Biomedical subjects
Publications and source records attributed to K Matsukuma.
Choriocarcinoma in mother and child is extremely rare and review of the literature revealed only six reported cases. We are presenting the seventh such case. Autopsy of the fetus of 39 weeks' gestation revealed metastatic choriocarcinoma. Workup of the mother showed an occult choriocarcinoma in the uterus. Aggressive chemotherapy was initiated promptly and remission was achieved.
The 11th well-documented case of malignant melanoma, arising in a cystic teratoma of the ovary, is described. The melanoma which recurred 4 months after surgery responded completely to immunochemotherapy.
Sixty-one patients with cancer of the uterine cervix received pretreatment laparotomy before the radiotherapy. As an operative procedure, several hemostatic clips were put on the serosal surface of the uterine wall in order to visualize the uterine contour in the localization X-ray films. By this method, six patients among them were proved to have uterine perforation at the time of small source insertion.
A case of adenocarcinoma of the descending colon during pregnancy is reported. The patient presented with bilateral large ovarian tumors in pregnancy, and surgery was performed for a presumed ovarian cancer. Only a small, 1 X 1-cm primary focus of adenocarcinoma was found in the resected descending colon. The association of pregnancy and colon cancer above the peritoneal reflection is rare, and only 20 such patients have previously been reported.
Five episodes of spinal cord compression (SCC) in four patients with gynecological malignancy are described. Two patients had a recurrent cervical cancer, one had a recurrent uterine sarcoma, and one had a primary ovarian cancer. All presented with back pain, and the site of compression was at the thoracic spine. Three patient were treated with radiotherapy, and one underwent decompression laminectomy followed by radiotherapy. One patient improved, but the other three did not. SCC is an oncologic emergency, which should be borne in mind by all physicians who take care of cancer patients.
Thirty previously untreated patients with epithelial ovarian carcinoma were treated with cisplatin and adriamycin (PA). Of eight evaluable patients, six were responders (two CRs and four PRs). The three-year survival rates were 83% for stage I, 67% for stage II, 50% for stage III, and none for stage IV. Toxicities included moderate myelo-suppression, mild nephrotoxicity, alopecia, and severe vomiting in almost all patients. Patients with residual lesions smaller than 2 cm had excellent prognosis when PA was given for more than five courses. Patients with residual lesions larger than 2 cm, however, had poor prognosis irrespective of the number of courses. No specific relation between histological grade and prognosis could be found. From the present data, aggressive cytoreductive surgery followed by PA therapy repeated more than five times is recommended for achieving a good outcome in the treatment of epithelial ovarian carcinoma.
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This report describes a case of recurrent and metastatic endolymphatic stromal myosis (ESM), which showed good response to progestin therapy. Metastatic lung nodules regressed after medroxyprogesterone acetate (MPA) treatment, recurred while MPA was stopped, and disappeared again when MPA was restarted. The levels of estrogen and progesterone receptors measured in the resected tumor amounted to 79.5 and 310 fmole/mg protein, respectively. Sex steroid hormone dependency of ESM was reviewed in the literature.
Three patients with advanced and recurrent endodermal sinus tumor (EST) of the ovary were treated with modified vinblastine, actinomycin-D, and bleomycin (VAB-3) regimen. Serum alpha-fetoprotein (AFP) levels were monitored for all patients during and after therapy. In all patients a clinical response was achieved. In one stage IV patient with huge multiple liver metastases complete response was attained and she is free of disease following secondlook larparotomy. In other two patients, one stage IV and another recurrent, with large liver metastases, partial responses were achieved with normalization of serum AFP. Serum AFP monitoring is valuable for the management of EST, but a negative AFP titer does not eliminate the possibility of persistent or recurrent disease. The VAB-3 combination, previously found effective in metastatic nonseminomatous testicular cancer, is also effective in advanced and recurrent EST of the ovary.
A 40-year-old female with ovarian cancer being treated with daily oral cyclophosphamide developed fatal interstitial pneumonitis. Autopsy did not show any evidence of ovarian cancer. The review of the literature revealed eight reported cases of cyclophosphamide-induced interstitial pneumonitis and fibrosis. The case is reported to alert gynecologists to this rare but lethal complication of cyclophosphamide.
A case of verrucous carcinoma of the uterine cervix was reported with a long-term follow-up and close observation. The patient was a 73-year-old, Japanese female, who had a suspicious Papanicolaou smear on routine examination. The cervix was replaced by a papillary mass, which was diagnosed as benign papilloma. The patient was followed every 6 months with cytology, colposcopy, and punch biopsy. No cytologic or microscopic diagnosis of invasive squamous cell carcinoma was made during the entire follow-up period. Total abdominal hysterectomy and partial vaginectomy were performed after 6 1/2 years' follow-up, and the tumor was finally diagnosed as verrucous carcinoma. The patient is alive and well 4 years after the operation.
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Therapeutic efficacy of cervical conization was examined on 93 patients with borderline lesions of the uterine cervix who underwent hysterectomy following conization. No lesions or only minimal residual lesions were found at subsequent hysterectomy when the surgical margins of cone specimens were not involved in the malignant or premalignant lesions. From these results, we concluded that cervical conization could be considered as a therapeutic procedure when the following conditions were fulfilled. Cone specimens are sufficient in size. Both endocervical and exocervical margins are negative. No malignancy is found on endocervical curettage. No abnormal cytologic findings are found after conization. Another follow-up study was performed on 69 patients who received therapeutic conization between 1971 and 1981. Among them one developed stage II cervical cancer two years after the last follow up. Two other patients had recurrent CIN in the cervix and another patient was found to have an endometrial cancer. These patients were successfully treated after early detection of the lesions by the cytological examination. From these facts, cytological examination is recommended in the follow-up after therapeutic conization.
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From January, 1973 to December, 1980, 396 cases of cervical cancer were treated with radical hysterectomy under the diagnoses of stage Ib, IIa and IIb. Precise postoperative pathological examinations about the extirpated uterus revealed that 63 of them had only early invasive cancer or less advanced lesions though they had been considered as frank invasive cancer by preoperatively performed biopsies. The major causes of the misinterpretations were, 1) misjudging the glandular involvements as frank invasive lesions, or 2) misjudging the tangentially sectioned lesions of the bulky outgrowth as frank invasions. Furthermore, it is sometimes difficult to identify the invasive lesions in the biopsy specimens whether they are early invasive or frank invasive. Colposcopic and cytological examinations were simultaneously performed to each cases. Either cytology or colposcopy did not suggest frank invasions in 44.2% of cases. Both of them did not suggest frank invasions in 37.2% of cases. At least, cone biopsy should have been performed to identify the degree of invasions of these 37.2% cases. The authors emphasize that the directed biopsies are not always accurate to diagnose the early invasions, and one should use colposcopy, cytology and directed biopsy to make an accurate diagnosis.
The cytomorphologic observations of peritoneal fluid from seven patients with ovarian serous adenocarcinomas are presented. Some different cytologic findings, including smaller cell and nuclear size, larger relative nuclear area, fewer cells with large discrete cytoplasmic vacuoles and macronucleoli, more frequent multinucleolation, and larger closely packed clusters of cells, were shown in serous adenocarcinoma of the ovary as compared with those in other types of ovarian malignant neoplasms. Although the materials of nonserous tumors are too limited for a valid comparative study, prediction of histologic types by the peritoneal fluid cytology will be possible if the close cytomorphologic studies are performed.
In a 69-year-old woman, a gynecologic smear was the first indication of the presence of a nonepithelial malignant tumor. While first thought to represent an adenocarcinoma, malignant lymphoma was later cytologically suspected because of the presence of isolated large malignant cells with macronucleoli. The initial clinical and histologic studies failed to indicate a malignancy. The malignant cells in postoperative tissue samples showed a positive immunohistochemical reaction for leukocyte-common antigen (LCA) and a negative reaction for epithelial membrane antigen, confirming the cytologic suggestion of a uterine lymphoma. Immunocytochemical staining subsequently performed on the destained cytologic specimen gave a positive immunoreactivity to LCA in the cytoplasm of the malignant cells.