The difference of the impacts of surgical approaches on cellular immunity in patients with uterine malignancies: a comparative study of laparoscopy and laparotomy surgery.

OBJECTIVE: To explore the impact of laparoscopy and laparotomy surgery on cellular immunity in patients with malignant uterine tumors. METHODS: Thirty-eight women with uterine malignancies were enrolled in a prospective nonrandomized cohort study. Either laparoscopy or laparotomy was performed according to the patients' choice. The frequency of CD3+, CD4+, CD8+ T cells and natural killer cells derived from peripheral venous blood was evaluated by flow cytometry. RESULTS: (1) Postoperatively, there was a decrease in the number of lymphocyte counts, especially after laparotomy, on the first postoperative day (p < 0.01). (2) Compared with preoperative levels, the frequencies of CD3+ and CD4+ cells and the CD4+/CD8+ ratio were declined both in the laparoscopy and laparotomy groups on postoperative day 1 (p < 0.01). (3) The frequencies of CD3+ and CD4+ cells and the ratio of CD4+ to CD8+ cells were less depressed in the laparoscopy group on the first postoperative day (p < 0.05). (4) The frequency of natural killer cells increased, both in the laparoscopy and laparotomy groups on the first postoperative day (p < 0.01), but there were no significant differences between the two groups (p > 0.05). CONCLUSION: Cellular immunity was temporally depressed in patients with uterine malignancy after surgical treatment, but laparoscopic surgery depressed the immunity less than laparotomy.

Peritoneal washing cytology of disseminated low grade endometrial stromal sarcoma: a case report.

BACKGROUND: Low grade endometrial stromal sarcoma (LESS) with dissemination is rare, and its cytomorphology has not been well described. Recently, we experienced a case of LESS with peritoneal dissemination that was confirmed by peritoneal washing cytology and histology. CASE: A 51-year-old woman was admitted for evaluation of vaginal bleeding. Uterine ultrasonography revealed a diffisely thickened endomyometrium with a vaguely circumscribed nodular mass-like lesion measuring 7.4 cm in the largest dimension. Under the impression of adenomyosis, an exploratory laparotomy was performed. On examination of the abdominal cavity, multiple tiny, grayish nodular excrescences firmly attached to the peritoneal wall and the serosal surface of the small bowel and uterus were noted. A total hysterectomy with bilateral salpingo-oophorectomy and peritoneal fluid sampling were performed. The peritoneal fluid smear demonstrated several loosely packed clusters of monotonous cells showing round to oval nuclei, rare small nucleoli and scanty cytoplasm. CD10 immunostaining revealed cytoplasmic positivity in these cells, but reactive mesothelial cells showed a negative reaction. Histologic examination of the uterus revealed the typical histologic findings of LESS. CONCLUSION: Cytopathologic diagnosis of disseminated LESS is not always easy. Immunocytochemical staining for CD10 can be helpful.

Establishment and characterization of a cell line (OMC-9) originating from a human endometrial stromal sarcoma.

Cell lines are very useful for clinical and basic research. The establishment of uterine malignant tumor cell lines with unusual histology is especially important. We describe the establishment and characterization of a new human endometrial stromal sarcoma cell line of the uterus. The cell line OMC-9 was established from a tumor mass in the uterine body of a 55-year-old woman. Characteristics of the cell line studied include morphology, chromosome analysis, heterotransplantation, tumor markers and chemosensitivity. This cell line has grown well for 196 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, appear to be spindle-shaped or multipolar and have a tendency to pile up without contact inhibition. The cells exhibit a human karyotype with a modal chromosomal number in the diploid range. The cells were able to be transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. OMC-9 cells produced tissue polypeptide antigen. Both CD10, a sensitive and diagnostically useful marker of endometrial stromal neoplasms, and vimentin were identified immunohistochemically in the original tumor and the heterotransplanted tumor. The cells were sensitive to actinomycin D, doxorubicin, carboplatin, cisplatin and etoposide, drugs used commonly in the treatment of gynecologic cancer. Only three reports of uterine endometrial stromal sarcoma cell lines have thus far been reported in the literature. OMC-9 is the first endometrial stromal sarcoma cell line in which CD10 expression and chemosensitivity have been identified.