Small cell carcinoma of the uterine cervix metastasizing to the bone marrow: a case report.

We report a case of small cell carcinoma (SmCC) of the uterine cervix that metastasized to the bone marrow. A 60-year-old woman with stage IIB SmCC of the cervix was treated with three courses of neoadjuvant chemotherapy followed by radical hysterectomy. Because of the presence of a large residual tumor, the patient underwent postoperative adjuvant chemotherapy. Two months after the last course of chemotherapy, severe pancytopenia developed, and erythroblastic cells were found in the peripheral blood. The hematological disorder was shown to be secondary to bone marrow metastasis, and no other metastases were found. The patient died of the disease 8 months after the initial diagnosis. This case suggests that SmCC of the cervix can metastasize to bone marrow, that such metastasis can occur in isolation and lead to severe pancytopenia, influencing the clinical course of the disease.

Expression of estrogen and progesterone receptors in smooth muscle metaplasia of rectovaginal endometriosis.

To investigate expression of estrogen receptors (ER) and progesterone receptors (PR) in smooth muscle metaplasia (SMM) outside the endometriotic foci of rectovaginal endometriosis (RVE). One hundred and ninety-five specimens were obtained from the rectovaginal areas of the 63 patients who were underwent laparoscopic surgery for RVE. The patients were divided into 3 groups: a gonadotropin-releasing hormone (GnRH) agonist group, a non-GnRH group, including a proliferative phase group, and a secretory phase group. Expression of ER and PR in the rectovaginal tissues of RVE were determined using immunohistochemical methods. Smooth muscle metaplasia occurred in 172 specimens (88.2%), and ER and PR expression were found in the smooth muscle cells in the SMM areas outside the endometriotic foci of RVE. The expression of ER and PR in the GnRH agonist group were significantly lower than those in the non-GnRH agonist group. This is the first report demonstrating ER and PR in the smooth muscle cells in SMM outside the endometriotic foci of RVE. The ER and PR were expressed in the SMM areas, but these receptors were not recognized in fibrotic areas. We could identify the expression ratio of these receptors during each menstrual phase, with or without administered GnRH agonist.

Laparoscopic adenomyomectomy and hysteroplasty: a novel method.

STUDY OBJECTIVE: To evaluate a novel method of laparoscopic adenomyomectomy. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Fourteen women with adenomyosis. INTERVENTION: Laparoscopic adenomyomectomy and hysteroplasty. After local injection by diluted vasopressin solution, a transverse incision was made in the adenomyotic tissue down to the endometrium, and the adenomyotic tissue was surgically removed with a monopolar needle. The normal muscle layer on the serosal membrane side was left as an upper and lower serosal flap. The flaps were overlapped and sutured to counteract the lost muscle layer to reconstruct the uterus. MEASUREMENTS AND MAIN OUTCOME: The changes of symptoms were evaluated before and after the operation. The visual analog scale of dysmenorrhea was significantly decreased, and hypermenorrhea was improved after the surgery. Postoperative pregnancy was achieved in 2 patients, and vaginal delivery was performed in the first case. CONCLUSION: For specific cases, laparoscopic adenomyomectomy may be a suitable method to relieve symptoms with minimally invasive surgery while conserving the uteri.

[Laparoscopic surgery for gynecologic malignancy].

The gynecologic laparoscopic surgery that has developed in the reproductive field is performed for most cases of benign disease. Introduction of laparoscopic surgery for a gynecologic malignancy is relatively late in comparison with other surgical regions and does not qualify for insurance. An operation for a gynecologic malignancy is classified roughly into a surgery of internal pelvic organs and lymph nodes. The techniques which extensive technology is pursued involve radical hysterectomy and paraaortic lymph node excision. In the surgeons who performed many laparoscopic surgeries, it seems that a surgical procedure other than these can be performed at present. The experienced laparoscopic techniques and the particular knowledge of pelvic anatomy were necessary to perform laparoscopic surgery for gynecologic malignancy.