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BackgroundTo adopt HPV self-sampling in Japan, we assessed the concordance between self- and physician-collected human papillomavirus (HPV) samples from Japanese patients and examined the performance of HPV self-sampling for cervical intraepithelial neoplasia grade 2 or worse (CIN2+).MethodsPatients who had previously tested negative for intraepithelial lesions or malignancy/HPV-positive, and patients with atypical squamous cells of undetermined significance or worse (ASCUS+) cytology were eligible for this cross-sectional study. Participants performed HPV self-sampling using an Evalyn brush, which was submitted at the Fukui Prefectural Health Care Association. The Evalyn brush heads were stored in ThinPrep vials. The physician, however, performed HPV and cell sampling using an endocervical brush and immediately stored the brush heads in ThinPrep vials. All participants underwent colposcopy and biopsy. Histopathological diagnoses were made by pathologists at Fukui University Hospital. HPV infection was confirmed using a PCR-based Cobas 4800 HPV DNA test. Cytological analysis was performed at Fukui Prefectural Health Care Association.ResultsHPV-positive rates for physician-collected samples and self-collected samples were 51 and 50%, respectively. The perfect match rate of HPV type between the groups was 88% (κ = 0.76). HPV16/18 showed higher agreement rates than other HPVs (99%, kappa 0.96 and 89% kappa 0.77, respectively). Both groups showed 100% sensitivity to CIN2+, but specificity was 57.0 and 58.1%, respectively.ConclusionFor HPV typing, a good concordance rate was seen between self- and physician-collected samples. Self-sampling showed high sensitivity for CIN2+. Self-sampling using the Evalyn brush and Cobas 4800 may be feasible for screening Japanese individuals.

The coronavirus disease (COVID‐19) pandemic has raised concerns about the impact of delayed health check‐ups and cancer screenings on cancer diagnosis and treatment. This study aimed to investigate the awareness of cancer patients on future screening measures during the pandemic in rural Japan. An anonymized open‐data survey was undertaken in Fukui Prefecture, a rural region of Japan, in 2021. Participants were asked about their cancer screening history, screening frequency during the pandemic, and reasons for not undergoing screening. Among the 1262 respondents, the proportion of patients who underwent cancer screening in 2020 during the pandemic was similar to the proportion who underwent regular (annual or biannual) screening in 2019 before the pandemic. Of those who underwent regular screening, 82% still underwent screening in 2020, while only 21% of those who had irregular screenings. The number of respondents who believed they were healthy and did not require screening increased over time, possibly due to restrictions on going out and refraining from activities during the pandemic. This study in rural Japan found that regular cancer screening prior to the pandemic was associated with a more positive attitude toward screening during the pandemic. Raising awareness about the importance of cancer screening and encouraging participation is crucial for promoting positive attitudes in the future. The findings highlight the need for continued efforts to ensure access to screening services during the pandemic and future public health emergencies. This study investigated the impact of the COVID‐19 pandemic on cancer screening awareness in rural Japan. The results showed that individuals who previously underwent regular screenings were more likely to continue screening during the pandemic. However, there was an increasing trend of individuals perceiving themselves as healthy and not requiring screening. Raising awareness about the importance of cancer screening and ensuring access to screening services during the pandemic and future public health emergencies are crucial for promoting positive attitudes toward screening.

Background/Objectives: Within human papillomavirus (HPV)-based screening, cytology remains essential for cervical cancer detection while also potentially revealing endometrial pathology. This pilot study aimed to distinguish benign (normal) cases from atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) within atypical glandular cell (AGC) cytology using quantitative analysis of liquid-based cervical cytology. Methods: SurePath and ThinPrep sets included 62 (37 normal, 25 AEH/EC) and 52 (24 normal, 28 AEH/EC) AGC cases, respectively. Semi-automatic QuPath analysis workflow detected cellular clusters; extracted texture, intensity, and geometric features; and produced case-level summaries. A random forest (RF) classifier was used to discriminate AEH/EC from normal cases. Feature subset selection was performed using a beam-search wrapper and joint hyperparameter tuning. Primary performance evaluation comprised stratified 5-fold cross-validation with metrics averaged across these folds. Results: Across both preparations, univariable analyses showed moderate discrimination overall which improved post-menopause. For SurePath and ThinPrep, the highest 10 areas under the curve (AUCs) were 0.701–0.773 (improving to 0.798–0.841 post-menopause) and 0.740–0.778 (improving to 0.832–0.884 post-menopause), respectively. Machine-learning RF models improved performance beyond univariable baselines. Cross-validated AUCs for SurePath and ThinPrep were 0.805 (95% confidence interval [CI], 0.683–0.927) and 0.887 (95% CI, 0.787–0.987), respectively. Features associated with higher AUCs differed between SurePath and ThinPrep, indicating platform-specific signals. Conclusions: Quantitative analysis of routine cervical cytology can augment expert reviews to help distinguish endometrial lesions among AGCs, particularly post-menopause. These software-based readouts can fit within existing workflows and may improve triage when morphology is subtle, including scenarios with HPV-negative screening results.

This case series presents six cases of low-grade endometrial stromal sarcoma (LGESS) and discusses their magnetic resonance imaging (MRI) findings in light of recent advancements in LGESS diagnosis. Data from six cases of LGESS treated at Fukui University Hospital between June 2007 and October 2024 were retrospectively analyzed. The clinical behavior, histopathological features, therapeutic approaches, and survival outcomes were evaluated. MRI images were assessed by two radiologists over multiple parameters that were considered specific to the LGESS. Among the six patients with LGESS, four patients had tumors located within the myometrium, whereas two patients had tumors located in the submucosal layer. All cases were classified as International Federation of Gynecology and Obstetrics Stage Ⅰ, and no recurrence was observed during follow-up. On MRI, all six tumors exhibited high signal intensity on T2-weighted images (T2WI), compared to the myometrium, and high signal intensity on diffusion-weighted images (DWI), compared to the endometrium. In four of the five evaluable cases, the mean apparent diffusion coefficient (ADC) value was 0.86 × 10⁻³ mm²/s (range: 0.81-0.99). Both clinically and based on imaging findings, distinguishing between LGESS and rare leiomyoma variants is challenging. MRI findings, including high signal intensity on T2WI and DWI as well as low ADC values, may prove valuable in differentiating these two entities.

Abstract Introduction: Uterine adenosarcoma (UA) is a rare malignant mesenchymal neoplasm characterized by benign epithelial and malignant stromal components. Comprehensive genomic profiling has identified a high frequency of murine double-minute type 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) amplification in UA. However, the significance of these genetic alterations in tumor biology remains poorly understood. This report presents a case of UA with immunohistochemically positive MDM2 and CDK4 expression. Case Presentation: The patient was a 72-year-old woman with a history of genital bleeding. Magnetic resonance imaging revealed an 11 × 5 × 7 cm mass in the endometrial cavity, extending into the uterine cervix. Biopsy of the tumor showed no malignant findings. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Microscopically, the tumor consisted of benign glandular epithelial components and low-grade sarcoma. The diagnosis was UA stage IA, pT1aNxM0. No sarcomatous overgrowth and no myometrial or lymphovascular invasions were observed. Immunohistochemistry confirmed MDM2 and CDK4 expression in the mesenchymal tissue. No recurrence was observed 12 months post-surgery. Conclusion: The pathological diagnosis of UA was based on histomorphological features. This study demonstrates that immunohistochemistry for MDM2 and CDK4 can help elucidate the molecular genetic features of UA. Further studies are needed to correlate the expression of these genes with the biological behavior of UA.

Endometrial cancer (EC) in women is increasing globally, necessitating improved diagnostic methods and prognosis prediction. While endometrial histology is the conventional approach, liquid-based endometrial cytology may benefit from novel analytical techniques for cell clusters. A clinical study was conducted at the University of Fukui Hospital from 2012 to 2018, involving 210 patients with endometrial cytology. The liquid-based cytology images were analyzed using cell cluster analysis with Image J software. Logistic regression, ROC analysis, and survival analysis were employed to assess the diagnostic accuracy and prognosis between cell cluster analysis and EC/atypical endometrial hyperplasia (AEH). Circularity and fractal dimension demonstrated significant associations with EC and AEH, regardless of age and cytology results. The ROC analysis revealed improved diagnostic accuracy when combining fractal dimension with cytology, particularly in menopausal age groups. Lower circularity and solidity were independently associated with poor overall survival, while higher fractal dimension values correlated with poorer overall survival in Grades 2 and 3 endometrial cancers. The combination of circularity and fractal dimension with cytology improved diagnostic accuracy for both EC and AEH. Moreover, circularity, solidity, and fractal dimension may serve as prognostic indicators for endometrial cancer, contributing to the development of more refined screening and diagnostic strategies.

This study aimed to assess the localization of chondroitin sulfate (CS), a primary extracellular matrix component, in the stromal region of endometrial carcinoma (EC). Immunostaining was performed on 26 endometrial endometrioid carcinoma (EEC) samples of different grades and 10 endometrial serous carcinoma (ESC) samples to evaluate CS localization. This was further confirmed by Alcian Blue (AB) staining as well. In the G1-EEC samples, CS showed reactivity with fibrovascular stroma, supporting closely packed glandular crowding and papillary structures. As the grade increased, the original interstitial structure was re-established, and the localization of CS in the perigulandular region decreased. In the ESC samples, the thick fibrous strands supporting the papillary architecture showed reactivity with CS; however, the delicate stromal region branching into the narrow region showed poor reactivity. The AB staining results showed similar characteristics to the immunostaining ones. The characteristic localization of CS in various EC types was elucidated. The present study provides new information on endometrial stromal assessment.

A human ovarian clear cell carcinoma cell line was established from a 46-year-old Japanese woman. That line, designated MTC-22, has proliferated continuously for over 6 months in conventional RPMI 1640 medium supplemented with 10% foetal bovine serum and has been passaged over 50 times. MTC-22 doubling-time is ~ 18 h, which is much shorter than most ovarian clear cell carcinoma lines reported to date. Morphologically, MTC-22 cells exhibit polygonal shapes and proliferate to form a monolayer in a jigsaw puzzle-like arrangement without contact inhibition. Ultrastructurally, cells exhibit numerous intracytoplasmic glycogen granules and well-developed mitochondria. G-band karyotype analysis indicated that cells have a complex karyotype close to tetraploid. We observed that the expression pattern of a series of ovarian carcinoma-related molecules in MTC-22 cells was identical to that seen in the patient’s tumour tissue. Notably, MTC-22 cells, and the patient’s carcinoma tissue, expressed low-sulphated keratan sulphate recognised by R-10G and 294-1B1 monoclonal antibodies, a hallmark of non-mucinous ovarian carcinoma, and particularly of clear cell ovarian carcinoma. Moreover, characteristic point mutations—one in ARID1A , which encodes the AT-rich interaction domain containing protein 1A, and the other in PIK3CB, which encodes the catalytic subunit of phosphoinositide 3-kinase—were seen in the patient’s tumour tissue and retained in MTC-22 cells. Collectively, these findings indicate that MTC-22 cells could serve as a valuable tool for investigating the pathophysiology of ovarian clear cell carcinoma, particularly that harbouring PIK3CB mutations, and for developing and validating new diagnostic and therapeutic approaches to this life-threatening malignancy.

Background Placenta accreta spectrum (PAS) cesarean hysterectomy is performed under conditions of shock and can result in serious complications. This study aimed to evaluate the usefulness of the “Holding-up uterus” surgical technique with a shock index (S.I.) > 1.5. Methods Twelve patients who underwent PAS cesarean hysterectomy were included in the study. Results Group I had S.I. > 1.5, and group II had S.I. ≤ 1.5. Group I had more complications, but none were above Grade 3 or fatal. Preoperative scheduled uterine artery embolization did not result in serious complications, but three patients who had emergency common iliac artery balloon occlusion (CIABO) and a primary total hysterectomy with S.I. > 1.5 had postoperative Grade 2 thrombosis. Two patients underwent manual ablation of the placenta under CIABO to preserve the uterus, both with S.I. > 1.5. Conclusions The study found that the “Holding-up uterus” technique was safe, even in critical situations with S.I. > 1.5. CIABO had no intervention effect. The study also identified assisted reproductive technology pregnancies with a uterine cavity length of less than 5 cm before conception as a critical factor. What does this study add to the clinical work •The holding-up uterus technique following periuterine cavity expanded enables safe placenta accreta spectrum (PAS) cesarean hysterectomy. •PAS hysterectomy with holding-up uterus is effective even in situation of critical bleeding or shock.

Background: The increasing trend of cervical cancer in women in their 20s in Japan is largely attributable to the low rate of cervical cancer screening. This study aimed to assess the usefulness of human papillomavirus (HPV) self-sampling among 24-year-old Japanese women who had never previously been screened for cervical cancer during the coronavirus disease (COVID-19) pandemic. Methods: In August 2021, consenting eligible women received HPV self-sampling kits. An Evalyn brush was used for self-sampling, and a Cobas 4800 PCR-based HPV DNA test was used to detect high-risk HPV genotypes. We analyzed the return rates of self-sampling kits and conducted a survey on the acceptability of the self-sampling method. Results: Of the total 1997 eligible women, 13.4% (268/1997) agreed to participate. The return rate of the kits was 72.4% (194/268), corresponding to 9.7% of the eligible population. Among the participants who returned the kits, 14.9% (29/194) tested positive for HPV, and 41.4% (12/29) of these underwent subsequent cytological testing. The questionnaire results indicated that 57.8% of participants reported no pain during self-sampling, and 72.9% expressed a willingness to continue using the self-sampling method in the future. Conclusion: This study demonstrated that opt-in HPV self-sampling among 24-year-old women who had never been screened for cervical cancer had a favorable kit return rate and was well accepted by the participants, especially during the COVID-19 pandemic. However, the follow-up cytology test rates were low, highlighting the need for improved post-screening management.