Yoshiko Kashimura

Gestational trophoblastic disease in women aged 50 or more

Twenty cases of gestational trophoblastic disease in women aged 50 or more are reported. The lesions were 7 hydatidiform mole (35%), 8 invasive mole (40%), and 5 choriocarcinoma (25%). The most common presenting symptom was abnormal vaginal bleeding. Three choriocarcinoma patients were postmenopausal and all of them had choriocarcinoma. None of the patients with hydatidiform mole or invasive mole died of the disease, but 4 of 5 choriocarcinoma patients died of the disease. Because of the high rate (56.3%) of malignant sequelae after molar evacuation, a primary hysterectomy for the treatment of hydatidiform mole in this age group is recommended. It is important to maintain a high level of suspicion for the diagnosis of gestational trophoblastic disease in the elderly women.

Prophylactic chemotherapy for hydatidiform mole: five to 15 years follow-up

The effectiveness of the prophylactic chemotherapy was evaluated in 420 patients with molar pregnancy. All patients were followed for 5 to 15 years after the evacuation. Twenty‐two (7.5%) of 293 patients with prophylactic chemotherapy and 23 (18.1%) of 127 patients without prophylactic chemotherapy (control) developed secondary trophoblastic disease. The prophylactic chemotherapy could reduce the occurrence of secondary trophoblastic disease. In these secondary trophoblastic diseases, 5 (22.7%) of 22 patients in the prophylactic chemotherapy group and 5 (21.7%) of 23 in the control had metastatic trophoblastic disease. Choriocarcinoma after the molar pregnancy developed in two patients (0.7%) of the prophylactic chemotherapy group and two (1.6%) of the control. Prophylactic chemotherapy did not eliminate the occurrence of choriocarcinoma. The complication of the prophylactic chemotherapy was seen in 27.3% of the patients. Neither severe complication nor death were related to the toxicity. Cancer 58:624‐629, 1986.

Choriocarcinoma occurring within the normal placenta with breast metastasis

Abstract Choriocarcinoma of the breast was found during pregnancy in a patient who had been delivered of a hydatidiform mole 3 years earlier. Serial sections of the grossly normal placenta revealed multiple, minute foci of Choriocarcinoma. Two sections showed the very early developmental stage, or the borderline lesion, of Choriocarcinoma. We are presenting this unusual case with a review of the literature.

Placental site trophoblastic tumor: Immunohistochemical and nuclear DNA study

A rare case of placentae site trophoblastic tumor (PSTT) studied by immunohistochemistry and nuclear DNA analysis is reported. The patient, a 24-year-old Japanese female, complained of amenorrhea. Dilatation and curettage revealed a small specimen that contained trophoblastic cells and caused intractable bleeding. Pelvic sonography revealed a 5-cm mass in the posterior uterine wall with multiple cystic lesions of several sizes. The cystic lesions were shown to be dilated vessels by magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Serum beta-hCG (beta subunit of human chorionic gonadotropin) was 3.7 ng/ml. Total abdominal hysterectomy revealed a well-circumscribed, yellow, soft mass in the posterior uterine wall. Microscopic findings were consistent with PSTT and the mitotic count was extremely low. Immunohistochemically, most of the tumor cells were intensely stained with human placental lactogen, whereas few were stained with human chorionic gonadotropin. The nuclear DNA content of the trophoblastic cells showed a sharp peak at the triploid range coexistent with a few cells of higher ploidy. This is the first report of sonographic findings and nuclear DNA analysis by spot cytometry in a case of PSTT.

Histological study of microinvasive carcinoma of the uterine cervix

Abstract Fifty-three cases of microinvasive carcinoma, 107 cases of carcinoma in situ , and 52 cases of dysplasia were studied histologically. When the original squamocolumnar junction (SCJ) was defined as it was at the last cervical gland, most of the abnormal epithelia located in the zone between this SCJ and 10 mm proximal to SCJ. Concerning the spreading extent of abnormal epithelium there was an apparent tendency that the more severe the lesion, the wider was the extent. The circumferential extent of the lesions was closely correlated to the longitudinal extent. The type of invasion was classified into four groups: drop, fingerlike, bulky, and confluent type. Since many invasions which began from the surface epithelium remained within 1 mm in depth, and invasions from a cervical gland were initially noted in deeper areas, the depth of invasion measured from the surface epithelium may not directly reflect the progression of the lesions.

Cellular characteristics of Arias-Stella reaction in ectopic pregnancy. Immunocytochemical studies with epithelial membrane antigen and vimentin

OBJECTIVE Endometrial cytology in nine cases of ectopic pregnancy was examined in order to elucidate the cellular characteristics of the Arias-Stella reaction and decidual change. STUDY DESIGN The cellular findings of epithelial and stromal cells were compared with histologic findings in each case. Furthermore, the immunocytochemical reactivity of each type of cell cluster-epithelial cells without atypia, epithelial cells with atypia, deep stromal cells and sheetlike stromal cells-to epithelial membrane antigen (EMA) or vimentin was investigated and compared with cytologic findings in smears stained with Papanicolaou stain. RESULTS The distribution of each type of cell cluster correlated fairly well with the histologic findings on the endometrium. Immunocytochemical examination revealed that EMA expression coincided with cell origin identified by Papanicolaou stain. Epithelial cells with atypia, probably corresponding to the Arias-Stella reaction, frequently showed positive reactivity to antivimentin antibody as well as anti-EMA antibody. Endometrial stromal cells usually indicated negative reactivity to anti-EMA antibody. Deep stromal cells expressed vimentin, but sheetlike stromal cells, thought to be decidual cells, infrequently expressed vimentin. CONCLUSION The Arias-Stella reaction may be the result of the regenerating and proliferating activity of endometrial glands. It is still controversial whether sheet-like stromal cells are identical to decidual cells.

A quantitative study of nuclear DNA of trophoblastic cells: Proliferation kinetics

The nuclear DNA contents of labeled and unlabeled nuclei of trophoblastic cells of 8 normal pregnancies, 2 missed abortions, and 14 cases of trophoblastic diseases were measured by Feulgen-DNA cytofluorometry combined with autoradiography. Syncytiotroblasts were rarely labeled and were considered to be inactive with regard to cell proliferation. Most of the labeled cells were cytotrophoblasts. The predominantly labeled cells ranged between 2 and 4C in cases of normal pregnancy and missed abortion, and a shift to a higher ploidy was seen in the more grave trophoblastic disease. From the point of cellular proliferation kinetics of trophoblastic cells, it is presumed that the cells in cases of normal pregnancy and type I hydatidiform mole are in the 2C cell cycle and in type II hydatidiform mole and in invasive mole there are heterogeneous cell populations, most of which are in the 2C cell cycle while the remaining are undergoing polyploidization or aneuploidization. In choriocarcinoma, the cells are not in the 2C cell cycle and also are probably undergoing polyploidization or aneuploidization in the hyper-4C area.

Evaluation of the colposcopically directed biopsy and the cone biopsy

Abstract Cytology and colposcopically directed biopsy were performed in 110 cases of borderline lesions of the cervix, of which 90 cases had cone biopsy. The correct diagnosis rate of colposcopically directed biopsy and the role of cone biopsy were evaluated. The correct diagnosis rates of directed biopsy of dysplasia, carcinoma in situ (CIS), and microinvasive carcinoma were 73, 77, and 45%, respectively. Cone biopsy was considered necessary in making an exact diagnosis of borderline lesions, since there was a fair discrepancy between the results of cone biopsy and colposcopically directed biopsy. Seventy-five of 90 cases had hysterectomy following cone biopsy. Though there were residual lesions found in the cervices of the removed uteri, they were not more severe than those found by cone biopsy. The frequency of the residual lesion in the removed uteri was 35% in total, 26% in CIS, and 52% in microinvasive carcinoma. There was a trend that, the more progressive the lesion, the more residual lesions were found. It is therefore very dangerous to perform conization as a definitive therapeutic method.

Evaluation of Pregnancy-Related Cells in Endometrial Cytology

OBJECTIVE To determine the significance of pregnancy-related cells in endometrial smears. STUDY DESIGN Pregnancy-related cells in 4429 endometrial smear samples were retrospectively analyzed and evaluated for clinicopathologic and cytomorphologic features. RESULTS Of the 4429 endometrial smears taken for cancer screening, pregnancy-related cells were detected in 12 cases (0.3%). They were estimated cytologically as negative or suspicious and confirmed as cases ofspontaneous abortion (8 cases), placental site nodule (3 cases), and partial hydatidiform mole (1 case). Decidual cells were observed in all cases, and some of these showed atypia. Trophoblasts were observed in 5 (41.7%) of the 12 cases. Syncytiotrophoblasts were observed in 1 case (8.3%) and nonsyncytiotrophoblasts in 5 (41.7%) of the 12 cases. Pregnancy-related cells were observed in an endometrial smear in 7 cases; other cases were missed during cytologic examination and were retrospectively identified. CONCLUSION Pregnancy-related cells are likely to be missed because they are difficult to identify or are surrounded by a cluster of endometrial cells. The decidual cell is a key cell for the cytologic diagnosis of pregnancy-related cells. Determining the existence of pregnancy-related cells in endometrial smears is important for the further assessment of patients and the differential diagnosis of several endometrial lesions.

Cytologic Studies of Endometrial Adenocarcinoma

子宮体癌患者38例について, 治療前細胞診と病理組織診との関連性を検討した. 内膜スメアでは癌の分化度と異型細胞出現率との間に関連性はなく, 高分化型腺癌, 低分化型腺癌いずれにも高い出現率が認められたが, 頸管スメアでは低分化型腺癌ほど異型細胞出現率が高いという結果が得られた.癌の筋層浸潤度による異型細胞出現率の違いでは, 頸管スメア, 内膜スメアいずれにおいても筋層浸潤度と異型細胞出現率との問に関連性は認められなかった. しかし頸管浸潤のあるものでは, 高い異型細胞出現率が頸管スメアで得られた.体癌細胞診の特徴について, 細胞診の背景と正常内膜細胞の出現状態という点から検討を行った. 腫瘍性背景は頸管スメアよりも内膜スメアにおいて高い頻度でみられ, また頸管スメアでは腫瘍性背景を示しながら異型細胞が認められないものもあった. 閉経後体癌患者の頸管スメアでは, 比較的高頻度に正常内膜細胞が認められるものがあり, このなかには異型細胞が認められないものもあった.