Evaluation of the feasibility of human papillomavirus sponge-type self-sampling device at Japanese colposcopy clinics

AIM

Self-sampling human papillomavirus (HPV) testing has been introduced for cervical cancer screening worldwide. In Japan, there are two types (brush and sponge) of HPV self-sampling devices. However, the recommended type for cervical cancer screening remains unclear. This study aimed to evaluate the feasibility of the HPV self-sampling device-sponge type (HSD-ST). Additionally, we aimed to examine the positive rate (sensitivity) for cervical intraepithelial neoplasia (CIN) 2 or worse using the HSD-ST. Finally, we aimed to perform a questionnaire survey regarding the usability of the HSD-ST.

METHODS

We included 165 women who underwent HPV testing at one of three gynecologic clinics. First, the women used the HSD-ST and completed a questionnaire regarding its usability. Subsequently, they underwent physician-sampling HPV testing and cytology. We examined the agreement rate of HPV positivity between self- and physician-sampling HPV testing.

RESULTS

The HPV-positive rates of self- and physician-collected samples were 59.4% and 62.4%, respectively, with an overall concordance rate of 88.5% and a calculated kappa coefficient of 0.76, indicating high concordance. Moreover, the positive (sensitivity) rates for CIN2 or worse were 81.4% and 89.8% in the self- and physician-collected samples, respectively.

CONCLUSIONS

Our findings demonstrated the feasibility and usability of the HSD-ST.

Effectiveness of human papillomavirus vaccination in young Japanese women: a retrospective multi-municipality study

In Japan, government support for human papillomavirus (HPV) vaccination began in November 2010. However, the mass media repeatedly reported on severe adverse events. The Japanese Ministry of Health, Labor and Welfare suspended proactive recommendations for HPV vaccines in June 2013. Japan's HPV vaccination rate dropped from 70% to less than 1% in 2017.We examined cervical cancer screening results in terms of abnormal cytology, histology, and HPV vaccination status among 11,903 women aged 20 to 25 y in the fiscal year 2015. The overall rate of HPV vaccination was 26.1% (3,112/11,903). Regarding cytology, the rate of atypical squamous cells of undetermined significance (ASC-US) or worse was 3.3% (103/3,112) in women who received HPV vaccination (vaccine (+) women) and 5.6% (496/8,791) in women who did not (vaccine (-) women). The rate of high-grade squamous intraepithelial lesion (HSIL) or worse was 0.26% (8/3,112) in vaccine (+) women and 0.81% (72/8,791) in vaccine (-) women. Regarding histology, the rate of cervical intraepithelial neoplasia 1 or worse (CIN1+) was 1.4% (42/3,112) in vaccine (+) women and 2.1% (178/8,791) in vaccine (-) women. The rates of CIN2+ and CIN3+ were similar regardless of vaccination. We found a significantly lower incidence of CIN in vaccine (+) women. These results suggest that the resumption of recommending HPV vaccination as primary prevention for cervical cancer is needed in Japan.

Long-term survival of patients with recurrent endometrial stromal sarcoma: a multicenter, observational study

Objective

The aim of this study was to evaluate the clinical behavior and management outcome of recurrent endometrial stromal sarcoma (ESS).

Methods

A retrospective review of charts of 10 patients with recurrent ESS was performed and relapse-free interval, relapse site, treatment, response to treatment, duration of follow-up and clinical outcome extracted. Survival outcome measures used were post-relapse survival which was defined as the time from first evidence of relapse to death from any cause. Living patients were censored at the date of last follow-up.

Results

The median age and median relapse-free interval at the time of initial relapse were 51.5 years and 66.5 months, respectively. The number of relapses ranged from one to five. Sixteen surgical procedures for recurrent disease included nine (56.0%) complete resections. There was no statistically significant difference between initial recurrent tumors and second/subsequent recurrent tumors in the rate of complete surgery (44.4% vs. 71.4%, respectively, p=0.36). Of the eleven evaluable occasions when hormonal therapy was used for recurrent disease, disease control was achieved in eight (72.7%). There was no difference between initial recurrent tumors and second/subsequent recurrent tumors in disease control rate by hormonal therapy (85.7% vs. 50.0%, respectively, p=0.49). The 10-year post-relapse survival rate was 90.0% and the overall median post-relapse survival 119 months (range, 7 to 216 months).

Conclusion

Post-relapse survival of patients with ESS can be expected to be >10 years when treated by repeated surgical resection and hormonal therapy or both.

A prospective study on the efficacy of octreotide in the management of malignant bowel obstruction in gynecologic cancer

OBJECTIVE

Malignant bowel obstruction (MBO), of which symptoms lead to a poor quality of life, is a common and distressing clinical complication in advanced gynecologic cancer. The aim of this study was to prospectively assess the clinical efficacy of octreotide to control vomiting in patients with advanced gynecologic cancer with inoperable gastrointestinal obstruction.

METHODS

Patients with advanced gynecologic cancer, who presented at least one episode of vomiting per day due to MBO, were enrolled in this prospective study from 2006 to 2009. Octreotide was administered when necessary at doses starting with 300 μg up to 600 μg a day by continuous infusion for 2 weeks. Primary end point was vomiting control, which was evaluated by common terminology criteria for adverse events version 3 (CTCAE v3.0). Adverse events were also evaluated by CTCAE v3.0.

RESULTS

Twenty-two cases were enrolled in this study. Octreotide controlled vomiting in 15 cases (68.2%) to grade 0 and 3 cases (13.6%) to grade 1 on CTCAE v3.0. Overall response rate to octreotide treatment was 81.8% in our patients' cohort. Among 14 cases without nasogastric tube, the overall response rate was 93.1% (13/14). Among 8 cases with nasogastric tube, 4 cases were free of tube with decrease of drainage, and overall response rate was 62.5% (5/8). No major adverse events related to octreotide were reported.

CONCLUSIONS

We conclude that 300-μg/d dose of octreotide was effective and safe for Japanese patients with MBO by advanced gynecologic cancer. Octreotide could contribute to better quality of life by avoiding placement of nasogastric tube.

Reduction/prevention of lower extremity lymphedema after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies

BACKGROUND

Lower extremity lymphedema (LEL) is a serious complication caused by lymphadenectomy in patients with gynecologic malignancies. In this study, we evaluated the effect of preserving the circumflex iliac lymph nodes (CILNs), i.e., the most caudal external iliac lymph nodes, for the prevention and reduction of LEL by comparing two groups of patients, one in which CILN were removed and the other in which CILNs were preserved.

METHODS

We retrospectively reviewed 329 patients with gynecologic malignancies who had undergone abdominal complete systematic pelvic and para-aortic lymphadenectomy. The patients were divided into nonpreserved (n = 189) and preserved (n = 140) groups, depending on whether CILNs were removed. Primary outcome measures included the incidence and severity of LEL.

RESULTS

The incidence of LEL was significantly lower in the preserved group than in the nonpreserved group (P < 0.0001). The frequency of LEL was also significantly lower in the preserved group than in the nonpreserved group regardless of the range of pelvic and para-aortic lymphadenectomy (P < 0.0001). LEL in the overwhelming majority of cases in the preserved group was mild, and no patients experienced severe LEL. Further, the incidence of cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from the preserved CILN along the iliac and large abdominal vessels.

CONCLUSIONS

This method of lymph node preservation is a simple and extremely effective approach for preventing/reducing LEL after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies.

Retrospective analysis of two modes of lymphadenectomy (para-aortic + pelvic vs. pelvic alone) with regard to survival in endometrial cancer: A comparative study of two gynecologic units

5599

Background: Patients with endometrial cancer are at high risk of severe post-operative complications because of obesity, diabetes mellitus, and hypertension. The purpose of this study is, for minimizing surgical injury, to determine whether para-aortic lymph nodes dissection is dispensable. Methods: 295 patients received hysterectomy and lymphadenectomy during 1995 - 2005 in two gynecologic units of hospitals, one of where para-aortic lymph nodes (to the level of renal vein) and pelvic lymph node (PAN+PLN) dissection were routinely performed and the other only pelvic lymph node (PLN) were dissected, were enrolled. Their overall survival was retrospectively compared between these units. Results: Mean lymph node count was 58.9±19.7 in 99 patients with PAN+PLN lymphadenectomy, and 36.8±14.6 in 196 patients with PLN alone. 5-year survival was 93.3% in PAN+PLN cases and 92.9% in PLN, with no significant difference. Cases who died of the disease (DD) were 6.1% in PAN+PLN and 9.2% in PLN (relative risk = 0.660). Distribution in each stage was ignorable between two units; however, specific histology types, such as serous, clear cell, and carcinosarcoma, were highly counted in DD of the PLN unit. 5-year survival of only endometrioid type, excluding specific histology types, was 92.9% in PAN+PLN and 95.1% in PLN, and DD were 6.6% in PAN+PLN and 6.0% in PLN (RR = 1.095). Lymph node metastases were found 13.1% in PAN+PLN and 4.1% in PLN. One case was observed PAN-alone metastsis, where histology was serous type. Conclusions: Overall survival in patients received PAN+PLN and PLN dissection is not significantly different in endometrial cancer. It is supposed that only PLN dissection is sufficient and PAN dissection is omittable especially in endometrioid type, however, PAN+PLN lymphadenectomy might be suggestive to reduce death in specific histology types.

No significant financial relationships to disclose.

A validation study of a scoring system to estimate the risk of lymph node metastasis for patients with endometrial cancer for tailoring the indication of lymphadenectomy

OBJECTIVE

The aim of this study was to verify whether a preoperative scoring system to estimate the risk of lymph node metastasis (LNM) in endometrial carcinoma is clinically useful for tailoring the indication of lymphadenectomy.

STUDY DESIGN

LNM score was set up using volume index, serum CA125 level, and tumor grade/histology, which were found to be independent risk factors for LNM in a pilot study. Based on the LNM score before a validation study was started, the estimated rates of LNM (para-aortic LNM) were 3.4% (0.0%) in a low risk group, 7.7% (5.8%) in an intermediate group, 44.4% (30.6%) in a high risk group and 70.0% (50.0%) in an extremely high risk group. The validation study was carried out using data for 211 patients with endometrial carcinoma for whom three risk factors were preoperatively confirmed. Logistic regression analysis was used to determine whether these factors remain valid. The actual rate of LNM was investigated according to the LNM score.

RESULTS

Volume index, serum CA125 level, and tumor grade/histology were found to be independent risk factors for LNM in the cohort of this study. The actual rates of LNM (para-aortic LNM) were 3.2% (1.0%) in the low risk group, 15.3% (11.9%) in the intermediate group, 30.2% (23.8%) in the high risk group and 78.6% (57.1%) in the extremely high risk group.

CONCLUSION

The actual rate of LNM for each score was fairly consistent with the estimated rate of LNM. Para-aortic lymphadenectomy may not be necessary in cases of a low risk group. A large prospective multicenter clinical trial needs to be conducted to establish the clinical usefulness of our preoperative scoring system.

Multivariate analysis for prognostic significance of histologic subtype, GST-pi, MDR-1, and p53 in stages II-IV ovarian cancer

It has been suggested that histologic subtype of ovarian cancer is a factor that determines the chemoresponsiveness of tumor. In this study, we wanted to clarify the prognostic significance of histologic subtype and its correlation to expression of chemoresistance-related proteins (CRPs) in ovarian cancer. A total of 93 stage II-IV ovarian cancers, where the proportion of serous, endometrioid, mucinous, and clear cell subtype was 61.3%, 14.0%, 7.5%, and 17.2%, respectively, were investigated for glutathione S-transferase-pi (GST-pi), MDR (multidrug resistance)-1, and p53 expression using immunohistochemistry. GST-pi expression was detected in 62.4% of the tumors and was not related to histologic subtype of tumor. MDR-1 expression was observed in 12.9% of the tumors tested and was more frequently detected in clear cell adenocarcinomas than other histologic subtypes of tumor (10/ 16 vs. 2 / 77, P < 0.001). P53 expression was found in 49.1% of serous, 53.8% of endometrioid, and 50% of mucinous adenocarcinomas. In contrast, none of 16 clear cell adenocarcinomas showed positive p53 staining. In univariate analysis, no direct correlations were found between CRPs and overall survival. Histology of mucinous/clear cell tumors (P = 0.0063), as well as FIGO stage III/IV (P = 0.0091) and residual tumor >or= 2 cm (P = 0.0045), was found to have independent prognostic value in multivariate analysis. In conclusion, histologic subtype proved to be the significant independent prognostic factor in addition to FIGO stage and residual tumor in stage II-IV ovarian cancer. GST-pi, MDR-1, and p53 expression pattern is closely related to histologic subtype of ovarian cancer, although they are not significant predictors of survival.

Multivariate analysis for prognostic significance of histologic subtype, GST-pi, MDR-1, and p53 in stages II-IV ovarian cancer

It has been suggested that histologic subtype of ovarian cancer is a factor that determines the chemoresponsiveness of tumor. In this study, we wanted to clarify the prognostic significance of histologic subtype and its correlation to expression of chemoresistance-related proteins (CRPs) in ovarian cancer. A total of 93 stage II-IV ovarian cancers, where the proportion of serous, endometrioid, mucinous, and clear cell subtype was 61.3%, 14.0%, 7.5%, and 17.2%, respectively, were investigated for glutathione S-transferase-pi (GST-pi), MDR (multidrug resistance)-1, and p53 expression using immunohistochemistry. GST-pi expression was detected in 62.4% of the tumors and was not related to histologic subtype of tumor. MDR-1 expression was observed in 12.9% of the tumors tested and was more frequently detected in clear cell adenocarcinomas than other histologic subtypes of tumor (10/ 16 vs. 2 / 77, P < 0.001). P53 expression was found in 49.1% of serous, 53.8% of endometrioid, and 50% of mucinous adenocarcinomas. In contrast, none of 16 clear cell adenocarcinomas showed positive p53 staining. In univariate analysis, no direct correlations were found between CRPs and overall survival. Histology of mucinous/clear cell tumors (P = 0.0063), as well as FIGO stage III/IV (P = 0.0091) and residual tumor >or= 2 cm (P = 0.0045), was found to have independent prognostic value in multivariate analysis. In conclusion, histologic subtype proved to be the significant independent prognostic factor in addition to FIGO stage and residual tumor in stage II-IV ovarian cancer. GST-pi, MDR-1, and p53 expression pattern is closely related to histologic subtype of ovarian cancer, although they are not significant predictors of survival.

Multivariate analysis for prognostic significance of histologic subtype, GST-pi, MDR-1, and p53 in stages II-IV ovarian cancer

It has been suggested that histologic subtype of ovarian cancer is a factor that determines the chemoresponsiveness of tumor. In this study, we wanted to clarify the prognostic significance of histologic subtype and its correlation to expression of chemoresistance-related proteins (CRPs) in ovarian cancer. A total of 93 stage II-IV ovarian cancers, where the proportion of serous, endometrioid, mucinous, and clear cell subtype was 61.3%, 14.0%, 7.5%, and 17.2%, respectively, were investigated for glutathione S-transferase-pi (GST-pi), MDR (multidrug resistance)-1, and p53 expression using immunohistochemistry. GST-pi expression was detected in 62.4% of the tumors and was not related to histologic subtype of tumor. MDR-1 expression was observed in 12.9% of the tumors tested and was more frequently detected in clear cell adenocarcinomas than other histologic subtypes of tumor (10/ 16 vs. 2 / 77, P < 0.001). P53 expression was found in 49.1% of serous, 53.8% of endometrioid, and 50% of mucinous adenocarcinomas. In contrast, none of 16 clear cell adenocarcinomas showed positive p53 staining. In univariate analysis, no direct correlations were found between CRPs and overall survival. Histology of mucinous/clear cell tumors (P = 0.0063), as well as FIGO stage III/IV (P = 0.0091) and residual tumor >or= 2 cm (P = 0.0045), was found to have independent prognostic value in multivariate analysis. In conclusion, histologic subtype proved to be the significant independent prognostic factor in addition to FIGO stage and residual tumor in stage II-IV ovarian cancer. GST-pi, MDR-1, and p53 expression pattern is closely related to histologic subtype of ovarian cancer, although they are not significant predictors of survival.

Multivariate analysis for prognostic significance of histologic subtype, GST-pi, MDR-1, and p53 in stages II-IV ovarian cancer

It has been suggested that histologic subtype of ovarian cancer is a factor that determines the chemoresponsiveness of tumor. In this study, we wanted to clarify the prognostic significance of histologic subtype and its correlation to expression of chemoresistance-related proteins (CRPs) in ovarian cancer. A total of 93 stage II-IV ovarian cancers, where the proportion of serous, endometrioid, mucinous, and clear cell subtype was 61.3%, 14.0%, 7.5%, and 17.2%, respectively, were investigated for glutathione S-transferase-pi (GST-pi), MDR (multidrug resistance)-1, and p53 expression using immunohistochemistry. GST-pi expression was detected in 62.4% of the tumors and was not related to histologic subtype of tumor. MDR-1 expression was observed in 12.9% of the tumors tested and was more frequently detected in clear cell adenocarcinomas than other histologic subtypes of tumor (10/ 16 vs. 2 / 77, P < 0.001). P53 expression was found in 49.1% of serous, 53.8% of endometrioid, and 50% of mucinous adenocarcinomas. In contrast, none of 16 clear cell adenocarcinomas showed positive p53 staining. In univariate analysis, no direct correlations were found between CRPs and overall survival. Histology of mucinous/clear cell tumors (P = 0.0063), as well as FIGO stage III/IV (P = 0.0091) and residual tumor ≥ 2 cm (P = 0.0045), was found to have independent prognostic value in multivariate analysis. In conclusion, histologic subtype proved to be the significant independent prognostic factor in addition to FIGO stage and residual tumor in stage II-IV ovarian cancer. GST-pi, MDR-1, and p53 expression pattern is closely related to histologic subtype of ovarian cancer, although they are not significant predictors of survival.

Cytogenetic analysis of uterine leiomyoma: the size, histopathology and GnRHa-response in relation to chromosome karyotype

OBJECTIVE

The aim of this study was to elucidate the clinical characteristics of uterine leiomyomas having abnormal chromosome karyotype.

STUDY DESIGN

A total of 394 myomas were obtained from 213 patients for cytogenetic analysis. The size (number of nodules=144), histopathology (n=302), and gonadotropin-releasing hormone analogue (GnRHa)-response (n=58) were investigated in relation to chromosome karyotype in myomas.

RESULTS

302 myomas from 166 patients were successfully karyotyped. A total of 21 myomas from 21 patients showed abnormal chromosome karyotype. The high frequencies of involved chromosomes 12, 14, 1, 7 were observed. The diameters of myomas with abnormal karyotype were significantly larger than those of myomas with normal karyotype. The frequency of the degeneration in myomas with abnormal karyotype was significantly higher than that with normal karyotype. The reduction rate in size of myomas by GnRHa treatments did not differ between the two types (karyotype normal versus abnormal) of nodules.

CONCLUSIONS

Chromosomally abnormal myomas were larger in diameter and showed a higher frequency of degeneration, suggesting that the cytogenetic background in uterine leiomyoma affects a tumor's growth potential.

Para-aortic lymph node metastasis in relation to serum CA 125 levels and nuclear grade in endometrial carcinoma

BACKGROUND

To investigate the relationship between preoperative serum CA 125 levels and para-aortic lymph node (PAN) metastasis as determined by systematic pelvic and para-aortic lymph node dissection in endometrial carcinoma.

METHODS

This study included 180 patients (n = 55, premenopausal; n = 125, postmenopausal) with endometrial carcinoma treated by complete surgical staging. Cut-off values of preoperative serum CA 125 levels for PAN metastasis were determined by receiver characteristic curve (ROC) analysis. Logistic regression analysis was used to determine independent predictors for PAN metastasis.

RESULTS

The median serum CA 125 levels of patients with PAN metastasis were significantly higher than the levels of those with no metastasis in both premenopausal and postmenopausal groups. Based on ROC analysis, we could determine four cut-off values (70 and 210 U/mL for premenopausal patients, 20 and 60 U/mL for postmenopausal patients) and categorize the serum CA 125 levels into low, moderate and high groups. By logistic regression analysis, the CA 125 level and nuclear grade were found to be significant predictors of PAN metastasis, respectively. Using this model, the patients were stratified into three risk groups. The probabilities of PAN metastasis for patients in the low-risk, intermediate-risk and high-risk groups were less than 2%, 2-25% and more than 50%, respectively.

CONCLUSIONS

Serum CA 125 levels and nuclear grade are important risk factors for PAN metastasis in endometrial carcinoma.

A phase I/II study of carboplatin and paclitaxel in patients with epithelial ovarian cancer

BACKGROUND

This study was conducted to investigate the recommended dose of paclitaxel for use in combination with a fixed dose of carboplatin and to evaluate the toxicity and efficacy of carboplatin-paclitaxel combination chemotherapy in patients with epithelial ovarian cancer.

METHODS

One hundred and ten patients were enrolled in the Phase I/II study and 97 patients were evaluated for further analysis, excluding 13 ineligible patients or patients with infringement of protocol: 15 patients for the Phase I and 82 for the Phase II study. In the Phase I trial, we studied dose escalation using a carboplatin dose of AUC 5 and paclitaxel levels of 150, 175 and 200 mg/m(2). The grades of toxicity of the regimen of all patients enrolled in the Phase II study (n = 82), the progression-free survival time (PFS) of optimal-debulked patients and complete responders (n = 62) and the response rate of suboptimal-debulked patients (n = 39) were investigated.

RESULTS

After observing grade 4 neutropenia in four of six patients in the paclitaxel 200 mg/m(2) administration group, we chose 175 mg/m(2) as the recommended dose of paclitaxel in this regimen. At this dose, the median of PFS and response rate were 432 days (range, 19-907 days) and 66.7%, respectively.

CONCLUSION

Combination chemotherapy using paclitaxel 175 mg/m(2) and carboplatin AUC 5 is very well tolerated and highly effective for the treatment of ovarian cancer.

A multivariate analysis of blood vessel and lymph vessel invasion as predictors of ovarian and lymph node metastases in patients with cervical carcinoma

BACKGROUND

To the authors' knowledge there are few available data regarding the influence of lymphovascular space invasion, which has been examined separately as two components (lymphatic vessel invasion [LVI] and blood vessel invasion [BVI]), in the metastasis of cervical carcinoma.

METHODS

LVI and BVI, which include capillary vessel invasion, were reviewed retrospectively based on the histopathologic slides of 239 women with cervical carcinoma who were treated with radical hysterectomy. The correlation between lymph node and/or ovarian metastases and LVI, BVI, and other histopathologic factors was investigated by multiple logistic regression analysis. The influence of LVI and BVI on survival was examined by Cox regression analysis.

RESULTS

The rate of incidence of LVI was higher than that of BVI in all stages of cervical carcinoma (P < 0.0001 for International Federation of Gynecology and Obstetrics Stage IB and Stage II disease and P < 0.05 for Stage III disease). The incidence rate of BVI increased as LVI became more prominent and there was a significant correlation between the two findings (P < 0.0001). BVI was more frequent in adenocarcinoma/adenosquamous carcinoma than in squamous cell carcinoma (P < 0.05). LVI (P < 0.0001) and parametrial invasion (P < 0.0001) were significantly related to lymph node metastasis on multivariate analysis. Conversely, BVI (P < 0.05) and parametrial invasion (P < 0.0025), as well as adenocarcinoma or adenosquamous carcinoma (P < 0.0005), were significantly related to ovarian metastasis on multivariate analysis. With regard to the prognostic significance of these components, it was found that BVI (hazards ratio [HR] = 2.0), ovarian metastasis (HR = 6.5), and lymph node metastasis (HR = 5.5) were significantly related to a poor prognosis in women with cervical carcinoma.

CONCLUSIONS

Ovarian metastasis may occur via hematogenous spread of cervical carcinoma. The results of the current study suggest that BVI, including capillary vessels, that is diagnosed separately from LVI using hematoxylin and eosin stained sections may be an important prognostic factor for patients with cervical carcinoma.

Prognostic significance of serous and clear cell adenocarcinoma in surgically staged endometrial carcinoma

BACKGROUND

The serous adenocarcinoma (SA) and clear cell adenocarcinoma (CCA) of endometrium have been shown to be associated with high relapse rate and poor survival. It is not clear whether prognostic significance of these specific cell types of tumor is independent of retroperitoneal lymph node metastasis and other histopathologic prognostic factors in endometrial carcinoma.

METHODS

We examined 240 consecutive patients with clinical stage I to stage III endometrial carcinoma who were treated prospectively with radical surgery and/or platinum-based chemotherapy. Surgery included extended hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic and paraaortic lymph node dissection. Prognostic significance of various histopathologic factors was determined by Cox regression analysis.

RESULTS

SA/CCA were more frequently associated with deep myometrial invasion, high nuclear grade (G3), lymph-vascular space invasion (LVSI), and pelvic lymph node metastasis when compared to endometrioid adenocarcinoma (EMA). Of 216 clinically staged stage I or II disease, seven of 12 cases of SA/CCA had extrauterine disease. This incidence was much higher than that for EMA (46/204) (p<0.01). A multivariate Cox regression analysis revealed that cell type, grade, LVSI, and paraaortic node metastasis (PANM) were independent prognosticators.

CONCLUSIONS

Prognosis of patients with endometrial carcinoma depends on cell type, grade, LVSI, and PANM. Poor prognosis for patients with SA/CCA is independent of lymph node metastasis and other histopathologic prognostic factors. The SA/CCA should be strictly discriminated from EMA.

[Successful treatment of a patient with recurrent ovarian clear cell adenocarcinoma under combination chemotherapy of 5-FU (civ) and low-dose CDDP (i.v.)]

Resistance to conventional chemotherapy including CDDP is the most important therapeutic problem in ovarian cancer. The combination chemotherapy of 5-FU (civ) and low-dose CDDP (i.v.) was applied to a patient with recurrent ovarian clear cell adenocarcinoma (stage IIa), which is often more resistant to systemic chemotherapy than other ovarian adenocarcinomas and is a poor prognostic factor. The patient underwent cytoreductive surgery. Then, 5-FU 375 mg/m2/day civ (days 1-5, 8-12, 15-19, 22-26) and CDDP 3.75 mg/m2/day i.v. (days 1-5, 8-12, 15-19, 22-26) were administered. After four courses of this treatment, there is no sign of recurrence. This result indicates that the combination of 5-FU and CDDP is useful in the treatment of recurrent ovarian cancers.

Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy

BACKGROUND

The incidence and distribution pattern of retroperitoneal lymph node metastasis in patients with cervical carcinoma should be investigated based on data from systematic pelvic lymph node (PLN) and paraaortic lymph node (PAN) dissection, so that a basis can be established for determining the site of selective lymph node dissection or sampling.

METHODS

A total of 208 patients with Stages IB, IIA, and IIB cervical carcinoma who underwent radical hysterectomy and systematic pelvic and PAN dissection were investigated for lymph node metastasis and histopathologic risk factors for lymph node metastasis.

RESULTS

Fifty-three patients (25.5%) had lymph node metastasis. The obturator lymph nodes were most frequently involved, with a rate of 18.8% (39/208). Forty-nine of 53 node-positive patients had lymph node metastasis in the obturator, internal iliac, or common iliac lymph nodes. Of 26 solitary lymph node metastases confined to one node group, 18 were in the obturator, 3 in the internal iliac, 3 in the parametrial, and 2 in the common iliac lymph nodes. A multiple logistic regression analysis revealed that deep cervical stromal invasion and lymph-vascular space invasion were related to PLN metastasis. It was also shown that metastasis to bilateral PLNs (excluding the common iliac lymph nodes) as well as metastasis to the common iliac lymph nodes were significantly related to PAN metastasis.

CONCLUSIONS

The results of this study suggest that the obturator lymph nodes can be sentinel lymph nodes of cervical carcinoma. PAN metastasis appears to occur secondarily to wide-spread PLN metastasis. These results provide a basis for determining the site of selective lymph node dissection and for estimating the existence of PAN metastasis from the pattern of metastasis in PLN in patients with cervical carcinoma.

Induction of macrophage migration inhibitory factor in human ovary by human chorionic gonadotrophin

The role of macrophage migration inhibitory factor (MIF) in human ovarian function remains obscure. The aim of this study was to investigate how MIF was related to ovulation by quantitative analysis of serum, follicular fluid and culture medium of granulosa cells obtained from in-vitro fertilization (IVF) and embryo transfer patients. Serum MIF concentrations in ovarian stimulation cycles for IVF-embryo transfer were higher at day 1 (median 92.6 ng/ml), which took place 35 h after human chorionic gonadotrophin (HCG) administration and just before the retrieval of oocytes, than those before day -6 (12.1 ng/ml), at day -5 to about day 0 (17.5 ng/ml) or at day 2 to about day 14 (8.2 ng/ml). MIF concentrations in the follicular fluid (113.4 ng/ml) obtained in ovarian stimulation cycles for IVF-embryo transfer were significantly higher than in serum (72.0 ng/ml) collected at the same time. MIF concentrations in the follicular fluid in natural cycles were higher in the ovulatory phase (51.6 ng/ml) than in the late follicular phase (13.8 ng/ml). MIF concentrations in the culture media of granulosa cells increased from 3.2 ng/ml to 7.2 ng/ml with HCG stimulation, and decreased from 2.4 ng/ml to 1.2 ng/ml when stimulation was withheld. These results indicate that HCG can induce the elevation of serum and follicular fluid MIF concentrations through the stimulation of ovarian cells, and that MIF is probably involved in the mechanism of ovulation.

Cox multivariate regression models for estimating prognosis of patients with endometrioid adenocarcinoma of the uterine corpus who underwent thorough surgical staging

The International Federation of Gynecology and Obstetrics (FIGO) adopted surgical staging criteria in 1988. Many studies have shown that histologic grade, nuclear grade, lymph-vascular space invasion and cell type are also important predictors of survival. It has not been clarified, however, how to integrate these histopathologic variables into the process of estimating individual prognosis. We performed Cox multivariate regression analysis to create models that incorporate various histopathologic factors for estimating the prognoses of patients with endometrioid adenocarcinoma of the uterine corpus. Our study was based on data from 206 patients who underwent complete surgical staging, including systematic pelvic and para-aortic lymph node dissection. Two models resulted: one included depth of myometrial invasion, para-aortic node metastasis and the number of sites involved by the tumor among the cervix, ovary and pelvic lymph nodes (which we designated as extracorporeal spread score, ECS) and the other incorporated nuclear grade and lymph-vascular space invasion as variables. These 2 models enabled the prognosis for patients with endometrioid adenocarcinoma to be stratified into several levels according to hazard ratio. Comprehensive integration of the histopathologic prognostic factors, categorized into those relating to tumor extent and those relating to tumor virulence, should facilitate the estimation of individual prognosis more accurately than FIGO staging alone.

Distribution pattern and risk factors of pelvic and para-aortic lymph node metastasis in epithelial ovarian carcinoma

The distribution of lymph node metastasis and the clinicopathologic risk factors for nodal involvement in ovarian carcinoma need to be clarified based on systematic lymph node dissection. We studied 115 patients with ovarian carcinoma who underwent systematic pelvic and para-aortic lymph node dissection between 1987 and 1997. The incidence and distribution of lymph node metastasis are described and the clinico-pathologic risk factors for nodal involvement are investigated. Based on the occurrence of lymph node metastasis in the early stages, the incidence of solitary node involvement and the distribution of lymph node metastasis, we conclude that the primary site of nodal involvement in ovarian carcinoma is the para-aortic node (PAN), especially PAN superior to the inferior mesenteric artery (IMA). By univariate analysis, clinical stage, histologic type (mucinous vs. others), grade, multiple peritoneal metastases, peritoneal cytology, volume of ascites and serum CA125 level were correlated with overall incidence of lymph node metastasis. By performing a multivariate analysis with the clinical stage excluded, it was revealed that grade and peritoneal cytology were independent factors for PAN metastasis (p < 0.0025 and < 0.001, respectively) and that multiple peritoneal metastases and PAN metastasis were significant predictors of pelvic node metastasis (p < 0.01 and < 0.005, respectively). In conclusion, the PANs superior and inferior to IMA should be explored in staging of ovarian carcinoma that appears to be confined to the ovaries. To determine accurately the extent of disease, both the para-aortic and pelvic areas may need to be sampled or dissected in the case of ovarian carcinoma involving the peritoneal surfaces.

Seminoma in a postmenopausal woman with a Y;15 translocation in peripheral blood lymphocytes and a t(Y;15)/45,X Turner mosaic pattern in skin fibroblasts

We report an unusual case of a 55 year old Japanese woman with a seminoma but relatively normal menses. The patient was a phenotypic female with late onset menarche (18 years of age), who was amenorrhoeic for the first year, followed by menses of one to three days' slight flow with dysmenorrhoea, but an otherwise normal menstrual history. A typical seminoma was removed from the left adnexal region and an immature testis was identified separately as an associated right adnexal mass. Repeated karyotypic studies on peripheral blood lymphocyte cultures showed only 46,X,-Y,t(Y;15)(q12;p13). Cytogenetic examination of the patient's younger brother, who had fathered three healthy children, showed an identical karyotype. Mosaicism of 46,X,-Y,t(Y;15)(q12;p13)/45,X cell lines was found in skin samples from the patient's elbow and genital regions, although there were no clinical stigmata of Turner syndrome. An androgen receptor binding assay of cultured genital skin fibroblasts was negative. Molecular analysis using Southern blot hybridisation, PCR, and direct DNA sequencing showed that neither the patient nor her brother had a detectable deletion or other abnormalities of Y chromosome sequences, including the SRY (sex determining region of the Y chromosome) gene sequence. These findings suggest that Turner mosaicism of the 45,X cell line may have contributed to this atypical presentation in an XY female, although we cannot exclude abnormalities of other genes related to sex differentiation.

Bcl-2 expression and prognosis of patients with endometrial carcinoma

Bcl-2 protein inhibits apoptosis, reduces the requirement for growth factors, and thereby extends the survival of cells. Recent findings of Bcl-2 in several solid tumors suggest that it might contribute to the genesis of some types of cancer. Over-expression of Bcl-2 might play a role in carcinogenesis and malignant progression of endometrial carcinoma. The aims of this study were to determine Bcl-2 expression in endometrial carcinoma in relation to other histopathologic prognostic factors, and to test its prognostic significance in patients with endometrial carcinoma. A total of 61 endometrioid-type endometrial carcinomas were immunohistochemically investigated for Bcl-2 expression on cryostat sections. Bcl-2 localization was observed in cytoplasm in 18 tumors, in nucleus in 27 tumors, or in both in 5 tumors. In 11 tumors, Bcl-2 was observed neither in cytoplasm nor in nucleus. There was not a statistically significant relationship between grade of tumor and Bcl-2 expression. Cytoplasmic Bcl-2 became less frequently expressed as the tumor invaded the myometrium deeper (p < 0.025). Retroperitoneal lymph-node dissection was performed in 57 patients. Multiple-regression analysis showed that lymph-vascular space invasion and nuclear expression of Bcl-2 were correlated to pelvic lymph-node metastasis (p < 0.0001 and < 0.05 respectively). Univariate Cox regression analysis revealed that nuclear Bcl-2 expression was associated with shorter survival (p < 0.05) than that of patients with cytoplasmic Bcl-2 expression. Pelvic node metastasis was a significant prognostic factor for patients who underwent systematic retroperitoneal lymph-node dissection. Cox multivariate-regression analysis revealed that pelvic node metastasis and cervical invasion were the most important prognostic factors in this series of patients. When the analysis was made after exclusion of pelvic node metastasis, histologic grade (hazard ratio = 2.4), cervical invasion (hazard ratio = 3.7) and nuclear Bcl-2 expression (hazard ratio = 11.5) were shown to be significant predictors of survival of the patients. These results indicate that aberrant Bcl-2 expression might be involved in malignant progression of endometrioid-type endometrial carcinoma. Site of Bcl-2 localization may be an important predictor of prognosis for patients with endometrioid-type endometrial carcinoma.

Lectin affinity electrophoresis in a yolk sac tumour in the vagina with yolk sac tumour-type glycoform of alpha fetoprotein

AIMS

To investigate a potential diagnostic use of alpha fetoprotein (alpha FP) isoform analysis by lectin affinity electrophoresis to distinguish between endodermal sinus tumours arising in the vagina in infants from those at other sites.

METHODS

alpha FP in the serum of a patient with a vaginal endodermal sinus tumour was analysed for its isoforms by lectin affinity electrophoresis. The isoforms were compared with that of cord serum, sera of hepatoid adenocarcinoma of the uterus, and endodermal sinus tumour of the ovary.

RESULTS

The isoforms of alpha FP obtained by lectin affinity electrophoresis in the serum of the patient with vaginal endodermal sinus tumour differed from the isoforms of alpha FP in the cord serum of normal neonates, and sera of patients with hepatoid adenocarcinoma of the uterus or endodermal sinus tumour of the ovary.

CONCLUSIONS

Endodermal sinus tumour arising in the vagina could be distinguished from that in the ovary by the lectin affinity electrophoresis, and a potential diagnostic use of alpha FP isoform analysis by the lectin affinity electrophoresis for the detection of the endodermal sinus tumour in infants was demonstrated.

Peritoneal cytology and its prognostic value in endometrial carcinoma

BACKGROUND

There has been a controversy about the prognostic significance of positive peritoneal cytology in endometrial carcinoma.

MATERIALS AND METHODS

Peritoneal cytology was obtained at the time of surgery, including systematic retroperitoneal lymph node dissection, in 114 patients.

RESULTS

The incidence of positive peritoneal cytology was 35.1%. The 5-year survival rates of the stage IIIA and IIIC (FIGO, 1988) cases were 82.8% and 58.3%, respectively. In pathological stage I (the disease was histologically confined to the uterine corpus), there was no significant difference in 5-year survival rates between patients with and without positive peritoneal cytology. Though the patients in stage IIIA who had only positive peritoneal cytology were given no postoperative therapy unless they had extrauterine disease, no patients developed recurrence. In stages IIIC and IV, the prognosis was significantly poorer for patients with positive peritoneal cytology than for those with negative cytology.

CONCLUSION

Positive peritoneal cytology is not an adverse prognostic factor endometrial carcinoma if disease is limited to the uterus.

A clinical and pathologic study on para-aortic lymph node metastasis in endometrial carcinoma

BACKGROUND

Recent studies have shown that poor survival for patients with early endometrial cancer was related to the extrapelvic spread of the cancer. The purpose of this study was to evaluate the correlation between para-aortic lymph node (PAN) metastasis and histopathologic findings and to assess the clinical utility of identifying PAN metastasis of endometrial carcinoma.

METHODS

The correlation of para-aortic lymph node metastasis to the clinical stages of endometrial carcinoma (FIGO, 1982), histopathologic findings, and prognosis were investigated in 200 patients with endometrial carcinoma, who were treated by radical operations, including systematic retroperitoneal lymphadenectomies, between July 1982 and February 1996.

RESULTS

Of these, para-aortic lymph node (PAN) metastasis was seen in 18 (9.0%) and pelvic lymph node (PLN) metastasis in 40 (20.0%). The incidence of PAN metastasis according to clinical stages Ia, Ib, II, and III were 2.5%, 8.5%, 15.7%, and 33.3%, respectively. The incidence of metastasis was significantly higher in stage II than in stage Ia (P < 0.05), and in stage III than in stage Ia (P < 0.01). PAN metastasis occurred significantly more frequently in the first of each of the following groups: invasion of > 1/2 of the myometrium (15.7%) vs. invasion of < 1/2 of the myometrium (3.6%) (P < 0.01), the group with cervical invasion (23.5%) vs. the group without (4.0%) (P < 0.0001), the group with lymph-vascular space involvement (17.2%) vs. the group without (1.0%) (P < 0.0005), and PLN-metastasis-positive group (40.0%) vs. the negative group (1.3%) (P < 0.0001). Multivariate analysis showed a significant correlation between PAN and PLN metastases (P < 0.0005). Positive PAN metastasis is not related to multiple PLN metastasis (bilateral PLN metastasis and the number of PLN metastatic groups). However, a correlation was seen between PAN metastasis and common iliac node metastasis. The prognosis was significantly poorer (P < 0.05) for patients with both PLN and PAN metastases than for those with PLN metastasis alone.

CONCLUSIONS

The results of the present study suggest that PAN metastasis may occur as a consequence of PLN metastasis or the two may occur simultaneously as PLN metastasis and also that careful examination of PAN metastasis is necessary to determine the prognosis.

Serum and tissue measurements of CA72-4 in patients with endometrial carcinoma

AIMS

To evaluate the clinical usefulness of CA72-4 as a serum tumour marker for endometrial carcinoma and to investigate its immunohistochemical localisation in endometrial carcinoma cells.

METHODS

Serum concentrations of CA72-4 were determined in 72 patients with endometrial carcinoma. Immunohistochemical localisation of CA72-4 was investigated using the streptavidin-biotin method, using monoclonal antibodies B72.3 and CC49.

RESULTS

Serum CA72-4 was increased above the cut off value in 31.9% of the patients with endometrial carcinoma. Serum CA72-4 positivity was correlated with depth of myometrial invasion, adnexal metastasis, lymphovascular space involvement, and pelvic and para-aortic lymph node metastasis. Multivariate analysis showed a significant correlation between serum CA72-4 positivity and adnexal metastasis. The serum concentrations of CA125 and CA19-9, which could be tumour markers for endometrial carcinoma, were measured at the same time. In seven of 72 patients increased concentrations of serum CA72-4 were found while those for CA125 and CA19-9 were within the normal ranges; in four of the seven patients the disease had spread beyond the uterus. Immunohistochemical positivity for CA72-4 antigen was 76.9% and occurred in the tumour cell membrane and cytoplasm. There was no significant difference in immunohistochemical positivity between patients with increased CA72-4 and those with normal CA72-4 values.

CONCLUSIONS

The measurement of serum concentrations of CA 72-4 could be useful for predicting and monitoring the progress of disease-for example, extracorporeal spread.

Non-grafting method of vaginal construction for patients of vaginal agenesis without functioning uterus (Mayer-Rokitansky-Küster syndrome)

We have treated 18 patients with vaginal agenesis without functioning uterus (MRK syndrome) during the period between January 1984 and December 1995 by Frank's dilatation method followed by the surgical method without grafting. Clinical records were retrospectively examined in regard to the size and functions of the constructed vagina and problems of the treatment procedure. The treatment by non-invasive dilatation was first carried out starting at the age of 21 years 2 months +/- 2 years 9 months (Mean +/- SD) for the duration of 10.9 +/- 9.8 months. It was successful (constructed vaginal length by pressure: 60 mm or more) in 6 patients (35.3%). The non-grafting surgical method was then performed. The operation time was 2:11 +/- 0:37 hours and no complications were observed. The vaginal lengths 1 month after operation and at the latest follow-up were enough to have coitus and no severe complications including shrinkage were observed. Our method to construct a new vagina is simple and useful, since it left no operation scar in contrast to McIndoe's method and other methods with grafting.

[An analysis of pelvic and para-aortic lymph node metastasis in ovarian carcinoma by systematic retroperitoneal lymph node dissection]

We performed a systematic retroperitoneal lymph node dissection (RPLND) on 137 patients with primary ovarian carcinoma, of whom 97 had undergone RPLND during the primary surgery before chemotherapy and 40 had undergone RPLND during the secondary cytoreductive surgery after preoperative chemotherapy. The tentative staging of the ovarian carcinoma used in this study was determined according to the FIGO criteria without considering the pathologic findings of retroperitoneal lymph nodes. Nodal metastasis was seen in 21.9% (30/137) of them. Thirteen had positive pelvic lymph nodes (PLN) but no positive para-aortic nodes (PAN). Eleven had both positive PLN and positive PAN. Six had positive PAN but no positive PLN. The PAN was the most frequent site of metastasis (17/137). Next were the common iliac, obturator, and lateral group of deep inguinal nodes. Solitary metastasis in the patients who had undergone RPLND during the primary surgery was seen in a PAN and a common iliac node. Among 24 patients with PLN metastasis, there was a significant (p < 0.05) difference in the number of positive PLN between the patients with PAN metastasis (5.27 +/- 3.00) and the patients without PAN metastasis (2.62 +/- 1.66). These results indicate that the PAN and common iliac nodes are the most important site of nodal metastasis in ovarian carcinoma. The metastasis to PLN such as obturator node and internal iliac node seems to occur independently of the PAN metastasis, and the PAN metastasis occurs not only through the direct route but also as a consequence of extension of PLN metastases. Systematic retroperitoneal lymph node exploration therefore seems to be necessary to clarify the lymph node status.

Alpha-fetoprotein production by a hepatoid adenocarcinoma of the uterus

A case of a 62 year old Japanese woman with an endometrial adenocarcinoma producing alpha-fetoprotein (AFP) is described. Microscopically, the tumour was composed of a major medullary portion and a minor tubular adenocarcinoma which had invaded the myometrium, the myometrial lymphatics and blood vessels. Neoplastic cells in the medullary portion were polygonal with glycogen-rich cytoplasm. Vascular permeation by neoplastic cells was prominent. Extensive hepatoma-like features were observed. The tumour cells lacked features suggestive of a diagnosis of embryonal carcinoma or endodermal sinus tumour. The production of AFP by the tumour cells was demonstrated immunohistochemically using the PAP technique. Only two cases of AFP producing endometrial adenocarcinomas have been reported previously.

Clinical usefulness of the dye-injection method for diagnosing premature rupture of the membranes in equivocal cases

OBJECTIVE

In 1981, we preliminarily reported on the clinical value and safety of the intra-amniotic dye (Phenol-sulfonphthalein, PSP)-injection method for diagnosing PROM. In the current study, through examination of 64 equivocal cases in the midtrimester of pregnancy, we investigated the clinical efficacy of the PSP test.

METHODS

In the present study we examined patients with equivocal PROM in their 14th week to 33rd week of gestation, whose findings were positive according to a combination of conventional diagnostic methods. The results of the PSP test and conventional diagnostic methods were compared with the final diagnosis of PROM.

RESULTS

The conventional diagnostic methods showed an accuracy rate of 63.9%-70.5%, in contrast to the PSP test, which had a 100%-accuracy rate (p < 0.001).

CONCLUSION

Using the PSP test in combination with amnioscopy, we have established a method of differentially diagnosing PROM. We have reconfirmed the clinical efficacy of the PSP test in 64 equivocal PROM cases.

[Proliferative activity of normal endometrial cells, endometrial hyperplasia cells and endometrial cancer cells using the monoclonal antibody to PCNA]

PCNA (Proliferating Cell Nuclear Antigen) index was studied by using an immunohistochemical technique in normal endometrium (n = 44), endometrial hyperplasia tissue (n = 12) and endometrial carcinoma (n = 60). In normal endometrial tissues, the PCNA index in the late proliferative phase (n = 11, 26.8 +/- 2.7% (mean +/- SE)) was the highest, and showed a significantly higher value than those of the early-mid secretory phase (n = 7, 12.5 +/- 3.4%, p < 0.01), late secretory phase (n = 11, 0.2 +/- 0.1%, p < 0.001), early proliferative phase (n = 7, 6.4 +/- 2.9%, p < 0.001) and postmenopausal endometrium (n = 8, p < 0.001). The mean PCNA index of premenopausal endometrial carcinoma (n = 17) was 17.1% and was not significantly higher than those of the proliferative phase and endometrial hyperplasia. Postmenopausal endometrial carcinoma (n = 43) presented a mean PCNA index of 19.9%, which was significantly higher than that of normal postmenopausal endometrium (p < 0.005). There was a clear relationship between the PCNA index and nuclear grade, cervical involvement, muscle invasion, lymph-vascular space involvement and lymphnode metastasis, respectively. There was a statistically significant difference in survival between a PCNA index of less than 25% and a PCNA index of 25% or above (p < 0.05). These results suggest that PCNA immunoreactivity in endometrial carcinoma cells may be clinically useful in predicting and/or determining the prognosis, and/or the necessity of adjuvant therapy.

A study on the hemostatic effect of sodium alginate on uterocervical hemorrhage

We examined a sodium alginate preparation (Alto) to determine its hemostatic effect, in comparison with other topical drugs, on hemorrhages in the uterocervical area. A total of 149 patients with hemorrhage from cervical erosion or after-treatment bleeding of the cervix uteri were subjects in this trial, and 84 (79%) of 106 patients treated with this preparation experienced a hemostatic effect. A significant positive correlation (p < 0.001) was noted between the degree of tissue adhesiveness and the hemostatic effect in all the drugs tested. As for the tissue adhesiveness, Alto was significantly more favorable (p < 0.001) than both Thrombin and Francetin T powder. Because Alto was softened by tissue moisture, its topical adhesiveness could be increased, which suggested that Alto was superior in hemostasis.

Decreased E-cadherin expression in endometrial carcinoma is associated with tumor dedifferentiation and deep myometrial invasion

Decreased E-cadherin expression in tumor cells has been suggested to promote tumor invasiveness. We examined E-cadherin expression in 30 cases of endometrial carcinoma by immunohistochemistry using a monoclonal antibody to E-cadherin and investigated its correlation with other histopathologic features of the tumor. We observed that: (1) E-cadherin expression decreased with loss of differentiation (P < 0.05); (2) E-cadherin expression was inversely correlated with depth of myometrial invasion (P < 0.05); (3) decreased E-cadherin expression was correlated with paraaortic node metastasis (P < 0.01); and (4) multivariate analysis comparing the depth of myometrial invasion to the pattern of E-cadherin expression, histologic grade, nuclear grade, and lymph-vascular space invasion showed that the depth of myometrial invasion was most strongly correlated with decreased E-cadherin expression (P < 0.005). These findings seem to be consistent with the concept that the dissociation of cancer cells due to decreased expression of E-cadherin facilitates invasion of tumor cells.

Cytologic and hormonal findings in a carcinoid tumor of the uterine cervix

A carcinoid tumor of the cervix in a 40-year-old woman was studied by cytology, histology, electron microscopy, immunohistochemistry and hormonal analysis. The preoperative cytologic and histologic findings strongly suggested a carcinoid tumor of the cervix. The serum serotonin level was elevated; immunohistochemical studies demonstrated the presence of serotonin in the cytoplasm of the tumor cells. Following radical hysterectomy, the concentration of serotonin was measured in the excised tumor; it was about 20 times higher than the level seen in normal cervical tissue, confirming that the tumor was a serotonin-secreting carcinoid of the uterine cervix.

[Fundamental studies on the introduction of chemotherapy of uterine cervical carcinoma--tissue level of 5-FU after oral administration]

In Japan, oral 5-FU has been popularly used as an adjuvant chemotherapy to surgical operation mainly gastrointestinal carcinomas. This drug is generally administered consecutively at a low dose over a long term, because of its distribution at high levels in the upper gastrointestinal organs after oral administration. The authors have attempted to introduce the oral administration of 5-FU as an adjuvant chemotherapy in the treatment of uterine cervical carcinoma, and the results of a preliminary trial are reported in this paper; that is, the 5-FU level in target organs was measured after oral administration of 5-FU in 44 cases of uterine cervical carcinoma. Judging from the 5-FU level in organs removed about 2 hours after preoperative administration of 5-FU at 300 mg, the distribution of the drug to bilateral lymph nodes and the uterine cervix was good, and when calculated on the basis of the trace as 0, the average tissue level was 0.0432 microgram/g in the left lymph node, 0.0104 microgram/g in the right lymph node and 0.0190 microgram/g in the uterine cervix. From the above, it was concluded that, in the application of oral 5-FU as an adjuvant chemotherapy to treatment of uterine cervical carcinoma, a different manner application procedure should be established from that used to treat gastrointestinal carcinoma; that is, 5-FU should be administered intermittently at a moderate dose.