytologic atypia. The patient was treated with CAP combination therapy following resection of the tumor; however, an intraperitoneal recurrence probably due to implantation was recognized 11 months later.