A Case of Erythropoietin-secreting Large Uterine Leiomyoma / 日本農村医学会雑誌

　　A 59-year-old woman, para 2, attended our hospital for an abdominal mass and atypical genital bleeding. Magnetic resonance imaging revealed a 30×25cm uterine myoma. A preoperative blood examination showed the following results: hemoglobin, 21g/dl; hematocrit, 71.5%; erythropoietin, 38.5mIU/ml; and estradiol, 29.9pg/ml. Abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed, with an estimated blood loss of 1650ml. The weight of the uterus, including the myoma nodule, was 4740g, and the results of histology confirmed the diagnosis of leiomyoma. By postoperative day 28, her hemoglobin, erythropoietin, and estradiol levels had fallen to levels of 15.1g/dl, 6.0mIU/ml, and 5.8pg/ml, respectively, which are normal for a postmenopausal woman. The findings suggest that the leiomyoma secreted erythropoietin and induced erythrocytosis. Estradiol stimulates erythropoietin secretion and enlargement of the leiomyoma. Some studies have shown that erythropoietin is also a growth factor for leiomyoma. More than half of the erythropoietin-producing leiomyomas are detected after menopause. It was discovered that leiomyoma cells can produce aromatase, which transforms androstenedione into estradiol. Although estradiol secretion from the ovaries decreases in the postmenopausal period, the estradiol and erythropoietin autocrine/paracrine system in leiomyoma might promote its own growth after menopause.

Problem in Epidermal Growth Factor Receptor Gene Mutation Detection Using Trans-Bronchial Lung Biopsy Samples / 日本農村医学会雑誌

　　Epidermal growth factor receptor (EGFR) gene mutation examination is now performed in most medical institutions in order to select the molecular targeted medicine for lung cancer. It became clear that the positive rate of the biopsy material was lower than that of the surgical sample in this hospital. The cause was attributed to false negatives due to low tumor cell content in biopsy specimens. We investigated the presence of the mutation using surgical samples and preoperative biopsy specimens from the same patients in 13 cases. Furthermore, we investigated the tumor cell content of the biopsy specimens by cell counting. Results showed that 3 of 6 biopsy specimens that were associated with positive surgical samples were judged to be negative. The tumor cell content was less than 5% in all negative cases. Regarding EGFR gene mutation examination, we should carefully determine tumor cell content when using biopsy specimens.

Usefulness of Rapid Immunostaining in Intra-Operative Diagnosis of Sentinel Lymph Node Metastasis of Breast Cancer / 日本農村医学会雑誌

　　In breast cancer cases, intra-operative diagnosis of sentinel lymph node metastasis has been performed widely. It is diagnosed at present by HE staining, but more objective methods are needed. In this study using 166 examples, we compared the methods using rapid immunostaining with the genetic examination. In rapid immunostaining, we recognized metastasis using cytokeratin which was an epithelial cell marker used in the serial sections for frozen histological diagnosis. In conclusion, because metastasis could be diagnosed accurately and pathologist&rsqup;s stress would be reduced, rapid immunostaining is useful for intraoperative diagnosis.

Detection of HER-2 Protein and DNA Amplification in Breast, Stomach and Colon Cancers / 日本農村医学会雑誌

　　We investigated the detection situation of the HER-2 examination that was performed to investigate the adaptation of the molecular targeted medicine trastuzumab for mammary and gastric cancers. The HER-2 positive rate was higher in biopsy specimens than in surgical specimen. In gastric cancer, the positive rate was significantly high when it was of the papillary type, histologically. In comparison with mammary cancer, the percentage of FISH positive was high in 2＋ cases. In addition, as the results of trial investigation showed, HER-2 positive cases ware few in colon cancer.

Detection of High Risk Type HPV by Means of Clinichiptm in Patients with Cervical Dysplasia / 日本農村医学会雑誌

　　It is known that uterine cervical cancer is caused by persistent infection with high-risk type of HPV (human papilloma virus). We have run HPV genotyping tests on patients since November, 2011. In 111 cases so far examined, HPV types 16, 52 and 58 were detected with high frequency, but type 18 was with low frequency. This trend was comparable to nationwide tendency. Type 52, 56 and 58 were detected from the patients of advanced age frequently. There weredifferences in HPV infection rate between cytology-negative cases and positive cases, but there was not the difference in HPV typing by cytology-negative and positive patients. Furthermore, it was made clear that the superinfection of HPV who significantly related to the development of tumor. In the cytology negative patients who were followed up because of dysplasia, there are many who are negative for high risk HPV. Therefore, HPV genotyping examination may help physicians determine the relative priority for treatment.