Treatment of the Early Stage Small Cell Carcinoma of the Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Small cell carcinoma of the cervix(SCC) is a rare aggressive tumor with a propensity for rapid distant recurrence and a high mortality rate. The purpose of this study was to review our experience in early stage disease and to perform a meta-analysis of the literature to compare neoadjuvant with adjuvant chemotherapy as prognostic factor. METHODS: Between 1990 and 1998, seven women with FIGO early stage(IB-IIA) SCC were treated with surgery and chemotherapy at our hospital. Medical records were retrospectively reviewed. And thirty-two early-stage SCC patients who similarly treated since 1990 were identified by a Medline search of the English literature and included in the analysis. The Kaplan-Meier method and log-rank test were used for survival analysis. RESULTS: Out of our patients, three patients died at 12-13 months after diagnosis due to distant metastases which were brain in two and was liver and lung in one. Other three are alive with no evidence of disease at 27, 66, and 121 months. From the meta-analysis, the overall 3-year survival rate was 49% in neoadjuvant and 33% in adjuvant chemotherapy, but there were no statistical significance.(log-rank test, 0.80) Neoadjuvant chemotherapy resulted in a high response rates(81.2%), no pelvic recurrence, and a low LN metastasis(18.8%), therefore the pelvic radiation therapy rates was low. CONCLUSIONS: Even in the early stage, SCC treatment must be combined with chemotherapy. There was no significant difference in prognosis between neoadjuvant and adjuvant chemotherapy. But this study showed neoadjuvant may extirpate the primary lesion, evaluate response, and assess more promising postoperative therapy according to pathologic features.

Microinvasive Carcinoma of the Uterine Cervix: Diagnosis and Management Pattern / 대한부인종양콜포스코피학회잡지

Microinvasive carcinoma of the uterine cervix(FIGO stage IA) has been reported as highly curable disease even with conservative surgery such as conization and simple hysterectomy. Nevertheless, the surgical management for microinvasive carcinomas has been proposed varying from conservative surgery to radical hysterectomy with pelvic nodes dissection according to different diagnostic criterias for microinvasive carcinoma. We reviewed 512 patients who had been diagnosed as microinvasive carcinoma of the uterine cervix at the Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center from Jan. 1988 to Dec. 1995. Among them, 376 patients were included in this study satisfying guided criterias such as proper management and follow up more than at least one year, and they were analyzed retrospectively based on the clinicopathologic characteristics, pattern of surgical management and postoperative status. (continue)

The Value of Magnetic Resonance Imaging with Endorectal Surface Coil in the Staging of Carcinoma of Uterine Cervix / 대한부인종양콜포스코피학회잡지

To assess the effectiveness of Magnetic Resonance Imaging (MRI) with endorectal surface coil in the ataging of carcinoma of the uterine cervix with emphasis on parametrial involvement. Thirty women with clinically and radiographically proven carcinoma of the uterine cervix were initially included for this study, but thirteen patients were excluded since the stages of tumors wore beyond stage IIa. CT and MR findings of the remaining seventeen patients were performed at Cheil General Hospital and compared a1ong with clinical findings with the special emphasis on the parametrial involvement by the tumor. Staging was assessed by CT and MRI, and the results were compared with the pathologic staging. Radiea1 abdominal hysterectomy with the pelvic and paraaortic lymphnode dissection was done to all sewenteen patients. The staging made primarily by CT and MRI was either stsge 1 or Ila, but MR images with endorectal surface coil was superior to CT in the visualization of depth of tumor infiltration, especially parametrial involvement. The determination of the depth of the tumor made by MR images showed statistically significant correlation with histologic evaluation(R =0.768, p<0.01). The accuracy rate for the evaluation of the parametrial invo1vement was 82.3% far CT and 94.1% for MRI with endorectal surface coil. The overall accuracy rate for tumor staging was 70.5% for clinical, 58.8% for CT and 82.3% for MR evaluation. The accurecy rate in evaluation of the pelvic and paraaortic lymphnode was 88.2% for CT, but the evaluation done by MRl was not adequate due to small FOV(field of view). In assessment of The steging of careinoma of the uterine cervlx, MR images with endorectal surface coil was superior to CT, especially in the evaluation of the parametrial involvement.

Adenoma Malignum(Minimal deviation adenocarcinoma) Resembling Benign Lesions of the Uterine Cervix: A Clinicopathological Analysis of six cases / 대한부인종양콜포스코피학회잡지

Six cases of a rare variant of endocervieal adenocarcinoma (Adenoma maligum, AM) were collected for clinicopethologic analysis. The everage age of six patients was 49.3 years, and their chief com plaints were persis(ent mucid or watery discharge and intermittent vaginal spotting, The clinical im presaion was carcioma of The uterine cervix in faur out, of six cases. All except one were pathologically confirmed by initia1 biupey. two cases by colposcopic biopsies, two by cone biopsies, one by cone biopsy after suggested AM in calposcopic hiopsy. One case was incidentally found from hysterectnmised speeimen, which waas suspected as adennmyosis. On gross examination, the cervix usualty appeared either firm or indurated with thickening af the wall excepl one which was presented es a fungnting mass. The characteristic histologic feetures were ext,ensive arborizing endeervical glands with marked variation in size and shape, and the glands lined by mucin conyaining columnar epithelial cells with basal bland looking nuclei but with occasional cytologic atypia and rare mitose. The nenplasi.ic glands were characterized by deep stronml invasion be yond normal enddcervical glands, assosiated with loose edematous periglandular desmaplastic stromal reaction in moat cases. Immunohistochemical stainnings for carcinoembryonie antigen (CEA) revealed ey- toplasmic positivity in five cases. The clinical stage for all exeept one incidental case were : four Ib and one II b. In three cases, the radical hysterectomy with unilateral salpingooophorectomy plus dissection of bilateral pelvic and paraaortic lymph nodes was performed, and in one case radiotherapy was done prior to radical hysterectomy with bilateral salpingoophorectomy plus the dissection of left pelvic lymph nodes followed by chemotherapy. Total abdominal hysterectomy with bilateral salpingooophorectomy plus Burch's operation followed by radiation therapy was performed in on case. The remaining one case was treated with radiation therapy. Metastasis to the left obturator lymph node was discovered in one case with state IIb, and the patient expired 29 months after the radiotherapy. The remaining five cases are being carefully followed up. From our experience, we conclude that the early diagnosis of AM can be made based on comprehensive analysis concerning the clinical features, histopathological and immunohistochemical findings. The early diagnosis and proper therapy can lead to the better prognosis.

Detection of HPV in cervical scrape specimens of cervical neoplasia using the polymerase chain reaction / 대한산부인과학회잡지

No abstract available.

Detection of human papillomavirus(HPV) using the polymerase chain reaction in paraffin-embedded cervical carcnomas anf their metastatic lymph nodes / 대한산부인과학회잡지

No abstract available.