Therapeutic dilemma in twin reversed arterial perfusion sequence.

The dissemination of minimally invasive in utero surgery reduced the mortality of twin reversed arterial perfusion sequence, but the mortality of expectantly treated surgical candidates remains high. A 26-year-old, non-parous, Japanese woman at 13 weeks of gestation had been diagnosed with twin reversed arterial perfusion sequence and was judged as a surgical candidate for radiofrequency ablation. However, she did not undergo surgery because of the anatomical location of the acardiac twin. At 18 weeks of gestation, the blood flow to the acardiac twin disappeared spontaneously. The pump twin began to demonstrate fetal growth retardation during the third trimester. The patient delivered a 1891 g female at term. We macroscopically identified the cause of the fetal growth retardation as velamentous insertion of the umbilical cord and microscopically diagnosed the acardiac twin with acardiac acephalus. We should give the same attention to the management of post-twin reversed arterial perfusion sequence as twin reversed arterial perfusion sequence itself.

Radiation effects on DNA content of cervical cancer cells: A rapid evaluation of radiation sensitivity by laser scanning cytometry.

Since uterine cervical cancer is regarded as a radiosensive tumor, ionizing radiation is the most frequently used treatment modality against the disease. Although the crucial end-point is radiation-induced cell death, the tumors are not equally sensitive to radiation. Determining the criteria that may be used to predict tumor radiosensitivity is of importance; however, little success has been achieved thus far. In radioresistant cases the therapeutic strategy should be changed, thereby avoiding ineffective or unnecessary treatment. Furthermore, identification of the underlying molecular processes leading to radioresistance may lead to novel radiosensitising strategies. Cervical smears were obtained from seven patients with locally advanced cervical cancer following each radiotherapy, and the radiation-induced damage of cancer tissue was examined by routine cytology. Since the formation of DNA double-strand breaks is considered critical for the cytocidal effect of radiation therapy, the molecular changes of the neoplastic cells were also assessed by laser scanning cytometry (LSC). Radiation-induced morphological changes of cancer cells were evident at a dose of 7.2 Gy, whereas increased DNA content (or DNA index) was observed prior to the onset of morphological changes. Molecular change was detected earlier than the morphological change of the irradiated cancer cells, indicating the feasibility of LSC in predicting the radiosensitivity of cervical cancer tissue.

Desmoplastic small round cell tumor in the ovary: Report of two cases and literature review.

Desmoplastic small round cell tumor (DSRCT) is a rare intra-abdominal tumor of uncertain histogenesis that occurs predominantly in young males. We report two cases of DSRCT in young women that presented clinically as ovarian tumor with extensive pelvic and abdominal dissemination. Both patients underwent debulking surgery and combined chemotherapy. After primary therapy, the tumors recurred and both women died of the disease. The clinical presentation and differential diagnosis, as well as the treatment, including surgical debulking and combined chemotherapy are discussed.

Primary adenocarcinoma of the vagina successfully treated with neoadjuvant chemotherapy consisting of paclitaxel and carboplatin.

Primary vaginal adenocarcinoma unassociated with antenatal diethylstilbestrol (DES) exposure is extremely rare. The strategy for treating this disease has not yet been established due to its rarity and, therefore, the prognosis remains poor. A 69-year-old woman presented with vaginal bleeding but no history of antenatal DES exposure. She had a solid tumor in the recto-vaginal space, diagnosed as FIGO stage III vaginal adenocarcinoma. After neoadjuvant chemotherapy consisting of paclitaxel and carboplatin, the tumor became undetectable. Thereafter, radiotherapy was applied to the pelvis and vagina in order to reinforce the state of remission. The patient remains free from recurrence 1 year after discharge. The present case was successfully treated with chemotherapy and radiotherapy, suggesting that chemotherapy may be an option for the treatment of this type of tumor.

Clinicopathological significance of cervical adenocarcinoma associated with lobular endocervical glandular hyperplasia.

Lobular endocervical glandular hyperplasia (LEGH) is usually assumed to be a benign tumor-like lesion of the glands of the uterine cervix. However, LEGH has been associated with obvious cervical adenocarcinoma. The clinicopathological significance of coexistence of LEGH with adenocarcinoma remains unclear. We microscopically examined the presence or absence of LEGH components in 95 stage Ib cervical adenocarcinomas. Gastric mucin was detected with the use of clone HIK1083. Associations of the coexistence of LEGH components with clinicopathological variables were analyzed. LEGH components were present in 16 cases (16.8%). Gastric mucin was positive in all 16 LEGH components, as compared with only 6 of the 95 adenocarcinoma components. Of the 16 adenocarcinomas with LEGH components, 15 were well-differentiated mucinous adenocarcinomas, and one was poorly differentiated adenocarcinoma. The mortality rate of tumor recurrence was 25% (4 of 16) in patients whose tumors had LEGH components, and 21.5% (17 of 79) in those whose tumors had no LEGH components. There was no significant difference in survival. Early cervical adenocarcinoma was relatively frequently associated with LEGH components. LEGH may be one of the factors related to the development of cervical adenocarcinoma, but adenocarcinoma with LEGH components does not necessarily develop into a highly aggressive "adenoma malignum."

Polypoid endocervical adenomyoma: a case report with clinicopathologic analyses.

A case of polypoid endocervical adenomyoma (PEA) in the uterine cervix was encountered in the uterine cervix of a 56-year-old woman. Grossly, a well-circumscribed polypoid tumor was observed protruding from the uterine cervix. Based on the findings of imaging studies, it was assumed to be an adenoma malignum in the uterine cervix. The tumor was composed of a mixture of proliferating glands of endocervical type and fascicles of smooth muscle. No distinct nuclear anaplasia, architectural abnormality or any evidence of destructive stromal invasion was observed. Adenoma malignum, which shows a gastric phenotype with immunoreactivity for HIK-1083, was a serious diagnostic possibility. In the present case, the tumor was a well-circumscribed polypoid lesion, with no cytologic or architectural abnormality; however, focal immunoreactivity was shown for HIK-1083, which thus suggested it to be PEA. Therefore, the results of these ancillary diagnostic modalities should be interpreted with caution and combined with the gross and light microscopy findings.

GnRH agonist acts as ovarian protection in chemotherapy induced gonadotoxicity: an experiment using a rat model.

To reduce chemotherapy induced gonadotoxicity, co-treatment with gonadotropin releasing hormone against analogue (GnRHa) was tested using rat model. Leuprorelin acetate (Leuplin) with or without cisplatin (CDDP) was given subcutaneously at a dose of 9.4 microg/ml to Wistar strain female rats. The total number of follicles was counted and the maturation of follicles was evaluated at the largest section of the ovary on the 5th and 10th day after administration. Leuplin led the ovary to a resting phase in which primordial follicle occupied 80% of all follicles in only 5 days after administration. The serum E2 level was also down by the 5th day and maintained a low level to the 10th day. In co-treatment with GnRHa and CDDP rats, the primordial follicle occupied 90% of all follicles and the total number of follicles was higher than in CDDP alone rats. This rat model verified that GnRHa co-treatment well minimized CDDP induced gonadotoxocity by desensitization of the ovary. These results were promising for the clinical application introducing GnRHa co-treatment as ovarian protection in cancer chemotherapy in young women.

Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary.

AIM: The aim of this study was to investigate whether fertility preservation influences the clinical outcome in patients with malignant germ cell tumors of the ovary (MGCTO). METHODS: A case study analysis was performed on patients with MGCTO treated at Kurume University Hospital between 1986 and 2004. Thirty-five patients were included in the study, 14 with immature teratoma, 11 with dysgerminoma, eight with endodermal sinus tumor, and two with mixed germ cell tumor. Twenty-three patients had International Federation of Gynecology and Obstetrics stage I (Ia, 11; Ib, 2; Ic, 10), one had stage II, seven had stage III, and four had stage IV disease. RESULTS: Five patients with stage III or IV disease received radical surgery. Thirty patients underwent conservative surgery. As the adjuvant treatment, 30 patients received chemotherapy, while five patients did not receive any chemotherapy. The overall survival rate was 97.1%. One patient died of the disease. She was 13 years old with a stage IV endodermal sinus tumor. Twelve have attempted conception, and eight have achieved at least one pregnancy (66.7%). CONCLUSIONS: Irrespective of the stage of the disease, conservative surgery and adjuvant chemotherapy for MGCTO can achieve a favorable outcome in terms of survival and fertility.