Yasuya Kishi

Differences in clinical significance of blood group antigens A, B, and H in carcinoma tissue in the uterine cervix

The losses of blood group antigens A, B, and H in carcinoma tissue of the uterine cervix were studied by the avidin-biotin-peroxidase complex (ABC) method and the relations of these losses to invasion and dedifferentiation of primary cancer were examined. The incidence of cases showing complete loss of A or B antigen increased in proportion to the progression of cancer, but in most cases even of invasive cancer, H antigen, the precursor of A and B antigens, was detected. Complete loss of H antigen was not demonstrated in well-differentiated keratinizing invasive carcinomas, but was seen in 15% (15/101) of the cases of large cell non-keratinizing type cancer and 50% (8/16) of those of small cell non-keratinizing type cancer. No relationship was found between losses of A, B, and H antigens and parametrial spread of carcinoma or metastasis to the pelvic lymph nodes, but the incidence of death within 2 years after hysterectomy was higher in H antigen-negative cases than in H antigen-positive cases. These results indicate that loss of A and B antigens depends on some activity of invasion of cancer, while loss of H antigen strongly indicates dedifferentiation of cancer cells and also may indicate a poor prognosis.

Thickness of uninvolved fibromuscular stroma and extrauterine spread of carcinoma of the uterine cervix

The minimum thickness of cervical fibromuscular stroma remaining uninvolved with invasive cervical carcinoma was examined in relation to pelvic node metastases and 5‐year cancer death rate, using specimens from Stage IB, IIA, and IIB patients who underwent radical hysterectomy and pelvic lymphadenectomy. The nodal metastasis and 5‐year cancer death rates were 7% and 8%, respectively, in patients with the uninvolved fibromuscular stroma thickness above 3 mm, and 37% and 26%, respectively, in patients with the thickness below 3 mm. The thickness of cancer‐unaffected cervical fibromuscular stroma seemed to be closely related to and to be a more useful parameter of the biological behavior of invasive cervical carcinoma than the depth of the cancer invasion. A threshold value of the minimum thickness of the tissue as a barrier against extrauterine spread of cervical cancer could not be identified in this study.

Colposcopy for postmenopausal women

The number of postmenopausal women colposcopically diagnosed has markedly increased during the last 15 years. In some of them, a clear colposcopic impression, required for planning an appropriate therapy, was disturbed by severe senile cervicocolpitis, when examined by the conventional technique using acetic acid. With a 5-year experience of 79 paired colposcopies, it was concluded that estrogen administration is necessary as a routine precolposcopic procedure in such cases and oral administration of conjugated estrogens at 1.25 mg/day for 14 days is adequate for this purpose.

Carcinosarcoma of the uterine body of mesonephric origin

A case of carclnosarcoma of mesonephric origin in a 58 year old woman Is reported. A cystic tumor with a solid area, measuring 14 cm in greatest diameter, was detected in the pelvic cavity by computerized tomography and ultrasound. Although it was diagnosed as an ovarian cancer for surgical removal, it was found to be entirely located in the myomet‐rium of the left lateral wall of the uterine body and neither ovary was remarkable. Histologically the tumor was composed of epithelial and sarcomatous components. The former showed low papillary pattern, crowded solid nests and cords of cells, and focal tubular structures. The latter showed a solid growth pattern with differentiation to leiomyo‐sarcoma. In the uterine cervix, a 1.2 cm mesonephric (Gartners) cyst was found. Neither neoplastic lesions nor endometriosis were identified in the cervix, endometrium, fallopian tubes or ovaries. Based on the histologic features and the specific location of the tumor, the coexistence of Gartners cyst, and the normal appearance of the endocervi‐cal mucosa as well as the endometrium, it was diagnosed as a mesonephric carcinosarcoma. The serum levels of carci‐noembryonic antigen, CA125, CA19–9, and CA72–4 were within normal ranges in the clinical course. The patient died of disease 8 months after surgery.

Cervical neoplasia and gland openings

Abstract A colposcopic classification of gland openings of the uterine cervix is presented. It seems to be important not only in the diagnosis of early neoplastic lesions, but also in the exclusion of deep invasive carcinoma of the uterine cervix.

Colposcopic findings of gland openings in cervical carcinoma: Their histological backgrounds

During the past 8 years 1501 colposcopies were performed paying a special attention to cervical glands for diagnosis of cervical intra‐epithelial neoplasia (CIN) and carcinoma. Normal openings could exclude these diseases at the error rate of only 5.1%, while atypical openings could identify them at the high confidence rate of 96.3%. False positive evaluations were mostly attributable to a marked degree of squamous metaplasia in the glands. The absence of gland openings in the main portion of the lesions amounted to 88.6% in invasive carcinomas but to only 12.4% in CIN. Adenoma malignum was a highly characteristic exception.

Vaginal lesions of patients with invasive cervical carcinoma

Abstract Vaginal lesions in patients with cervical carcinoma were examined. These lesions seemed to be an extension of cervical carcinoma to the vagina. No cancerous tissue was observed at the vaginal resection edge in cases with cervical adenocarcinoma. Sewing a stainless steel device to the vaginal surface reduced the incidence of the lesion at the resection edge to about one third. The 5-year survival rate is 90% in patients with histological patterns of severe dysplasia or carcinoma in situ at the resection edge and 50% even in those with invasive patterns, perhaps because of intracavitary irradiation.

Two Autopsy Cases of Sucklings Dying from Arsenic Poisoning Contained Accidentally in Dry Milk

In regards to As-poisoning, there is a relatively large number of previous reports by KUCZINSKI,(~) O’LEARY(~) and others.(3). (4) However, crowded cases of poisoning in suckling who were given dry milk intermingled with As, are not encountered. The child was given MF-dry milk (5413). With the chief symptoms of anemia, sleeplessness, poor appetite and diarrhea, the child was sent to a physician, who heard systolic murmur in the heart. Under the condition of generalised weakness the child died. Autopsy findings. Gross appearance: A female child, 4 months afterbirth, stature 58 cm., poor nutritional condition, the skin of the forehead and around both eyes showed slight dark-brown pigmentation. Anemia, cyanotic lips and fingers of the extremities. Liver : 195 gr., enlarged, grayish-brown ; the cut surface revealed indistinct acinar figures. Heart : 50 gr., hypertrophic, a marked thickening of the right ventricle wall, gray-brown myocardium with whitish patches, increased consistency. Kidney: Left 16.5 gr., right 17 gr., demarcation between cortex and medulla partly indistinct. Both lungs and spleen congestive. Brain: Edema of the brain. The As comprised in the organs was calculated from 10 gr. of the examined tissue, and gave the following values in gamma : liver 5, kidney 19, heart 15.5 spleen 16, radius 15, which were mostly involved. Histologic findings. Liver: Atrophic liver cells, partly distorted, in the cytoplasm, vacuoles of varying sizes, which stained with Sudan I11 as orange granules. In the lesioned parts, small liver cell necrosis. Distended sinusoids contained protein-like substance. Kupffer’s cells, swollen, shed off, some fatty . tained accidentally in the dry milk was responsible for the poisoning.