Yoshiki Inoue

Evidence-based guidelines for treatment of cervical cancer in Japan: Japan Society of Gynecologic Oncology (JSGO) 2007 edition

Clinical practice guidelines for gynecologic cancers have been published by the National Comprehensive Cancer Network and the National Cancer Institute. Whereas these guidelines form the basis for the standard of care for gynecologic malignancies in the United States, it has proven difficult to institute them in Japan due to differences in patient characteristics, health-care delivery systems, and insurance programs. Therefore, evidence-based guidelines for treating cervical cancer specifically in Japan have been under development. The Guidelines Formulation Committee and Evaluation Committee were independently established within the Committee for Treatment Guidelines for Cervical Cancer. Opinions from within and outside the Japan Society of Gynecologic Oncology (JSGO) were incorporated into the final draft, and the guidelines were published after approval by the JSGO. These guidelines are composed of ten chapters and comprise three algorithms. Each chapter consists of a clinical question, recommendations, background, objectives, explanations, and references. The objective of these guidelines is to clearly delineate the standard of care for cervical cancer treatment in Japan in order to ensure equitable care for all Japanese women diagnosed with cervical cancer.

Immunohistochemical Studies on Matrix Metalloproteinase-9 (MMP-9) and Type-IV Collagen in Endometrial Carcinoma

Immunohistochemical staining of MMP‐9 and the type‐IV collagen was performed on paraffin sections of endometrial carcinoma. Immunostaining in 129 cases of endometrial cancer detected MMP‐9 in 19.0% of the cases. MMP‐9 positive was shown in 30% of the cases with vessel invasion, and in 12.7% of the cases without vessell invasion (p < 0.05). MMP‐9 showed positive in many cases with poor differentiation and lymph node metastasis, but still failed to achieve statistical significance. MMP‐9 staining did not correlate with disease outcomes. We can not clarify that MMP‐9 is associated with tumor‐cell invasion and metastasis. Type‐IV collagen deposition at the tumor‐stromal border was studied in 58 cases of endometrial carcinoma in which disruptions were seen in varying degrees. The type‐IV collagen in the primary lesion decreased as the differentiation decreased. Even in the lymph node metastasis lesions, the type‐IV collagen was stained and was almost in agreement with the primary lesions. In the primary lesions, there was no relationship between MMP‐9 staining and the type‐IV collagen. It was suggested that the type‐IV collagen observed in endometrial carcinoma was more concerned with the differentiation of the tumor than with the degradation by MMP‐9.

Clear cell adenocarcinoma arising from umbilical endometriosis.

Umbilical endometriosis is a very rare condition, and as far as we are aware, there have been no reported cases of its malignant transformation. Here, we report a case of clear cell adenocarcinoma arising from umbilical endometriosis in a 60‐year‐old woman who underwent hysterectomy for a uterine myoma at the age of 38, and who denied cyclic bleeding at the site of an umbilical cutaneous nodule correlating with menses until the age of 48. An umbilical tumor (3 cm diameter) was identified by magnetic resonance imaging and an abnormal accumulation was found only at the umbilical lesion by positron emission tomography examination. We observed endometriosis adjacent to the clear cell adenocarcinoma and transformation to carcinoma from endometriosis at the umbilical lesion histopathologically. Clear cell adenocarcinoma of the umbilicus was thought to have arisen from endometriosis; it expressed HER‐2 protein and showed strong mesothelial characteristics immunohistochemically.

Immunohistochemical Studies concerning Cathepsin D in Endometrial Carcinomas

Objectives: To study the prognostic value of immunohistochemical detection of cathepsin D and laminin in endometrial carcinomas.