[Show abstract][Hide abstract] ABSTRACT: Krukenberg's tumor, an metastatic ovarian tumor originating from gastric cancer, is a disease with extremely poor prognosis, and it is rare for patients to survive for more than 2 years after the diagnosis. We encountered a patient in whom a long-term good prognosis could be obtained probably because of the effects of chemotherapy after the ovarian tumor extraction. This patient was treated by a combination of UFT and cisplatin. Enhancement of the antitumor effects by the concomitant use of 5-FU and cisplatin has been attracting attention, and the methods of administration of these drugs have been investigated by numerous researchers as FP therapy. It was characteristic to the treatment of our patient that 5-FU was administered in the form of oral UFT. We believe this was an important experience suggesting that this administration method is safe and effective, and even influences the long-term prognosis.
No preview · Article · Jul 2004 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study are to analyze the clinicopathologic features of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix and to discuss the management thereof. We examined 13 patients with VGPA.
Clinical profiles, including patient age, clinical stage, surgical procedure, and outcome, were recorded. Pathologically, macroscopic features, polypoid tumor size, horizontal spread and depth of endophytic tumor, nuclear atypicality, mitotic count, lymph capillary space invasion, and lymph node metastasis were investigated.
The median age of 13 patients was 45 years, with 10 and 3 patients staged Ib and IIb, respectively. All the patients underwent hysterectomy and pelvic lymphadenectomy and are alive without recurrence. Macroscopically, the tumor showed a polypoid pattern in 8 patients and a flat pattern in the remaining 5 patients. Polypoid tumor size ranged between 4 x 2 and 20 x 15 mm. Horizontal spread and depth of endophytic tumor ranged between 8 and 30 mm and between 3 and 11 mm, respectively. The tumor in all the 13 patients except 1 showed moderate nuclear atypicality. The mean mitotic count was 43/10 high-power fields. Lymph capillary space invasion was present in 4 patients, 1 of whom also had bulky lymph node metastases.
VGPA has been reported to rarely involve lymph capillary space invasion or lymph node metastasis, leading some surgeons to conduct less radical surgeries such as conization. Nevertheless, we encountered patients with these pathologic risk factors. Much caution should be exercised in managing patients with VGPA.
No preview · Article · Feb 2004 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: A patient with stage IIb cervical adenocarcinoma underwent Wertheim hysterectomy with pelvic lymphadenectomy and bilateral adenexectomy followed by radiotherapy. Review of histologic sections diagnosed villoglandular papillary adenocarcinoma (VGPA) with metastatic lymph nodes. The patient has been disease-free for 17 years. This patient is the third case of VGPA with lymph node metastasis ever reported.
No preview · Article · Dec 2002 · European Journal of Obstetrics & Gynecology and Reproductive Biology
[Show abstract][Hide abstract] ABSTRACT: Recurrence of FIGO stage IA1 cervical adenocarcinoma is extremely rare. We herein report a patient with early invasive cervical adenocarcinoma who developed a recurrence in the vaginal stump.
A 52-year-old female complained of contact bleeding. Biopsy of the uterine cervix verified cervical adenocarcinoma, and the patient underwent Okabayashi hysterectomy with pelvic lymphadnectomy and bilateral adnectomy. Histopathologic examination of the uterus revealed an invasive cancer 3 mm in depth. Neither lymph node metastasis nor lymph-vascular space invasion was observed. However, the depth of her normal cervical gland area was 2 mm only, and the cancer invasion involved an area which was deeper than the normal cervical gland area. The vaginal stump recurrence developed 4 years after surgery.
The depth of invasion with reference to that of normal cervical glands may become a possible prognostic factor for early invasive cervical adenocarcinoma.
No preview · Article · Aug 2001 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: A 46-year-old woman with stage IV "high-grade" endometrial stromal sarcoma presented with massive uterine bleeding and dyspnea. Her WHO performance status was grade 4. After chemotherapy consisting of ifosfamide, Adriamycin, and cisplatin, the uterus shrank from 20 x 15 x 15 to 6 x 6 x 8 cm and multiple pulmonary nodules almost completely disappeared. The PO2 increased from 57.8 to 89.3 mmHg and her performance status improved to grade 0, making it possible for pelvic surgery to be performed. At 10 months postoperatively, there was no evidence of disease. This case suggests that IAP might be effective chemotherapy for patients with high-grade endometrial stromal sarcoma.
No preview · Article · Mar 1997 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: Background
No effective chemotherapy has been established for the treatment of ovarian clear cell adenocarcinomas. Based on the results of a sensitivity test in cultured cells, we investigated combination chemotherapy using irinotecan hydrochloride and mitomycin C.
Six patients with ovarian clear cell, adenocarcinoma and evaluative lesions were infused with irinotecan (140 mg/m2) intravenously over 4 hours and mitomycin C (7 mg/m2) was infused over 60 minutes directly into the pleuroperitoneal cavity or intravenously. One course comprised 3 doses of each agent at 2-week intervals and patients received at least 2 courses.
A complete response was obtained in 1 patient (maintained for 12 months so far) and a partial response in 1 patient (maintained for 3 months and followed by relapse with peritoneal dissemination). In 3 of the 4 patients without tumor regression, carcinomatous effusions decreased or disappeared. Myelosuppression and gastrointestinal side effects were grade II or less in severity and thus were considered tolerable.
Because no chemotherapy regimens employing cisplatin are effective for ovarian clear cell adenocarcinomas, this regimen warrants further study.
No preview · Article · Oct 1996 · International Journal of Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: To assess whether squamous cell carcinoma (SCC) antigen and carcinoembryonic antigen (CEA) are useful as tumor markers of vulvar cancer.
The serum levels of SCC antigen and CEA were determined for 30 patients with invasive vulvar carcinoma.
There was a significant difference not only between tumor sizes of 2 cm or larger and those of less than 2 cm (p < 0.001), but also between patients with lymph node metastasis and patients free from it (p < 0.001). Tumor marker levels well reflected the response to neoadjuvant chemotherapy. The sensitivity to recurrence was 63%, and the specificity was 94%. In 2 of 8 recurrent cases, it was only the re-increase in tumor markers that indicated the recurrence.
The measurement of serum levels of SCC antigen and CEA is useful not only for preoperative evaluation of the risk of lymph node metastasis, but also for the detection of recurrence.
No preview · Article · Sep 1996 · Journal of Obstetrics and Gynaecology Research
[Show abstract][Hide abstract] ABSTRACT: Serum levels of CA125 and CA19-9 were examined in 225 cases with endometrial carcinoma before treatment and 32 cases with recurrent endometrial carcinoma. The positive rates in the 225 cases were 27.1% for CA125, 24.0% for CA19-9, and 38.7% for the combined assay. The serum levels of both CA125 and CA19-9 significantly increased with surgical staging. The presence of lymph node metastasis and extrauterine spread exhibited a marked influence on the serum levels of both CA125 and CA19-9. Myometrial invasion and vessel permeation also increased serum levels of CA125, whereas peritoneal cytology and adnexal metastasis exhibited no influence on CA125 levels or CA19-9 levels. Twenty-five of 33 cases who showed either more than 100 U/ml of CA125 level or more than 100 U/ml of CA19-9 level were classified as surgical stage III or IV. The combined assay demonstrated a 71.9% positive rate at the time of detection of the recurrence (65.6% for CA125, 43.7% for CA19-9). In 34.4% of the 32 recurrent cases, elevated levels of the tumor markers were the first sign of recurrence. These data indicate that the use of CA19-9 in combination with CA125 is noteworthy in the management of patients with endometrial carcinoma.
No preview · Article · Oct 1994 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: The frequency of K-ras point mutation(PM) at codon 12 was studied in 45 patients with endometrial carcinoma. In vitro amplification of target sequences of DNA extracted from endometrial cancer tissues by polymerase chain reaction and dot blotting with oligonucleotide hybridization were performed. Ten of 45 endometrial carcinomas disclosed K-ras PM at codon 12 (22.2%). Transition from GGT to GAT was most frequent in PM(41.7%). Simultaneously, double PM (GAT/GCT) were also detected in 2 cases. No relationship appeared to be present between PM and clinical prognosis such as clinical stage, histological type, histological grade of differentiation, depth of myometrial invasion, and ascitic cytology. The positive rates of lymph node metastasis tended to be higher in the group with positive PM than in the group without PM. K-ras and C-myc gene amplifications were found in 2 (5.1%) and 3 (7.7%) of 39 cases, respectively. No PM of H-ras at codons 12 and 61 was detected. Our results showed that the PM of K-ras gene at codon 12 was a fairly common event in genetic abnormality and suggested it would have some role in the progression of carcinogenesis in endometrial carcinoma.
No preview · Article · Mar 1993 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: Fourteen patients with recurrent gynecological adenocarcinomas (nine with endometrial cancer and six with ovarian cancer) were treated with cisplatin given by 14-day continuous infusion at a daily dose of 10 mg/m2 in combination with aclarubicin (ACR) at a dose of 20 mg/body on alternate days during each 14-day course. The daily dose of cisplatin was given with 1 liter of fluids; no diuretics were administered. The overall response rate was 71.4% (50% in endometrial cancer and 100% in ovarian cancer). It was especially interesting that a 100% response rate was obtained in five patients previously treated with cisplatin; i.e., the present cisplatin dosing schedule was highly effective as second-line therapy in these patients. No renal or gastrointestinal toxicity was observed. These results were pharmacokinetically explained by the plasma concentration of filterable platinum. A low-level, plateau-like curve with a great area under filterable [Pt]-time curve (AUC) seemed to ensure exposure of cancer cells to filterable platinum for sufficiently long periods and freedom from gastrointestinal and renal side effects.
No preview · Article · Aug 1990 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: Combination chemotherapy consisting of bleomycin, vincristine, mitomycin C, and cisplatin (BOMP) was first applied to an inoperable case (57-year-old) with FIGO stage IV (T3N3 + M1B) squamous cell carcinoma of the vulva. After three courses of BOMP therapy, the patient achieved a complete response with few toxic effects and subsequently could undergo radical vulvectomy with bilateral inguinal and pelvic lymphadenectomy. On microscopic examination, only a minute focus of viable squamous cell carcinoma was observed in the vulvar lesion and regional lymph nodes, which was surrounded by fibrotic or necrotic tissues. The patient received a further two courses of BOMP as postoperative chemotherapy. Five courses of BOMP were extremely tolerable and did not require special care. She has been free of disease for 20 months and her present performance status is 0. The encouraging result warrants the use of this combination chemotherapy regimen in other patients with advanced squamous cell carcinoma of the vulva.
No preview · Article · Apr 1990 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: Between 1950 and 1986, fifteen cases of primary carcinoma of the fallopian tube were diagnosed and treated at the Cancer Institute Hospital, Tokyo. These cases constituted 0.14% of the total number of gynecologic malignancies at the hospital during that period. The average age of the 15 patients was 55.7 years. The most frequent symptom was atypical genital bleeding, seen in 12 cases (80%). Massive watery discharge was seen in 4 cases (27%). In preoperative cytologic examination, 6 cases (40%) were positive for cancer. All cases underwent operation as therapy. Postoperative irradiation, adjuvant chemotherapy, and/or second- or third-look operations were also performed. Histopathologically, all materials were found to be adenocarcinoma. Four cases were well differentiated, eight were moderately differentiated, and three were poorly differentiated. As for the prognosis, 7 patients were followed more than 5 years postoperatively. The 5-year survival rate was 57% (4/7). In stage I cancers, the 5-year survival rate was 80% (4/5). The prognosis of stage I cancer patients was estimated to be rather good.
No preview · Article · Aug 1989 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: With an enzymatic technique, serum sialic acid (SA) levels were determined in patients with gynecologic tumors. Since the SA level for healthy females was 57.4 +/- 7.3 mg/dl, we set the upper normal limit of this parameter at 72 mg/dl. The SA level became larger in ascending order of uterine myoma, benign ovarian tumor, cervical cancer, corpus cancer, and ovarian cancer. The SA level proved to be significantly higher in cancer patients showing poor prognosis than in those having good prognosis irrespective of the category of therapy and it reflected well the clinical course of cancer patients. In patients who receive a combination therapy and need to be followed up for a long term, complete follow-up is sometimes impossible with tumor-derived markers alone. Even in such cases, the sialic acid level will work as a useful follow-up marker because it is nonspecific to histologic types of cancer.
No preview · Article · Jun 1989 · Gynecologic Oncology