Case of minimal deviation adenocarcinoma: possible clinical link to lobular endocervical glandular hyperplasia as its origin.

Minimal deviation adenocarcinoma (MDA) is defined as an extremely well differentiated variant of endocervical adenocarcinoma. Several reports have stated that MDA associates with lobular endocervical glandular hyperplasia (LEGH). It is difficult to distinguish LEGH from MDA based on clinical and histologic similarities. There is no definite evidence proving that LEGH is a precursor lesion of MDA. A 45-year-old woman was admitted to our hospital for minute investigation of her neurological disorder. The multiple-cystic lesion at the uterine cervix was identified by magnetic resonance imaging. Based on her normal histological findings and severe underlying conditions, a careful follow-up strategy was adapted. Two years later, atypical glandular cells were observed and the multiple-cystic lesion had increased. Pathological diagnosis of a conization specimen was MDA. Radical hysterectomy was carried out. Pathological examination revealed coexistence of LEGH and MDA. Her clinical course and histological findings suggested the possibility that LEGH might be a precursor lesion of MDA.

Diagnostic usefulness of intraoperative ultrasonography in avoiding unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma.

OBJECTIVE: To evaluate the usefulness of intraoperative ultrasonography (IU) in reducing the number of unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma. METHODS: Computed tomography (CT) and IU were used to assess whether para-aortic lymph nodes were enlarged in 91 women with endometrial carcinoma. All women underwent hysterectomy and systematic pelvic and para-aortic lymphadenectomy. On the basis of the intrauterine pathological findings (IPF) of the removed uterus, the women were classified into low- and high-risk groups. It was assumed that para-aortic lymphadenectomy would be performed only when enlarged nodes were detected by CT or IU or only when women were classified into the high-risk group. The numbers of women who would have had missed metastases and who could have avoided para-aortic lymphadenectomy were calculated. RESULTS: Eighteen women had pathological para-aortic node metastases. Theoretically, the number of women who would have had missed metastases on the basis of CT, IU, and IPF were 11, 2, and 2, respectively; more metastases were missed with CT than with the other 2 methods. The number of women who could have avoided para-aortic lymphadenectomy on the basis of CT, IU, and IPF were 84, 59, and 29, respectively; compared to IPF, IU helped avoid para-aortic lymphadenectomy in more women. CONCLUSIONS: Intraoperative ultrasonography is the most efficient method for avoiding both unnecessary para-aortic lymphadenectomy and missed para-aortic node metastases in women with endometrial carcinoma.

Postoperative concurrent chemoradiotherapy for the high-risk uterine cervical cancer.

AIM: To determine whether concurrent chemoradiotherapy (CCRT) can improve the survival rate of high-risk uterine cervical cancer. MATERIAL & METHODS: We analyzed 16 cases of uterine cervical cancer that had undergone radical hysterectomy and pelvic lymphadenectomy from 2003 to 2008. The patients were eligible if they had histologically confirmed positive parametrial involvement, positive pelvic lymph nodes or non-squamous cell carcinoma. They received 50 Gy of external beam radiotherapy (RT) for the pelvis which was combined with chemotherapy. Cisplatin was administered intravenously every 3 weeks at a dose of 70 mg/m(2) during the RT. For renal function complication case, carboplatin was administered weekly. For control purposes, there were 14 cases treated in our hospital from 1995 to 2003 who had received only RT. RESULTS: We did not find any statistically significant difference in the disease-free survival rate between the CCRT group and the RT group. However, the overall survival rate was significantly higher for patients in the CCRT group compared with the RT group in positive lymph node cases and non-squamous cell carcinoma cases. Adverse effects were more frequent in the CCRT group. Over grade 3 toxicities were manifested as leukopenia, diarrhea and anemia. There was no local recurrence in CCRT group patients. CONCLUSION: CCRT seems to be beneficial for improving the survival rate of either positive lymph node or non-squamous cell carcinoma cases in high-risk uterine cervical cancer patients.

[Concurrent chemoradiation therapy for advanced cervical cancer].

In 2003, we began a clinical application of concurrent chemoradiation therapy (CCR) in patients with cervical cancer in our hospital. We analyzed 14 cases of advanced cervical cancer in stages IIa through IIIb by FIGO classification. Tumor size of the uterine cervix ranged from 1.5 cm to 8.0 cm in diameter. Patients received radiation therapy (50 Gy of external beam radiotherapy for pelvis and 20 Gy of high-dose rate intracavitary brachytherapy) combined with chemotherapy. Cisplatin was administered intravenously every 3 weeks at a dose of 70 mg/m(2) during the radiation therapy. In two cases, CCR was stopped because of the side effects. One case developed acute renal failure and another suffered intolerable exhaustion. As for the antitumor effects of CCR, the response rate was 75% (CR 58.3%,PR 16.7%). At the end of the CCR, 10 of 12 patients (83.3%) were negative for viable cells by cytology or biopsy of the uterine cervix. The grade 3 adverse effects were leukopenia, diarrhea and anemia. There was no statistical difference in the overall survival between CCR and radiation therapy alone. The CCR response rate in patients with paraaortic lymph node swelling (suspected metastasis) was low, and they had a poor prognosis. Further examinations for the long-term survival benefit of CCR are necessary.

Radiofrequency ablation for cystic adenomyosis: a case report.

BACKGROUND: Cystic adenomyosis is an uncommon feature of adenomyosis, and women with the disease usually undergo laparotomy. We treated a case of cystic adenomyosis with radiofrequency ablation. CASE: A 21-year-old woman had severe dysmenorrhea supposedly caused by cystic adenomyosis. Under general anesthesia and ultrasound guidance, a radiofrequency needle was inserted into the cyst through the cervix, and the cyst was ablated. The procedures took about 15 minutes, with no complications. Lower abdominal pain and a high fever occurred 3 days later but disappeared soon after necrotic tissue was discharged. The cystic lesion disappeared, and the severity of the dysmenorrhea decreased by one-third as compared with that before the ablation. CONCLUSION: This was the first case of cystic adenomyosis treated with radiofrequency ablation.

Prompt diagnosis of ectopic pregnancy with the human chorionic gonadotropin test using exuded extract from endometrial curettings.

Using saline solution including exuded extract from uterine curettings, hCG tests were performed in 63 women in whom there was a suspicion of ectopic pregnancy, and their results correlated highly with the microscopic existence of chorionic villi and trophoblasts. Ectopic pregnancy can be mostly excluded when the test is positive, and either ectopic pregnancy or complete abortion is probable when it is negative.

[Anaphylaxia induced by etoposide--a case report].

A 32-year-old woman, gravida 4, para 2, visited Teikyo University Hospital with complaints of abnormal uterine bleeding and lower abdominal pain. Urine hCG level was 1,024 x 10(3) IU/l. MRI examination showed a vascular, rich solid mass 10 cm in diameter at the posterior region of the uterus. Under the clinical diagnosis of choriocarcinoma, she underwent total hysterectomy with right salpingooophorectomy. The ovarian choriocarcinoma was confirmed by pathologic examination. Additional chemotherapy was planned using the combined regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin. After 2 min of etoposide administration (100 mg/m2), the patient complained of acute dyspnea, which was caused by bronchospasms and cutaneous flushing. Etoposide infusion was immediately stopped, and anti-anaphylaxic treatment was done by administering hydroxyzine hydrochloride. Five min after the episode had occurred, the patient recovered. This episode was thought to have been induced by etoposide, but etoposide was a key agent for choriocarcinoma. Thus, we devised a modified chemotherapy using etoposide as follows. The regimen was hydrocortisone 100 mg i.v. q6 h and promethazine hydrochloride 50 mg i.m. q6 h for 24 h before infusion of etoposide. The etoposide concentration was diluted to 50%, and the drug administration rate reduced by half. With the modified regimen, the patient showed no anaphylaxic symptoms. The few reports on anaphylaxic reactions to chemotherapeutic agents induced by side effects must be taken into account when we use these drugs.