We performed a review of the current modalities of surgical treatment of malignant ovarian germ cell tumors by clinical stages and histological types. Stage IA dysgerminoma is performed with a unilateral salpingo-oophorectomy (USO) without chemotherapy. However, for Stage IB or IC patients with dysgerminoma, USO plus chemotherapy as a primary treatment may or may not be followed with a second-look operation (SLO). For non-dysgerminomas, USO is indicated only for Stage IA immature teratoma grade 1. The treatment for Stage IA immature teratoma grade 2 or 3 and other histological types is USO plus chemotherapy. Patients with Stage IB, IC or higher with non-dysgerminoma are treated with USO plus chemotherapy or USO with contralateral partial ovariectomy plus chemotherapy. For patients who require non-conservative surgery, a total abdominal hysterectomy (TAH) and a bilateral salpingo-oophorectomy (BSO) plus chemotherapy are performed. For patients with Stage II of all histological types, conservative surgery consists of USO and a cytoreductive operation plus chemotherapy, followed by SLO or a second cytoreductive operation. For non-conservative surgery, TAH+BSO with or without a cytoreductive operation plus chemotherapy is followed by SLO. Conservative surgery for patients with Stage III and IV is USO and a cytoreductive operation plus chemotherapy followed by a second cytoreductive operation. Non-conservative surgery is TAH+BSO with a cytoreductive operation plus chemotherapy, followed by SLO or a second cytoreductive operation. However, primary or secondary cytoreductive surgery with or without lymphadenectomy and SLO are still controversial in terms of improving patient survival.

Adolescent↗

PubMedDate not supplied

Minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix; four case reports.

Four cases of minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix are analysed in this clinicopathological study. Four patients, one Ib, two IIb and one IIIb stage, showed poor prognosis, which included three patients who died within 36 months, because of diagnostic delays of 5 years, 6 months and 1 year due to cytohistologically benign appearances. Cytologically, the nuclei were somewhat more irregular in size and shape than those of normal columnar epitherial cells. Slightly multilayered cell clusters were arranged as honeycombs, palisades or sheets with glandular openings. The characteristic histological features were the presence of sharp points projecting from the glands and marked variation in the size and shape of the glands. Ultrastructurally, intestinal metaplastic cells containing both microvilli with core filaments and rootlets, and secretary granules in the same cell were present in the specimens of two evaluable patients. These features indicate a disorder of differentiation. In order to diagnose this tumor accurately, comprehensive analysis should be required concerning the clinical features, cytohistological findings and ultrastructural findings.

Adenocarcinoma↗

PubMedDate not supplied

Imaging studies in patients with malignant melanoma in the female genital tract.

The purpose of this study was to review magnetic resonance imaging (MRI) and pathologic features of primary malignant melanoma (melanoma) in the female genital tract. We retrospectively evaluated MRI in six women with melanoma of the genital tract. The signal intensity of the tumor on T1-weighted images (WI) was compared with the amount of melanin granules in hematoxylin-eosin stained sections of resected specimen. On T1WI, four melanomas showed a high signal intensity, one intermediate, and one low. The four melanomas with a high signal intensity on T1W1 were rich in melanin granules, while the one intermediate tumor had few granules. The other one was amelanotic. We believe that a high signal on T1WI is characteristic of primary melanotic melanoma of the female genital tract. Our findings suggest that it is strongly influenced by the presence of melanin granules.

Diagnostic Imaging↗

PubMedDate not supplied

Neoadjuvant chemotherapy with cisplatin, aclacinomycin A, and mitomycin C for cervical adenocarcinoma--a preliminary study.

Between 1989 and 2002, 28 patients with locally advanced cervical adenocarcinoma (bulky IB-IIIB) were recruited for a pilot study aimed at evaluation of the effectiveness of neoadjuvant chemotherapy with cisplatin, aclacinomycin-A, and mitomycin-C (PAM), followed by radical surgery. This regimen was administrated intra-arterially or intravenously. In addition to patients treated with PAM, we retrospectively analyzed the prognoses of 26 patients in stage I and II, who had been treated between 1975 and 1981 with radical surgery with/without radiation therapy. Twenty-eight patients received PAM therapy as neoadjuvant chemotherapy, and 75.0% of the 16 intra-arterially infused patients showed a response, as did 66.7% of the 12 intravenously infused patients. There was a significant difference in the 5-year prognosis of stage II (PAM group, 72.9%; without-PAM group, 36.4%). The results suggest that, as the free space in the parametrium is widened by neoadjuvant chemotherapy with PAM, it is possible that the tumor could be completely resected by radical hysterectomy. Thus, neoadjuvant chemotherapy with PAM is expected to improve the survival rate of patients with advanced cervical adenocarcinoma by the preliminary study. However, the survival rates of stage II with lymph node metastasis in the without-PAM group seem low, and we must also consider that the various technologies to evaluate and treat the cervical adenocarcinomas, e.g. computed tomography, magnetic resonance imaging, and surgical equipments, had improved during 1989-2002 than was the scenario during 1975-1981, and these improvements contributed to better prognosis. A prospective-randomized study is needed to assess the value of this approach compared with standard management.

Aclarubicin↗

PubMedDate not supplied

HMB-45 staining for cytology of primary melanoma of the vagina. A case report.

BACKGROUND: Malignant melanoma in the vagina is very rare, but its diagnosis is usually easy if a melanin pigment is present. With cytodiagnosis, however, it is difficult to differentiate amelanotic melanoma or scantily pigmented melanoma from other conditions. In the present case, monoclonal antibody HMB-45, the efficacy of which has been established in histologic studies, was used in the cytodiagnosis of amelanotic melanoma in the vagina. CASE: A woman, aged 78 years, presented with a brownish, nodular tumor, diameter 3 cm, in the vagina. Scraping smears with Papanicolaou staining showed nonepithelial malignant cells without granules suggesting melanin. Smears stained with HMB-45 showed positive immunoreactivity. The diagnosis underwent histologic confirmation of amelanotic melanoma on the initial biopsy. CONCLUSION: Cytodiagnosis was made with HMB-45, which proved very effective in the differential cytodiagnosis of amelanotic melanoma and scantily pigmented melanoma, particularly because it obviated the need for tissue invasion.

Aged↗

PubMedDate not supplied

Electron microscopic examination of cytologic samples.

OBJECTIVE: To review the results of observations of cytologic samples performed in our laboratory by light microscopy (LM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM) performed in succession (LM-SEM-TEM examination) using the same cytologic sample and to assess the diagnostic value of this method of successive examination. STUDY DESIGN: Using a previously reported method of LM-SEM-TEM sample preparation and observation, we analyzed 201 cytologic specimens over a seven-year period (1986-1993) and investigated whether the histologic origin and malignancy can be estimated from SEM and TEM findings on the cells. RESULTS: Observations of many cytologic samples over a seven-year period (by LM, SEM and TEM) showed that several basic interpretations of cellular ultrastructure are possible. In cases where cell identification was difficult by LM, electron microscopic findings were sometimes useful for determining the biologic characteristics of cells and for estimating their tissue origin. Electron microscopic findings also provided important information for cytodiagnosis. CONCLUSION: SEM and/or TEM findings are useful for determining the morphologic (including biologic) characteristics of cells in cases where they cannot be determined by LM. With the accumulation of data on electron microscopic examination of cytologic samples, it is expected that in the future, electron microscopy will continue to provide new information that can be used to improve the accuracy of cytodiagnosis by LM.

Adenocarcinoma↗

PubMedDate not supplied

Fertility and uterine size among Asian women undergoing hysterectomy for leiomyomas.

OBJECTIVE: To ascertain whether an epidemiological relationship exists between fertility and uterine leiomyomas, and whether uterine size is associated with fertility among Asian women undergoing hysterectomy for leiomyomas. METHODS: The study was conducted in Sapporo, Japan. 91 women undergoing hysterectomy for myomas were compared with age-matched controls with respect to reproductive factors. Further comparisons were made of these factors in women with large myomas and those with small ones. RESULTS: Women with leiomyomas were more likely to be nulliparous than controls (P < .01), and the risk of leiomyoma increased as the number of births decreased (P < .01). Time since last birth was associated with increased risk in women with large myomas (P < .05). Women with fewer births undergoing hysterectomy for leiomyomas tended to have greater uterine weight. CONCLUSION: Fewer births may be a cause of larger leiomyomas.

Adult↗

PubMedDate not supplied

Specific detection of circulating tumor cells by reverse transcriptase-polymerase chain reaction of a beta-casein-like protein, preferentially expressed in malignant neoplasms.

Beta-casein-like protein (BCLP) is a putative protein on cervical cancer and exhibits immunological characteristics similar to those of bovine beta-casein. We evaluated if BCLP mRNA detection in the blood is useful in gynecologic malignancies. We examined 30 patients with uterine cancer, nine cultured cancer cell lines and 26 healthy women volunteers. From these study populations and samples, total RNA was obtained. Reverse transcriptase-PCR (RT-PCR) of BCLP was performed on each sample. Eighteen (60.0%) patients and 4 (15.4%) volunteers were positive for BCLP mRNA. The RT-PCR reached sensitivity and specificity of 60.0% and 84.6%, respectively. Of eight patients having diagnosed recurrence, 7 (87.5%) were positive for BCLP mRNA. In patients with recurrence, sensitivity and specificity were 87.5% and 50%, respectively. The expression of mRNA showed a correlation with recurrence, but no correlation with metastasis or histological type. BCLP was specifically expressed in cancer cells and might be an aid in clinical diagnosis.

Antigens, Neoplasm↗

PubMedDate not supplied

Morphology of adenocarcinoma in situ and microinvasive adenocarcinoma of the uterine cervix. A cytologic and ultrastructural study.

Adenocarcinoma in situ (AIS) and microinvasive adenocarcinoma of the uterine cervix and normal endocervical columnar epithelium were studied by cytology, morphometry and electron microscopy to identify differentiating features and to ascertain the cellular origin of cervical adenocarcinoma. Smears from AIS showed the characteristic cytology, consisting of glandular rosettes, palisading and crowded sheets; most nuclei had a relatively uniform oval shape. Smears from microinvasive adenocarcinoma showed more crowded sheets, with enlarged, round and irregular-shaped nuclei and prominent oval nucleoli. These nuclear features were confirmed by the morphometric results. Ultrastructurally, reserve cells in the normal tissues contained tonofibers and secretory granules and showed squamous and adenomatous features. The ultrastructural features of microinvasive adenocarcinoma were similar to those of well-differentiated invasive adenocarcinoma. The cells from both contained tonofibers and secretory granules. These findings suggested that the reserve cell is the cell of origin for cervical adenocarcinoma.

Adenocarcinoma↗

PubMedDate not supplied

Peritoneal washing cytology at second-look laparotomy in cisplatin-treated ovarian cancer patients.

The use of peritoneal washing cytology during second-look laparotomy in 58 cisplatin-treated ovarian cancer patients was evaluated. Washing was performed for the 41 patients who showed no gross evidence of persistent disease. Peritoneal washing cytology was positive in 8 of 18 cases with histologically identified residual disease and in 4 of 23 cases without residual disease. However, three of the four cytologically positive patients without other evidence of disease later died of recurrences. The five-year survival rate of the 23 patients who showed no residual carcinomas macroscopically was 60.9%; when their washing cytologies were negative, there was a 73.7% five-year survival rate. These findings indicate that, despite its limitations, a peritoneal washing cytology at the time of second-look laparotomy is important to assess the response to treatment and to evaluate the prognosis of patients with ovarian cancer.

Cisplatin↗