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Objective: We conducted a prospective, multicentre study to compare the clinical performance of liquid-based endometrial cytology (LBEC) using SurePath™ with that of suction endometrial tissue biopsy (SETB). This study is officially advocated and reported by the Japan Association of Obstetricians and Gynecologists. By publishing our midterm data, we intend to disseminate the benefits of LBEC system, using the descriptive reporting format and algorithmic interpretational approach., Methods: From April 2014 to December 2015, we consecutively assessed 1116 LBEC specimens and 1044 SETB specimens in our five outpatient clinics., Results: The sensitivity of suction tissue biopsies was 85.2%, whereas the sensitivity of LBEC was 92.2%. The specificity of suction tissue biopsies was 98.9% and that of LBEC was 98.5%. The negative predictive value of LBEC (99.1%) was higher than that of SETB (98.1%), although the difference between these values was not significant., Conclusions: The clinical performance of LBEC for detecting endometrial malignancies was almost identical to the performance of SETB. This indicates that LBEC was not inferior to SETB for the detection of endometrial cancer. The LBEC is appropriate for various clinical situations as the first-step detecting tool. In addition, it could be used for cancer surveillance for women with signs highly suggestive of endometrial malignancies and in Lynch syndrome patients, on a larger scale., (© 2018 John Wiley & Sons Ltd.)

We report a long-term survival case of metastatic endometrial stromal sarcoma. A 45-year-old woman with acute abdomen was operated at another hospital. Her uterine histology was endometrial stromal sarcoma. She came to our hospital to treat a metastatic endometrial stromal sarcoma. Endometrial stromal sarcomas were found in liver, spleen and lung. Intra-arterial hypertension chemotherapy was repeatedly performed. After this therapy, metastatic legion in the liver and the spleen disappeared on image studies and metastatic lesions in the lung grew smaller.

In mass screening tests for uterine cancer carried out Shimane Prefecture, we used three different scraping methods. This summary is a report of a comparison of the findings with each method. Results are as follows: From 1973-1982, 214, 798 Japanese women were examined in mass screening tests. Among the 42, 443 examined using a cotton tipped applicator, there were 15 (0.035%) with mild dysplasia, 8 (0.019%) with severe dysplasia, 6 (0.014%) with carcinoma in situ and 8 (0.019%) with invasive carcinoma. In 38,106 women examined using the spatula, 25 (0.066%) had a mild dysplasia, 10 (0.026%) a severe dysplasia, 18 (0.047%) a carcinoma in situ and 26 (0.068%) an invasive carcinoma. In 134,249 examined using a cotton tipped applicator plus colposcopy, 283 (0.211%) had a mild dysplasia 108 (0.080%) a severe dysplasia, 57 (0.042%) a carcinoma in situ and 78 (0.058%) an invasive carcinoma. Thus, the use of a cotton tipped applicator plus colposcopy leads to higher rates of detection of mild and severe dysplasia. In the group with a negative Papanicolaou smear and for whom the cotton tipped applicator plus colposcopy was used, there were 214 with a mild dysplasia, 65 with a severe dysplasia, 11 with a carcinoma in situ and 7 with an invasive carcinoma. The combination of cotton tipped applicator and colposcopy proved to be the most effective for mass screenings for uterine cancer, as the detection rates for severe dysplasia and carcinoma in situ were higher and there were fewer incidences of false negative results.

Mass screenings for uterine cancer have been done on 200,000 women in Shimane Prefecture, Japan, from 1972-1981. Up to 1978, a cotton-tipped applicator was used for sample procurement and since that time a wooden spatula type instrument has been used. A central, cytological diagnostic system has been used since 1979. The cytology activity index (CAI) was about 90 each year. The rate of second examination performed is about 60% for women requiring an accurate examination. Cancer detection rates increased from 0.05% to 0.12%, the false negative rate decreased, cytological and histological findings were in close parallel and the mortality rates have decreased. These positive results are attributed to the use of the wooden spatula and central diagnostic systems. By the mass screening for uterine cancer during these 10 years, 81 women were detected as having carcinoma in situ and 107 women as having invasive carcinoma in the histological findings. The number of first screenings has decreased gradually, but the number examined 6 times or more has increased. These results include that same women have tended to undergo the mass screening examination. In women over 50 y.o., particularly those 60 or over, the number screened was low, yet the incidence of invasive cancer exceeded that in other groups.

The immunological effect has been studied of the non-specific immunopotentiator sizofiran (SPG) on patients with advanced uterine cervical cancer treated with radiation. Ten cases (study group: SPG group) were administered weekly 40 mg of SPG throughout the course of radiation and two weekly 40 mg during 12 months after radiotherapy. Nineteen cases (control group) were treated with irradiation alone. The lymphocyte count, the PHA index and the ratio of CD4 cells/CD8 cells were significantly reduced by radiotherapy, being observed the most remarkable decrease at post-radiotherapy. But in SPG group, these decreasing values were significantly smaller than in control group and the values showed a more progressive rise during the 12 month respectively. There was no significant difference in peripheral T lymphocyte; CD3, CD4, CD8. The NK cytotoxic activity showed a progressive rise during the 12 month period following a minimal change after radiotherapy. These results suggest that the SPG have some enhancing effect on the function of the lymphocytes.

We report here Doppler color flow mapping carried out before and after chemotherapy for an invasive mole. This mapping revealed an abnormal color blood flow within the echo-free space in the uterine myometrium, and pulsed Doppler ultrasound showed a prominent arteriovenous shunt flow. Similar features were obtained by pelvic angiography (PAG). After 4 courses of chemotherapy, the area of abnormal colored flow was reduced and findings on the PAG were supportive. The patient is being closely followed, using Doppler color flow mapping.

To differentiate pre-operatively between leiomyomata uteri and adenomyosis, we measured serum levels of an antigen (CA 125) common to most nonmucinous epithelial ovarian carcinoma in patients with benign uterine tumor (11 of leiomyomata uteri, 7 of adenomyosis and 1 of adenomyosis with leiomyomata uteri). CA 125 in serum samples pre and postoperatively were measured using an RIA Kit. The normal range of CA 125 levels was below 35U/ml. The mean CA 125 level (+/- S.D.) was 18.3 +/- 6.1U/ml in patients with leiomyomata uteri and 93.3 +/- 49.4U/ml in those with adenomyosis. Student's t-test showed a significant correlation (0.001 less than p less than 0.01). The mean CA 125 level in patients with adenomyosis was statistically higher than that in disease-free women. Among 7 patients with surgically demonstrable adenomyosis, the CA 125 values were over 35U/ml (87.5%). In all 11 patients with surgically demonstrable leiomyomata uteri, the CA 125 level was below 35U/ml. The CA 125 level in patients with adenomyosis gradually decreased postoperatively and in all was below 35U/ml up to one month postoperatively. Using this approach, leiomyomata uteri and adenomyosis can be differentiated, pre-operatively.

We report a case in which bone metastasis from carcinoma corporis was treated by intra-arterial hypertension chemotherapy. The patient was a 53-year-old female whom we treated by intra-arterial hypertension chemotherapy of CDDP 80 mg and ADM 30 mg with Angiotensin II. Four weeks later she underwent abdominal total hysterectomy, bilateral salpingo-oophorectomy and right common iliac lymph nodes resection. The response of intra-arterial hypertension chemotherapy was charged microscopically. About half (Grade I b) the carcinoma tissue was necrosed.