MR findings of ovarian tumours with cystic components.

This article depicts the MR findings of ovarian tumours with cystic components. MRI can predict the cyst contents and evaluate the potential for malignancy when an irregular solid portion or a papillary nodule is observed within the cystic tumour. Post-contrast T1 weighted MRI is helpful for the identification of solid areas that enhance. Fat suppression imaging is useful for differentiation between mature cystic teratoma and other pathology. Fat suppressed post-contrast T1 weighted MRI may demonstrate contrast enhancement, reflecting inflammatory or neoplastic processes in the pelvis.

Serum retinol level and risk of subsequent cervical cancer in cases with cervical dysplasia.

We followed up on 134 women who had been diagnosed with cervical dysplasia to examine the relationship of dietary and serum vitamin A to subsequent cervical cancer. The subjects were women attending the Papanicolaou test screening for residents in Miyagi, Japan and histologically diagnosed as having cervical dysplasia between October 1987 and September 1988. Personal interviews were carried out, and blood samples were taken on the date of diagnosis of cervical dysplasia. The subjects were followed-up with cervical smear and colposcopy at about 3-month intervals from the date of interview until the end of February 1995. During the follow-up, 8 women (5.9%) developed cancer in situ or invasive cervical cancer and 106 (79.1%) reverted to normal. The rate of progression of the cancer in situ or invasive cervical cancer was 4.5 times higher in women with lower serum retinol levels than those with higher serum retinol levels (p = 0.08). The results suggest an association of low serum retinol level with development of cervical cancer.

Presacral neurilemmoma mimicking degenerated subserosal uterine leiomyoma.

A case of presacral neurilemmoma extending into the pelvic cavity is reported. T2-weighted MR sagittal images showed a tumor resembling subserosal uterine leiomyoma with degeneration. CT revealed features distinguishing retroperitoneal neurilemmoma from gynecological tumors. The possibility of retroperitoneal neurilemmoma should be raised when a large pelvic tumor attached to the sacrum is noted on CT or MR study.

Decreased serum retinol levels in women with cervical dysplasia.

To examine the relationship of dietary and serum vitamin A to the risk of cervical dysplasia, a case-control study was conducted in Miyagi, Japan. Cases were 137 women who were found by Papanicolaou test screening and histological examination provided by Miyagi Cancer Society between October 1987 and September 1988 to have cervical dysplasia. Controls were selected from participants of the general health examination provided by the Society and individually matched to cases on age and screening date. The consumption of retinol or carotene-rich foods during the past 7 days was assessed at interview. Information was also collected about other risk factors of cervical dysplasia, such as reproductive histories and sexual behaviour. The mean serum retinol levels were significantly lower among cases compared with controls, although dietary intake levels of retinol and carotene were not different between the two groups. When examined by tertile, the risk of cervical dysplasia was significantly higher among women in the highest tertile of dietary vitamin A level. An inverse association was observed between serum retinol level and risk of cervical dysplasia, although it did not achieve statistical significance.

Diagnostic efficacy and validity of the ThinPrep method in cervical cytology.

OBJECTIVE: To examine the efficacy of the ThinPrep method, an automated, fluid-based technique for the collection and preparation of exfoliated and aspirated cells in cervical cytology. STUDY DESIGN: A total of 251 patients participated. From each patient a sample was obtained by scraping with a wooden spatula, split and prepared with both conventional Papanicolaou and ThinPrep methods. In the ThinPrep processor, epithelial cells were homogenized in a vial of preservative solution and randomly sampled onto a microscopic slide. From a single vial of sample suspension a series of 10 ThinPrep slides of the same quality were made. All cells were concentrated within an approximately 20-mm-diameter circle in a uniform, thin layer on the ThinPrep slide. RESULTS: Twenty-five percent of the screening area, 10% of the epithelial cells observed and 50% of the screening time were required to arrive at a final diagnosis as compared with the Papanicolaou smear. Virtually complete concurrence was ascertained between the Papanicolaou and ThinPrep diagnoses, for direct agreement of 95.3% and agreement within one diagnostic grade of 99.5%. CONCLUSION: An overall improvement was ascertained in the preparation of microscopic slides and the recognition of abnormal cells with the ThinPrep method.

[A histopathological study on the biological behavior of carcinoma in situ of the uterine cervix].

Fifty-two cases of carcinoma in situ (CIS) of the uterine cervix were examined histopathologically and compared with seventeen cases of microinvasive carcinoma of the uterine cervix (restricted to the general rules for clinical and pathological management of uterine cervical cancer of the Japan Society of Obstetrics and Gynecology) in order to investigate the influence of the patient's age on the intraepithelial extension of CIS. The results were summarized as follows. 1. There was a positive correlation between circular spread and longitudinal spread of the lesion in CIS cases. 2. There was a positive correlation between circular spread and the depth of gland involvement of the lesion in CIS cases. 3. Circular spread of the lesion in microinvasive carcinoma cases was significantly more extensive than that in CIS cases. 4. Circular spread of the lesion in microinvasive carcinoma at menopause was significantly more extensive than that in microinvasive carcinoma at sexual maturity. These results suggest that CIS has intraepithelial extensibility, and that in CIS at sexual maturity there is a higher risk of invading stroma when circular spread of the lesion becomes greater than one fourth of the whole circle in the cervix, whereas CIS at menopause is more likely to invade the stroma when the circular spread of the lesion becomes greater than half of the whole circle in the cervix. In this respect we can find the influence of the patient's age on the biological behavior of CIS of the uterine cervix.

[A histopathological study on intraepithelial extensivity of carcinoma in situ of the uterine cervix in the period of sexual maturity].

To investigate intraepithelial extension of CIS, thirty-two cases of carcinoma in situ (CIS) of the uterine cervix in the period of sexual maturity were examined histopathologically and compared with ten cases of microinvasive carcinoma of the uterine cervix (restricted to Japanese criteria). The results were summarized as follows. 1) A positive correlation was found between the circular spreads and longitudinal ones in the lesion in CIS cases. 2) A positive correlation was found between circular spread and the depth of gland involvement in the lesion in CIS cases. 3) Circular spread of the lesion in microinvasive carcinoma cases was significantly more extended than that in CIS cases. These results suggest that CIS in the period of sexual maturity is intraepithelially extensive and that there is a high risk possibility of invading stroma when circular spread of the CIS lesion is greater than one fourth of the whole circle of the uterine cervix.

Observer variability in endometrial cytology using kappa statistics.

AIMS: To analyse the current state of endometrial cytology practice by determining the interobserver variability in grading the atypicality of endometrial cells using kappa statistics. METHODS: A series of 70 clusters of benign, hyperplastic, and malignant endometrial cells on cytology specimens were examined by 19 experienced Japanese cytopathologists. They assigned each cluster to one of three diagnostic categories according to increasing cellular atypicality: negative for, suspicious of, and positive for malignancy. Each observer used their subjective judgement in grading without receiving any discriminatory criteria. RESULTS: Most classified the series of 70 clusters of endometrial cells into 33 negative, 20 suspicious, and 17 positive grades. However, observer variation was considerable, kappa statistics showing unfavourable overall agreement (kappa = 0.36). Although there was good agreement on negative and positive (kappa = 0.46 and 0.47, respectively), poor reproducibility occurred in grading suspicious ((kappa = 0.15). CONCLUSIONS: Currently, Japanese cytopathologists are not reliable in grading the atypicality of endometrial cells. This could be attributed mainly to the situation in endometrial cytology practice in which there are no generally accepted criteria for defining cells in which malignancy is suspected.

Method for the quantitative evaluation of the distribution pattern of nuclei in normal and malignant endometrial epithelia.

A quantitative method of evaluating the pattern of distribution of nuclei within a cell cluster was developed and applied to endometrial cytology. The distribution pattern (DP) is mathematically expressed using a "DP index," which can be determined as a product of the square root of the nuclear density, square root of n0, and the mean distance between the two nearest nuclei, r. The DP index has a limited range of decreasing values from 1.074 to 0.5 to 0, indicative of regular, random and aggregated patterns of nuclear distribution, respectively. The estimated DP index was 0.831 +/- 0.031 (mean +/- standard deviation) in the clusters of normal endometrial epithelial cells from 16 nonneoplastic cases, but 0.638 +/- 0.041 in malignant epithelia from 19 cases of well-differentiated adenocarcinoma. The index of normal epithelia was close to 0.877 of the regular hexagonal distribution pattern. Contrary to this, the DP index was significantly smaller in well-differentiated adenocarcinoma (P less than .001), approaching 0.5, the theoretical value of a random distribution pattern. These findings suggest that quantitative analysis of the distribution pattern of nuclei can be a useful aid in the cytodiagnosis of endometrial lesions.

Nipple discharge cytology in mass screening for breast cancer.

Since 1977 mass screening for breast cancer has been conducted in Miyagi Prefecture, Japan; inspection, palpation and cytologic examination of any nipple discharge are part of the initial screening procedures. Among 149,681 subjects examined, 404 cancer cases and 63 papilloma cases were detected. The nipple discharges from 20,537 women were examined cytologically; of the 61 cancer cases, the smears were positive in 18 cases, suspicious in 7, negative with atypical findings in 12 and negative in 24. Ten of the cancer cases were detected exclusively by the cytologic examination of a nipple discharge. In eight of these ten cancer cases, there was no other initial evidence of the primary tumor. The cytologic diagnosis of discharges without blood from 28 cancer cases was positive or suspicious in 10 cases and negative in 18. Thirty-seven of the papilloma cases were initially detected only by the cytologic examination of a nipple discharge; neither physical examination nor mammography showed any abnormal findings.

[Previous cytology in patients with carcinoma of the cervix].

The cytologic history of 317 patients with uterine cancer, in a mass survey using mobile units, was reviewed. They included 152 cases of carcinoma in situ of the cervix, 151 cases of invasive epidermoid carcinoma of the cervix, 11 cases of adenocarcinoma of the cervix, one case of verrucous squamous cell carcinoma and 2 cases of adenocarcinoma of the endometrium. There was no history of cytology in 17.1% of CIS or in 29.8% of invasive epidermoid carcinoma in the preceding 3 years (same order in the following); in the preceding 5 years the figures were 24.3% and 23.6% respectively. Suspicious or positive cytology noted more than once were 22.2% and 21.7% in the preceding 3 years, and 24.3% and 23.6% of the cases in the preceding 5 years. At least 2 negative Papanicolaou smears were 19.1% and 20.5% in the preceding 3 years, and 28.3% and 28.5% of the cases in the preceding 5 years. The yearly rate of suspicious and/or positive cytology in the preceding 5 years fluctuated between 13.5% and 30.4% in CIS, and between 9.1% and 23.0% in invasive epidermoid carcinoma. They showed no significant rise or trend. Verrucous squamous cell carcinoma as well as adenocarcinoma of the cervix and of the endometrium not infrequently showed successive negative cytology.

Immunohistochemical and electron microscopic demonstration of human papillomavirus in dysplasia of the uterine cervix.

Twenty-five cases of dysplasia of the uterine cervix were studied for the presence of human papillomavirus (HPV) by means of immunohistochemical and electron microscopic techniques. Serial sections of the same histological specimen were examined in each case. HPV was detected in 14 cases by both immunohistochemistry and electron microscopy, while 10 cases were negative with both methods. In only one case, there was a discrepancy in the results derived from these two methods. It was concluded that the relation between HPV infection and cervical dysplasia was confirmed and that immunohistochemical and electron microscopic methods led almost to the same result in detecting HPV in cervical dysplasia.

[Studies on the prevalence and incidence rate of epithelial neoplasia of the uterine cervix by mass survey using mobile units].

In this paper, we analyzed the results obtained in a mass survey using mobile units. The survey covered 276,846 women of whrom 78,018 (24.6%) were women who were being screened for the first time and the other 208,828 had been screened previously. 1) The total detection rate was 0.04% for invasive cancer, 0.03% for carcinoma in situ and 0.06% for severe dysplasia of the uterine cervix. The prevalence rate for 1,000 women was calculated as 0.40, 0.30 and 0.63 respectively. 2) The detection rate for invasive cancer, carcinoma in situ and severe dysplasia was 0.08%, 0.07% and 0.08% respectively for women who were being screened for the first time and 0.03%, 0.02% and 0.06% respectively for repeats. Through the latter results, the incidence rate for 100,000 women was calculated as 30 for invasive cancer, 20 for carcinoma in situ and 60 for severe dysplasia. 3) The detection rate for invasive cancer and severe dysplasia increased abruptly above 60 years and that for carcinoma in situ at 65 years old and over. 4) The detection rate for invasive cancer, carcinoma in situ and severe dysplasia in previously screened women showed little fluctuation by age group.

[Immunoperoxidase demonstration of papillomavirus antigen in dysplasia of the uterine cervix].

Recently, it has been widely recognized that human papillomavirus (HPV) infection plays an important role in the etiology of carcinoma of the cervix. Paraffin sections of cervical malignancies and premalignancies were screened for the presence of papillomavirus antigen by means of peroxidase-antiperoxidase (PAP) method. No case of invasive carcinoma, carcinoma in situ or normal cervix revealed positive HPV staining. In 81 cases (18%) of 461 cervical dysplasias, positive reaction for HPV was detected as brown intranuclear precipitates. The mean age of the women with HPV was significantly lower than that of women without HPV. Characteristic findings of histology of the dysplasias with HPV were koilocytosis and binucleation.

Therapy for cervical cancer detected by mass screening.

Over a 19 year period since 1962, 972 cases of cervical cancer have been detected by mass screening in Miyagi Prefecture, a detection rate of 0.11%. Among these cases, 551 (56.7%) were cases of carcinoma in situ. In contrast, cervical cancers detected by means of private screening gave a detection rate of 0.39% (889 cases), among which there were 611 cases of invasive carcinoma (68.7%). Among the 421 cases of invasive carcinoma detected by mass screening, 352 were Stage I, 52 were Stage II, 14 were Stage III and 1 was Stage IV. Moreover, 178 of the 352 Stage I cases were Stage Ia. The 5 year survival rate for the cervical cancer patients detected by mass screening was 97.8% for Stage 0, 92.9% for Stage I, 75% for Stage II, 45.5% for Stage III and 0% for Stage IV. The 5-year survival rate for invasive carcinoma was 88.7%. Twenty-five deaths due to recurrence of the cancer were found, but all such cases were invasive carcinomas. There were no mortalities due to recurrence of carcinoma in situ among such cases detected by mass screening.

[The present status of mass population screening for cancer of the uterine cervix and the therapeutic results in the detected cases in Miyagi Prefecture].

The mass screening for cervical cancer in the population of Miyagi Prefecture has covered the total 1,078,999 women by March 1981. Invasive cancer of the uterine cervix was discovered in 1032 women, carcinoma in situ in 829. 2) By methods of the examination, the institutional examination was on 72.5% of the examined in 1980. 3) With regards to the rates of examinees by age and the detection rate of the cancer of uterine cervix in 1980, the low detection rate in the age range of 30-50 years whose examination rate was over 20% compares against the high detection rate in the high age range, whose examination rate was low. 4) CAI in years 1965, 1970, 1975 and 1980 were 60.0, 116.7, 193.2 and 229.8 respectively. 5) The 302 cases of invasive cancer detected and treated before the end of 1974 were classified in clinical stages and investigated the results of treatment. The detection in Stage I was in 84.1%, this high percentage being a main factor to make the total treatment results of uterine cervical cancer pushed up to the high figure.

Combination chemotherapy in advanced ovarian cancer.

Among the 95 cases of ovarian cancer treated by us between May, 1975 and August, 1978, only 33 were suitable for complete resection. The remaining 62 cases underwent incomplete resection, followed by F.Q.C. combination chemotherapy (1-(2-tetrahydrofuryl)-5-fluorouracil, carbazilquinone, cytosine arabinoside); 54.8% showed an antitumor response. The median survival time of the responders was 13.2 months, whereas it was 7.4 months for the non-responders. The survival rate after 24 months, however, was 13% and 4%, respectively. Side effects of the drugs, including leucopenia, thrombocytopenia, nausea and vomiting, were found in roughly one half of the cases.

[Studies on immunotherapy of uterine cervical cancer by administration of schizophyllan (SPG) (author's transl)].

This study was designed to investigate effects of immunopotentiator on cervical cancer. We administered schizophyllan (SPG) as immunopotentiator to patients of cervical cancer therapy with irradiation, and examined successively immunological parameters such as blastformation of lymphocytes, skin reaction of PPD, lymphocyte counts, concentration of serum immunoglobulins, and other clinical inspections. Moreover we examined ability of interferon induction of SPG. We also calculated and compared 3 year relative survival rate of the cases administered SPG and historical controls therapy with only irradiation. In patients administered SPG the results revealed: 1) an enhancement of stimulation index of lymphocytes blastformation with PHA, 2) an enlargement of skin reaction to PPD, 3) no effects to number of lymphocytes, serum immunoglobulins, liver function and renal function, 4) an interferon activity on patients' sera of cervical cancer after administration of SPG, and 5) patients administrated SPG had significantly high relative survival rate in comparison with the historical control of cervical cancer cases treated solely by irradiation.