子宮頚部悪性腺腫の補助診断法，特に粘液中のシダ状結晶とＭＰＡ負荷試験について

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  • An adjunctive diagnostic method for adenoma malignum of the uterine cervix: use of MPA(medroxyprogesterone acetate) challenge test and its effects on the fern-like phenomenon in cervical mucus.

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In adenoma malignum we usually see a number of variously sized cysts, whereas only a few malignant glandular structures are observed in the cervix histologically, and abundant mucous secretion is noticed clinically.<BR>As we incidentally recognized a fern-like phenomenon (FLP) in the dry smears of adenoma malignum patients, we speculated that the MPA challenge test might serve an adjunctive diagnostic role in differentiating between adenoma malignum and similar benign lesions. In this study, we investigated four patients (from 50 to 59 years old), with complaints of abundant mucous discharge, and administered the following treatments:<BR>1) We recognized FLP in the dry smears of all four cases, despite some being post-menopausal. Their common cytologic characteristics were a solid sheet with round nuclei and a circle-like pattern composed of columnar cells.<BR>2) Serum E2 levels were 20, <10 and 124 pg/ml in three cases (54, 59 and 50 years old, respectively). In the latter two cases, we observed FLP and the abundant discharge did not diminish despite taking 2, 000 mg of MPA. Therefore, we did not consider the FLP and abundant mucus to be related to the serum E2 level. The polycystic histologic appearances were identical to those detected by imaging of HSG or vaginal sonography of the cervix and positive stainings for CEA and CA 19-9. Thus, there was no doubt that these 3 cases had adenoma malignum.<BR>3) In the one remaining patient (50 years old), we observed FLP but the abundant discharge abated after she had taken 5, 600mg of MPA. Although her polycystic appearance was identical to the vaginal sonography image, CEA was negative, and we thus judged this case to be benign.<BR>We suggest that if FLP is not inhibited by gestagen, it is apparently estrogen-independent. Thus, the MPA challenge test may serve as a useful adjunct in the diagnosis of adenoma malignum, complementing cytologic and imaging findings.

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