Shinichi Tate

Early invasive cervical adenocarcinoma: its potential for nodal metastasis or recurrence

Objective To investigate the potential for nodal spread or recurrence in patients with early invasive cervical adenocarcinoma. The possible application of the International Federation of Gynecology and Obstetrics (FIGO) classification (1994) to this variant was also examined.

Ectopic chromosome around centrosome in metaphase cells as a marker of high-risk human papillomavirus-associated cervical intraepithelial neoplasias.

This report describes the appearance of ectopic chromosome around centrosome (ECAC) in metaphase cell nuclei of high‐risk HPV‐associated cervical neoplasms. ECAC are clearly visible on HE‐stained sections as a tiny (approx. 0.7 μ), round, dark structure or an aggregate of filamentous chromosome, often symmetrical at bilateral centrosomes. They appear in CINs from an early stage (CIN I), with the highest incidence in HPV16‐associated CIN II–III (75%), and are less common in HPV‐related invasive carcinomas (21%) and in lesions associated with high‐risk HPV types other than 16. Rates for ECAC‐positive nuclei in metaphase preparations (ECAC rate) for each lesion ranged 3.6–30%, the average being 14.5%. ECAC appeared very rarely in CINs associated with intermediate‐risk HPVs and was never encountered in HPV6/11‐induced condylomas or HPV‐unrelated neoplasms in other organs. ECAC may be morphologic evidence of HPV‐induced chromosomal instability working as a background mechanism in cervical carcinogenesis and also a useful marker for the histopathologic differentiation of high‐risk CINs.

Retroperitoneal lymphadenectomy for ovarian cancer with double inferior vena cava

Objective Double inferior vena cava (IVC) is present in 1.0%–3.0% of the general population and can create clinical problems [1,2]. This anomaly is classified according to the presence and pattern of an interiliac vein; 23% of double-IVC cases do not have an interiliac vein, and variations exist in those with one [3]. Fewreports on retroperitoneal lymphadenectomy in patients with a double IVC exist. Herein, we show retroperitoneal lymphadenectomies in two patients with different double IVC classifications. Methods We performed an interval debulking surgery, including retroperitoneal lymphadenectomy, in two cases of advanced ovarian cancer with double IVC. The retroperitoneal lymphadenectomy procedure was the same as that for patients with normal IVC. Case 1 involved a 53-year-old female having a double IVC without an interiliac vein. Case 2 involved a 51-year-old female having a double IVC with an interiliac vein from the right common iliac vein to the left IVC. Preoperative enhanced computed tomography revealed double IVC flow pattern in both cases; however, the presence of the interiliac vein in case 2 remained unrecognized. Results Lymphadenectomy in case 1 was without complications. In case 2, major bleeding from the interiliac vein occurred during lymphatic tissue removal from the front of the sacral region. The bleeding was difficult to stop, and was finally stopped using Tacho Sil®. We then completed lymphadenectomy. Conclusions During retroperitoneal lymphadenectomy in patients with a double IVC, it is important to determine the presence of an interiliac vein. Furthermore, its flow pattern should be considered with care.

Comparative analysis of endometrial cytology between endometrial serous adenocarcinoma and ovarian or fallopian tubal serous adenocarcinoma.

目的: 子宮内膜細胞診において, 子宮体部の漿液性腺癌と卵巣, 卵管の漿液性腺癌の鑑別を目的に, 細胞学的検討を行った.方法: 1977年～1998年の21年間, 癌研究会附属病院にて手術を施行し, 確定診断された子宮体部漿液性腺癌32症例と, 子宮内膜細胞診陽性であった卵巣, 卵管原発の漿液性腺癌21症例を対象とした.子宮内膜細胞診はすべて増淵式吸引スメア法で採取した.結果: 細胞標本が見直し可能であった42例中, 子宮体部原発の26症例と, 卵巣, 卵管原発の16症例 (うち, 卵管癌7例) について細胞像を比較した.子宮体部漿液性腺癌では背景が腫瘍性 (92%) で, 正常子宮内膜細胞の混入は少なく, 腫瘍細胞集塊の辺縁が鋸歯状不整 (85%) な症例が多くみられた.一方, 卵巣, 卵管の漿液性腺癌では背景がきれい (81%) で, 正常子宮内膜細胞が多数混在しており, 腫瘍細胞集塊の辺縁が平滑 (94%) な症例が多くみられた.また, 腫瘍細胞集塊の構成細胞数は子宮体部漿液性腺癌では125.8±9.4個, 卵巣および卵管の漿液性腺癌では54.6±4.9個であり, 子宮体部漿液性腺癌の方が有意に多かった (t-test; p=0.000).結論: 子宮体部漿液性腺癌と卵巣, 卵管原発の漿液性腺癌は, 子宮内膜細胞診上個々の腫瘍細胞形態のみでは, 区別が困難であるが, 背景や集塊の出現形式, 正常子宮内膜細胞の混在に注目すると区別が可能と考えられた.