Seminoma leading to detection of testicular feminization syndrome: a case report.

The authors here report a 54-year-old (gravida 0, para 0), who claimed to have had her menarche at age 13 and menopause at 52 years. Two months prior to presentation, the subject first noticed a hard but elastic fist-sized mass in the left inguinal region that gradually grew, causing pressure-related pain. Although the external genitalia appeared female, the vagina was short and blind-ending, and no uterus or ovaries were identified on transvaginal ultrasound. Chromosome banding results (G-band method) showed 46XY. Laparoscopy revealed no traces of a vestigial uterus or ovaries; thus, based on the appearance of the external genitalia, a diagnosis of testicular feminization syndrome was made. Pathological testing of the palpable mass led to a diagnosis of seminoma with Leydig cell hyperplasia. Thus, in this case, the development of a seminoma in an undescended testis led to the detection of testicular feminization syndrome.

Retroperitoneal leiomyosarcoma: a case report.

Retroperitoneal leiomyosarcoma is a relatively rare and aggressive tumor. Because of its rarity, it is difficult to arrive at a definite diagnosis preoperatively and to design an effective strategy. Here the authors report a case of peritoneal leiomyosarcoma in which diagnosis was difficult because the clinical course resembled that of ovarian cancer. A 77-year-old woman diagnosed with ovarian cancer underwent laparotomy. The excised tumor contained a necrotic polypoid mass that histologically displayed the features of leiomyosarcoma. The patient received adjuvant chemotherapy with a combination of gemcitabine and docetaxel but died two months after surgery owing to the aggressive behavior of the tumor. Because the preoperative diagnosis in this case was ovarian cancer, arriving at a treatment strategy assuming peritoneal leiomyosarcoma was difficult. If complete surgical resection of tumor is not performed, as in the present case, the prognosis can be extremely poor.

Follow-up study of symptomatic submucous fibroids after hysteroscopic myomectomy.

PURPOSE OF INVESTIGATION: This study aimed to estimate the effectiveness of hysteroscopic myomectomy for symptomatic submucous uterine fibroids and to identify prognostic factors for persistent or recurrent symptoms. MATERIALS AND METHODS: A total of 237 patients who underwent hysteroscopic myomectomy were divided into three groups according to the classification of the European Society for Gynaecological Endoscopy: Type 0 (n=116), Type I (n=97), and Type II (n=24). Medical records and videotape records of all patients were retrospectively reviewed. RESULTS: Improvement of symptoms was achieved in 100% of Types 0 and I, and 66.7% of Type II. The five-year cumulative symptom-free rates after hysteroscopic myomectomy were 96.7% ± 1.9%, 87.8% 6.7%, and 44.5% ± 12.7% in Types 0, I, and II, respectively. The mean symptom-free periods were 46.2 ± 2.6, 47.7 ± 2.7, and 24.7 ± 6.3 months in Types 0, I, and II, respectively. Logistic regression analysis showed that co-existence of other myomas and Type II were independent prognostic factors for recurrence of symptoms. CONCLUSION: Type I fibroids are a good indication for hysteroscopic myomectomy. In Type II, some patients feel that their symptoms improve, but this curative effect could be temporary.

The relation between causes and onset time of polyhydramnios.

The aim of this analysis was to investigate the onset time and significance of maximum volume of polyhydraminios and whether the tter was associated with causes. This was a retrospective cohort study between 2012 and 2014. A total number of 68 singleton pregancies were analyzed. Gestational age at onset of polyhydramnios was 30.0 ± 2.8 (25-36) weeks in maternal factor, 30.0 ± 3.5 (25- 7) weeks in fetal factor, and 32.3 ± 2.0 (27-37) weeks in idiopathic factor. Median of maximum amniotic fluid index (AFI) was gnificantly late onset in idiopathic factor. Diabetes, gestational or pre-existing, was present in all of women (ten cases) in maternal facror. Higher AFI was found to be associated with an increased frequency of prenatally detected congenital anomalies. Abnormal fetal kary- type noted in 18/45 (40%) cases of polyhydramnios. Polyhydramnios diagnosed on ultrasound requires further maternal and fetal iagnostic tests.

Histologic chorioamnionitis prevalence in patients with premature rupture membranes.

This was a retrospective cohort study between 2002 and 2011. A total number of 150 singleton pregnancies with preterm premature rupture of membranes (PROM) (before 34 weeks) were analyzed. Histological chorioamnionitis (Blanc grade III) was significantly increased over three days from onset of premature rupture of membranes. The positive relationship was strengthened (odds ratios, 3.5; 95% confidence intervals, 1.5-5.2) over three days from onset of preterm PROM. PROM is a risk factor important for histological chorioamnionitis. To avoid neonatal infection, early termination is recommended in preterm PROM patients.

Rupture risk factors of fallopian tubal pregnancy.

The present authors analyzed patients' backgrounds and pre-surgical findings to clarify the risk factors of rupture of fallopian tubal pregnancy. The surgical findings 113 cases were clearly diagnosed as fallopian tubal pregnancy with or without rupture. Twenty-six cases of fallopian tubal pregnancy were ruptured and 87 cases were not ruptured at the time of operation. The risk factors of fallopian tubal rupture were assessed by Chi-square for independence test and multiple regression analysis. Obesity (BMI over 26), prior birth history, social welfare entitlement, ultrasonography findings of fetal heart movement, and pre-surgical serum beta-hCG level more than 3,000 mIU/ml patient were significantly higher risk in fallopian tubal rupture. Fertility treatment patient were at significantly lower risk for fallopian tubal rupture. Higher beta-hCG levels, especially >3,000 mIU/ml is associated with increased risk of fallopian tubal rupture in ectopic pregnancy.

Defective provirus form of human T-cell leukemia virus type I in adult T-cell leukemia/lymphoma: clinicopathological features.

Human T-cell leukemia virus type I (HTLV-I) is associated with adult T-cell leukemia/lymphoma (ATLL). To examine the relationship between defective HTLV-I proviruses and clinicopathological features, we examined 95 patients with ATLL showing clonal integration of HTLV-I proviral DNA; 77 patients (81%) showed 1 clonal band, 15 (16%) showed 2 clonal bands, and 3 (3%) showed 3 clonal bands. In addition, the defective proviral form was detected in 28 patients (29%): 23 (30%) of the 77 with 1 clonal band, 4(27%) of the 15 with 2 clonal bands, and 1(33%) of the 3 with 3 clonal bands. The numbers of clonal bands had no association with the presence of defective proviruses. We classified the 95 patients with ATLL into four types according to clinicopathological features (smoldering leukemia, chronic leukemia, acute leukemia, and lymphoma types). The distribution of patients with the defective form was not different among these four types. The HTLV-I genomes must have integrated into the human genome DNA and been deleted partially in the cells. The defective form was kept during the clinical stage. All patients with the defective form showed defect of the gag or/and env region. No patient had a defect of the pX region. These data suggest that the pX region of HTLV-I must have played an important role in ATLL genesis.

Bcl-2 Gene and Prognosis of B-cell Lymphoma.

Both the polymerase chain reaction (PCR) and Southern blot analysis were used to detect bcl-2 gene rearrangement in B-cell lymphoma. Recent molecular studies have shown that the translocation of karyotypic abnormalities t(14;18) results in the juxtaposition of the candidate proto-oncogene bcl-2 on chromosome 18 with the immunoglobulin heavy-chain locus on chromosome 14. We detected the bcl-2 rearrangement in three of six follicular lymphomas (50%), two of five follicular and diffuse lymphomas (40%), one of 13 diffuse medium-sized cell lymphomas (7.7%) and two of 33 diffuse large cell lymphomas (6.0%) through Southern blot analysis. With PCR, the rearrangement was demonstrated in five of eight follicular (63%), three of five follicular and diffuse (60%), seven of 36 diffuse large cell lymphomas (19%) and two of 13 diffuse medium-sized lymphomas (15%). Diffuse large cell lymphomas with bcl-2 rearrangement detected by PCR have a good prognosis as do cases of follicular lymphoma The bcl-2 gene is closely related to follicular lymphoma as described in previous reports and has general prognostic importance in diffuse large cell lymphoma of B cell type.

Genotypic and immunophenotypic analysis of anaplastic large cell lymphoma (Ki-1 lymphoma).

Genotypic and immunological analysis was performed in 10 patients with anaplastic large cell lymphoma (Ki-1 lymphoma), 4 were male and 6 female. Immunophenotypically, 9 of these patients expressed some T cell markers; CD 2 in 9, CD 4 in 9, CD 3 in 6, CD 8 in 4, and UCHL-1 in 8. For B cell markers, 4 patients expressed B 1 and one expressed L 26; these patients also expressed T cell markers. In genotypic analysis, 9 of 10 cases displayed some incidence of T cell receptor gene (TCR) rearrangement or deletion, which was found in 3 patients for C beta 1, 7 for C beta 2, 8 for J gamma, 5 for C gamma (Hind III), 5 for C gamma (EcoRI), 3 for J delta 1 (Hind III), 3 for J delta 1 (BamHI), 3 for J delta 2, and 2 for C delta. One patient with rearrangement of TCR also showed rearrangement of immunoglobulin heavy chain. Another patient exhibited rearrangement of both TCR and immunoglobulin chain. These results indicate a common T cell lineage for this type of lymphoma.

[Fundamental and clinical studies on cefpimizole in the field of obstetrics and gynecology].

Cefpimizole (AC-1370), a new cephem antibiotic, was studied in the field of obstetrics and gynecology, fundamentally and clinically. And the following results were obtained. The concentrations of the drug in uterine arterial and cubital venous blood, and internal genital organs following intravenous drip infusion were measured. The results demonstrated favourable transfer of the drug into the various internal genital organs. Four patients with obstetric and gynecological infections were treated with AC-1370. The therapeutic results were good in 3, and poor in 1 case, therefore the effective rate was 75%. No side effects were noted in any cases, but the severe eosinophilia (37%) was found in 1 patient. It is therefore presumed that AC-1370 is a useful drug for infectious diseases in the field of obstetrics and gynecology.

[Examination on efficacy and safety of concurrent use of ondansetron hydrochloride and steroid in gynecological cancer patients on cisplatin].

The anti-emetic effect and safety in patients receiving ondansetron hydrochloride (OND group) and ondansetron and dexamethasone (DEX group) concurrently in cases of acute and delayed onset emesis induced by a single high dose of cisplatin, given as a chemotherapy to gynecological cancer patients, were comparatively studied. The study subjects were 139 gynecological cancer patients. The OND group received 4 mg of ondansetron via slow intravenous injection on Day 1, 30 minutes prior to cisplatin, and for Days 2 to 5, the subjects orally received 4 mg ondansetron tablet each day. The DEX group received the same dose regimen of ondansetron as the OND group for Days 1-5, but in addition the subjects received dexamethasone injection in doses of 8 mg twice daily on Day 1 and 4 mg (1 mg QID) daily for Days 2-5. An anti-emetic effect against acute nausea and vomiting was achieved in 47.9% of the OND group and in a higher rate of 84.2% of the DEX group. Significantly better efficacy was seen in the DEX group also in the complete suppression rate of nausea and vomiting and the improvement of food intake. The group also achieved better efficacy in delayed onset of emesis. Adverse reactions were observed in 2 cases (2 reports of headache) in the OND group and 5 cases (2 reports of hiccups, 2 headache, 2 diarrhea, one constipation, one hot facial flushes and one elevation of gamma-GTP) in the DEX group; however, since the symptoms were all mild, we did not consider there was any problem in safety. We conclude from the above findings that concurrent administration of ondansetron hydrochloride and dexamethasone is a clinically useful treatment for acute and delayed onset emesis induced by a single high dose of cisplatin given to gynecological cancer patients.

[The prevention of cancer chemotherapy-induced emesis with granisetron and clonazepam].

The antiemetic efficacy of a combination of granisetron and clonazepam was investigated in 39 gynecological cancer patients treated with cisplatin. Granisetron (3 mg/body/day) was administered by intravenous drip infusion before and 24 hours after anticancer drug administration, and clonazepam was taken orally twice a day. With a combination of granisetron and clonazepam, excellent efficacy was found in 87% (34/39) of the cases. Delayed emesis occurred in 38% (13/34), but the degree of nausea was mild. Clinically, antiemetic therapy with a combination of granisetron and clonazepam demonstrated superior antiemetic effects and seems to be useful for controlling nausea and vomiting associated with cancer chemotherapy.

Phase II trial of docetaxel in advanced or metastatic endometrial cancer: a Japanese Cooperative Study.

The purpose of this study was to determine whether docetaxel has antitumour activity in patients with advanced or recurrent endometrial carcinoma. Chemotherapy-naïve or previously treated patients (one regimen) with histopathologically documented endometrial carcinoma and Eastern Cooperative Oncology Group performance status

[A stable culturing method and pharmacological effects of the Agaricus blazei].

There have been some reports suggesting the effectiveness of medicinal mushrooms in not only keeping health but also preventing and curing diseases as well as recovering from illnesses. However, no uniformity has been observed with its medicinal effect and thus there are some problems in these materials from clinical aspects. Ununiformity of constituents which has resulted from the lack of established optimum culturing methods and inadequacy of experimental approaches are given as the causes of the problems. In the present study, the authors established a culturing method for harvesting fruit bodies with stable constituents by the use of the best cytogenetical technique for Agaricus blazei(CJ-01)which has attracted special interest recently among medicinal mushrooms. Fundamental medical scientific researches have been conducted with the medicinal effect of Agaricus blazei(CJ-01)obtained by the new culturing method by the widely use of immunological and pharmacological approaches. Based on the results of these studies, the author demonstrated the effect scientifically on the cases where the effect had already been observed clinically (hypertension, atopic dermatitis and diabetes).

Amplified bcl-2/JH rearrangements in reactive lymphadenopathy.

Using the polymerase chain reaction (PCR) to examine the occurrence of bcl-2/JH joining produced by t(14;18) chromosomal translocation, amplified DNA was detected in 2 of 18 lymph nodes showing reactive lymphadenopathy. The PCR was repeated in these two lymph nodes using the same DNA samples, but no amplification was detected at the second attempt. Thus the amplified DNA was considered to be derived from one copy of joined bcl-2/JH in one cell, or from a few copies in a few clonal cells with the same joined bcl-2/JH. These results suggest that false joining of bcl-2/JH at the t(14;18) junction may occur in reactive lymph nodes.

The blood flow characteristics in borderline ovarian tumors based on both color Doppler ultrasound and histopathological analyses.

To clarify the tumor behavior in borderline ovarian tumors, we examined the characteristics of neovascularization in these tumors by using a transvaginal color Doppler ultrasound (TV-CDU). Twelve patients with borderline ovarian tumors were preoperatively evaluated for the characteristics of intratumoral blood flow by TV-CDU, using both the resistance index (RI) and pulsatility index (PI). As a control group, 100 patients with benign ovarian tumors and 31 patients with malignant ovarian tumors were also examined by TV-CDU. An intratumoral blood flow was significantly detected in both borderline (91.6%; 11/12) and malignant ovarian tumors (90.3%; 28/31), but not in benign ovarian tumors (53%; 53/100) (P < 0.01). In addition, both the mean RI and mean PI values were significantly lower in the borderline (RI; 0.45, PI; 0.67) and malignant ovarian tumors (RI; 0.39, PI; 0.58) than those in the benign ovarian tumors (RI; 0.61, PI; 1.05) (P < 0.01). In mucinous tumors, the borderline tumors showed a significantly high intratumoral vascularity (P < 0. 01) and both borderline and malignant tumors significantly demonstrated a low-resistance blood flow (P < 0.01), in comparison to those of the benign tumors. Mucinous borderline tumors of the intestinal type also tended to have a lower RI as well as a lower PI value than müllerian type. Regarding neovascularization as represented by intratumoral blood flow characteristics, this study thus suggests that a close relationship exists in the tumor behavior between borderline and malignant ovarian tumors, especially in mucinous epithelial tumors.

Clostridium difficile colitis associated with cisplatin-based chemotherapy in ovarian cancer patients.

The purpose of this study was to examine the incidence and cause of Clostridium difficile colitis occurring after cisplatin-based combination chemotherapy in ovarian cancer patients. Thirty-three patients with primary ovarian malignancy were treated with cisplatin-based combination chemotherapy ranging from 1 to 12 (mean 4.6) cycles. All patients who developed diarrhea after undergoing the cancer chemotherapy were examined to determine whether or not they were complicated by C difficile colitis. The diagnosis of C. difficile was confirmed by a stool-cytotoxin test and endoscopic examination. Severe C. difficile colitis occurred in 2 patients (6.1%) after receiving cisplatin-based combination chemotherapy for ovarian malignancies. Although both patients recovered from the colitis after the administration of vancomycin, the first case demonstrated a relapse of the colitis after receiving a subsequent course of the same chemotherapy with cisplatin. Both patients were then treated with a carboplatin alternative to cisplatin in the following courses, which resulted in neither a relapse of the colitis nor a recurrence of the malignancies up to this time. This report suggests the importance of searching for the presence of C. difficile and its toxin in patients with diarrhea after undergoing cancer chemotherapy since C. difficile may cause severe colitis. Based on our findings, it is thus concluded that cisplatin may cause C. difficile colitis.

Expression of steroid receptors, Ki-67, and epidermal growth factor receptor in tamoxifen-treated endometrium.

Endometrial specimens of 34 (25 premenopausal and 9 postmenopausal) breast cancer patients receiving tamoxifen were immunohistochemically examined using estrogen receptor (ER), progesterone receptor (PR), Ki-67, and epidermal growth factor receptor (EGFR) antibodies. Proliferative (n = 6), secretory (n = 9), and postmenopausal (n = 6) endometria served as controls. The ER and PR expressions of the glandular cells in tamoxifen-treated patients did not differ from those of the glandular cells in the control women regardless of menopausal status. The Ki-67 index of glandular cells in tamoxifen-induced amenorrheic women was found to be lower than that of the proliferative glandular cells in the control women (p < 0.03), whereas the Ki-67 index of glandular cells in the tamoxifen-treated postmenopausal patients was higher than that of the glandular cells in the control women (p < 0.02). No EGFR overexpression was found in the glandular cells of the tamoxifen-treated premenopausal patients, but expression of EGFR was high in glandular cells of the tamoxifen-treated postmenopausal patients associated with a high Ki-67 index. In competition with ovarian estrogen secretion, tamoxifen may have an antiestrogenic effect on the endometrium, but tamoxifen probably has an estrogenic effect in the absence of ovarian estrogen secretion. This estrogenic effect of tamoxifen may be associated with an EGFR autocrine system.

Proliferating cells in histiocytic necrotizing lymphadenitis.

The phenotypes of proliferating cells in histiocytic necrotizing lymphadenitis (HNL) were examined. The affected areas consisted mainly of CD 8-positive (suppressor/cytotoxic T-cells) and CD 4-positive (helper/inducer T-cells) in association with some CD 15-positive cells (monocytes). A marker of proliferating cells (Ki-67) and monoclonal antibodies for determining the phenotypes of cells (CD 4, CD 8, CD 15) in the affected areas were applied using a double-staining method. Ki-67-positive proliferating cells were mainly CD 8-positive. A few CD 4-positive cells and rare CD 15-positive cells were also Ki-67-positive. The percentage of CD 8-positive cells increased gradually over time and the ratio of CD 8-positive to proliferating cells did not decrease throughout the observation period of 6 weeks. These results suggest that the proliferation of CD 8-positive T-cells together with the accumulation of CD 4- and CD 15-positive cells is the main phenomenon occurring in HNL.

Virus-associated haemophagocytic syndrome with Epstein-Barr virus infection.

The clinical and histological findings of a 10-year-old girl with virus-associated haemophagocytic syndrome are presented. The serum levels of Epstein-Barr viral antigens were elevated. Epstein-Barr virus (EBV) genome was detected by polymerase chain reaction in bone marrow and lymph node specimens. Histologically, haemophagocytic histiocytes were present in bone marrow, and areas of non-suppurative necrosis were present in lymph nodes, where silver grain deposition of the EBV genome was demonstrated by in situ hybridization.