Four cases of ovarian clear cell carcinoma were studied ultrastructurally and histochemically in comparison with normal endometria (10 cases), endometria in pregnancy (8 cases) and endometrial adenocarcinoma in various degree of differentiation (20 cases).
CEA staining was carried out by immunoperoxidase technique in one case. Clear cell carcinomas examined consisted predominantly of a compact arrangement of large pleomorphic cancer cells with hyperchromatic, indented often lobulated nuclei. The hobnail cells had bulging nuclei into the lumens of tubules. The lumens of the tubules contained moderate electron dense substances which revealed positive reaction with PAS staining. In narrow intercellular spaces, there was an accumulation of basement membrane-like materials. The cytoplasm of the neoplastic cells was characterized by a massive aggregates of glycogen depositions and a parallel array of rough endoplasmic reticulum. Moreover numerous lipid droplets often associated with glycogen depositions and lysosome-like dense granules were observed. From the morphological viewpoint, the clear cell carcinoma of the ovary revealed several resemblances with the fine structures of secretory or hypersecretory (Arias-Stella type) endometria with emphasis on the presence of cytoplasmic glycogen and the arrangement of rough endoplasmic reticuli but not to endometrial adenocarcinoma. Moreover, two cases out of four disclosed the co-existence of pelvic endometriosis. By CEA staining, a small number of neoplastic cells revealed intense positive reaction on the cytoplasmic membrane and faintly positive reaction in their cytoplasm. From the results obtained, it is suggested that the clear cell carcinoma may be an expression of endometrioid carcinoma with secretory manifestations. On the basis of the facts described and the available histologic evidence, the histogenesis of the ovarian clear cell carcinoma has been discussed referring the reports dealing with related problems.

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Pelvic artery embolization, which was performed by inserting gelform sponges and steel coils into the internal iliac arteries via an angiographic Seldinger catheter, was applied in three patients of cancer of cervix in their end stages for controlling the severe bleeding from bladder in one case and from cervix in other two cases. It is suggested that this means was very advantageous to control the massive bleeding if other conservative measures failed and also suggested that administration of Nitrogen mustard through the pelvic arterial catheter was very effective for reducing the severe pains of the patients with pelvic infiltration of the cancer.

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An operative chemotherapy was performed in six cases of advanced uterine cervical carcinoma. The vasa ovarica, the internal iliac vain, the internal iliac artery and its branches excluding uterine, vaginal, vesical and perineal ones were ligated extraperitoneally, and 40-60mg of Mitomycin C was injected by one shot into the peripheria from the ligated internal iliac artery.
About three weeks after the surgery, no cancer tissue was seen colposcopically, no malignant cell was detected by the vaginal smear test, and defective parts were found microscopically to be filled with repair tissues.
Serious side-effects such as depilation and leukopenia occurred, but they were fatal in no case.
Two cases in stage IV died of renal insufficiency within the following postoperative two years. However, of four cases in stage III one has been survived over 6 years, another over 4 years without relapse, and the other two cases over two years with the disese.

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In the 15 years from 1967 through 1981, a total of 225 patients with gestational trophoblastic disease were treated at the Kobe University Hospital. Based upon histopathological diagnosis, there were 115 cases of invasive mole and 29 cases of choriocarcinoma, while 81 cases were histopathologically undetermined due to the achievement of sustained remission with chemotherapy alone. These 3 groups of gestational trophoblastic disease were further categorized based upon the extent of spread of lesions into 3 subgroups as having nonmetastatic intrauterine, metastatic and direct extrauterine invasive type. In this paper, antecedent pregnancy, interval from the antecedent pregnancy to diagnosis, regression patterns of hCG concentrations after molar evacuation, preoperative findings with pelvic angiography, effects of treatment and prognoses were respectively analized in order to elucidate a characteristic of each of the categories of gestational trophoblastic disease. Significant differences between invasive mole, undetermined cases and choriocarcinoma were recognized as follows.
(1) 94.8% (109/115) of patients with invasive mole and 95.1% (77/81) with undetermined cases had had a hydatidiform mole as the antecedent pregnancy, whereas only 51.7% (15/29) with choriocarcinoma were found to have hydatidiform mole.
(2) 93.0% (107/115) of patients with invasive mole and 90.1% (63/81) with undetermined case were diagnosed within 3 months after the antecedent pregnancy, whereas only 10.3% (3/29) with choriocarcinoma were diagnosed within 3 months and 58.6% (17/29) were diagnosed over one year after the antecedent pregnancy.
(3) 37.4% (43/115) of patients with invasive mole and 37.0% (30/81) with undetermined case were found to have metastatic lesion, while 82.8% (24/29) of patients with choriocarcinoma demonstrated to have metastasis. The most frequent site of distant metastasis was to the lung, and the brain metastasis was next. There were, however, no patients with brain metastasis of invasive mole. Metastasis in more than one organ were found in 41.4% (12/29) of patients with choriocarcinoma, whereas those were in 3.5% (4/115) of patients with invasive mole.
(4) In 115 patients with invasive mole, only one died of disseminated intravascular coagulation syndrome (DIG) caused by massive hemorrhage due to extensive extra-uterine invasion, and the remission rate was 99.1%. In the patients with histopathologically undetermined type, the remission rate was 100% (81/81). In choriocarcinoma, remission rate for the subgroup with nonmetastatic intrauterine disease was 100%, while the overall remission rate of choriocarcinoma was 55.2% (16/29).
(5) Four (3.5%) of the 114 patients with invasive mole later had recurrence of trophoblastic malignancy following initial diagnosis of remission and all were successfully retreated. None of the 81 patients with undetermined type had recurrence. Five (31.3%) of the 16 patients with choriocarcinoma who achieved remission later had recurrence and two out of the four patients were successfully retreated, while one died of brain metastasis and two showed recurrence again after the remission retreated.

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This is a case report of clear cell carcinoma of endometrium which is extremely rare in Japan. The microscopic findings in cytology of cervicovaginal smear and ascites, and in histolcgy of carcinoma tissue are discussed. The large size and sheet-like arrangement of tumor cells were important points to observe, in addition of clear cytoplasm but there was no mucous substance in cells in most of cases. The clinical course of clear cell carcinoma of endometrium was suggested to be mcre aggressive than that of non-clear cell carcinoma of endometrium.

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