Yoshiya Miyahara

Value of fusion of PET and MRI for staging of endometrial cancer: Comparison with 18F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI

PURPOSE To investigate the diagnostic value of retrospective fusion of pelvic MRI and (18)F-fluorodeoxyglucose ((18)F-FDG) PET images for assessment of locoregional extension and nodal staging of endometrial cancer. MATERIALS AND METHODS Thirty patients with biopsy-proven endometrial cancer underwent preoperative contrast-enhanced PET/CT (PET/ceCT) and pelvic dynamic contrast-enhanced MRI for initial staging. Diagnostic performance of PET/ceCT, contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) for assessing the extent of the primary tumor (T stage) and metastasis to regional LNs (N stage) was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis. RESULTS Fused PET/MRI and MRI detected 96.7% of the primary tumors, whereas PET/ceCT detected 93.3%. Accuracy for T status was 80.0% for fused PET/MRI, and MRI proved significantly more accurate than PET/ceCT, which had an accuracy of 60.0% (p=0.041). Patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis were 100%, 96.3% and 96.7% for both fused PET/MRI and PET/ceCT, and 66.7%, 100% and 96.7% for MRI, respectively. These three parameters were not statistically significant (p=1). CONCLUSION Fused PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for assessment of the primary tumor and nodal staging in patients with endometrial cancer.

Super high-dose intraarterial cisplatin infusion under percutaneous pelvic perfusion with extracorporeal chemofiltration for advanced uterine cervical carcinoma I. analysis for pharmacokinetics, tumor response, and toxicity of platinum

&NA; The present study was designed to elucidate the clinical feasibility of a new intraarterial infusion system with an extracorporeal charcoal chemofiltration circuit, which is expected to achieve a super high‐dose cisplatin pelvic perfusion with a limited systemic exposure to platinum. After inferior vena cava isolation was percutaneously achieved by balloon catheter technique, cisplatin (140–240 mg/m2) was administered by selective intrauterine arterial infusion, with inferior and superior gluteal arterial embolization. The platinum‐containing blood was pumped through an extracorporeal charcoal chemofiltration circuit. Pharmacokinetics, tumor response, and toxicity of platinum under this system were studied in 14 patients with locally advanced uterine cervical carcinoma. Extracorporeal charcoal filters significantly (p < 0.05) reduced the prefilter area under concentration‐time curve of plasma‐free platinum by 86.7 ± 5.2% at postfilter site and 76.3 ± 6.6% at peripheral circulation, respectively. Although all adverse effects were mild under this system, tumor response and tissue platinum concentrations were augmented dose dependently with the administration of cisplatin. The extracorporeal chemofiltration system achieved a super high‐dose cisplatin pelvic perfusion with the minimal adverse effects, allowing further cisplatin dose escalation with further augmented tumor response. This will contribute to the reduction in the extent of disease of locally advanced uterine cervical carcinoma.

The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage

Abstract Objective: The transcatheter pelvic arterial embolization (TAE) is effective for postpartum hemorrhage (PPH). There has been a little information about the factors for ineffectiveness of TAE. The aim of this study was to determine factors associated with TAE failure for PPH. Study design: Fifty-five women who underwent TAE for intractable PPH were included. Clinical factors involving age, history of pregnancy, gestational weeks of delivery, mode of delivery, causes of PPH, complete blood count, blood loss volume, transfusion amount, shock index and disseminated intravascular coagulation (DIC) score were compared between TAE success group (n=48) and TAE failure group (n=7). Results: The uni- and multi-variate analyses revealed that advanced maternal age (OR 1.46, 95% CI 1.12–2.18) and retained placenta as a cause of PPH (15.48, 2.04–198.12) were found to be significant factors for TAE failure. Conclusion: The advanced age and retained placenta were independent factors associated with TAE failure for intractable PPH.

Role of diffusion weighted imaging and contrast-enhanced MRI in the evaluation of intrapelvic recurrence of gynecological malignant tumor.

Background and Purpose To investigate the diagnostic performance of diffusion-weighted imaging (DWI) and contrast-enhanced imaging in combination with T2-weighted imaging (T2WI) for magnetic resonance imaging (MRI) evaluation of intrapelvic recurrence of gynecological malignancies. Materials and Methods Sixty-two patients with suspected intrapelvic recurrence of gynecological malignancies underwent pelvic MRI including T2WI DWI, and contrast-enhanced imaging. Diagnostic performance for detection of local recurrence, pelvic lymph node and bone metastases, and peritoneal lesions was evaluated by consensus reading of two experienced radiologists using a 5-point scoring system, and compared among T2WI with unenhanced T1-weighted imaging (T1WI) (protocol A), a combination of protocol A and DWI (protocol B), and a combination of protocol B and contrast-enhanced imaging (protocol C). Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. Receiver operating characteristic (ROC) analysis and McNemar test were employed for statistical analysis. Results Locally recurrent disease, lymph node recurrence, peritoneal dissemination and bone metastases were present in 48.4%, 29.0%, 16.1%, and 6.5% of the patients, respectively. The patient-based sensitivity, specificity, accuracy, and area under the ROC curve (AUC) for detection of intrapelvic recurrence were 55.0, 81.8, 64.5% and 0.753 for protocol A, 80.0, 77.3, 79.0% and 0.838 for protocol B, and 80.0, 90.9, 83.9% and 0.862 for protocol C, respectively. The sensitivity, accuracy, and AUC were significantly better for protocols B and C than for protocol A (p<0.001). There was no significant difference between protocols B and C. Conclusion MRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies.

Super high-dose intraarterial cisplatin infusion under percutaneous pelvic perfusion with extracorporeal chemofiltration for advanced uterine cervical carcinoma II. its impact on clinical response and subsequent surgery

&NA; The present pilot study was conducted to investigate the clinical efficacy of super high‐dose intraarterial cisplatin infusion with percutaneous pelvic perfusion under extracorporeal chemofiltration (PPPEC) for locally advanced uterine cervical carcinoma. Cisplatin (140—240 mg/m2) was infused in uterine arteries in a neoadjuvant setting in 20 patients under the PPPEC system twice during a 2‐week interval. Fourteen of 17 patients in whom reduction of the disease (tumor downstaging) was confirmed underwent radical surgery. Despite the tumor downstaging, the remaining three patients had poor PS and the other three showed insufficient stage regression. Clinical responses, histologic responses, and surgical review were studied. The rate of overall tumor response (complete response plus partial response), tumor downstaging, overall histologic response, and radical surgery performance after the second course of PPPEC were 95.0%, 85.0%, 95.0%, and 70.0%, respectively. Curative surgery, defined as negative carcinoma cells in surgical margins, was achieved in 85.7% of the cases, whereas the rate of complete surgery defined as negative carcinoma cells both in surgical margins and regional lymph nodes was 42.9%. With 42 months of median follow‐up time, 3 of the 14 surgical patients died of the original disease, and the remaining 9 patients are in recurrence‐free survival, whereas 2 patients are alive with disease. PPPEC achieved a high frequency of rapid tumor downstaging of locally advanced uterine cervical carcinoma without severe adverse effects and resulted in the favorable performance of the subsequent radical surgery and prognosis.

Expression of Epithelial-Mesenchymal Transition-related Factors in Adherent Placenta.

Epithelial-mesenchymal transition is a key process influencing cancer progression and metastasis. The purpose of this study was to investigate the expression of epithelial-mesenchymal transition-related factors in chorionic villi and decidual cells in adherent placenta. The current study included 19 patients diagnosed with adherent placenta after hysterectomy. The expression of E-cadherin, Vimentin, Snail, and transforming growth factor-&bgr; in placental tissues was analyzed by immunohistochemical staining. Immunostaining intensity was semiquantitatively evaluated using the HSCORE algorithm. In the chorionic villi of the invasive part (placenta with invasion into myometrium), E-cadherin expression was significantly lower than that in the noninvasive part (placenta with no invasion). In the decidual cells of the invasive part, expression of transforming growth factor-&bgr; and Snail significantly increased. These results suggest that epithelial-mesenchymal transition may contribute to excessive trophoblast invasion into the myometrium in adherent placenta.

In vitro fertilization-embryo transfer pregnancy was a risk factor for hemorrhagic shock in women with placental polyp

Abstract Objective: The aim of this study was to determine the risk factors for hemorrhagic shock in women with placental polyp. Materials and methods: Twelve women (group A) developed hemorrhagic shock (shock index < 1.5) and received uterine artery embolization (UAE). The other 25 women (group B) had shock index < 1.5 and did not receive UAE. All women underwent transcervical resection (TCR). The risk factors for the development of hemorrhagic shock, including the age, conception mode, numbers of previous abortion, gestational weeks at termination of pregnancy (TOP), blood loss weights at TOP and at TCR, were analyzed. Results: When compared with group B, group A had higher in vitro fertilization-embryo transfer (IVF-ET) pregnancy rate (58.3 versus 12.0%, p < 0.01), number of previous abortion (median 1.58 versus 0.68, p < 0.05), gestational weeks at TOP (median 36.5 versus 17.0 weeks, p < 0.05), and blood loss weight at TOP (median 2151 versus 40 g, p < 0.05). A logistic regression analysis reveled that IVF-ET (OR 41, 95% CI 1.3–1264) and blood loss weight at TOP (1.0025, 1.0006–1.0044) were independent risk factors for hemorrhagic shock. Conclusions: For the first time, IVF-ET pregnancy was found to be a risk factor for the development of hemorrhagic shock in women with placental polyp.

Transient Increase in Squamous Cell Carcinoma Antigen Expression in Cultured Cervical Carcinoma CaSki Cells in Response to Exposure to cis-Diamminedichloroplatinum

The present study was conducted to elucidate the molecular mechanism underlying the transient increase in circulating squamous cell carcinoma antigen (SCC Ag) levels in response to cis-diamminedichloroplatinum (CDDP) infusion using an in vitro model. The uterine cervical squamous carcinoma CaSki cells were cultured for 72 h after 3 h exposure to 5.0 µg/ml CDDP. The effects of CDDP exposure on the proliferative activity and apoptosis in cultured CaSki cells were determined by bromodeoxyuridine (BrdU) uptake and cell counting and by the TUNEL assay, respectively. SCC Ag levels in cultured CaSki cells and culture media were determined with the use of SCC-RIA kit. The expression of SCC Ag-1 mRNA and SCC Ag-2 mRNA in cultured CaSki cells was assessed using semiquantitative RT-PCR with Southern blot analysis. The number of BrdU-positive CaSki cells significantly decreased 6 h after exposure to CDDP, whereas the apoptosis-positive rate of cultured CaSki cells significantly increased 12 h after the CDDP exposure. The number of cultured CaSki cells significantly decreased 72 h after the CDDP exposure. The total SCC Ag protein levels in both cultured CaSki cells and the culture media after the 3-hour CDDP exposure increased in a time-dependent manner during the subsequent incubation for 48 h. Semiquantitative RT-PCR revealed that the expression levels of both SCC Ag-1 and SCC Ag-2 mRNA increased (1.7- and 2.7-fold, respectively) 12 h after the exposure to CDDP relative to those before the subsequent cultures. Exposure of uterine cervical squamous carcinoma CaSki cells to CDDP resulted in a transient increase in SCC Ag protein and mRNA expression in those cells during the initial 12 h after the exposure, being associated with decreased proliferative activity and increased apoptosis of those cells.

Ectopic pregnancy in a patient undergoing therapy for ovarian hyperstimulation syndrome: a case report

We report a case of an ectopic pregnancy removed via laparoscopic surgery in a patient undergoing therapy for ovarian hyperstimulation syndrome (OHSS). A 36-year-old woman, with a history of egg retrieval after ovulation induction with human menopausal gonadotropin and human chorionic gonadotropin (hCG), was referred to our hospital because of abdominal pain and bloating. Ultrasound examination showed an 8-9 cm bilateral adnexal mass and subphrenic ascites. She was diagnosed with moderate OHSS. Despite conservative therapy, symptoms did not improve and the bilateral adnexal mass did not decrease in size. Serum hCG level was 6339 mIU/ml. Ultrasound examination did not detect a gestational sac in the uterus. Magnetic resonance imaging indicated a cystic mass in the peritoneal cavity. We strongly suspected ectopic pregnancy in the abdominal cavity. Laparoscopic surgery and intrauterine curettage were performed. The histopathological diagnosis was peritoneal pregnancy. Symptoms disappeared and serum hCG levels decreased. We believe that the peritoneal pregnancy caused OHSS. Even if there is a period when of pregnancy failure via assisted reproductive technology, ectopic pregnancy should be considered. Pregnancy should be confirmed and egg retrieval performed before initiating medical treatment in patients with OHSS.

Adenocarcinoma Represents the Most Frequent Pathological Type among Giant Ovarian Tumors Weighing More than 5,000 g

Objectives: The aim of this study was to evaluate the relation between pathology, operative complications and giant ovarian tumor weighing more than 5,000 g. Materials and Methods: We assessed eleven factors of 18 patients with giant ovarian tumors after surgery, including age, Performance Status (PS), total weight of the tumor, fluid weight of the tumor, pathology, side, preoperative serum D-dimer, rate of Deep Venous Thrombosis (DVT), intraoperative complications (rate of intra-abdominal adhesion and blood loss weight), and rate of postoperative ICU management. The subjects were divided into two groups: tumor weight ≥10,000 g (group ≥10,000 g) and tumor weight <10,000 g (group <10,000 g), and the same factors were compared between two groups. Results: The most frequent pathology of giant ovarian tumors weighing more than 5,000 g was found to be adenocarcinoma. Compared with eleven patients of group<10,000 g, seven patients out of group ≥10,000 g had significantly higher PS (median: 3 vs. 1, p<0.05), rate of intra-abdominal adhesion (85.7% vs. 9.0%, p<0.05), fluid weight (15.000 g vs. 4.400 g, p<0.05), blood loss weight (890 g vs. 130 g, p<0.05), and rate of postoperative ICU management (85.7% vs. 18.2%, p<0.05), respectively. Conclusions: Much attention should be paid to patients with giant ovarian tumors who confined to bed more than 50% of waking hours (PS 3 or 4), and aggressive surgery is recommended due to a frequent incidence of cancer.