Takafumi Izumi

Primary squamous cell carcinoma of the endometrium.

A rare case of primary squamous cell carcinoma of the endometrium, probably originating from adenomyosis, is presented. A 58-year-old Japanese woman was referred to Kitasato Institution Medical Center Hospital to explore the cause of her postmenopausal bleeding. The endometrial cytology specimen obtained with the Endocyte (an device for endometrial check up) showed cells suggesting well differentiated squamous cell carcinoma. The patient underwent modified radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy, followed by postoperative radiation therapy. The dissected uterus revealed keratinizing-type squamous cell carcinoma localized in the fundal portion of the uterine body and invading deeply into the myometrium, coexistent with a large area of adenomyosis with a transitional area to carcinoma. The residual endometrium was atrophic. There was no atypical finding in the cervix. Human papilloma virus DNA was not detected. The carcinoma recurred 26 months after the surgery, and the patient died of the disease.

Cytological study of endometrial cell cluster

エンドサイトを用いて採取された無病正常例354例の内膜細胞診標本を詳細に観察し, 子宮内膜腺細胞塊normal glandular cell cluster (n-GCC) と子宮内膜間質細胞塊normal stromal cellsheet (n-SCS) に注目し, これを規定した. また, 内膜細胞診標本1枚あたりにみられたn-GCC, rSCSの出現数, 出現頻度を検討し, 以下の結果を得た.(1) 年齢別に検討したところ, n-GCCは20歳代, 30歳代, 40歳代において出現数, 出現率ともに多く認められ, 50歳代以後では有意に漸減していた (p<0.01). n-SCSも同様減少したが, 60歳以後で, n-GCCに比べ一年代遅かった (p<0.01).(2) 性周期別に検討した177例では, 分泌期に比べ増殖期でn-GCCの判別が容易であり, 出現数も有意に多かった (p<0.025). (3) 閉経前後で検討した270例では, 閉経後n-GCCの平均出現率が1.7個であり, 閉経前10.1個に比べ著しく少なかった (p<0.01).以上, 正常内膜細胞診に出現する細胞塊をn-GCC, n-SCSとして把握し, 年齢, 性周期, 閉経の有無によるそれらの出現パターンを理解しておくことは, ともすれば細胞診断が難しい子宮内膜異型増殖症や分化型子宮内膜癌の早期発見に役立つ基礎的資料となり得ると考える.

A trial of YAG Laser vaporization for pelvic endometriosis.

A trial of YAG Laser vaporization for pelvic endometriosis. Takafumi Izumi,Hirotane Suga and Tastuo Genda Department of Obstetrics and Gynecology, Kitasato Institute Medical Center Hospital,Saitama Abstract: Me report a case of YAG Laser vaporization for residual endometrial ovarian cyst which had been treated by LH-RHa for 10 month . The case was 37-years-old ,P(1)G(1).She consulted our hospital because of severe algomenorrhea.By pelvic examination severe tenderness of Douglas pouch and left ovarian cyst was found out and bilateral ovarian cysts were revealed by CT,echo image.Serum level of CA-125 was 56U/ML, CA19-9 was 43U/ML.She had been treated by LH-RHa for 10 month on the diagnosis of bilateral ovarian chocolate cysts and pelvic endometriosis . The size of ovarian cysts was redused and her complains of algomenorrhea was softened.But 4 month later algomenorrhea and tenderness of duoglas pouch recurred. After , successing of treatment by LH-RHa for 4 month laparoscopy was done. By findings of pelvic cavity,left ovary was enlarged as over hens egg sized and adhered to douglas pouch.This adhesion was convinced as the cause of recurred algomenorrhea. After punctation of the surfase of the left ovary and absorption of the chocolate contents, latex balloon named VP-16 was inserted and swelled by 15ml saline solution and was oppressed to the ovarian surface. YAG laser was irradiated through the balloon by output power of 10 watts for 5 minutes.The inner surface was degenerated evenly. Me incised a part of it and confirmed degeneration by microscopy . During all these procedure there was no apparent side effects. After this procedure algomenorrhea was diminished and ovarian enlargement has not been observed.