Motoiki Koizumi

Distinctive features of female-to-male transsexualism and prevalence of gender identity disorder in Japan.

INTRODUCTION The prevalence of transsexualism is thought to differ among socio-geographic backgrounds, and little is known about its prevalence in Japan. Polycystic ovary syndrome (PCOS), which is known to be associated with insulin resistance and metabolic syndrome, is often seen in female-to-male (FTM) transsexual patients. Consequently, detection of PCOS is an important part of health care for these individuals. AIM The purpose of this study was to assess the prevalence of transsexuality in Japan, as well as the incidences of PCOS and insulin resistance among Japanese FTM transsexual patients. METHODS One hundred four male-to-female (MTF) and 238 FTM Japanese transsexual patients were studied. Medical histories, including histories of menstrual cycling and hormone treatment, were taken. To exclude other diseases, such as congenital adrenal hyperplasia and hormone-secreting tumors, thorough medical assessments, including transvaginal or transrectal ultrasonography and measurement of serum hormone levels and insulin resistance indexes, were performed. MAIN OUTCOME MEASURES The diagnosis of PCOS was based on the Rotterdam 2003 criteria. RESULTS Based on demographic statistics, the prevalences of MTF and FTM transsexuality are about 3.97 and 8.20 per 100,000 people, respectively, making the MTF-to-FTM ratio about 1:2. Of the FTM transsexual patients studied, 128 had not taken hormones before their initial assessment (untreated group); the remaining 50 self-administered androgen. Among the untreated group, 32.0% were diagnosed with PCOS, 30.1% were insulin-resistant, and 31.1% showed hypoadiponectinemia. CONCLUSIONS The sex ratio among Japanese transsexuals is different than among Caucasians. PCOS and insulin resistance are common findings in FTM transsexual patients at initial presentation.

Epidermal growth factor increased the expression of α2β1-integrin and modulated integrin-mediated signaling in human cervical adenocarcinoma cells

Epidermal growth factor (EGF) receptor (EGFR) is involved in various basic biochemical pathways and is thus thought to play an important role in cell migration. We examined the effect of EGF on motility, migration, and morphology of a human adenocarcinoma cell line CAC-1. EGF treatment increased the motility of cervical adenocarcinoma cells and promoted migration of the cells on fibronectin and type IV collagen. EGF induced morphological changes with lamellipodia during EGFR-mediated motility. The results of an immunoprecipitation study showed that EGF up-regulated the expression of alpha2beta1-integrin in a dose-dependent manner. EGF-induced cell migration was blocked by alpha2beta1-integrin antibody. Our results also showed that EGF treatment stimulated the level of tyrosine dephosphorylation of FAK, which is required for EGF-induced changes in motility, migration, and cell morphology. A tyrosine kinase inhibitor (ZD1839) blocked EGF-induced changes in cervical adenocarcinoma cells. The results suggest that EGF promotes cell motility and migration and increases the expression of alpha2beta1-integrin, possibly by decreasing FAK phosphorylation.

Immunohistochemical comparison of new monoclonal antibody 1C5 and carcinoembryonic antigen in the differential diagnosis of adenocarcinoma of the uterine cervix.

The reactivities of new monoclonal antibody 1C5 and anti-carcinoembryonic antigen (CEA) were determined immunohistochemically in 4 adenocarcinomas in situ, 20 invasive adenocarcinomas of various types, and 6 adenosquamous carcinomas of the uterine cervix, as well as in 10 endometrial adenocarcinomas and 10 normal cervices. Among the invasive adenocarcinomas, 90% were positively stained by 1C5 and 55% stained for CEA. Three of four in-situ adenocarcinomas were positively stained by 1C5 and two of four were positively stained by anti-CEA. All adenosquamous carcinomas were stained by 1C5 and four of six stained for CEA. Invasive adenocarcinomas always stained more intensely with 1C5 than did noninvasive lesions in the same specimen. Poorly differentiated adenocarcinomas were stained as strongly with 1C5 as were well-differentiated tumors, but CEA was less effective in identifying poorly differentiated lesions. 1C5 was also more useful than CEA was in distinguishing glandular from squamous neoplastic differentiation, and also appears to be useful in distinguishing endocervical from endometrial differentiation.

Multiple primary malignancies in patients with gynecologic cancer.

&NA; A retrospective analysis was made of 1044 patients with gynecologic malignancies treated in our department over a 12‐year period, in order to review the frequency and types of multiple primary neoplasms. Multiple primary neoplasms were detected in 45 (4.3%) cases, including 16 (2.1%) out of 733 cervical cancers, 14 (8.2%) out of 166 endometrial cancers, three (15%) out of 20 vaginal cancers and 12 (9.8%) out of 123 ovarian cancers. Fifteen cases were synchronous and the remaining 24 cases were heterochronous, with an average 4.9‐year interval. The most frequent other site of neoplasm was the breast, particularly in patients with endometrial or ovarian cancer. We conclude that gynecologic malignancies are often associated with primary cancers elsewhere, especially in the breast, stomach, colon and thyroid. A patient presenting with a gynecologic malignancy should be thoroughly examined for a second cancer, as should patients being followed‐up after treatment for genital tract cancer.

HMB-45 staining for cytology of primary melanoma of the vagina. A case report.

BACKGROUND Malignant melanoma in the vagina is very rare, but its diagnosis is usually easy if a melanin pigment is present. With cytodiagnosis, however, it is difficult to differentiate amelanotic melanoma or scantily pigmented melanoma from other conditions. In the present case, monoclonal antibody HMB-45, the efficacy of which has been established in histologic studies, was used in the cytodiagnosis of amelanotic melanoma in the vagina. CASE A woman, aged 78 years, presented with a brownish, nodular tumor, diameter 3 cm, in the vagina. Scraping smears with Papanicolaou staining showed nonepithelial malignant cells without granules suggesting melanin. Smears stained with HMB-45 showed positive immunoreactivity. The diagnosis underwent histologic confirmation of amelanotic melanoma on the initial biopsy. CONCLUSION Cytodiagnosis was made with HMB-45, which proved very effective in the differential cytodiagnosis of amelanotic melanoma and scantily pigmented melanoma, particularly because it obviated the need for tissue invasion.

A New Technique for Radical Hysterectomy with Emphasis on Preservation of Bladder Function

Bladder dysfunction always occurs, to varying degrees, following radical hysterectomy. In Japan, various techniques for preserving the pelvic autonomic nerves in a radical hysterectomy have been used to reduce the severity of bladder dysfunction. The authors describe a newly developed technique for preserving the pelvic autonomic nerves and present the post-operative urodynamic findings in cases in which this technique was used. Preservation techniques can be broadly classified into three types: preservation of the pelvic parasympathetic nerves, preservation of the pelvic sympathetic nerves, and preservation of the nerves to the bladder. In this new technique, as many of the pelvic parasympathetic nerves as possible are preserved when the cardinal ligament is cut. Then, the cardinal ligament is inserted into and pulled through the anterocranially located connective tissue in front of the pelvic plexus, which lies below the ureter. Finally, as many as possible of the vesical branching nerves are preserved ...

Cloning and characterization of a cDNA fragment coding β-casein-like protein preferentially expressed in cervical adenocarcinoma cell line CAC-1

We generated new murine monoclonal antibodies against bovine beta-casein. One of eight new monoclonal antibodies generated, 12G2, specifically reacted not only with beta-casein, but also with human cervical adenocarcinoma cell line CAC-1. To identify the gene encoding the putative protein (BCLP) defined by monoclonal antibody (mAb) 12G2, a complementary DNA library was constructed. We obtained the inserted cDNA fragment that showed high homology to reported DNA sequences of unknown function in normal human placenta. We think that BCLP was overexpressed or changed its structure by carcinogenesis.

Electron Microscopic Examination of Cytologic Samples

OBJECTIVE To review the results of observations of cytologic samples performed in our laboratory by light microscopy (LM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM) performed in succession (LM-SEM-TEM examination) using the same cytologic sample and to assess the diagnostic value of this method of successive examination. STUDY DESIGN Using a previously reported method of LM-SEM-TEM sample preparation and observation, we analyzed 201 cytologic specimens over a seven-year period (1986-1993) and investigated whether the histologic origin and malignancy can be estimated from SEM and TEM findings on the cells. RESULTS Observations of many cytologic samples over a seven-year period (by LM, SEM and TEM) showed that several basic interpretations of cellular ultrastructure are possible. In cases where cell identification was difficult by LM, electron microscopic findings were sometimes useful for determining the biologic characteristics of cells and for estimating their tissue origin. Electron microscopic findings also provided important information for cytodiagnosis. CONCLUSION SEM and/or TEM findings are useful for determining the morphologic (including biologic) characteristics of cells in cases where they cannot be determined by LM. With the accumulation of data on electron microscopic examination of cytologic samples, it is expected that in the future, electron microscopy will continue to provide new information that can be used to improve the accuracy of cytodiagnosis by LM.

A Report on More than 10,000 Vaginal Hysterectomies Performed Without Ligation of the Paracervical Ligaments

Objective: To review 10,016 cases of total vaginal hysterectomy (TVH) performed in our department by a method without ligation of the paracervical ligaments.

Three cases of uterine serous adenocarcinoma.

背景: 非常に予後不良であり, また有効な術後補助療法の確立されていない子宮内膜漿液性腺癌3症例を経験したので報告する.症例: 平均年齢68.7歳, 全例が不正性器出血を主訴に他院を受診し, 内膜細胞診が疑陽性または陽性のため精査・治療目的で紹介となる.細胞計測結果は, 核は円形～ 楕円形で, 核長径は, 平均11.5±2.4μm, 核短径, 10.4±2.0μmと小型であり, 細胞質内には空胞を認めることが多く, 核小体 (平均2.4±0.4μm) が著明.術後病理組織分類はそれぞれpT3aNlMO, pTlbNOMOそしてpTlcNlMOであった.術後補助療法として2症例に化学療法, 1症例に放射線療法が追加施行.その後前2症例は再発し死亡, 1例は経過観察中である.結論:臨床診断上, 細胞診所見が特徴的であり, ブドウ房状, 乳頭状の細胞集塊, 核は小型で, 細胞質はN/C比大, さらに砂粒小体を認める場合がある.また一般的に筋層浸潤が浅くとも, 子宮外に浸潤していることが多いとされているが, 本症例でもその傾向は明らかであり予後不良の一因と考えられた.