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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.

明細胞腺癌は子宮内膜症と関連のあることが報告されているが, 内膜症の好発部位であるダグラス窩に発生することはまれである。われわれは, ダグラス窩に発生した明細胞腺癌の1例を経験し, その診断に細胞診が有用であったので, 細胞所見・病理所見を臨床経過とともに報告する.症例は54歳, 不正性器出血を主訴に平成10年2月6日近医を受診したところ, 膣癌と診断され, 当院を紹介受診.子宮・両側付属器は正常で, 膣後方に発生した腫瘍により膣は膨隆していたが, 膣粘膜は平滑だった.膨隆部を穿刺し, 腫瘍内溶液および内腔の擦過細胞診を施行した.大型の核・豊富な明るい細胞質を有する細胞が, シート状・乳頭状に出現し, hobnail patternを示唆する集塊もあった.組織学的には, 腫瘍細胞は明るく豊富な細胞質を有し核小体が目立つ異型性の強い細胞からなり, 腫瘍は充実性・乳頭状または小腺管を形成しっっ発育していた.hobnail patternを呈する部分も多く, 核は大型で大小不同性・多形性に富み, 1～2個の明瞭な核小体を有していた.ダグラス窩腹膜に子宮内膜症の所見を認めたことから, 内膜症に由来する明細胞腺癌の可能性が示唆された.

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.

Serum tumor markers are useful in diagnosis and follow-up for patients with gynecological malignancy or breast cancer. In epithelial ovarian cancer, CA125 has been identified as the most sensitive marker. Unfortunately, CA125 detection in the serum of patients with minimal malignant tumor has not been possible. Many nonmalignant conditions including endometriosis, menstruation and massive ascites may elevate the CA125, and almost 50% of patients with clear cell adenocarcinoma do not show CA125 elevated above 100 U/ml. To improve sensitivity and specificity in the diagnosis of ovarian cancer, the use of multiple tumor markers and the simultaneous use of image diagnosis should be employed. The value of tumor markers in the screening for cervical cancer and endometrial cancer has received little attention. However, the utility of serum SCC as a marker for monitoring cervical squamous cell carcinoma has been established. Since hCG is produced by gestational trophoblastic neoplasia and is a sensitive marker of trophoblastic cells in the body, patients with choriocarcinoma or invasive mole must be followed closely for this parameter. The improvement of the hCG detection technique has reduced the mortality rate from trophoblastic neoplasia. In breast cancer, many markers including CEA and CA15-3 are used, and they are reported to be useful as markers for monitoring.

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.