Comparison of postoperative adjuvant platinum-based chemotherapy and no further therapy after radical surgery in intermediate-risk early-stage cervical cancer.

OBJECTIVE: To identify a relatively high-risk population in postoperative intermediate-risk cervical cancer and evaluate the effect of platinum-based adjuvant chemotherapy (CT). METHODS: We retrospectively reviewed the medical records of patients with stage IA2-IIA cervical cancer who had been treated with radical hysterectomy and pelvic lymphadenectomy and classified as the intermediate-risk group for recurrence by postoperative pathological examination from January 2007 to December 2018 at 3 medical centers in Japan. First, patients with intermediate-risk were stratified by histological type and the number of intermediate-risk factors (IRF; large tumor diameter, lymph vascular space invasion, and deep cervical stromal invasion) and then divided into 2 groups: high and low-risk population (estimated 5-year recurrence-free survival [RFS] rate with no further therapy [NFT] <90% and ≥90%, respectively). Second, the efficacy of CT for the high-risk population was evaluated by comparing RFS and overall survival (OS) between the patients receiving CT and those with NFT. RESULTS: In total, 133 patients were included in the analysis. Among patients with squamous cell carcinoma (SCC) with all IRF or those with non-SCC with 2 to 3 IRF, the 5-year estimated RFS was <90% when treated with NFT. In this population, adjuvant CT was significantly superior to NFT regarding RFS (log-rank, p=0.014), although there was no statistical difference in OS. CONCLUSION: Patients with SCC with all 3 IRFs and those with non-SCC with 2 to 3 IRFs were at high risk for recurrence. Adjuvant CT is a valid treatment option for these populations.

Three cases of seromucinous carcinoma of the ovary arising in endometriotic cysts.

Ovarian seromucinous carcinoma (SMC) is an uncommon neoplasia and is composed predominantly of serous and endocervical-type mucinous epithelium. Due to its low frequency and difficult diagnosis, the natural history, characteristic imaging findings, and pathological features of SMC have not been adequately described in the literature thus far. We herein report three cases of ovarian SMC along with magnetic resonance imaging (MRI) findings. The diagnosis of SMC was made after staging laparotomy in all cases, and systemic chemotherapy was performed in two cases. No recurrence was observed in any of the cases. The MRI findings in SMC were so varied that characteristic imaging features useful for diagnosis were not found. In two cases, MRI suggested endometriotic cysts, and endometriosis and seromucinous borderline tumors (SMBTs) were detected concurrently in all cases by histological examination. Thus, it was suggested that SMC develops in multiple stages via endometriosis and SMBT. The cooccurrence of endometriosis and SMBT could also make the diagnosis of SMC more convincing.

[Problems facing undergraduate clinical practice training in laboratory medicine and proposed solution: remodeling of a point-of-care automatic analyzer].

It is essential that medical students learn how to precisely assess the results of laboratory tests. This may be accomplished by improving students' understanding of the processes involved in the laboratory testing of specimens, from blood collection to analysis, and by discovering factors that may influence these processes and impact results. Currently, medical students are generally taught the process by using a large automatic analyzer. However, because the students cannot observe the actual operation of the analyzer, they do not learn the process of analysis, that is, the chemical analysis of the specimen. To solve this problem, we remodeled a point-of-care automatic analyzer. The analyzer enabled students to observe its actual operation during specimen analysis. We used this analyzer for clinical practice training and obtained information on its effectiveness as a learning tool by means of a questionnaire survey. The questionnaire survey indicated that most of the students agree that the analyzer helped them learn more about the following, aspects of clinical practice: general clinical laboratory medicine (68.5%); method of analysis (57.5%); sampling method (70.0%); and point-of-care tests (52.8%). Above all, 60% of the students became interested in clinical laboratory medicine after their practical experience with the analyzer. The analyzer enables medical students to observe directly the process of biochemical analyses, and is a valuable learning tool for the students.