Tsutomu Arai

High expression of skp2 correlates with poor prognosis in endometrial endometrioid adenocarcinoma

Purpose: Skp2 interacts with the degradation of cyclin-dependent kinase inhibitor p27. This study aimed to investigate the correlation of skp2 expression with the expression of p27 and other cell cycle regulators, and clinicopathological parameters in endometrial endometrioid adenocarcinoma. Methods: Tissue samples of 136 endometrioid adenocarcinomas, in addition to 20 endometrial hyperplasias and 20 normal endometria, were immunohistochemically stained for skp2. The expression was represented as a labeling index (LI), which indicates the percentage of positive nuclei. Results: Skp2 staining was localized in the nuclei of the glandular cells of the proliferative phase endometrium, and endometrial hyperplasia and carcinoma cells. Skp2 expression was increased significantly in those of higher histological grade. The high level of skp2 expression was significantly correlated with the presence of lymph node metastasis and lymph-vascular space involvement. The LI of skp2 in endometrial carcinoma was significantly correlated with that of p27, Ki-67, cdk2, cyclin A, cyclin D1, cyclin E, p53 and PTEN. The high level of skp2 expression (LI≧20%) was significantly correlated with the patients’ poor survival. Conclusions: The skp2 level might have increased due to p27 accumulation and may be a good indicator of proliferative activity and poor prognosis.

Cytologic scoring of endometrioid adenocarcinoma of the endometrium.

Endometrial carcinoma is one of the most frequent malignancies in the female genital tract, and its incidence has been increasing in Japan. Histologic grade is an important factor for organizing treatment strategies, including hormone therapy, and for predicting the prognosis of the patient. The objective of this study was to evaluate the applicability and usefulness of cytologic scoring in assessing the morphologic differentiation of endometrioid adenocarcinomas of the endometrium using endometrial smears.

HEC-1 Cells: Establishment of an In Vitro Experimental System in Endometrial Carcinoma

The HEC-1 cell line was the first in vitro cell line of a human endometrial adenocarcinoma, which enabled us to perform research work on the endometrium and endometrial carcinoma at the level of a simplified cellular system; contributing to cell and molecular biological studies on endometrial carcinoma. Once a cell line is established, it provides a stable experimental system that facilitates and progresses the study of the tissues and/or neoplasias from which the cell line is derived. In this article, we report how HEC-1 cells have been established and cleared the proposed requirements to characterize an established cell line. In addition, in order to demonstrate the usefulness of the cell lines for research work once they have been established, we illustrate these concepts by recalling results obtained with HEC-1 and the HEC family of endometrial carcinoma cells and review the literature with regard to what has been achieved by using these cells.

Clinicopathologic relevance of asymptomatic endometrial carcinoma.

OBJECTIVE To assess whether screening asymptomatic women is significant for early detection of endometrial carcinoma. STUDY DESIGN We compared the clinicopathologic findings and prognoses of 21 asymptomatic patients with 427 symptomatic patients with endometrial carcinoma. RESULTS The incidence of asymptomatic endometrial carcinoma was 4.7%. Nineteen of 21 asymptomatic patients with endometrial carcinoma were found by cytologic screening for endometrial cancer. There was a statistical difference in the histopathology and depth of myometrial invasion between the asymptomatic and symptomatic groups. However, no statistical differences were found in tumor grade, lymph node metastasis, adnexal metastasis, cervical invasion, peritoneal cytology, surgical stage and patient age. Univariate analysis showed that the presence or absence of symptoms was not related to survival. CONCLUSION The detection of asymptomatic endometrial carcinoma is not related to a reduced mortality rate. Screening asymptomatic women for endometrial carcinoma is not recommended.

Assessment of transposed ovarian movement: how much of a safety margin should be added during pelvic radiotherapy?

Abstract The purpose of this study was to analyze transposed ovarian movement. Data from 27 patients who underwent ovarian transposition after surgical treatment for uterine cancer were retrospectively analyzed. Computed tomography (CT) images including transposed ovaries were superimposed on other CT images acquired at different times, and were matched on bony structures. Differences in ovarian position between the CT images were measured. The planning organ at risk volume (PRV) margins were calculated from the formula of the 90% reference intervals (RIs) and the 95% RI, which were defined as mean ± 1.65 standard deviation (SD) and mean ± 1.96 SD, respectively. The 90% RI in the cranial, caudal, anterior, posterior, left and right directions were 1.5, 1.5, 1.4, 1.0, 1.7 and 0.9 cm, respectively. The 95% RI in the corresponding directions were 1.5, 2.0, 1.7, 1.2, 1.9 and 1.2 cm, respectively. These data suggest that bilateral ovaries need a PRV margin of ∼2 cm in all directions. The present study suggests that a transposed ovary needs the same PRV margin as a normal ovary (∼2 cm). Even after transposition, ovaries should be kept away from the radiation field to take into consideration the degree of ovarian movement.

Endometrical cytology with thinlayer method-Usefulness for predicting prognosis of endometrical cancer before therapy-

目的: Thinlayer法による子宮内膜細胞診材料を用い, 術前予後判定法としての有用性を検討した.方法: 2004年4月～2005年5月の子宮内膜癌44例における, それぞれの外来時, 手術摘出時採取標本を対象とした.複数枚作製したThinlayer標本を用いてcyclin A, p53, Progesterone Receptor B (PR-B), Estrogen Receptor-α (ER-α) を免疫細胞化学染色し, 臨床病理学的因子と比較した.成績: cyclinA, p53が陽性である症例は, 低分化で, stageが進行しており, 脈管侵襲があり, 筋層浸潤が深いといつた悪性度の高い傾向を認めた.また, PR-B, ER-α が陽性であるものは, 高分化で, earlystageであり, 脈管侵襲はなく, 筋層浸潤が浅いといった悪性度の低い傾向を認めた.外来時および手術時採取標本におけるこれら各因子の染色結果は, 有意に相関していた.結論: Thinlayer法にて複数の標本を作製することにより, 免疫細胞化学への応用が可能となった.また, 術前予後判定法としての有用性が期待される.目的: Thinlayer法による子宮内膜細胞診材料を用い, 術前予後判定法としての有用性を検討した.方法: 2004年4月～2005年5月の子宮内膜癌44例における, それぞれの外来時, 手術摘出時採取標本を対象とした.複数枚作製したThinlayer標本を用いてcyclin A, p53, Progesterone Receptor B (PR-B), Estrogen Receptor-α (ER-α) を免疫細胞化学染色し, 臨床病理学的因子と比較した.成績: cyclinA, p53が陽性である症例は, 低分化で, stageが進行しており, 脈管侵襲があり, 筋層浸潤が深いといつた悪性度の高い傾向を認めた.また, PR-B, ER-α が陽性であるものは, 高分化で, earlystageであり, 脈管侵襲はなく, 筋層浸潤が浅いといった悪性度の低い傾向を認めた.外来時および手術時採取標本におけるこれら各因子の染色結果は, 有意に相関していた.結論: Thinlayer法にて複数の標本を作製することにより, 免疫細胞化学への応用が可能となった.また, 術前予後判定法としての有用性が期待される.

A case of ovarian carcinosarcoma with a recurrence of sarcomatous component suggested by ascites cytology

背景:卵巣癌肉腫はきわめてまれであり, 卵巣悪性腫瘍の1%以下とされている. 加えて, 腹水中に出現した卵巣癌肉腫の細胞所見を詳細に記載した報告もまれである. また, これらの報告では腺癌と組織型推定されている. 今回, 再発患者の腹水中に肉腫と判断される細胞が出現した症例を経験したので, その細胞像と病理組織像を比較検討した.症例:50歳, 女性. 主訴は下腹部痛. 平成12年6月, 内診および画像診断により最大径20cm大の卵巣腫瘍が指摘された. 同年7月, 術中の腹水細胞診にてClass V腺癌, 迅速組織診にて癌肉腫とされ, 単純子宮全摘術, 両側付属器切除術, 大網切除術および骨盤リンパ節郭清術が施行された. その後, 化学療法が行われたが再発し, 翌年3月, 腹腔内再発腫瘍切除術が施行された. 同時に行われた術中の腹水細胞診にて, 上皮性結合, 細胞質内の粘液や核縁の肥厚は認められず, 細顆粒状のクロマチン, 核の切れ込み, 核小体周囲の明庭などが確認されたところから, 肉腫細胞が示唆された.結論:まれな卵巣癌肉腫の細胞所見を呈示した. 腹腔内に進展する場合, 腺癌と細胞診断されることが多いが, 本症例では肉腫が再発の原因であった.