Lymph node metastasis in stage I epithelial ovarian cancer

OBJECTIVES

A relatively high incidence of para-aortic and pelvic lymph node metastasis is found in epithelial ovarian cancer. This paper investigates the clinicomorphological features of intra-abdominal stage I epithelial ovarian cancer that may predict the occurrence of lymph node metastasis and the prognosis of patients in whom lymph node metastases are identified.

METHODS

From November 1988 to December 1997 we performed systematic para-aortic and pelvic lymphadenectomy as primary surgery in 47 patients with intra-abdominal stage I epithelial ovarian cancer. The incidence of lymph node metastasis in these patients and the clinicomorphological features of the patients with lymph node involvement were examined.

RESULTS

Five patients (10.6%) were metastasis positive (IC: four; IA: one), of whom four had serous adenocarcinoma. Serous adenocarcinoma was associated with a significantly higher incidence of metastases than other histological types (P < 0.05). The number of positive lymph nodes was one in four patients and two in one patient, and the metastatic sites ranged from the para-aortic to the suprainguinal lymph nodes. All five metastasis-positive patients were alive and disease free at the time of this report (survival 28-85 months: median 59 months).

CONCLUSION

This clinical study suggests that serous adenocarcinoma carries a high risk of lymph node metastasis, requiring systematic lymphadenectomy for accurate staging in intra-abdominal stage I epithelial ovarian cancer.

Phorbol ester facilitates apoptosis in murine fibroblasts pretreated by mild ultraviolet radiation

Although phorbol 12-myristate 13-acetate (PMA) inhibits apoptosis and promotes the growth of some types of cells, it induces apoptosis in other cells. We evaluated the apoptotic effects of PMA on murine fibroblasts (L-929) that had been exposed to ultraviolet-B (UV-B) radiation at 312 nm, which promotes tumor cell growth. Exposure to PMA alone did not induce Fas, Fas-L, or apoptosis. Cells exposed to mild UV-B irradiation (80 J/m(2)) alone exhibited a slight expression of Fas and Fas-L 36 to 48 h after the exposure, and exhibited apoptosis as evidenced by DNA fragmentation 72 h after exposure. The addition of PMA (0.8 x 10(-5) to 3.2 x 10(-5) M) to the medium 24 h after the UV-B exposure markedly and dose-dependently enhanced these cell responses. Confluent untreated cells, cells cocultured with PMA, and cells cocultured with PMA for 24 h after the UV-B exposure consistently expressed mRNAs for wild-type p53, bcl-2, and ICE. Expression of c-myc mRNA was initially observed, but became undetectable in the cells cocultured for 24 h with a high concentration of PMA (3.2 x 10(-5) M) following UV-B exposure. Such cells subsequently exhibited the maximal apoptotic response. We conclude that mild exposure to UV-B altered murine fibroblast cells in such a way as to facilitate their death by apoptosis upon addition of PMA.

Radical cytoreductive surgery combined with platinums-carboplatin and cisplatin chemotherapy for advanced ovarian cancer

In an attempt to improve the therapeutic outcome for patients with advanced ovarian cancer, primary radical cytoreductive surgery consisting of hysterectomy, bilateral salpingo-oophorectomy, omentectomy and retroperitoneal lymph node resection, with optimal cytoreduction in case of metastatic lesions, was followed by five courses of chemotherapy of carboplatin 280 mg/m2 i.v. on day 1 and cisplatin 70 mg/m2 i.v. on day 2, every four weeks. A total of 51 patients with advanced epithelial ovarian cancer comprised the study (6 with stage IIC, 32 with stage III, and 13 with stage IV). Following radical cytoreductive surgery, 29 patients (57%) showed 2 cm or less of residual disease. There was a low incidence of severe complications and no postoperative mortality. An overall response rate of 76% of patients consisting of 42% pathologic complete response and 34% partial response was observed. The overall four-year survival rate for patients with stage III cancer was 70%. The dose-limiting toxicity was identified to be hematologic toxicity, which showed grade 3/4 of leuopenia 37% (neutropenia 73%) and thrombocytopenia 24%. The incidence of peripheral neurotoxicity was comparatively low. An evaluation of nerve conduction velocity revealed that motor neurotoxicity was liable to appear in the lower extremity, while sensory nerve damage was often noted in the periphery in both the upper and lower extremities. The combined chemo-surgery treatment resulted in good response and good survival without fatal toxicity for patients with advanced ovarian cancer.

Rare case of small-cell carcinoma arising from the endometrium with paraneoplastic retinopathy

We present the fourth known case of endometrial carcinoma, and the second case of endometrial small-cell carcinoma, to be associated with paraneoplastic retinopathy. Initial symptoms were decreased visual acuity and a narrowing of the visual field. Endometrial carcinoma was diagnosed several months later. An antibody to 34-kDa bovine retinal antigen was detected in the patient's serum. Thus, autoimmunity was suspected as the cause of the retinopathy. In patients with endometrial carcinoma with visual disturbance of unknown cause, paraneoplastic retinopathy should be suspected.

Apoptosis as a criterion for sensitivity of uterine cervical adenocarcinoma to cisplatin

Two patients with uterine cervical adenocarcinoma received two courses of intra-arterial cisplatin administration. In the specimens of cervix 24 or 48 h after chemotherapy, marked apoptosis were observed. These bulky cervical tumors almost disappeared, and good PRs were confirmed by CT before operation. Apoptosis which is observed in the tissues of cervical adenocarcinoma 24 or 48 h after intra-arterial infusion of cisplatin, might be a new criterion of this chemotherapy effect.

Combined effects of S-1, a new form of oral tegafur, plus modulators on ovarian cancer in nude rats

We evaluated the efficacy of S-1 as a new oral antitumor agent in ovarian cancer-bearing nude rats. This drug consists of tegafur, 5-chloro-2,4-dihydroxypyridine, and oxonic acid in a molar ratio of 1:0.4:1.S-1 was given alone or in combination with cisplatin. When administered alone at a daily dose of 20 mg/ kg, S-1 produced a significant inhibition of tumor growth [inhibition rate (IR) 89%] in the treated versus the control animals (p < 0.05). The effects of S-1 resembled those of cisplatin-treated groups. The consecutive daily administration of S-1, 20 mg/kg, combined with cisplatin, 1 mg/kg, markedly inhibited cell growth (IR 99%), a significant difference relative to cisplatin alone (p < 0.05). The daily administration of S-1 combined with low-dose cisplatin induced tumor regression with a low toxicity.

Cancer-associated retinopathy in a patient with endometrial cancer

PURPOSE

We studied a case of unusual retinopathy in a 60-year-old woman.

METHOD

The patient developed bilateral retinopathy with iridocyclitis and vitreitis. Corticosteroid therapy could not prevent deterioration of visual acuity and field. The electroretinogram became nonrecordable, and fluorescein angiogram exhibited retinal pigment epithelium window defects, fluorescein stainings to the vascular walls, and narrowed arterioles.

RESULTS

The patient underwent hysterectomy and lymphadenectomy for endometrial cancer in the corporis uteri. She was found to possess antibodies against retinal 34-kd protein, leading to a diagnosis of cancer-associated retinopathy.

CONCLUSION

Cancer-associated retinopathy may occur in patients with endometrial cancer of the corporis uteri.

Expression of c-fms proto-oncogene product by ovarian cancer cell lines with effects of macrophage colony-stimulating factor on proliferation

We studied the production of macrophage colony-stimulating factor (M-CSF) and the expression of c-fms mRNA, an M-CSF receptor, in four human ovarian cancer cell lines. All four cell lines expressed c-fms mRNA while three secreted M-CSF into the culture medium. The exogenous administration of M-CSF caused no significant enhancement of cellular proliferation in any cell line. Interestingly, the proliferation of KK cells was not affected by anti-M-CSF antibody. These results, taken together with the fact that ovarian cancer cells simultaneously produce M-CSF and c-fms, suggest that an autocrine mechanism may modulate cellular proliferation.

Effects of cisplatin on cell cycle kinetics, morphological change, and cleavage pattern of DNA in two human ovarian carcinoma cell lines

We evaluated the effects of cisplatin on the cell kinetics, cytomorphological changes, and cleavage patterns of DNA in two lines of human ovarian carcinoma cells. KF-1 cells displayed a cell cycle arrest in the G2M phase, while HMG cells displayed a transient cell accumulation in the S phase, without obvious G2M arrest. Morphological changes characterized by condensation and fragmentation of chromatin, and DNA cleavage by oligonucleosome-sized DNA fragments were observed in the HMG cells but not in the KF-1 cells. The pattern of cell death in HMG cells was considered to be apoptosis, but that of KF-1 cells necrosis. These findings showed the different mechanisms of anti-tumor effect of cisplatin on human ovarian carcinoma cell lines, including cell kinetics and pattern of cell death.

[Remnant-like particles-cholesterol (RLP-C) assay and its clinical application to lipid tests in a postprandial as well as fasting state]

It was during the past few years that postprandial hyperlipidemia is believed to be more closely related to a risk for coronary artery disease. However, the high variability in the postprandial triglyceride (TG) levels could have made overlooked such diagnostic value in estimating an individual's risk for coronary artery disease. To minimize the impact of such variability, the remnant lipoproteins, TG-rich lipoproteins, might be measured in cholesterol using remnant-like particles (RLP-C) assay as a more reliable marker. In place of the previous cholesterol reagent (CHOD-Iodine) in RLP-C assay, the RLP-C assay was improved by employing a new cholesterol reagent (POD-EMSE). The correlation between these two assays was high (r = 0.978). The variations in RLP-C levels in healthy normolipidemic subjects was within 7.5mg/dl in a day. In oral-fat loading test, the variations of RLP-C levels in healthy subjects were also within 7.5mg/dl. However, patients with coronary artery disease showed much higher levels (over 7.5mg/dl) of RLP-C during the test. In conclusion the RLP-C assay can be used for the measurement of remnant lipoproteins in serum prepared from the fasting as well as postprandial states for predicting subjects who may be at risk of coronary artery disease.

Clinical evaluation of squamous cell carcinoma antigen in squamous cell carcinoma arising in mature cystic teratoma of the ovary

We attempted to assess the clinical utility of squamous cell carcinoma antigen (SCC) for detecting squamous cell carcinoma arising in mature cystic teratoma of the ovary. SCC in serum from 16 patients with this malignancy and from 56 patients with mature cystic teratoma without malignancy was measured using radioimmunoassay. Serum SCC levels exceeded the cut-off of 2.0 ng/ml in 9 (56%) of the 16 patients with malignancy. This rate was significantly higher than that in the patients with nonmalignant mature cystic teratoma (9 to 56, 16%; p < 0.01). The positive rate for SCC was as low as 30% for stage I cancer. All cases in which the tumor size was > 500 cm3 had a positive response for SCC, whereas all other cases had a negative response (p < 0.001). SCC is useful as a tumor marker for this malignancy. However, the serum SCC level depends on the tumor volume, so it may not be suitable for early detection of small tumors.

Comparison of the effects of whey mineral complexes on bone metabolism in male growing rats

The effects of whey mineral complexes (WMC1 and WMC2) on bone metabolism were studied in male growing rats. The contents of Ca, P, and protein in WMC1 were 18.2, 8.4, 2.3%, respectively, whereas those of WMC2 were 26.4, 14.6, and 10.5%, respectively. WMCs were added to diets as a sole source of Ca: the levels of dietary Ca were 0.3 and 0.6%. CaCO3 was used as a reference. There was no difference in body weight gain and quantitative values for Ca balance among the groups at the same level of dietary Ca. Rats fed WMC2 had a higher femoral Ca and bone density of humerus. The bone properties in rats fed WMC1 were not as high as those in rats fed WMC2. The P absorption and absorption rate were affected significantly by the type of dietary Ca source as well as the levels of dietary Ca. The percent of tubular reabsorption of P of rats fed WMC1 or WMC2 had a tendency to be higher than that of rats fed CaCO3 at each dietary Ca level. The results of urinary cAMP excretion showed that the parathyroid hormone function in rats fed WMC2 was relatively lower. The differences in minerals and other constituents between WMC1 and WMC2 are discussed from the viewpoint of bone metabolism.

Effect of cyclic cisplatin and etoposide therapy with continuous UFT administration on the recurrence of endometrial cancer in nude mice

Effects of cisplatin and etoposide chemotherapy and/or continuous administration of oral anticancer agent UFT following the initial chemotherapy with cisplatin and etoposide on the tumor recurrence rate were studied in endometrial cancer-bearing mice. Complete response (CR) rate of cyclic administration of cisplatin and etoposide (91%) was significantly higher than that in the control group (60%; p < 0.05). Continuous UFT administration raised a CR rate of 75%, which was not significantly higher than that of the control group. When cyclic administration of cisplatin and etoposide was combined with continuous UFT administration, 100% of CR rate was obtained (p < 0.01). Our results suggest that cisplatin-based cyclic chemotherapy has a therapeutic effect on gynecologic malignancies and is particularly effective in preventing tumor recurrence in mice. Combining this therapy with continuous administration of an oral anticancer agent enhances its therapeutic effect.

The effect of casein phosphopeptides on calcium utilization in young ovariectomized rats

The effect of casein phosphopeptides (CPPs) on Ca utilization in ovariectomized (OVX) rats was studied. A mixture of CPPs corresponding to the amino acid sequences 1-25 and 1-28 in the beta-casein was isolated from the tryptic digest of beta-casein (beta CPP). After being fed a low Ca diet for 30 days, OVX rats were fed experimental diets of which the Ca level was 0.1%, 0.3% or 0.5% with or without 0.15% beta CPP for 28 days. During days 1-3 of the Ca refeeding period, rats fed beta CPP with 0.5% Ca showed a higher Ca absorption than control rats not supplemented with beta CPP. During days 7-9 and 26-28, there were no significant differences in Ca and P balances between the beta CPP group and the control group for each dietary Ca level. Femoral Ca and P contents from rats fed beta CPP tended to be higher than those from control rats. These results suggest that beta CPP supplementation could have an effect on Ca absorption at a certain degree of Ca deficiency.

Increased mitochondrial uptake of rhodamine 123 by CDDP treatment

Rhodamine 123 (R 123) is a positively charged dye at physiological pH that accumulates specifically in the mitochondria of living cells without cytotoxic effect. In the present study, the uptake of R 123 by EL-4 lymphoma cells in culture with anticancer agents was measured by flow cytometry. Changes in R 123 uptake during the cultivation period were compared with cell distribution at different phases of the cell cycle. According to the increase in the proportion of S phase cells, mitochondrial synthesis increased, giving rise to a maximal fluorescence intensity of about 1.3-fold. Synchronous cultures showed the same relationship between increased mitochondrial uptake of R 123 and the S phase fraction as was observed in normal cultures. After treatment with 10(-3) M 5-fluorouracil (5-FU) for 1 h, EL-4 cells showed an increased binding of R 123 per cell followed by an accumulation of early S phase cells transiently. However, uptake of R 123 decreased 24 h later. On the contrary, after treatment with 10 micrograms/ml of cis-diamminedichloroplatinum (CDDP), a G2 + M block was observed from 12 h of reseeding and accumulation of the G2 + M cells continued. In this case, high uptake of R 123 continued during the observation period. From these results, mitochondrial synthesis seemed to increase according to the increment in proportion of S phase when the acceleration of the cell cycle turnover was augmented or the cycle was blocked in S phase by 5-FU. CDDP inhibited the cell division at G2 + M phase and caused increased R 123 fluorescence per cell. The stainability of R 123 may indicate the activity of cell division and may be a good way of evaluating the efficacy of antitumor drugs on the cells.

[Establishment and characterization of a human undifferentiated carcinoma cell line (HMG)]

The undifferentiated carcinoma cell line (HMG) was established from a nude mouse tumor which had been produced by transplantation of a intraperitoneal tumor of 27-year-old woman. The HMG cell line has the following biological properties. 1. The HMG cells are round to oval in shape and grow as floating cell aggregates like a rouleau or a cluster of grapes. 2. 100 passages have been carried out over a year, and the population doubling time is about 17 hrs. 3. In the original tumor, keratin and vimentin were expressed simultaneously, in HMG cells, however, only localization of vimentin was confirmed. 4. By chromosomal analysis, over 90% of the cells revealed 46, XX, with no karyological abnormalities, at passage 82. 5. When heterotransplanted into the subcutis of a nude mouse, HMG cells produced a undifferentiated carcinoma resembling the original tumor.

Anticancer activity of the combination of cisplatin and etoposide in endometrial cancer-bearing nude mice

We investigated the efficacy of the combination of cisplatin and etoposide in endometrial cancer using mice bearing human endometrial cancer. Cisplatin (5 mg/kg) plus etoposide (10 mg/kg) caused markedly greater inhibition of the growth of medium-sized tumors (96.1% inhibition) than cisplatin alone at the same dose. Similarly, the combination of cisplatin (7.5 mg/kg) and etoposide (10 mg/kg) produced a significantly higher complete remission rate in small tumors, compared with cisplatin alone at the same dose (82.6% vs 35.3%, P less than 0.01). As a single agent, etoposide had almost no inhibitory effect on tumor growth and produced a considerably lower complete remission rate. Total platinum and etoposide concentrations in serum and tumor tissue were unaltered when these agents were used either singly or in combination. Our results suggested that combination cisplatin-etoposide therapy was synergistic against endometrial cancer.

Protective effect of elastase on cis-platinum-induced renal toxicity

The protective effects of elastase (Ela) and fosfomycin against renal toxicity of cis-diamminedichloroplatinum (II) (CDDP) were evaluated in an experimental study using rats. When Ela was used concomitantly with CDDP, the elevation of urinary N-acetyl-beta-D-glucosaminidase levels in the early phase and the sharp fall in these levels in the latter phase were prevented. It was also found that the blood urea nitrogen levels and serum creatinine levels were significantly lowered. Histologically, atrophic and necrotic changes in the tubular epithelium were prevented. The total serum platinum levels showed no change with the addition of Ela; however, the platinum levels in the renal tissues were significantly reduced. These results suggested that Ela is effective against platinum deposits in the renal tissues, particularly in the tubular epithelium, thus protecting the kidneys. On the other hand, fosfomycin demonstrated no such positive results suggestive of a protective effect on the renal function parameters or during histological observation.

[The study on the immunological effect of sizofilan combined with radiotherapy in patients with uterine cervical cancer]

To investigate the immunological effect of Sizofilan (SPG) combined with radiotherapy, we evaluated the immunological parameters in 22 patients with uterine cervical cancers. Twelve cases were treated with SPG combined with radiotherapy (SPG group), and the other ten cases, with radiotherapy only (control group). As a result, 1) During radiotherapy, the numbers of lymphocyte and CD2 positive cell decreased in SPG and control groups. After radiotherapy, however, its numbers in SPG group became significantly higher than in control group (p less than 0.05). The number of CD3 positive cell also presented a tendency to increase after radiotherapy in SPG group. As for CD20 positive cell, its numbers were kept unchanged after radiotherapy in both two groups, and no significant difference was observed between them. 2) NK cell activity decreased during radiotherapy in both two groups. After radiotherapy, its activity in SPG group recovered to its pre-value and became significantly higher than that in control group (p less than 0.05). 3) SPG did not any prominent effect on CD4/CD8 ratio. 4) The adverse effect of SPG to liver or kidney function were not observed in our patients. The SCC level in SPG group decreased rapidly by radiotherapy as well as that in control group, and no significant difference was observed in SCC levels between them. So it was suggested that SPG did not suppress the cytocidal effect of radiation to cancer cells. Based on these findings, it was concluded that SPG prompted the recovery of not only lymphocyte, especially T cell, but also NK cell activity. These immunological findings presented a usefulness of clinical application of SPG to radiotherapy in patients with uterine cervical cancers.

Clinical evaluation of tumor-associated mucin-type glycoprotein CA 54/61 in ovarian cancers: comparison with CA 125

Studies were conducted in 343 women on the clinical utility of the newly developed tumor-associated mucin-type glycoprotein, CA 54/61, as a tumor marker in serum for ovarian cancer. The overall positivity rate of the new marker was 60%, lower than the rate of 88% obtained with CA 125 measured concurrently. Concerning tumor histology, CA 54/61 had a positivity rate of 78% in mucinous adenocarcinoma, compared with 44% with CA 125. There was no correlation between the serum levels of CA 54/61 and CA 125 (r = 0.05). CA 54/61 showed a low rate of positivity in benign disease and only exceeded the cutoff value in one patient with an endometrial cyst, whereas CA 125 had a positivity rate of 60%. The false-positive rates for CA 125 during the first trimester of pregnancy and during menstruation were 57 and 16%, respectively, whereas the rates for CA 54/61 were only 11 and 5%, respectively. Assay of both CA 54/61 and CA 125 increased the success rate in diagnosing ovarian cancer to 95% (38 of 40 patients).

[Clinical value of a new serum tumor marker CA602 in ovarian cancers]

We investigated the usefulness of CA602, a newly developed serum tumor marker, for ovarian cancer. When the cut-off value was set at 60 U/ml, the overall positive rate of this marker in ovarian cancer was 92%, a slightly high rate relative to CA125 measured at the same time (88%). Considering tumor histology, CA602 revealed a high positive rate of 100% in serous adenocarcinoma, whereas the positive rate was 67% in mucinous adenocarcinoma. However, the positive rate was relatively high in benign diseases such as endometrial cysts (64%) and benign ovarian tumors (29%). It is concluded that CA602 is a tumor marker with low specificity and high sensitivity in general. The definite correlation between CA602 and CA125 in ovarian tumors (R = 0.96) suggests that these markers have certain similarities. Thus, CA602 may be a useful serum tumor marker for ovarian cancer as a substitute for CA125.

Thymidylate synthase inhibition as a predictor of tumor sensitivity of fluorinated pyrimidines

The thymidylate synthase (TS) content of tumor tissue was assayed and the levels of 5-fluorouracil (5-Fu) in serum and tumor tissue were determined in 21 patients with cervical cancer who were treated with UFT, a fluorinated pyrimidine. Subrenal capsule assay, a predictive tumor sensitivity test, was conducted concurrently on cervical tumor samples. TS inhibition and serum and tissue 5-Fu levels widely varied between both samples. Investigation of the relationship between the tumor growth inhibition rate determined by subrenal capsule assay and the above parameters (TS inhibition, serum and tissue 5-Fu levels) showed that TS inhibition and tumor growth inhibition were well correlated (r = 0.73). This suggests that a TS inhibition assay in tumor tissue can be a useful predictive test for tumor sensitivity of fluorinated pyrimidines.

[Responsiveness of gynecological malignancies to oral antitumor agents in subrenal capsule assay and individualization of oral adjuvant chemotherapy]

A subrenal capsule assay (SRCA) was performed to test the sensitivity of 45 gynecological malignancies, including 24 cervical and 15 ovarian carcinomas, to oral antitumor agents, UFT, cyclophosphamide (CPM) and carboquone (CQ). Additionally, using a human endometrial carcinoma (Ishikawa carcinoma), the utility of SRCA in oral adjuvant chemotherapy was also investigated. Thirty-six of 45 cases (80.0%) were found to be evaluable. Regardless of the origin or of the histological type, each gynecological tumor showed a different degree of sensitivity. The results suggested that it is necessary to choose an oral antitumor agent according to the degree of sensitivity in oral adjuvant chemotherapy. In an experimental study with an implanted tumor, 14 of 20 mice (70.0%) developed a recurrent tumor in the control group. Compared to this, the recurrence rates for tumors in mice treated with CPM, CQ and UFT were 10.0% (p less than 0.001), 25.0% (p less than 0.01) and 30.0% (p less than 0.02), respectively. All these agents were considered to be effective in preventing tumors from recurring. In SRCA, the implanted tumor was sensitive to CPM and CQ, but not sensitive to UFT. These data suggested that SRCA is useful in predicting the effect of dose-dependent agents in oral adjuvant chemotherapy, although, with UFT, a time-dependent agent, it is not clear whether SRCA is appropriate for estimating the usefulness of its agent.

Estrogen producing activity in epithelial ovarian tumors and dermoid cysts

In 28 cases of postmenopausal women with non-functioning ovarian tumors, the estradiol (E2) level was assayed in peripheral plasma and tumor tissue extract. E2 precursors were also assayed in the tissue extract, and localization of 3beta-hydroxysteroid dehydrogenase (3beta-HSD) in the tissue was investigated. The plasma E2 levels were 153.8 +/- 205.9 pg/ml in 15 benign tumor cases, 244.3 +/- 336.5 pg/ml in 13 malignant tumor cases, and both of which were significantly higher than 12.3 +/- 3.6 pg/ml in normal postmenopausal women (p less than 0.01). The postoperative plasma E2 level (33.3 +/- 32.7 pg/ml) was significantly lower than the preoperative one (228.3 +/- 319.0 pg/ml). Twelve of 19 cases (68.2%) showed a postoperative decline in the E2 level to less than a half of the preoperative level. E2 and its precursors were found in tumor tissue. These findings demonstrate that E2 is produced by the tumor tissue itself. In addition, 3beta-HSD activity was localized in the stroma of ovarian tumors, indicating that E2 synthesis is mainly carried out in stromal cells rather than in epithelial cells.

[Level of inhibition of thymidylate synthase activity and 5-fluorouracil in tumor tissues after administration of UFT or tegafur]

The antitumor effects of tegafur and UFT, fluorinated pyrimidines, were investigated in endometrial carcinoma bearing mice. Following administration of tegafur and UFT, each at a clinical dosage, the levels of 5-fluorouracil (5-Fu) and the inhibition of thymidylate synthase (TS) activity in the tumor tissue were measured. As a result, the mean levels of 5-Fu in the tumor tissue were approximately six times higher in the UFT group (29.2 +/- 10.7 ng/g) than in the tegafur group (4.9 +/- 4.8 ng/g) (p less than 0.01). The UFT group showed a mean inhibition of TS activity in the tumor tissue significantly higher (61.60 +/- 2.02%) than did the tegafur group (56.08 +/- 4.87%) (p less than 0.05). Hence, not only the higher tumor tissue levels of 5-Fu but also the higher inhibition of TS activity in the UFT group as compared with the tegafur group suggested that UFT had more potent antitumor effect.

[Histopathological study regarding the protective effect of elastase on cis-platinum-induced renal toxicity]

A histopathological study was effected by using rats to evaluate whether or not elastase has a protective effect on the renal toxicity of cis-diamminedichloroplatinum (II) (CDDP). It was found that CDDP caused disorders mainly to the renal tubule--that is, atrophic and necrotic changes of the tubular epithelium. When elastase was used concomitantly with CDDP, such changes were considerably inhibited so that a relatively large part of the normal tissue architecture was preserved. The increase of the total platinum levels in the renal tissues was significantly suppressed with the addition of elastase and in the enzyme histochemical observation, the activity of the lysosomal enzymes and the alkaline phosphatase was maintained. The detailed mechanism of the protective effect of elastase against CDDP renal toxicity is unknown. However, these results suggested that elastase inhibited the platinum deposits in the renal tissue and played a role in the stabilization of the lysosomal and the plasma membranes, thus protecting the kidneys.

Arrest of follicular development in a patient with 17 alpha-hydroxylase deficiency: folliculogenesis in association with a lack of estrogen synthesis in the ovaries

The degree of follicular development was examined in a patient with 17 alpha-hydroxylase deficiency that accounted for impairment of estrogen and androgen biosynthesis. The ovarian content of P was markedly higher than those of any other steroids requiring 17 alpha-hydroxylation for synthesis. The morphologic analysis of the ovaries demonstrated that normal follicles could not develop to more than 2.2 mm in diameter, and most follicles with diameters of 1.0 mm or more yielded to atresia. It is known that estrogen and FSH act synergistically on the growth of the follicles. Our data suggest that the follicles can develop up to the size of 2.2 mm in diameter at most with the sole stimulation of gonadotropin.

[Experimental studies on the antitumor effect of oral antitumor agents on gynecological malignant tumors]

In order to evaluate the antitumor effect of oral antitumor agents on gynecological malignant tumors, experimental studies were carried out using nude mice which had received implants of human endometrial carcinoma. The agents used for the study were tegafur (T) and UFT, and their effects on inhibiting tumor growth, and on preventing tumors from implanting or recurring were investigated in mice in continuous long-term administrations. The results were as follows: As to the inhibitory effect on the tumor growth, while both T and UFT had no inhibitory effect on large to medium tumors, both were mildly effective on small tumors having a diameter of 2-3 mm (Inhibition Rate (IR): T-60.0%, UFT-71.0%), however, the no effect great enough to reduce the tumor size was recognized with either agent. The implantation rates of tumor under the administration of T and UFT were 80.0% and 70.0% respectively, indicating no significant differences from the control (90.0%) and either agent, however, UFT was judged to have the effect of preventing tumors from implanting to a certain extent. The recurrence rates for tumor under the administration of T and UFT were 30.0% (6/20) in both cases, which was significantly lower than the control (70.0%) (p less than 0.05). Both agents were evaluated as useful for preventing tumors from recurring. These findings, indicated that while the maintenance therapy of an oral antitumor agent has no effect on macroscopic tumors, a fairly good effect is expected on microscopic tumors, especially on the prevention of tumor recurrence.

[Estrogen production by epithelial ovarian tumors and dermoid cyst]

The estrogen-producing activity was investigated in subjects with common epithelial tumors and dermoid cysts, which were not included in the category of hormone-producing tumors. Serum estradiol (E2) in peripheral blood of patients with ovarian tumors were assayed pre-and post-operatively. In addition, cytological examinations of vaginal smears and histological examinations of the endometrium were carried out. The results were as follows: The mean of preoperative serum E2 levels in postmenopausal cases (16) was 230.9 +/- 248.5pg/ml, which was significantly higher than the control of the same age group (p less than 0.01). In seven (63.3%) out of 11 cases followed up, a distinct postoperative decline was indicated in the serum E2 level. The mean of preoperative serum E2 levels in 28 cases of premenopause collected in the early follicle phase was 135.6 +/- 148.8pg/ml, which was apparently higher than the level in normal females in the follicle phase. Also, an evident decline was observed postoperatively in the E2 level in 8 (40%) out of 20 cases. The cytological observations of vaginal smears in 44 cases of postmenopausal ovarian tumor provided the following results: The karyopyknotic index was 12-23% on the average in each age group, which was comparatively higher than that of the control. The maturation index also indicated a deviation to the right compared to the control. The following were the results of histological examinations of the endometrium carried out in 23 cases of postmenopausal ovarian tumor: 5 cases (21.7%) of proliferative endometrium; 3 cases (13.0%) of cystic hyperplasia and 2 cases (8.7%) of adenomatous hyperplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Level of 5-FU in uterine cervical cancer tissue after oral administration of UFT]

We measured concentrations of 5-FU in cancerous and normal cervical tissues in 16 patients with cervical cancer to whom UFT or tegafur had been administered. The results were as follows: Concentrations of 5-FU in cancerous tissues measured 30 minutes and 2 hours after UFT administration were 0.181 +/- 0.034 microgram/g and 0.562 +/- 0.145 micrograms/g respectively, while in patients to whom tegafur had been administered, they were 0.105 +/- 0.030 microgram/g and 0.126 +/- 0.015 microgram/g respectively. The comparison of 5-FU concentrations in cancerous tissues within each individual patient indicated that the value was higher after UFT administration than after tegafur administration in 13 cases (81.3%). When classified by histological typing, cases of non-keratinizing carcinoma showed the highest value, followed by keratinizing cases and adenocarcinomas, which indicated the lowest value with administration of UFT. However, there were no differences among these three types when tegafur was administered. Based on the above findings, it was indicated that UFT is an antitumor agent with a higher tumor specificity, especially in non-keratinizing carcinoma.

[Level of 5-FU in cancerous and normal tissues of nude mice after oral administration of tegafur coadministered with uracil (UFT)]

In order to investigate the effect of UFT, a new antitumor agent, 5-fluorouracil (5-FU) levels in serum and various tissues were measured by the gas chromatographic-mass fragmentographic method. The subjects used for the study were nude mice which had received implants of human endometrial carcinoma. The results were as follows: As compared with tegafur, the concentration of 5-FU in serum rose quickly when UFT was administered, and the values were clearly high. The concentration of 5-FU obtained in tumor tissues with the use of UFT were 2.5 times higher than those obtained by the use of tegafur. Even with one third of the dose of UFT, values were still 1.5 times higher. In normal tissues, the administration of UFT against that of tegafur resulted in higher concentrations of 5-FU. On the other hand, when one third of the dose of UFT was used, 5-FU concentrations in major organs, such as the liver or kidney, showed clearly low values. Based on these findings, it became clear that the 5-FU concentration in tumor tissue is specifically raised by tegafur coadministered with Uracil (UFT), while such an effect is prevented from proceeding in normal tissue.