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Rationale: Since primary pure squamous cell carcinoma of the breast is a rare disease, few reports describe the characteristic findings on performing preoperative imaging that can be used to distinguish it from normal breast cancer. The rapid evolution and lack of an established method of treatment has resulted in several reports of advanced cases of primary pure squamous cell carcinoma of the breast., Patient Concerns: Case 1 was a 44-year-old woman with an elastic, hard tumor in the left C region. Ultrasonographic analysis revealed a maximal 11-mm hypoechoic area. Histologically, the tumor was a well-differentiated squamous cell carcinoma with prominent keratinization, and there was prominent inflammatory cell infiltration, necrosis, and fibrosis. Case 2 was a 58-year-old woman with an elastic, hard tumor in the left C/D region. Ultrasonographic analysis revealed a maximal 31-mm hypoechoic area with partially calcified areas and a hyperechoic margin. Histologically, the tumor was a squamous cell carcinoma with prominent keratinization exhibiting an infiltrative growth pattern. The tumor had no connection to the epidermis and partially transitioned into the atypical ductal epithelium in the area surrounding the focus., Diagnoses: The patient in Case 1 was preoperatively diagnosed with T1cN0M0 Stage I cancer of the left breast, but both patients were finally diagnosed with T2N0M0 Stage IIA cancer., Interventions: Case 1: left partial mastectomy and axillary lymph node dissection were performed. The patient was administered 4 courses of FEC100 and 4 courses of DTX as postoperative adjuvant therapy. Case 2: left modified radical mastectomy and axillary lymph node dissection were performed without any postoperative adjuvant therapy., Outcomes: Case 1: no sign of relapse was observed, but the patient moved away from the area to another hospital in March 2014 and eventually died due to relapse in January 2016. Case 2: four years after surgery, no relapse has been observed., Lessons: We should always keep the presence of primary pure squamous cell carcinoma among breast cancers in mind although the crisis rate is very low. Due to its high malignancy, needle biopsy and aspiration biopsy cytology should be performed to make a definitive diagnosis.

The objective of this retrospective study was to determine the survival rate, incidence of late complications, and incidence of second cancers when radiation therapy alone is used for carcinoma of the uterine cervix. Between 1971 and 1995, 1495 patients with squamous cell carcinoma of the uterine cervix (stages I-IV) were treated with radiation therapy alone in our hospital. Radiation therapy consisted of a combination of high-dose-rate intracavitary brachytherapy and external beam radiotherapy. The cumulative 5-year survival rates for stages Ib, II, and III/IVa carcinoma were 93.5, 77.0, and 60.3%, respectively, and the 10-year survival rates were 90.9, 74.5, and 56.1%, respectively. Local control rates for stages Ib, II, and III/IVa carcinoma were 92.0, 79.4 and 64.2%, respectively. Eighty-two (5.5%) patients suffered grade III/IV or V (fatal) complications. A second cancer developed in 13 (0.87%) patients. Second cancers were observed most frequently in the rectum (five cases), colon (three cases), and uterine body (two cases). Long-term follow-up data revealed that our method of radiation therapy alone for locally advanced carcinoma of the uterine cervix is effective, with low incidences of late complications and second cancers.

Background: To determine whether neoadjuvant chemotherapy would improve disease control and clinical outcome of patients with locally advanced cervical cancer undergoing radiotherapy., Materials and Methods: Sixty-one patients with primary invasive squamous cell carcinoma of the cervix of stage IIIB or IVA were randomized to receive either three courses of chemotherapy followed by radiotherapy (CT + RT) or radiotherapy alone (RT). The chemotherapy regimen consisted of bleomycin, vincristine, mitomycin and cisplatin (BOMP). The radiotherapy was carried out by the use of a combination of external beam radiation and intracavitary brachytherapy., Results: The response rate of the chemotherapy (complete or partial response) in the CT + RT group was 72% (3 + 20 out of 32). The 5-year survival rates were 52% in RT group and 43% in the CT + RT group with no significant difference. Recurrence outside the irradiated field occurred in 17% (5 out of 29) in the RT group, whereas it was 25% (8 out of 32) in the CT + RT group., Conclusion: Despite the high response rate of BOMP chemotherapy, the combination (CT + RT) failed to improve the survival of patients with locally advanced cervical cancer when compared with radiotherapy alone. It was also noteworthy that the incidence of distant metastasis was not reduced by the use of neoadjuvant chemotherapy.

Background and Objectives: To determine the prognostic significance of the colposcopic tumor size in the management of cervical cancer., Methods: Clinicopathological analysis was performed in 751 consecutive patients with stage IB squamous cervical cancer who were surgically treated in a single institute. The colposcopic tumor size was measured postoperatively on surgical specimens. Univariate and multivariate analyses were performed to determine the prognostic significance of various pathological factors., Results: Among the pathological factors examined, lymph node metastasis, parametrial extension, deep stromal invasion, vessel permeation, endometrial extension, and colposcopic tumor size were found to be prognostic factors in univariate analysis, whereas multivariate analysis has confirmed that only three factors, i.e., lymph node metastasis, parametrial involvement, and colposcopic tumor size were independently associated with the disease-free interval., Conclusions: These results indicate that the colposcopic tumor size is an independent prognostic factor in squamous cervical cancer and can be used as an indicator of treatment options.

Objective: The aim of this study was to investigate the value of the International Federation of Obstetrics and Gynecology (FIGO) classification (1995) for early invasive cervical cancer. Methods. Clinico-pathological analysis was performed in 402 patients with invasive squamous cervical cancer in whom the depth of stromal invasion was 5 mm or less., Results: The incidence of lymph node metastasis was 1.2% (1/82) in patients with 3 mm or less depth of invasion; the node-positive patient was in stage IA1. The incidence of lymph node metastasis was 6.8% (5/73) in patients with 3-5 mm depth of invasion; this increased with increasing horizontal spread from 3.4% for 7 mm or less to 9.1% for more than 7 mm. None of the patients in this series had metastasis to the parametrial tissues. Of 4 patients with recurrence, 3 had horizontal spread of more than 7 mm and the remaining patient was in stage IA2., Conclusion: The FIGO definition of early squamous cervical cancer is generally acceptable in its present form., (Copyright 1999 Academic Press.)

Preoperative serum squamous cell carcinoma antigen (SCC) levels were examined in 148 cases of stage Ib squamous cervical cancer undergoing radical hysterectomy. The effect of the pelvic lymph node status on the marker level was examined by comparing 113 cases with cancer limited to the uterus and 23 cases with cancer confined to the uterus and pelvic lymph nodes using two different multivariate analyses. Ninety-five percent of patients with cancer limited to the uterus showed SCC levels of 4 ng/ml or below. Nearly two-thirds (65%) of patients with serum levels above 4 ng/ml exhibited pelvic lymph node metastasis. The marker values exceeding 4 ng/ml increased the risk of nodal metastasis by eight times, compared with serum levels of 4 ng/ml or below. Multivariate analyses confirmed that the pelvic lymph node metastasis had a larger impact on the marker level than did tumor size or depth of stromal infiltration. SCC levels greater than 4 ng/ml can be considered a high-risk zone for nodal metastasis.

Peritoneal cytology was obtained in 374 patients with carcinoma of the uterine cervix (stage IB-IIB) in whom gross intraperitoneal disease was absent at the time of radical hysterectomy and node dissections. The relevance of positive peritoneal cytology in relation to the cell type of the tumor was examined. An exceedingly small rate of peritoneal cytologic positivity was found in patients with squamous cell carcinoma (1.7%, 4/242). One of the four patients with positive cytology developed a lung recurrence. On the other hand, the incidence of positive peritoneal cytology in patients with adenocarcinoma and adenosquamous carcinoma was 11.4% (15/132). The 3-year disease-free survival rate in patients having adenocarcinoma and adenosquamous carcinoma with positive peritoneal cytology was 57.8%, while it was 80.7% in patients with negative peritoneal cytology. However, this factor was closely associated with other adverse prognostic factors. A multivariate analysis revealed that positive peritoneal cytology was not an independent prognostic factor in patients with adenocarcinoma and adenosquamous carcinoma. In addition, intraperitoneal recurrence was not correlated with the presence of cancer cells in the peritoneal fluid. The series indicates that peritoneal cytology in cervical cancer is of little value in treatment planning.

Cancers in which mutations have been identified in putative tumor suppressor genes, such as the TP53 gene, the retinoblastoma (RBI) gene, the adenomatous polyposis coli (APC) gene, and the Wilms tumor (WTI) gene, frequently show loss of the corresponding allele on the homologous chromosome. To identify locations of tumor suppressor genes involved in uterine cancer, we examined loss of heterozygosity (LOH) by using genomic probes detecting RFLPs in 35 uterine cancers at 29 loci throughout the genome, and with highly informative microsatellite markers in 21 uterine cancers at nine putative or known tumor suppressor gene loci. High frequencies of allelic loss found at loci on 3p (71%), 9q (38%), 10q (35%), and 17p (35%) suggest that tumor suppressor genes involved in uterine carcinogenesis exist in these regions. There were no significant differences in frequencies of LOH between cancers of the uterine cervix and cancers of the uterine endometrium at any of the loci tested.

The frequency of K-ras point mutation(PM) at codon 12 was studied in 45 patients with endometrial carcinoma. In vitro amplification of target sequences of DNA extracted from endometrial cancer tissues by polymerase chain reaction and dot blotting with oligonucleotide hybridization were performed. Ten of 45 endometrial carcinomas disclosed K-ras PM at codon 12 (22.2%). Transition from GGT to GAT was most frequent in PM(41.7%). Simultaneously, double PM (GAT/GCT) were also detected in 2 cases. No relationship appeared to be present between PM and clinical prognosis such as clinical stage, histological type, histological grade of differentiation, depth of myometrial invasion, and ascitic cytology. The positive rates of lymph node metastasis tended to be higher in the group with positive PM than in the group without PM. K-ras and C-myc gene amplifications were found in 2 (5.1%) and 3 (7.7%) of 39 cases, respectively. No PM of H-ras at codons 12 and 61 was detected. Our results showed that the PM of K-ras gene at codon 12 was a fairly common event in genetic abnormality and suggested it would have some role in the progression of carcinogenesis in endometrial carcinoma.

An 84-year-old woman was seen on June 19, 1989 with the chief complaint of excessive abnormal genital bleeding of 10 days' duration. The patient was diagnosed as FIGO stage IV b (positive metastasis to lung and Virchow's nodes) and was urgently admitted because of massive bleeding, which was well controlled by whole pelvic irradiation (Lineac 3,000 rad). However, subsequent 3 courses of systemic combination chemotherapy including cisplatin delivered progressing disease (PD) with the evidence of exacerbation of primary and metastatic lesions. In such an intelligible case, authors applied 5 mg of CDDP for 13 consecutive days directly into the vaginal wall and made a pharmaco-dynamic kinetic study by measuring the blood and tissue Pt concentration. Cyto- and pathological analysis of tissue specimen revealed that this topical used of low-dose consecutive CDDP was effective for local tumor control even after failure of systemic chemotherapy.

Combination chemotherapy consisting of bleomycin, vincristine, mitomycin C, and cisplatin (BOMP) was first applied to an inoperable case (57-year-old) with FIGO stage IV (T3N3 + M1B) squamous cell carcinoma of the vulva. After three courses of BOMP therapy, the patient achieved a complete response with few toxic effects and subsequently could undergo radical vulvectomy with bilateral inguinal and pelvic lymphadenectomy. On microscopic examination, only a minute focus of viable squamous cell carcinoma was observed in the vulvar lesion and regional lymph nodes, which was surrounded by fibrotic or necrotic tissues. The patient received a further two courses of BOMP as postoperative chemotherapy. Five courses of BOMP were extremely tolerable and did not require special care. She has been free of disease for 20 months and her present performance status is 0. The encouraging result warrants the use of this combination chemotherapy regimen in other patients with advanced squamous cell carcinoma of the vulva.

Of a total of 1,025 cases of radical hysterectomy for histological squamous cell carcinoma (543 stage I cases and 482 stage II cases), we examined 50 cases of recurrence of the carcinoma (4.9 percent; 24 stage I cases and 26 stage II cases) at the site of the vaginal stump. The percentage of recurrence at the site of the vaginal stump was significantly higher in stage I and stage II cases, in which metastases to the lymph nodes or vascular invasion was observed (p less than 0.01). The length of vagina excised during the radical hysterectomy was measured and its relationship to recurrence at the site of the vaginal stump was investigated. In stage I cases that did not exhibit metastases to the lymph nodes, the shortest vaginal length excised in cases with a positive recurrence at the site of the vaginal stump was 2.5 +/- 0.9 cm; the shortest vaginal length in cases with a negative recurrence at the site of the vaginal stump was 1.8 +/- 0.8 cm. A significant difference (p less than 0.05) was observed between them. Furthermore, in stage I cases with no metastases to the lymph nodes, one recurrence at the site of the vaginal stump was observed when the vaginal length excised was 3 cm. In stage I cases with metastases to the lymph nodes and in stage II cases, no significant difference was discovered between the length of vagina excised in cases with positive and those with negative recurrences of the carcinoma at the site of the vaginal stump.

Radical hysterectomy and pelvic lymphadenectomy were performed on 135 patients with Stage I epidermoid carcinoma of the uterine cervix invading less than 5 mm below the basement membrane. These cases were studied to determine the biological behavior of early invasive carcinoma and to establish diagnostic criteria for microinvasive carcinoma of the cervix (Stage IA). None of the 135 patients had metastasis to the parametrial tissue in the final surgical specimen. One (0.9%) of 106 patients with invasion up to 3 mm had lymph node metastasis, while 4 (13.9%) of 29 patients with invasion of 3.1-5 mm had nodal metastasis. Of the 106 patients with invasion up to 3 mm, 25 had confluent invasion. None of the 25 patients had lymph node metastasis. In view of our result, carcinomas with invasion less than 3 mm may be regarded as a separate diagnostic group because of their limited metastatic potential, and may be treated by conservative methods used for carcinoma in situ, even if there is a confluent pattern. For carcinoma with invasion of 3.1-5 mm, more extensive procedures as used for frankly invasive carcinomas are probably necessary.

Between 1949 and 1987, 84 cases of primary vulvar malignancy were treated at the Cancer Institute Hospital. These cases accounted for 0.8% of the total number of gynecologic malignancies at our hospital during the same period. The clinicopathological findings were described. The mean age of the 84 cases was 61.7 years. The most frequent symptom was a vulvar mass, seen in 35 cases (41.7%). In preoperative cytologic examination of vulvar smears, 44/78 cases (56.4%) had suspected malignancy. Histopathologically, 57 cases (67.9%) were found to be squamous cell carcinoma. According to FIG0 staging system, there were 4 (4.8%) stage 0 tumors, 11 (13.0%) stage I tumors, 25 (29.8%) stage II tumors, 41 (48.8%) stage III tumors, and 3 (3.6%) stage IV tumors. The patients were treated by operation and/or irradiation. The five-year survival rate was 51.4% (36/70) in all stages. The five-year survival rate was 66.7% (2/3) in stage 0 cases, 87.5% (7/8) in stage I, 78.9% (15/19) in stage II, 28.9% (11/38) in stage III, and 50.0% (1/2) in stage IV, respectively. In patients treated by radical vulvectomy, the five-year survival rate was 26.7% (4/15) when there was inguinal nodal metastasis, and 73.7% (14/19) when there was no inguinal nodal metastasis. The five-year survival rate was 59.5% (25/42) in cases treated by operation and was 39.3% (11/28) in cases treated by irradiation. In preoperative adjuvant chemotherapy, the histopathological effect was 44.4% (4/9). In conclusion, the first choice for treatment of vulvar malignancy was considered the operative method.

The relationship between the histology and prognosis has been analyzed, using 608 surgically removed uterus with endometrial carcinoma. Among the uterus studied, 506 cases (92%) were determined as being an adenocarcinoma, endometrial type, including adenoacanthomas. This type of carcinoma showed a favourable postoperative survival rate (83.3%), when compared to serous adenocarcinomas (65.8%), clear cell (mesonephroid) adenocarcinomas (32.4%), and adenosquamous carcinomas (63.7%). Among adenocarcinomas of the endometrial type, these with a well differentiated variant showed a better prognosis than others. The squamous component of the adenoacanthoma was found to play no significant role in the prognosis.