Search

OBJECTIVE: To assess whether screening asymptomatic women is significant for early detection of endometrial carcinoma. STUDY DESIGN: We compared the clinicopathologic findings and prognoses of 21 asymptomatic patients with 427 symptomatic patients with endometrial carcinoma. RESULTS: The incidence of asymptomatic endometrial carcinoma was 4.7%. Nineteen of 21 asymptomatic patients with endometrial carcinoma were found by cytologic screening for endometrial cancer. There was a statistical difference in the histopathology and depth of myometrial invasion between the asymptomatic and symptomatic groups. However, no statistical differences were found in tumor grade, lymph node metastasis, adnexal metastasis, cervical invasion, peritoneal cytology, surgical stage and patient age. Univariate analysis showed that the presence or absence of symptoms was not related to survival. CONCLUSION: The detection of asymptomatic endometrial carcinoma is not related to a reduced mortality rate. Screening asymptomatic women for endometrial carcinoma is not recommended.

A 51-year-old patient presented with an abdominal mass and ascites as well as a left pleural effusion. Her serum CA125 was 820 U/ml. Surgical exploration revealed a benign leiomyoma of the uterus without malignant cytology in the ascites. Postoperatively, the pleural effusion was resolved dramatically and the CA125 decreased to the normal range after 4 months post-operatively. This is an extremely rare case of pseudo-Meigs' syndrome caused by uterine leiomyoma.

目的:北里大学病院では, 細胞異型のみならず構造異型を重視して内膜細胞診の判定を行ってきた.そこでわれわれの判定基準に従って細胞診断を施行した症例を対象に, 体癌症例の細胞診成績, クラスIII以上と判定した症例の組織所見, 内膜細胞診判定基準に関して検討した.対象・方法:1988年から1997年に治療した体癌297例および複雑型子宮内膜異型増殖症22例と, 同期間中に内膜細胞診でクラスIII以上と診断された1,955例である.細胞はエンドサイトで採取し, スライドグラスに直接塗抹したものを用いた.成績:体癌, 複雑型異型増殖症における偽陰性率は各3.4%, 18.2%であった.体癌の組織型別の偽陰性率は, G1, G2類内膜腺癌, 癌肉腫でそれぞれ4.7%, 3.7%, 8.3%で, この他の組織型では偽陰性症例を経験しなかった.G1類内膜腺癌では筋層浸潤の深さにかかわらず偽陰性症例を認めた.クラスIII以上の1,324例では, 内膜細胞診の前後3ヵ月以内に組織診がなされていた.クラスIIIからは241例の内膜増殖症と41例の体癌が, クラスIV, Vからは各6例, 266例が発見された.結論:内膜細胞診の判定では, 構造異型に着目することが重要である.

The clinical course and pathological findings of 3 rare cases of androgen-producing ovarian tumors are presented. The ages of the 3 patients (Cases 1, 2, and 3, respectively) were 43, 34, and 57 years, respectively. Their preoperative serum testosterone levels were 506, 491, and 231 ng/dl, respectively. The pathological diagnoses of Cases 1, 2, and 3 were a Sertoli-stromal cell tumor of intermediate differentiation, a stromal tumor containing Leydig cells, and a stromal tumor with minor sex cord elements, respectively. Patient 1 experienced a recurrence, of a lesion at the vaginal stump 1 year and 2 months after the initial surgery. The clinical courses of Cases 2 and 3 have been non-contributory.

Five patients who developed leukemia after chemotherapy for ovarian cancer are reported. All patients received the platinum analogue cyclophosphamide, a known leukemogen. In two patients, the leukemia was diagnosed after second-line chemotherapy with carboplatin, cyclophosphamide, and pirarubicin hydrochloride following intraperitoneal chemotherapy that included etoposide. Four patients had acute nonlymphocytic leukemia. The latency period was 16–63 months. Chromosomal analysis was performed in four patients and partial deletion of the long arm of chromosome 6, partial deletion of the long arm of chromosome 7, and multiple abnormalities were observed in all four. Remission of leukemia was not experienced; three patients died of leukemia and two died of primary ovarian cancer.

本邦においても子宮体癌は増加傾向にあるが, 内膜増殖症はその前癌病変として注目されている.また, 早期体癌は高率に内膜増殖症を合併していることから, 前癌状態での発見のみならず, 体癌の早期発見のためには, この増殖症を細胞診断する意義はきわめて高い.一方, 1996年に改訂された子宮体癌取り扱い規約で, 子宮内膜増殖症は単純型, 複雑型, 単純型異型, 複雑型異型の4型に分類されることとなった.そこで, この複雑型増殖症と複雑型異型増殖症の細胞所見について検討したところ, 複雑型増殖症では (1) 背景に出血はあっても壊死物質は出現しない,(2) 多くの場合正常増殖期内膜の共存を認めるが, 正常増殖期よりは集塊の出現数が多い,(3) 細胞集塊辺縁の乳頭状突出, 半島状突出を認める,(4) 有端集塊, 分枝集塊の頻度が高い,(5) 腺細胞の重層化・腺管の増生back to back,(6) 集塊辺縁の柵状配列の乱れが特徴的であった.複雑型異型増殖症ではさらに,(7) 重層性の強化,(8) 核の大小不同・著明な核小体を伴っていた.

多数のReinke crystalを有する卵巣間質性ライディク細胞腫を経験したので, その組織所見と捺印細胞所見を報告する.組織学的には, 線維腫様の腫瘍組織の中に, 好酸性の豊富な細胞質と多数のReinke crystalを有するライディク細胞が, 島状に増生していた. また, 小範囲の粘液性腺腫を合併していた. 捺印細胞診標本上に出現した細胞は,(1) 結合性が粗で, N/C比の高い長円形の核を有する紡錘状の細胞,(2) ライトグリーンのやや豊富な細胞質と類円形の核を有し, 重積性ある集塊を形成する細胞,(3) 核が偏在し, 柵状配列を示す細胞, の3種類である.(2) の細胞集塊の中にオレンジGに好染する細長い結晶 (Reinke crystal) が多数出現していた.

A rare case of primary squamous cell carcinoma of the endometrium, probably originating from adenomyosis, is presented. A 58-year-old Japanese woman was referred to Kitasato Institution Medical Center Hospital to explore the cause of her postmenopausal bleeding. The endometrial cytology specimen obtained with the Endocyte (an device for endometrial check up) showed cells suggesting well differentiated squamous cell carcinoma. The patient underwent modified radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy, followed by postoperative radiation therapy. The dissected uterus revealed keratinizing-type squamous cell carcinoma localized in the fundal portion of the uterine body and invading deeply into the myometrium, coexistent with a large area of adenomyosis with a transitional area to carcinoma. The residual endometrium was atrophic. There was no atypical finding in the cervix. Human papilloma virus DNA was not detected. The carcinoma recurred 26 months after the surgery, and the patient died of the disease.