Transcervical needle biopsy for the differential diagnosis between uterine sarcoma and leiomyoma

BACKGROUND

The clinical differential diagnosis between uterine sarcoma and benign leiomyoma is difficult even with magnetic resonance imaging (MRI). Therefore, a considerable number of patients have undergone hysterectomies due to an indication of "suspected malignancy" based on tumor size alone. However, approximately 80% of these hysterectomies have been judged to have been recommended inappropriately. In such situations, reliable preoperative diagnostic tests are required. The authors have evaluated the accuracy of needle biopsy for uterine myoma-like tumors, a procedure that to the authors' knowledge has been performed infrequently.

METHODS

Transcervical needle biopsy was performed in 435 patients with uterine myoma-like tumors. The biopsy specimens were scored for degree of malignancy according to the histopathologic criteria proposed by Bell et al. Histopathologic evaluation of surgical specimens and clinical outcome after 2 years of follow-up were used as the reference standards.

RESULTS

Of 435 patients, 7 had uterine sarcomas, 4 of which were scored as > or = 4 points and were diagnosed as "sarcoma" by needle biopsy alone. No sarcoma cases were included in the group of patients with a score of 0. The cutoff score combining the highest sensitivity and specificity with respect to distinguishing uterine leiomyosarcoma from uterine leiomyoma was 2; sensitivity, specificity, and positive and negative predictive values were 100%, 98.6%, 58%, and 100.0%, respectively.

CONCLUSIONS

Transcervical needle biopsy using histopathologic scoring is a reliable diagnostic test for the differential diagnosis between uterine sarcoma and leiomyoma. This diagnostic method, combined with MRI screening, could reduce the number of patients currently undergoing unnecessary surgery.

Cyclic changes in the umbilical arterial flow in mono-chorionic, di-amniotic twin pregnancy

OBJECTIVE

To determine the effect of arterio-arterial anastomosis on the umbilical arterial flow in mono-chorionic, di-amniotic twin pregnancy.

SUBJECTS

Thirty-three women with mono-chorionic, di-amniotic twin pregnancy.

METHODS

Pulsed Doppler ultrasonographic examination was performed every 4 weeks to obtain umbilical arterial flow velocity waveforms in both two fetuses.

RESULTS

In five of the women, cyclic flow changes in the umbilical arterial flow were detected in the smaller fetus. All of these twins had arterio-arterial anastomosis on the surface of the placenta.

CONCLUSION

The fetuses in mono-chorionic and di-amniotic twin gestation who showed cyclic changes in umbilical arterial flow had arterio-arterial anastomosis. But, this characteristic flow was not observed every time.

Shrinkage effect of gonadotropin releasing hormone agonist treatment on uterine leiomyomas and t(12;14)

Specific chromosomal abnormalities, e.g. del(7q), t(12;14), 12 trisomy, and the rearrangement of 6p, are seen in approximately 30% of uterine leiomyomas. We investigated the association between the shrinkage effect of GnRH agonist on uterine leiomyomas and t(12;14), the second most frequent chromosomal abnormality in myomas. This study involved 42 women with uterine leiomyomas treated with a gonadotropin releasing hormone (GnRH) agonist before surgery. The volume of the largest myoma nodule was measured by MRI before and at 12 weeks after the beginning of GnRH agonist treatment, and the percentage change in volume was calculated. A specific chromosomal abnormality, t(12;14), was examined on thin sections of frozen leiomyomas by fluorescence in situ hybridization with chromosome-specific probes. Of the 42 tumors, 8 (19%) showed translocation. The mean (+/- SD) percentages change in volume of the largest myomas without and with translocation were -32+/-24 and 23+/-60%, respectively (p=0.006). The myomas showing translocation had significantly less reduction in size with GnRH treatment than did those without translocation. No myoma with trisomy 12 was found. On the basis of our results, we assumed that uterine leiomyomas showing t(12;14) are not so dependent on ovarian hormones for growth.

Telomerase activity in needle biopsied uterine myoma-like tumors: differential diagnosis between uterine sarcomas and leiomyomas

Preoperative differential diagnoses between uterine sarcomas and leiomyomas are difficult. As telomerase activation is thought to be essential for the immortality of malignant cells, it is considered a potentially useful diagnostic marker. The aim of the present study was to evaluate the potential diagnostic use of measuring telomerase activity in needle biopsy samples to distinguish uterine sarcoma from leiomyoma. Sixty-two patients with suspected uterine sarcomas based on clinical findings or magnetic resonance imaging findings, and who were scheduled for surgery, underwent transcervical ultrasound-guided needle biopsy. Three samples were obtained per patient for histopathological examination and telomerase activity measurement. Telomerase activity was measured using the telomeric repeat amplification protocol and correlated with final histopathological findings of surgical specimens. Of the 62 patients, 6 leiomyosarcomas and 1 endometrial stromal sarcoma (high grade) were diagnosed by histopathology. In 6 of the 7 samples from uterine sarcomas, relatively high telomerase activity (22-102 units) was detected, whereas only low telomerase activity (11-18 units) existed in 3 of the remaining 55 samples from benign or borderline uterine smooth muscle tumors. At a cut-off value of 20 units, sensitivity, specificity, positive predictive, and negative predictive values for detecting uterine sarcoma were 86% (95% confidence interval, 59-100%), 100% (94-100%), 100% (54-100%) and 98% (95-100%), respectively. The results indicated that telomerase activity in needle biopsy samples is a useful diagnostic marker to distinguish uterine sarcoma from leiomyoma.

Cirsoid aneurysm after hysterectomy

Cirsoid aneurysm, an uncommon abnormal either congenital or acquired arteriovenous communication, is described. As massive life-threatening bleeding can be a consequence, diagnosis is very important. Earlier, angiography was the only imaging method available for visualizing vascular lesions and recent developments in imaging techniques have made diagnostic imaging of cirsoid aneurysms possible using ultrasonography, color flow mapping, magnetic resonance imaging and magnetic resonance angiography. In this report, a patient with intrapelvic cirsoid aneurysm posthysterectomy who died 8 h after she had been kicked in the abdomen is described and the results obtained by various imaging techniques are discussed.

A perforated sigmoid diverticulum abscess difficult to differentiate from an ovarian tumor

We report a case of a perforated sigmoid diverticulum abscess that was difficult to differentiate from an ovarian tumor. A 53-year-old woman was diagnosed with an ovarian tumor, but laparotomy revealed a perforated sigmoid diverticulum abscess and appendicitis, with normal ovaries.

Decreased plasma tetrahydrobiopterin in pregnant women is caused by impaired 6-pyruvoyl tetrahydropterin synthase activity

Tetrahydrobiopterin (BH4) is an essential cofactor of nitric oxide synthase as well as a cofactor of aromatic amino acid hydroxylases. However, its role in pregnancy is not yet understood. We evaluated the concentrations of BH4 throughout normal pregnancy and puerperium, and compared them with those of non-pregnant women by measuring its oxidation product biopterin. In addition, we also measured 6-pyruvoyl tetrahydropterin synthase (PTPS) activities, the rate-limiting enzyme in synthesizing BH4, in pregnant women at the 30th gestational week and non-pregnant women. Although the urinary biopterin levels did not remarkably change, plasma biopterin levels significantly decreased from the 10th gestational week to the 1st day of postpartum compared with those of non-pregnant women. There was no significant difference in PTPS activities between pregnant and non-pregnant women. However, the proportion of reticulocytes, which have been shown to possess high PTPS activity, is significantly higher in pregnant women than in non-pregnant women. Our results suggest that decreased plasma BH4 levels in pregnancy is caused by impaired PTPS activity.

Vascular endothelial growth factor concentrations in follicular fluid obtained from IVF-ET patients: a comparison of hMG, clomiphene citrate, and natural cycle

PURPOSE

Evaluation of vascular endothelial growth factor (VEGF) concentrations of follicular fluid (FF) in accordance with an ovarian stimulation protocol and ovarian response.

METHODS

The subjects of this study were 38 patients undergoing IVF-ET in our hospital. They were divided into three groups according to ovarian stimulation protocols; Group 1: hMG cycles (n = 19), Group 2: clomiphene citrate cycles (n = 10), Group 3: natural cycles (n = 9). They reclassified into three groups according to the number of oocytes harvested. VEGF concentration was measured in FF, employing ELISAs.

RESULTS

Group 1 shows lower VEGF concentrations in FF than Group 2 or Group 3. Excluding high responders from Group 1, no difference was found among these three groups. As for the reclassified groups, group of highest number of oocytes havested showed lowest VEGF concentrations in FF.

CONCLUSIONS

VEGF concentrations in FF might negatively correlate with the number of follicles, irrespective of the ovulation induction protocol.

Expression and distribution of cyclooxygenase-2 in human periovulatory ovary

Cyclooxygenase, which converts arachidonic acid into prostaglandins, has two types of isoforms, cyclooxygenase-1 and cyclooxygenase-2 (COX-2). The latter is thought to be essential for the ovulatory mechanism. However, expression or distribution of COX-2 in periovulatory human ovary has not been reported. The aim of our study was to examine COX-2 expression and distribution in pre- and postovulatory human ovary. COX-2 was detected by Western blot analysis of pre-ovulatory human ovarian follicular fluid. The levels of COX-2 in preovulatory fluid obtained from 20 subjects underwent in vitro fertilization and embryo transfer, and were assayed using enzyme immunoassay for human COX-2. The results showed 7.3+/-4.1 ng/ml (mean +/- SD) with a COX-2 level range of 2.7 to 19.5 ng/ml of follicular fluid. Detection of COX-2 is considered to reflect its production in the preovulatory follicle. Immunofluorescence microscopic examination of an ovary obtained from a woman at the postovulatory period showed distribution of COX-2 in interstitial but not in granulosa cells in a ruptured follicle. These findings collectively suggest the possibility that COX-2 is mainly produced in follicles in a preovulatory phase, while after ovulation, COX-2 is produced in interstitial cells in human ovary.

An antibody against anemia-inducing substance inhibits cation influx in red blood cells from cancer patients

Resealed ghost of red blood cells (RBCs) from advanced cancer patients includes proteins with antigenicities common to an anemia-inducing substance that we separated from plasma of patients with advanced malignant neoplasms. Although cation influx in vitro in RBCs from a cancer patient is larger than that from a normal healthy volunteer, an antibody against anemia-inducing substance inhibited the in vitro cation influx in RBCs from the cancer patient. Activation of the cation influx with N-ethylmaleimide after reaction with the antibody reversed the effect to create a greater cation influx in RBCs from the patient, as compared with that from the healthy volunteer.

Cyclooxygenase-2 expression in malignant mesenchymal tumors and related uterine lesions

The aim of this study was to determine whether the expression of cyclooxygenase-2 (COX-2) in uterine sarcoma cells and carcinosarcoma cells is associated with cell type. Nineteen sections of tissues from uterine sarcomas, carcinosarcomas, and an adenosarcoma, and endometrial stromal sarcomas, were immunohistochemically analyzed for the cellular expression of COX-2. Positive immunostaining for COX-2 was observed in 88.9% (8/9) uterine carcinosarcomas, uterine adenosarcomas but was not observed in uterine sarcomas and the endometrial stromal sarcoma (0/10). But positive immunostaining for COX-2 was observed in some sarcomatoid cells in carcinosarcoma tissue. These findings suggest that some of the sarcoma cells in uterine carcinosarcomas resemble epithelial malignant cells in regard to the increase in COX-2 expression, and support the hypothesis that some uterine carcinosarcomas are combination tumors. This may serve as a basis for new chemoprevention and treatment strategies for uterine carcinosarcomas through the inhibition of COX-2 activity.

Pharmacokinetics and pharmacodynamics of serum platinum of gynecologic cancer patients treated with nedaplatin

Nedaplatin (cis-diammine glycolate platinum) is one of the effective platinum agents for gynecologic carcinoma. In order to assess the pharmacokinetics and pharmacodynamics of serum platinum of gynecologic cancer patients treated with nedaplatin, we calculated 10 course AUCs (area under the curve) of the free and total platinum from blood samples of 4 patients. Peak serum platinum concentrations were dependent on infusion times. In the case of a patient with renal dysfunction or ascites, the concentration of serum platinum tended to stay at a high level for a long time. Serum-free platinum ratios were maintained longer than cisplatin. Low dose nedaplatin administration and divided administration were effective, but total AUC was not so great. The relation between AUC ratio (free platinum AUC/total platinum AUC) and dose/m(2) was not clarified.

Expression of cyclooxygenase-2 in ovarian mature cystic teratomas with malignant transformation

Cyclooxygenase-2 (COX-2) has been reported to be associated with tumor progression and angiogenesis and we previously reported that an increase in COX-2 expression might be associated with malignant transformation and tumorigenesis of epithelial ovarian neoplasms. In this study, COX-2 expression of ovarian mature cystic teratomas with malignant transformation, a rare entity accounting for just 1.8% of all mature cystic teratomas, was investigated using immunohistochemical techniques. There were 89 cases of mature cystic teratomas treated with surgery as their initial therapy at Osaka City University Medical School Hospital between 1995 and 2001. Ten cases of these were selected for study; five cases of mature cystic teratoma with malignant transformation, and five cases of mature benign teratoma. Expressions of CD34, vascular endothelial growth factor (VEGF), and COX-2 were investigated. Expressions of VEGF and COX-2 were strong in tissues of mature cystic teratomas with squamous cell carcinoma; however, expressions of them were hardly apparent in mature benign teratomas and in mature cystic teratomas with adenocarcinomas. These results tend to suggest that COX-2 is associated with tumor growth and progression in mature cystic teratomas with squamous cell carcinoma, as opposed to mature benign teratomas and mature cystic teratomas with adenocarcinomas.

Phase I-II study of neoadjuvant chemoradiotherapy followed by radical surgery in locally advanced cervical cancer

The usefulness of neoadjuvant chemotherapy (NAC) regimens has been reported; however, the effect of NAC for advanced stages (especially stage III-IVA) is thought to be insufficient. We conducted a phase I-II study of neoadjuvant chemoradiotherapy consisting of intra-arterial (i.a.) infusion of carboplatin and intracavitary brachytherapy in patients with locally advanced cervical cancer to achieve the new NAC method. Sixteen eligible patients included those with previously untreated stage IIB, III or IVA cancer with bulky tumor. Brachytherapy using iridium-192 was performed with concurrent i.a. chemotherapy with carboplatin (200, 300 and 400 mg/m2). Treatment was repeated every 4 weeks for a total of two cycles. Both hematologic and non-hematologic toxicities were generally mild. Grade 4 hematologic toxicity was observed in 12.5% and there were no grade III or IV non-hematologic toxicities. The optimal dose of carboplatin was determined to be 400 mg/m2. Among 16 patients, six showed complete response (37.5%) and nine showed partial response (56.3%), for an overall response rate of 93.8%. All 15 responding patients underwent radical surgery with a pelvic lymphadenectomy and postoperative radiotherapy. The combination of brachytherapy and i.a. chemotherapy with carboplatin is a promising regimen for NAC in locally advanced cervical cancer.

Angiogenesis in adipose tissues and skeletal muscles with rebound weight-gain after diet-restriction in rabbits

The mechanisms of excessive body weight gain after diet-restriction are still unclear. In this study, we investigated expression of angiogenic factors in adipose tissue and skeletal muscle of rabbits which had rebound weight gains; trying to make inquiries into the mechanisms of this rebound weight gain. Ten rabbits were divided into two groups. One group had free food intake (group C), and the other group had restricted food intake until day 40 of the experiments and then had free food intake (group DR). Specimens of adipose tissue and skeletal muscle were collected from each rabbit on days 20, 40, and 60 after the initial examination, and expressions of CD34, vascular endothelial growth factor (VEGF), and platelet-derived endothelial cell growth factor (PD-ECGF) were investigated. Expression of VEGF was significantly strong in the adipose tissue of group DR at the recovery period of body weight. In conclusion, rebound weight gain after a restricted-diet may be associated with angiogenesis in adipose tissue, and the angiogenesis may be induced by VEGF.

Association between overexpression of cyclooxygenase-2 and suppression of apoptosis in advanced cancer of the uterine cervix after cyclic balloon-occluded arterial infusion

Recent advances in cancer chemotherapy have drawn the attention of investigators to the usefulness of chemotherapy for cancer of the uterine cervix in general, and we ourselves have previously reported satisfactory therapeutic results of cisplatin-based cyclic balloon-occluded arterial infusion chemotherapy (BOAI), which enabled treatment by hysterectomy in patients with advanced cervical cancer. Nevertheless, there have been some patients in whom CDDP therapy by BOAI was ineffective, and hysterectomy was impracticable. In the present study we investigated the expression of cyclooxygenase-2 (COX-2) in these cases in an attempt to identify the cause of the lack of efficacy. The subjects of the study were 38 women with advanced cervical cancer classified as FIGO (International Federation of Gynecology and Obstetrics) stage III or higher who were admitted to the Department of Gynecology of Osaka City University Medical School Hospital between July 1993 and April 2000. All of these patients were treated by BOAI, and expression of COX-2, angiogenic factors, and cancer cell apoptosis, before and after BOAI were examined, and survival rates were compared. The 18 patients in whom BOAI was ineffective showed significantly higher expression of COX-2 after BOAI, and cancer cell apoptosis was inhibited. The 5-year survival rate of these patients was 16.8%, as opposed to 54.1% in the 20 patients in whom BOAI was effective. These results suggest that overexpression of COX-2 inhibits cancer cell apoptosis and adversely influences the prognosis.

Primary abdominal pregnancy associated with severe ovarian hyperstimulation syndrome

An uncommon case of primary abdominal pregnancy that was detected after rapid resolution of OHSS is reported. A 27-years-old nulligravida woman underwent ovarian hyperstimulation with human menoposal gonadotrophin (hMG) at another clinic and was admitted to our hospital with severe OHSS. Intravenous fluid therapy, albumin supplementation, and abodminal paracentesis was performed. The patient's massive ascites rapidly resolved, and she was discharged from our hospital. However, 4 weeks later, at about the 8th gestational week, she was readmitted to our hospital because of strong suspicion of abdominal pregnancy. Ultrasonography revealed a gestational sac (GS) and fetus with heartbeat in Douglas' pouch and an emergency laparotomy was performed. Both fallopian tubes, both ovaries and the uterus were completely intact and the GS was found on the anterior surface of the rectum. After removing GS, the muscle layer and serosal layer of the rectum were repaired. No bowel complications developed, and the post operative course was uneventful. To our knowledge, this is the first report of this very rare variant of ectopic pregnancy complicated by OHSS.

Expression of angiogenic factors in extrapelvic endometriosis

The expression of vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) were immunohistochemically examined in both pelvic and extrapelvic endometriotic lesions. Different expressions of VEGF and COX-2 were observed in both lesions. VEGF immunoreactivity was distributed mainly in the cytoplasm of the adenocytes in inguinal tumors, but was not seen in ovarian tumors. COX-2 showed the same findings. These results suggest that angiogenesis may be involved in the pathogenesis of extrapelvic endometriosis.

Primary peritoneal clear cell carcinoma: excellent results from paclitaxel and carboplatin combination chemotherapy

While papillary serous adenocarcinomas are histocytologically common in primary peritoneal carcinomas, clear cell carcinomas are rare. We report a new regimen for the treatment of recurrent clear cell carcinomas of the peritoneum. A 45-year-old woman was referred to our hospital and underwent optimal debulking surgery. Thirty-two months after the operation, lymph node swelling and elevation of serum CA19-9 were detected and recurrence was diagnosed. Paclitaxel (175 mg/m(2)) in a 3-hour and carboplatin (300 mg/m(2)) in a 1-hour infusion were repeated at three-week intervals. After completion of four courses, abdominal CT and serum CA19-9 were undertaken and results compared. Lymph node swelling was significantly decreased and the serum CA19-9 level was decreased to within a normal range. Paclitaxel and carboplatin combination chemotherapy may be effective in preventing the recurrence of peritoneal carcinomas.

Comparison of expression of apoptosis regulatory proteins in the adipose tissue of tumor-bearing and diet-restricted rabbits

We investigated the expression of apoptosis regulatory proteins in the adipose tissue of tumor-bearing and diet-restricted rabbits, and analyzed the differences between the two groups. The apoptotic index in the tumor-bearing group was 25.1+/-12.4 on day 10 and increased to 27.2+/-14.4 by day 20. Thereafter, however, it gradually decreased, falling to 11.2+/-7.8 on day 30 and 0.67+/-0.88 on day 40. By contrast, no apoptotic cells were detected in the diet-restricted group at any of the times examined. Bcl-2 immunoreactivity was either not detected at all, or was only weakly observed in both groups. Bax expression, on the other hand, gradually increased after implantation in the tumor-bearing group. In 2 of the 5 tumor-bearing rabbits, Bax expression in adipocytes was moderate 10 days after tumor implantation, and strong by day 20, but steadily decreased thereafter. By contrast, hardly any Bax-immunopositive cells were detected in the diet-restricted group. These results suggested that loss of body weight in the tumor-bearing group was different from that in the diet-restricted group, and that it was related to adipocyte apoptosis.

Involvement of angiogenesis in weight-loss in tumor-bearing and diet-restricted animals

The body's weight loss mechanism while in a tumor-bearing state is still unclear. In this study, we investigated expressions of angiogenic factors in the adipose tissue of tumor-bearing and diet-restricted rabbits evaluating the differences between the two groups. We postulated that low nutrition induced vasculogenesis to transport nutrition in the adipose tissues of diet-restricted rabbits, unlike in tumor-bearing rabbits, and that vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) were related to angiogenesis of the adipose tissues. Although we investigated the expressions of VEGF and PD-ECGF immunohistochemically in tumor-bearing and diet-restricted rabbits, there was no significant difference between the two groups. Whether angiogenesis of the adipose tissue in the diet-restricted animals may be observed during the nutritional recovery period should be investigated.

Transient shrinkage of a uterine leiomyosarcoma treated with GnRH agonist for a presumed uterine leiomyoma: comparison of magnetic resonance imaging finding before and during GnRH agonist treatment

We present a case of a premenopausal woman treated with GnRH agonist for a presumed uterine leiomyoma. This tumor reduced at first, but subsequent surgical specimens revealed a leiomyosarcoma. Magnetic resonance imaging (MRI), one of the most useful modalities for distinguishing between uterine leiomyoma and leiomyosarcoma, was undertaken twice, before GnRH agonist administration and then after 6 months of GnRH agonist administration. Apparent differences were observed between these MRI findings. Tumor-size reduction with GnRH agonist treatment does not always mean that the possibility of a leiomyosarcoma should be ruled out.

Probucol decreases total body fat loss in VX2-carcinoma-induced cachectic rabbits

We previously reported the continuous decrease of total body fat in VX2-carcinoma-bearing rabbits after tumor implantation, as well as changes in the serum lipid profile. Probucol, an antioxidant drug, has a cholesterol lowering effect against hyperlipidemic subjects. VX2-carcinoma-bearing rabbits fed with a diet containing 1% probucol did not show any difference in serum lipid compositions as compared with rabbits fed with a control diet. Similarly serum lipolytic activity showed no differences, whether probucol was administered or not, while the decrease in total body fat was significantly less when probucol was administered.

Anemia-inducing substance is related to elimination of lipolytic hyperactivity by cyclic plasma perfusion in human cancer cachexia

We previously reported that cyclic plasma perfusion suppressed lipolytic activity in malignant tumor-bearing animals and reversed their body weight loss. In this study we investigated the relation between this phenomenon and interleukin (IL)-1 alpha, IL-1 beta, IL-6, interferon-gamma, leukemia inhibitory factor, tumor necrosis factor-alpha, and anemia-inducing substance (AIS) in vitro by examining changes in their levels in the plasma of advanced ovarian cancer patients. When the patients' plasma was incubated with noncoated charcoal for one hour, its lipolytic activity decreased by 39.0 +/- 2.4%, which was similar to the results obtained with the plasma of healthy subjects. IL-1 alpha, IL-1 beta, interferon-gamma, leukemia inhibitory factor, and tumor necrosis factor-alpha did not adsorb the charcoal. IL-6 was 3.7% adsorbed, but this did not cause a significant difference (p = 0.131). Nor was the recombinant form of these cytokines adsorbed to the charcoal. AIS, however, was 98.1% adsorbed. These results indicate that AIS is strongly associated with the reduction in lipolytic activity by cyclic plasma perfusion through noncoated charcoal resin.

Angiogenesis in the adipose tissue of tumor-bearing rabbits treated by cyclic plasma perfusion

The mechanisms of cancer cachexia have not been elucidated. We previously reported that cyclic plasma perfusion using non-coated charcoal was effective in cancer cachexia. In the present study we investigated the angiogenic effect of cyclic plasma perfusion on adipose tissue. Twenty rabbits were divided into two groups, i.e., tumor-bearing rabbits subjected to cyclic plasma perfusion (n=10, PP group), and tumor-bearing rabbits subjected to sham-perfusion (n=10, SP group). The changes in body weight, total body fat, and expression of angiogenic factors were investigated. Loss of body weight and total body fat was significantly suppressed in the PP group. Apoptosis of adipocytes was seen in both groups only in the early stage of tumor bearing. Lipolytic activity in the PP group showed a lower ratio than that in the SP group. In the PP group, increased microvessel density and expression of vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) were seen at 40 days after transplantation. Similar findings were not seen in the SP group. These results suggest that cyclic plasma perfusion not only decreased lipolytic activity but induced angiogenesis in the adipose tissue.

Metachromasia of the endocervical epithelium in women treated with gonadotropin releasing hormone agonist

Endocervical epithelium from women treated with gonadotropin releasing hormone agonist (GnRH agonist) were compared with those from untreated women, using metachromatic stain with toluidine blue and immunohistochemistry, for estrogen and progesterone receptors. Smaller endocervical epithelium with lower intraepithelial mucus and more prominent nuclear distribution of estrogen receptors were seen in a woman who was treated for twelve months with GnRH agonists, as compared with those from an untreated premenopausal woman.

Conservative management of placental polyp with oral administration of methotrexate

Surgical treatment is usually selected for placental polyp accompanied by massive bleeding but patients wishing to conserve their fecundity require conservative management. A 35-year old nullipara was diagnosed as having placental polyp on the basis of typical episodes, and detection of placental polypeptide hormones and blood flow by Doppler ultrasonography and dynamic magnetic resonance imaging. Oral administration of methotrexate (2.5 mg, three times a day for 5 days) was repeated for three cycles because surgical treatment was rejected. Serum human placental lactogen, blood flow and the polyp disappeared sequentially following chemotherapy. This report thus advocates considering conservative management for placental polyp.

Survivin, bcl-2 and matrix metalloproteinase-2 enhance progression of clear cell- and serous-type ovarian carcinomas

Clear cell adenocarcinomas (CA), unlike serous adenocarcinomas (SA) of the ovary, are often at stage I, are resistant to platinum-based drugs and have a poor prognosis. The causes of these differences are unclear. In this study, the differences in progression between CA and SA were examined in terms of apoptosis-related and tumor invasion-related factors. The 16 cases of CA and the 16 cases of SA were reviewed. Excised tissues were classified into primary or metastatic loci, and the expressions of survivin, Bcl-2 and matrix metalloproteinase-2 (MMP-2) in each locus immunohistochemically assayed. Whether the expression of each protein was correlated to prognosis was investigated and additionally the invasion ability of cell strains established from CA and SA were examined using in vitro invasion assay. CA at stage I showed significantly higher survivin expression than SA (p<0.05). In CA, survivin tended to be expressed higher in primary locus than in metastatic locus (p=0.068), however, Bcl-2 was expressed relatively higher in the latter (p=0.087). SA did not have these tendencies. While MMP-2 was expressed significantly higher in SA than in CA (p<0.05), and more so in metastatic locus than in primary locus of SA (p<0.05). Invasion assay showed that the invasion of cells derived from SA was significantly inhibited by tissue inhibitors of metalloproteinase-2, an MMP inhibitor. The disease-free interval was significantly shorter when survivin expression was observed in the nucleus. These results suggest that the expression of apoptosis inhibiting factors and enhanced invasion ability affect progression of CA and SA, respectively.

Expression of apoptosis regulatory proteins in the skeletal muscle of tumor-bearing rabbits compared with diet-restricted rabbits

The mechanism of body weight loss in the tumor-bearing state is still unclear. In this study, we investigated expressions of apoptosis regulatory proteins in the skeletal muscle of tumor-bearing and diet-restricted rabbits, and tried to evaluate the differences between the two groups. The apoptotic index (AI) in the tumor-bearing group was 28.1+/-2.84 on day 10. By day 20, many more apoptotic cells were found (AI: 40.5+/-3.20), but then after day 20 their numbers gradually decreased (AI: 9.67+/-2.22 on day 30 and 0.93+/-0.96 on day 40). By contrast, no apoptotic cells were detected in the diet-restricted group at any of the times examined. Bcl-2 immunoreactivity was either not detected at all or only weakly observed in both groups. By contrast, Bax expression increased gradually after implantation in the tumor-bearing group. Bax expression in skeletal muscle cell was graded (moderate) 10 days after tumor implantation, and (high) by day 20, in 2 of the 5 tumor-bearing rabbits. After day 20, however, Bax immunoreactivity decreased continuously in the tumor-bearing group. By contrast, hardly any Bax-immuno-positive cells were detected in the diet-restricted group. These results suggest that loss of body weight in the tumor-bearing group is different from that in the diet-restricted group, and is related to apoptosis of skeletal muscles.

Mouse erythroblast formation is inhibited by anemia-inducing substance from the plasma of a patient with a malignant neoplasm

An anemia-inducing substance (AIS) was found as a protein, with a molecular weight of 50,000 on SDS electrophoresis gel, that decreased the osmotic resistance of erythrocytes. In this study, the plasma fraction containing AIS is shown to inhibit mouse erythroblast formation in vitro. The addition of the plasma fraction from a patient with an advanced malignant neoplasm to a liquid culture of mouse bone marrow cells with erythropoietin results in low numbers of erythroblast formation and low cellular yields of alpha- and beta-globin mRNAs. These inhibitions were not observed after immunoadsorption of the plasma fraction with an antiserum against AIS.

Cyclooxygenase-2 expression in an adenoid cystic carcinoma of the uterine cervix

Adenoid cystic carcinoma (ACC) of the uterine cervix is extremely rare, frequently metastasizes to distant organs, and its prognosis is poorer than squamous cell carcinoma of the uterine cervix. The reasons for its poor prognosis are unclear. This case had both an ACC and a carcinoma in situ (CIS) of the uterine cervix, so the expressions of CD34, vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) were investigated in both tumors. Hysterectomy was performed on a 76-year old woman and the uterine cervical tissues immunohistochemically analyzed. Expressions of CD34 were positive in the ACC lesions but negative in the CIS ones and angiogenesis was confirmed in ACCs. Furthermore, expressions of VEGF and COX-2 were shown in ACC, but were absent in CIS. In conclusion, the expression of COX-2 in ACC may induce the expression of VEGF, increase angiogenesis and enhance tumor growth and invasion.

An intranodal morcellation technique employing loop electrosurgical excision procedure for large prolapsed pedunculated myomas

For minimally invasive resection of large prolapsed pedunculated submucous myomas, improved techniques need to be established. An intranodal loop electrosurgical excision procedure (LEEP) was specifically developed for the morcellation of myoma tissue during vaginal myomectomy. Vaginal myomectomy was performed on a 28-year old woman with a large myoma occupying the small pelvis. A prolapsed pedunculated leiomyoma of the uterus 13 cm in maximal diameter was resected by intranodal morcellation of the myoma tissue employing LEEP. Intranodal morcellation technique utilizing LEEP is an effective method for the minimally invasive resection of large prolapsed pedunculated myomas.

Combined analysis of p53 and RB pathways in epithelial ovarian cancer

Disruptions of the p16-CDK4/cyclin D1-pRb pathway (RB pathway) and the p14ARF-MDM2-p53 pathway (p53 pathway) are important mechanisms in the development of human malignancies. In this study, we investigated RB and p53 pathways in 46 epithelial ovarian cancers (EOCs). In the RB pathway, 16 (34.8%) of 46 cases had p16 gene alterations or loss of expression. The deletion of the p16 gene was a rare event. In 7 cases, we observed methylation in the 5'CpG island in the promoter region of the p16 gene. Abnormal expressions of pRb and CDK4/cyclin D1 were 10.9% and 30.4%, respectively. In the p53 pathway, 10 (21.7%) of 46 cases had p14ARF gene alterations or abnormal expression. In 4 cases, methylation in the 5'CpG island in the promoter region of the p14ARF gene was present. MDM2 overexpression was a rare event. Thirty-six (78.3%) of 46 patients had p53 gene alterations or expression. In our studied cases, p14ARF abnormalities were independent of p16 abnormalities. Abnormal RB and p53 pathways were present in 60.9% and 80.4% of cases, respectively. In conclusion, disruptions of p53 and RB pathways are frequent events and the inverse correlations were present between the abnormality of p16 and p14ARF in EOCs.

Vascular endothelial growth factor levels in pleural and peritoneal fluid in Meigs' syndrome

We report that we found differences in changes in vascular endothelial growth factor (VEGF) levels in pleural effusion and ascites after removal of ovarian tumor complicated by Meigs' syndrome. Postoperative VEGF levels decreased in the patient's pleural fluid but not in the peritoneal fluid. The mechanism of the development of the pleural effusion and ascites in Meigs' syndrome may differ.

Involvement of phenotypes and serum levels of haptoglobin in the outcome of in vitro fertilization and embryo transfer

Haptoglobin (Hp) possesses many functions in the immune system and angiogenesis as well as scavenging released hemoglobin, and thus it is speculated that Hp may also play a critical role in the reproductive process. To investigate the possible involvement of Hp in the outcome of in vitro fertilization and embryo transfer (IVF-ET), the serum Hp of 50 patients who underwent IVF-ET was analyzed by the Western blot method. The results showed a higher pregnancy rate in the patients with the Hp2-2 phenotype (38%) than in those with the Hp2-1 phenotype (16%) (p = 0.08), and the serum alpha 2 subunit levels in the patients who achieved pregnancy within four attempts at IVF-ET were higher than in the others (p < 0.05). The results of this study suggest that Hp is involved in the outcome of IVF-ET.

Effect of cyclic plasma perfusion on apoptosis regulatory proteins in primary tumors of VX2-carcinoma-bearing rabbits

Although the mechanism of cancer cachexia is unknown, in previous studies we reported that cyclic plasma perfusion through non-coated charcoal was effective in preventing cancer cachexia. In the present study we investigated the effect of cyclic plasma perfusion on VX2 carcinoma. Sixteen tumor-bearing rabbits were divided into two groups: i) a group subjected to cyclic plasma perfusion (n=8, group PP) and ii) a group subjected to sham-perfusion (n=8, group SP), and changes in body weight, tumor size, and morphological findings were investigated. Body weight loss and tumor growth were significantly suppressed in group PP. The tumor cells in group PP showed apoptosis and a high Bax/Bcl-2 ratio, and the survival rate was significantly higher than in group SP. These results suggest that cyclic plasma perfusion is effective not only in preventing cancer cachexia but in suppressing tumor growth and improving outcome.

CD71 antibody enhances iron uptake by mouse bone marrow cells and the survival potential of erythroid progenitor cells

Transferrin has been shown to have cytoprotective functions. The aim of this study was to evaluate the effect of antibody against CD71 (transferrin receptor) on survival potential of erythroid progenitor cells. After anti-CD71 IgG or control IgG was reacted with cells for 20 min on ice, the uptake of transferrin-bound 59Fe by the MEL cells or the mouse bone marrow cells during 2-day incubation without erythropoietin was measured. Erythropoiesis was evaluated by addition of erythropoietin after 4-5 weeks' culture without erythropoietin or beta-mercaptoethanol, and production of cells containing hemoglobin was compared by immunocytological methods. MEL cells reacted with anti-CD71 IgG incorporated more transferrin-bound 59Fe than MEL cells reacted with control IgG. Uptake of transferrin-bound 59Fe by mouse bone marrow cells reacted with anti-CD71 IgG was also greater than by cells reacted with control IgG. Erythrocytes developed from cells reacted with anti-CD71 IgG and cultured for 4-5 weeks, but few erythrocytes developed from cells reacted with control IgG. Bone marrow cells depleted of TER119+ cells, CD34+ cells, or CD45+ cells and reacted with CD71 antibody did not differentiate into erythrocytes. Survival potential of erythroid progenitor cells were enhanced by reaction with anti-CD71 antibody.

Expression of apoptosis regulatory proteins in advanced cancer of the uterine cervix after cyclic balloon-occluded arterial infusion chemotherapy

We have already reported satisfactory therapeutic results of cisplatin-based cyclic balloon-occluded arterial infusion chemotherapy (BOAI) because it enabled advanced cervical cancer of the uterus (cervical cancer) to be treated by simple total hysterectomy (STH). In the present study, we investigated the expression of apoptosis regulatory proteins in advanced cervical cancer treated by cyclic BOAI. The results showed that the proportion of Bax-positive cells was 75.2 +/- 5.6% after the first BOAI in the cases in which STH became possible (group C), and significantly lower, 11.6 +/- 11.7% (p=0.0001), in the cases in which STH remained impossible (group I). The proportion of Bax-positive cells was significantly higher in group C than in group I throughout the treatment period, but there was no significant difference in Bcl-2 expression between the two groups. The survival rate by the Kaplan-Meier method was significantly higher in group C than in group I. These results suggest that the antitumor effect of cyclic BOAI is closely associated with apoptotic cell death, which may in part be influenced by the expression of Bax.

Excellent results of radiotherapy for neuroendocrine carcinoma of the uterine cervix

Neuroendocrine carcinoma of the uterine cervix is a rare neoplasm that is associated with a poor prognosis, and there have been no reports of excellent results of radiotherapy to treat it. We report a case of neuroendocrine uterine cervical carcinoma, as stage IIIa (FIGO), in which the patient showed a complete clinical response to radiotherapy.

Combined diagnostic imaging for retroperitoneal schwannoma

Retroperitoneal tumors are occasionally encountered by gynecologists, and differential diagnosis from adnexal tumors is important, however, it is difficult in many cases. We report a case in which we preoperatively diagnosed a benign solid tumor in the retroperitoneum of the pelvic cavity on the basis of a variety of diagnostic images, including FDG-PET. Postoperative histological examination showed a benign schwannoma in the pelvis. We discuss the usefulness of FDG-PET combined with MRI and other diagnostic images as a means of differentiating between the characteristics of retroperitoneal tumors.

Cyclooxygenase-2 expression in normal ovaries and epithelial ovarian neoplasms

Cyclooxygenase-2 (COX-2) expression was investigated immunohistochemically in 57 epithelial ovarian neoplasms and in histologically normal ovaries. Positive immunostaining for COX-2 was observed in 78.6% (22/28) of the ovarian cancers and in 66.7% (14/21) of the borderline-malignant tumors. The rate of expression was significantly higher among the ovarian cancers than the benign cystadenomas (4/8; 50%) (p<0.05). There was a significant correlation between vascular endothelial growth factor (VEGF) expression and microvessel count (MVC), but no correlation between COX-2 expression and MVC. There was a significant correlation between VEGF expression and COX-2 expression in all of the ovarian neoplasms as a whole (p<0.05). These findings suggest that an increase in COX-2 expression may be associated with malignant transformation and tumorigenesis of epithelial ovarian neoplasms.

The usefulness and limits of magnetic resonance imaging in the differential diagnosis of pelvic tumors

Three cases of benign pelvic tumors are presented (2 leiomyomas and 1 fibroma). All three tumors were suspected of being malignant neoplasms because they were visualized as heterogeneous high signal intensity on T2-weighted images, and thus they were difficult to diagnose preoperatively. One of the leiomyomas was located in the retroperitoneum and had been misdiagnosed as an ovarian tumor. All three tumors exhibited secondary myxoid changes, these changes may have been responsible for the high signal intensity on the T2-weighted MR images. Since benign tumors sometimes mimic malignant tumors on MR images, exploratory laparotomy is essential to make a definitive diagnosis.

Expression of skeletal muscle cells apoptosis regulatory proteins in plasma-perfused VX2 carcinoma-bearing rabbits

BACKGROUND

In tumor-bearing animals we found that the skeletal muscle apoptosis might be involved in muscle wasting. In this study, we investigated changes in the skeletal muscle cell apoptosis regulatory proteins after cyclic plasma-perfusion (CPP).

MATERIALS AND METHODS

We studied changes in body weight, lean body mass (LBM), apoptotic index (AI) and expression of Bax and Bcl-2 in skeletal muscle in VX2 carcinoma-bearing rabbits.

RESULTS

20 days after tumor implantation, LBM had decreased by 5.06+/-1.10%, while the AI had increased to 40.5+/-3.20%. By 40 days, LBM had decreased by 11.0+/-0.81% and the AI was only 0.93+/-0.96%. Bax expression was detected in proportion to the AI, but no Bcl-2 expression was detected in either the experimental or control groups. CPP improved LBM, but did not prevent Bax expression.

CONCLUSION

Skeletal muscle cell apoptosis related to Bax was concluded to be the cause of muscle wasting in VX2 carcinoma-bearing rabbits. CPP appears to reduce muscle wasting and increase LBM, but it did not suppress Bax expression or skeletal muscle cell apoptosis.

Clinical evaluation of the Q-tip test in normal pregnant women

The crisis frequency of stress incontinence (SI) is known to be high among pregnant women. This preliminary study was performed to determine whether the diagnostic standard of the Q-tip test used in the diagnosis of SI in nonpregnant women is applicable to pregnant women. The Q-tip tests were performed regularly during pregnancy and after parturition on primipara (n = 71) and multipara (n = 55) who were not in SI crisis at any time during the pregnancy. The values measured in multipara were significantly higher than in primipara (p = 0.0001), and the tendency to be higher was more prominent at 2-5 months and 10 months of pregnancy. These findings show that different normal values of the Q-tip test are necessary for primipara and multipara.

Microwave endometrial ablation at a frequency of 2.45 GHz. A pilot study

OBJECTIVE

To investigate the clinical application of a microwave tissue coagulator at 2.45 GHz with a needle electrode customized for endometrial ablation.

STUDY DESIGN

In a pilot clinical study, endometrial ablation was performed under intravenous thiopental anesthesia on five women suffering from hypermenorrhea caused by aplastic anemia (3), von Willebrand's disease (1) and a submucosal myoma (1) using a microwave tissue coagulator at 2.45 GHz.

RESULTS

Four patients were amenorrheic after endometrial ablation. The patient with the submucosal myoma experienced minor menstrual bleeding. No notable complications were observed during or after ablation.

CONCLUSION

Endometrial ablation using a microwave tissue coagulator at 2.45 GHz is a simple and useful method of treating hypermenorrhea.