Mitsunori Shioji

Apoptosis and Related Proteins in Placenta of Intrauterine Fetal Death in Prostaglandin F Receptor-Deficient Mice

Abstract The present study investigated whether the increase of apoptosis in the placenta is associated with intrauterine fetal death in prostaglandin F receptor-deficient mice. Apoptosis was demonstrated within placental and decidual tissue by the TUNEL method. The majority of apoptosis was found in syncytiotrophoblast tissues. Enhanced TUNEL-positive staining in the syncytiotrophoblast layer was scattered in the placental tissues in clusters of apoptotic cells in the death group. Marked TUNEL-positive cells were identified in decidua of both groups. The rate of apoptosis in the placenta and decidua in the death group was higher than that in the survival group (P < 0.05). Immunohistochemical analysis showed that the level of active caspase-3 protein expression in the placenta in the death group was much higher than that in the survival group. The level of Bcl-2 protein expression in the placenta in the death group was much lower than that in the survival group. Western blot analysis demonstrated that increased expression of the active form of caspase-3 was detected in the placenta and decidua in the death group compared with that in the survival group. In contrast, a decrease in the expression of Bcl-2 was detected in the placenta and decidua in the death group compared with that in the survival group. Enhanced expression of Bax:Bcl-2 ratio was detected in placenta and decidua in the death group compared with that in the survival group. Thus, significantly increased apoptosis in the mouse placenta and decidua might be involved in the pathophysiologic mechanism of intrauterine fetal death.

Reduction of aquaporin‐8 on fetal membranes under oligohydramnios in mice lacking prostaglandin F2α receptor

Aim:  To investigate the association between aquaporin‐8 (AQP‐8: a water channel protein) expression in fetal membranes and oligohydramnios during near‐term and postdate pregnancy, we set up an oligohydramnios model using prostaglandin F2α receptor (FP)‐deficient mice.

Postoperative administration of dienogest for suppressing recurrence of disease and relieving pain in subjects with ovarian endometriomas.

Abstract To assess the effect of dienogest on recurrence of ovarian endometriomas and severity of pain after laparoscopic surgery, a retrospective study of 81 patients was performed at three institutions in Osaka, Japan. Patients had a six-month minimum follow-up after laparoscopic surgery for ovarian endometriomas performed between June 2012 and August 2014. Patients who chose to receive 2 mg dienogest daily and those who were managed expectantly postoperatively were included. Recurrence was defined as the presence of endometriomas of more than 2 cm. A visual analog scale (VAS) was used to score the intensity of pelvic pain. The cumulative recurrence rate and absolute VAS score changes between the baseline and at 6, 12, 18 and 24 months after the start of administration were evaluated in both groups. The recurrence rate was 16.5% and 24.0% in the expectant management group at 12 and 24 months, respectively. No recurrences occurred in the dienogest treatment group. The rate of VAS score reduction was significantly higher in the dienogest than in the expectant management group. Dienogest is effective on the recurrence of ovarian endometrioma and relieving pelvic pain after laparoscopic surgery.

Serial Transvaginal Sonography of a Case of Complete Hydatidiform Mole

Sonography has achieved a position of preeminence in the diagnostic evaluation of molar gestation. However, little information is available about the serial change of the transvaginal sonographic features of molar pregnancy. We describe a case of complete hydatidiform mole, and present serial transvaginal views taken during the early gestational period.

Mesonephric adenocarcinoma of the uterine corpus with intracystic growth completely confined to the myometrium: a case report and literature review

BackgroundMesonephric adenocarcinoma (MA) is a rare tumor believed to arise from mesonephric remnants occurring mostly in the uterine cervix and, to a lesser extent, the corpus. Since the first case report of MA in the corpus in 1995, only 16 cases have been reported in the English literature. A recent report suggested that MA originates in Müllerian tissue and exhibits the mesonephric differentiation phenotype.Case presentationAn asymptomatic 61-year-old woman was referred to our hospital because of elevated levels of tumor markers. Imaging revealed an intramural lesion of the uterine corpus exhibiting fluorodeoxyglucose uptake. A total hysterectomy and bilateral salpingo-oophorectomy were performed. The tumor was completely confined to the corpus wall and was composed of an intracystic bulky component and an invasive component in the myometrial layer. The tumor exhibited a variety of growth patterns, including a characteristic tubular pattern with dense eosinophilic secretion reminiscent of the thyroid, as well as a variety of morphologies, such as acinar, papillary, and ductal structures. The structures were immunoreactive for CK7, vimentin, CD10, calretinin, PAX8, and GATA3 and almost completely negative for ER/PgR. CA125 and CA19–9 antigen expression was also detected.ConclusionA case of MA with a unique growth pattern of an intracystic mass within the corpus wall is presented. The histogenesis and differential diagnoses are discussed. The histogenesis of MA is not yet clear. We hypothesize two different pathways involved: 1) direct development from the mesonephric remnants and/or 2) mesonephric transformation of Müllerian adenocarcinoma.

Assessment of age‐specific safety of laparoscopic surgery in elderly patients with ovarian tumors

We assessed the age‐specific safety of laparoscopic surgery in elderly patients with ovarian tumors.

Sister Mary Joseph's nodule: Malignant transformation of umbilical endometriosis.

Dear Editor, Here, we report a rare case of Sister Mary Joseph’s nodule presenting as a primary adenocarcinoma arising from umbilical endometriosis. A 45-year-old woman presented with a nodule on the umbilicus. She clearly noticed it 3 months prior. A 20-mm diameter nodule with a purple-red skin surface was observed on the umbilicus (Fig. 1a). She often experienced umbilical discharge but did not complain of pain. Based on the clinical impression, the differential diagnoses included an urachal remnant, hernia and metastatic carcinoma. Magnetic resonance imaging showed a giant mass (30 cm 9 25 cm 9 16 cm) in the pelvis that was highly suspicious of uterine leiomyoma. Whole-body contrast-enhanced computed tomography (CT) did not reveal any lesions with the exceptions of the pelvic mass and umbilical nodule. Total hysterectomy and subsequent biopsy of the umbilical nodule were performed. Regarding the pelvic mass and the uterus, leiomyoma and endometrial hyperplasia were diagnosed. Regarding the umbilical nodule, adenocarcinoma was diagnosed. Additional positron emission tomography (PET)-CT and endoscopy of the esophagus, stomach, and small and large intestines did not detect a primary tumor; therefore, we considered the umbilical nodule either a primary adenocarcinoma of the urachal elements or an apocrine adenocarcinoma. Total resection of the umbilical tumor with a 1-cm margin and an intraoperative biopsy of an ovary were performed. A frozen section of the ovary revealed no malignancy. Endometrial glands adjacent to the adenocarcinoma were observed in the umbilical nodule specimens (Fig. 1b). Under immunohistochemical staining, both the glands of the endometrium and the adenocarcinoma were positive for cytokeratin (CK)7 and estrogen receptor (ER) (Fig. 1c) and negative for CK20. Based on these histological findings, we diagnosed the umbilical nodule as a primary adenocarcinoma arising from umbilical endometriosis. Endometriosis manifests as an umbilical nodule in less than 1% of all endometriosis cases. Malignant transformation is a rare complication of endometriosis and is estimated to occur in 0.6–0.8% of women with ovarian endometriosis. Additionally, there has been only a single report of an adenocarcinoma arising from umbilical endometriosis. The previously reported patient was a 60-year-old woman who underwent hysterectomy for a uterine myoma 12 years prior and presented with an umbilical tumor with bleeding, which was diagnosed as adenocarcinoma by biopsy. Like our patient, PET-CT examination revealed an abnormal accumulation only at the site of the umbilical lesion, and resection of the umbilical tumor clarified endometriosis adjacent to the adenocarcinoma. The authors surmised that the patient developed endometriosis at the umbilicus following hysterectomy, whereas our patient had no surgical history before she noticed the umbilical nodule. The most common origins of Sister Mary Joseph’s nodule are gastrointestinal (35–65%) and genitourinary (12–35%) carcinomas. In our patient, PET-CT, endoscopies, hysterectomy and an ovarian biopsy did not reveal malignancies other than the umbilical nodule. The malignant transformation of umbilical endometriosis has been reported only twice, including the present case. Therefore, additional cases are needed to estimate

Enormous Cystic Tumor of Peritoneal Psammocarcinoma Exhibiting Complete Response to Cisplatin and Cyclophosphamide after Suboptimal Cytoreduction: Case Report and Review of the Literature

Psammocarcinoma is a serous peritoneal tumor arising from the ovary or the peritoneum and characterized by low-grade nuclear features, extensive psammoma bodies, and invasiveness. Only 62 cases have ever been documented, 30 primary peritoneal and 32 primary ovarian, most of which presented as small tumors. Adjuvant therapies, including chemotherapy and radiation, were performed in 12 of the primary peritoneal cases, without any clear evidence of benefit. We present a case of an unusually large primary peritoneal psammocarcinoma with unexpected outcome. The patient was a 38-year-old woman with a tumor of the peritoneum which adhered densely to the uterus and rectum and developed into the intra-abdominal cavity and retroperitoneal space. After adhesiolysis of the tumor and rectum, suboptimal surgical reduction left a 4 cm × 2 cm tumor segment. Postoperative chemotherapy, consisting of paclitaxel and carboplatin (TC) for 1 course, and cyclophosphamide and cisplatin (CP) for 5 courses, was conducted. The residual tumor responded completely to the chemotherapy and the patient is alive today, with no evidence of disease 15 months after the surgery. Our case implies that CP therapy is a potential regimen of postoperative remission-induction therapy for suboptimally resected primary peritoneal psammocarcinoma.