Extramammary Paget's Disease Combined with Squamous Cell Carcinoma In Situ of the Vulva: A Case Report and Differential Diagnosis

No abstract available.

A Case of Leiomyoma of The Lateral Vaginal Wall / 영남의대학술지

Leiomyomas are common in the myometrial layer of the uterus, though they are rarely found in other reproductive organs. Leiomyomas are benign, hormone-sensitive smooth muscle tumors. They develop during the reproductive years and regress after menopause. Preoperative diagnosis is difficult to make. We present a case of a 54-year-old woman with a vaginal wall tumor. The management in this case included surgical excision. Histologic examination definitively confirmed the diagnosis of a vaginal leiomyoma. We report the details of this case along with a brief review of the literature.

A clinical analysis of pelvic actinomycosis / 대한산부인과학회지

OBJECT: Pelvic actinomycosis is a relatively rare chronic suppurative and granulomatous infectious disease, caused by a gram-positive anaerobic bacteria. Actinomyces israelli is the most common subtype in human disease commonly associated with intrauterine device (IUD). This study was designed to analyze clinical and laboratory characteristics of patients with pelvic actinomycosis. METHODS: We reviewed medical records of 12 patients with pelvic actinomycosis who were admitted between January 1, 1995 and December 31, 2005. The clinical characteristics, diagnostic evaluation and surgical treatment results were retrospectively analyzed. RESULTS: The ages of the cases varied between 30 and 53 years old. Of the 12 patients, 11 patients had been using an IUD. Two cases had hydronephrosis due to infection. All our cases involved ovary and/or uterus and had predisposing factors of disease progression, including IUD, dilatation and curretage. Most common presenting symptom of patients were abdominal pain (75%). Preoperatively, 5 cases were diagnosed as actinomycosis, but 7 cases misconceived as a pelvic malignancy, secondary degenerated myoma and tuboovarian abscess. Exploration were performed in all patients. All cases were cured following surgery with subsequent antibiotics. CONCLUSION: Actinomycosis should be considered preoperatively, especially in long-term IUD usage, fever and laboratory findings that indicate the presence of pelvic infection. Radiologic findings (CT) can assist in making the diagnosis of pelvic actinomycosis. Appropriate antibiotics, as well as surgery, are important in the treatment of pelvic actinomycosis.

A case of malignant Brenner tumor developed at an ovary after contralateral oophorectomy / 부인종양

The Brenner tumors of the ovary are uncommon and constitute 1.5-2.5% of all ovarian neoplasms. And their malignant counterparts are rare. Although the first malignant Brenner tumor was described by Von Numers in 1945, only a few malignant Brenner tumors have been reported. The definition and its biologic behavior, and the optimal treatment has not been established. We present a patient who had total abdominal hysterectomy with unilateral salpingooophorectomy due to adenomyosis. The resected ovary had only follicular cysts and the remained ovary was grossly normal . Malignant Brenner tumor developed at the remained ovary 15 years after operation. Operation and adjuvant chemotherapy was applied and patient is alive without evidence of disease. We have experienced a case of malignant Brenner tumor developed at the remained ovary after contralateral oophorectomy with a brief review of literature.

Three cases of squamous cell carcinoma arising in mature cystic teratoma of the ovary / 부인종양

Benign mature cystic teratoma is a very common ovarian lesion. It commonly occurs during a woman's reproductive years and most often is benign. In approximately 1% to 3% of cases, however, it can undergo a malignant transformation with a very poor prognosis. The frequency of malignant degeneration of dermoid is related to age, with the highest in-cidence in the postmenopausal years. Squamous cell carcinoma accounts for 70-88% of all malignant tumors arising in the mature cystic teratom-as followed by the much rarer adenocarcinomas and carcinoids. Preoperative diagnosis is difficult due to the rarity of this tumor and its similarity to mature cystic teratoma. We experienced 3 cases of squamous cell carcinoma arising in mature cystic teratoma and report our cases with a brief review of the literature.

Gangioneuroma Misdiagnosed as Ovarian Tumor / 대한비뇨기과학회지

A ganglioneuroma is a rare neoplasm in adults, which is most commonly locating in the posterior mediastinum, but can also be located in the retroperitoneum, pelvis, adrenal medulla and neck. They predominantly occur in females, with 60-70% of diseases originating before the age of 20 years. Herein, a case of a 51-year-old woman suffering from a pelvic mass, with a history and physical findings similar to those of an ovarian tumor, is reported.

Transvaginal Expulsion of Intramural Leiomyoma after Uterine Artery Embolization: Case Report

We report a case in which an intramural uterine leiomyoma was transvaginally expelled after uterine arterial embolization (UAE). A 29-year-old unmarried female presented with vaginal bleeding, and at pre-treatment MRI an intramural leiomyoma was diagnosed. UAE was performed and after 13 days the tumor was transvaginally expelled. Follow-up MRI performed seven days later depicted a large myometrial defect in the anterior uterine wall; subsequent follow-up MRI showed that the defect became gradually smaller, and the size and configuration of the uterus progressively normalized.

Usefulness of Rapid PSA Kit(R) / 대한비뇨기과학회지

PURPOSE: The incidence rate of prostate cancer has increased remarkably in Korea. The serum prostate specific antigen (PSA) value has been used for screening, although its clinical significance in prostate cancer screening is still inconclusive. However, if the measurement time was short and the cost was low, such an assay kit should be sufficient for prostate cancer screening. MATERIALS AND METHODS: We developed pared monoclonal antibodies against PSA which could be used in assay kits for PSA. The Rapid PSA Kit(R) used an immunochromatographic method to qualitatively judge a positive or negative result. Serum specimens from 78 men with benign prostate hyperplasia or prostate cancer were tested using the kit. RESULTS: The sensitivity of the kit was determined to be 4ng/ml. 33 samples had a value of greater than 5ng/ml, so were considered positive. 5 samples had values between 4ng/ml and 5ng/ml, of which 3 were positive. The other 40 samples had values less than 4ng/ml, and 11 of these were judged positive. These results indicated that the sensitivity and specificity of the Rapid PSA Kit(R) were 94.7 and 72.5%, respectively. CONCLUSIONS: Tests using the Rapid PSA Kit(R) can be easily performed at outpatient clinics or elsewhere. This kit is useful in the initial screening of prostate cancer as the results can be obtained within 15 minutes and the cost is lower than with ordinary serum PSA tests.

Usefulness of Rapid PSA Kit(R) / 대한비뇨기과학회지

PURPOSE: The incidence rate of prostate cancer has increased remarkably in Korea. The serum prostate specific antigen (PSA) value has been used for screening, although its clinical significance in prostate cancer screening is still inconclusive. However, if the measurement time was short and the cost was low, such an assay kit should be sufficient for prostate cancer screening. MATERIALS AND METHODS: We developed pared monoclonal antibodies against PSA which could be used in assay kits for PSA. The Rapid PSA Kit(R) used an immunochromatographic method to qualitatively judge a positive or negative result. Serum specimens from 78 men with benign prostate hyperplasia or prostate cancer were tested using the kit. RESULTS: The sensitivity of the kit was determined to be 4ng/ml. 33 samples had a value of greater than 5ng/ml, so were considered positive. 5 samples had values between 4ng/ml and 5ng/ml, of which 3 were positive. The other 40 samples had values less than 4ng/ml, and 11 of these were judged positive. These results indicated that the sensitivity and specificity of the Rapid PSA Kit(R) were 94.7 and 72.5%, respectively. CONCLUSIONS: Tests using the Rapid PSA Kit(R) can be easily performed at outpatient clinics or elsewhere. This kit is useful in the initial screening of prostate cancer as the results can be obtained within 15 minutes and the cost is lower than with ordinary serum PSA tests.

Loss of Fhit Expression in Cervical Intraepithelial lesion and Invasive Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The author evaluated the relationship between the loss of Fhit and prognostic factors of invasive cervical carcinomas. METHODS: The formalin prepared tissue specimens of 64 CINs and 27 invasive cervical carcinomas patients diagnosed and treated at the department of obstetrics and gynecology, Yeungnam university hospital from June 1977 to February 2001 were obtained. And then the tissue specimens were analysed & measured by immunohistochemical methods. RESULTS: The loss of Fhit was significantly reduced in invasive cervical carcinomas compared to CINs. But we found there is no relationships between the loss of Fhit and prognostic factors, stage, tumor marker, lymphatic spread and radiation therapy of invasive cervical carcinomas. CONCLUSIONS: Although the loss of Fhit was not related to the precancerous lesion of cervix, we could confirm that the loss of Fhit was important in the progression of precancerous lesions to invasive cervical carcinomas.

An Economic Evaluation of Pharmacological Therapy and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: An economic analysis of pharmacological therapy and transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH) was conducted. MATERIALS AND METHODS: Twenty six patients had undergone TURP from January to June 2000 were enrolled in this study. The costs associated with this group of patients were compared with those of 7 patients treated with medication (doxazosin, terazosin, tamsulosin, and finasteride only and alpha-blocker with finasteride). RESULTS: The mean cost for TURP was 1,900,000 won. The most expensive medical therapy was finasteride, which was followed by tamsulosin, terazosin, and doxazosin, with an estimated 12-month cost of 817,000won, 695,000won, 396,000won, and 372,000won respectively. The costs associated with doxazosin remained lower than those associated with TURP for approximately 5.3 years (the corresponding break-even point was 2.4 years for finasteride vs. TURP). CONCLUSIONS: Among the pharmacological therapies, doxazosin is the most cost effective. TURP was more cost effective than doxazosin therapy after 5.3 years. In view of the cost-effectiveness, TURP may be considered as the mode of primary therapy for the patients with severe symptoms of BPH.

Lipid Peroxidation and Antioxidant Activity in Pregnant Women with Pregnancy-Induced Hypertension / 대한주산의학회잡지

OBJECTIVE: To assess maternal circulating levels of lipid peroxides, superoxide dismutase and total antioxidants of women with pregnancy-induced hypertension. METHODS: Cross-sectional study consisting of 18 preeclamptic, 21 uncomplicated pregnant and 22 healthy non-pregnant women. Fasting venous blood samples were collected during the 3rd trimester of antepartum period and maternal circulating levels of malondialdehyde as a lipid peroxidation product, superoxide dismutase activity and total antioxidants were measured. RESULTS: In the preeclamptic group, lipid peroxides were significantly increased, otherwise the activity of superoxide dismutase in the erythrocytes was significantly decreased compared to normal pregnant women. The value of serum total antioxidants was similar in both groups. Strong correlation was detected between malondialdehyde and blood pressure in the pregnant women. CONCLUSION: Preeclampsia is associated with decrease of antioxidant enzyme activity while lipid peroxidation was increased during the 3rd trimester of pregnancy. Therefore, a significant elevated lipid peroxidation and reduced superoxide dismutase activity may contribute to pathophysiology and pathogenesis of preeclampsia via vascular endothelial cell damage.

Two Cases of Advanced Ovarian Serous Tumor of Borderline Malignancy / 대한부인종양콜포스코피학회잡지

Ovarian serous tumors of low malignant potential (borderline serous tumors) are intermediate in their clinical behavior between benign serous cystadenoma and malignant neoplasm, and are associated with 10 year survival rates in excess of 90%. Borderline ovarian serous tumors are characterized by absence of stromal invasion but presence of some characteristics of malignancy. Borderline ovarian tumors occur predominantly in premenopausal women, and associated with a very good prognosis. The principal treatment of borderline malignancy is surgical resection of the primary tumor. But approximatley 20% of patients with ovarian tumors of low malignant potential present with Stage III or IV disease at the time of diagnosis. The benefit of postsurgical therapy in this group of patients has not been well established. We report two cases of advanced ovarian serous borderline tumor, one of which was treated with 3 cycles of cisplatin-taxol chemotherpy.

Quality of Life in Women Who Underwent Radical Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: he authors evaluated the quality of life in women who underwent radical hysterectomy. METHODS: he protocol of functional assessment of chronic illness therapy by Cella was used to evaluate the quality of life after radical hysterectomy in 156 women. The data was standardized and scaled 0-100 points by Rasch's assessment model. The statistical analysis was done with ANOVA and post-Hoc test. RESULTS: Those with a lower ECOG performance score, housewives, workers, and those who are married had a higher sense of well-being than those with a higher ECOG performance score or who were jobless or widowed. Women with no family or who are single mothers showed lower emotional well-being (EWB) and Medicare patients had a lower social/family well-being (SFWB) or functional assessment of cancer therapy with general (FACT-G) than those who had medical insurances. The EWB and specific symptoms confined to cervical cancer (CxCs) were found to be higher in women who were diagnosed to be at stage I than those to be at stage II. The physical well-being (PWB) was found to be lower in women when adjunctive chemotherapy or radiation therapy had been performed than only the surgery had been done, and the CxCs was found to be lower in women when radiation therapy had been performed than only the surgery had been done. Conclusions: The results of this study suggest that familial, social condition, clinical stage, and treatment modality affect the quality of life of each patient. In conclusion, our results support the importance of earlier prediction and a proper management plan to improve the quality of life in women who had underwent radical hysterectomy.

A Case of Epithelioid Trophoblastic Tumor / 대한부인종양콜포스코피학회잡지

We report a rare case of epithelioid trophoblastic tumor. The patient was initially thought to have endometrial carcinoma with high possibility of clear cell carcinoma on endometrial biopsy and pelvic MRI. The Pap smear showed feature of squamous cell carcinoma and was not consistent with the physical findings. The serum beta-hCG was 33.26 mIU/ml. The initial biopsy and pelvic MRI findings lead the clinicians to misdiagnose the case as a carcinoma.

Telomerase Activity in Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: Telomerase is a ribonucleoprotein that synthesizes TTAGGG repeats onto chromosome ends. The expression of telomerase is thought to be required for cellular immortality and carcinogenesis. This study was conducted to examine the telomerase activation occurs in cervical carcinogenesis. METHODS: The standard telomeric repeat amplification protocol(TRAP) was used to examine telomerase activity in tissues of 10 normal cervix, 10 carcinoma in situ, and 21 invasive cervical carcinoma. RESULTS: Telomerase activity was detected in tissues of 16/21(76.2%) invasive carcinoma, in 5/10(50.0%) carcinoma in situ, and in 3/10(30.0%) normal cervix. But the degree of telomerase activity in normal cervix was weak. There was significant difference in 3 groups(p<0.05). The results of neoadjuvant chemotherapy in 10 invasive cervical carcinoma were as follows. In 8 cases of which tumor size decreased more than 50%, 5 were positive for telomerase. In 2 cases that didn't respond to chemotherapy by tumor size, 1 was positive for telomerase. There was no significant difference between 2 groups. All of the 5 cases that had pelvic lymph node metastasis revealed positive telomerase activity, and the 11 cases of 16 cases that didn't have pelvic lymph node metastasis were positive for telomerase, but there was no significant difference in 2 groups. The positivity of telomerase activity in clinical stage of invasive cervical carcinoma was 73.3% in stage I(11/15), 75.0% in stage II(3/4), 100% in stage III(1/1), and 100% in stage IV(1/1), but there was no significant difference in each stages. CONCLUSION: Telomerase seems to be uniquely associated with malignant transformation of cervix and can be used as a tumor marker. Additional studies are needed to better clarify the biological significance of telomerase expression in cervical tumorigenesis.

Human Papillomavirus Detection and E6 Oncoprotein Expression in Uterine Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: To evaluate the correlation of HPV infection and E6 oncoprotein expression with carcinogenesis and prognostic role of cervical carcinoma METHODS: Paraffin embedded tissues were obtained from 35 invasive cervical carcinoma, 15 carcinoma in situ, 12 dysplasia of cervix and 20 patients with benign uterine disease as control. HPV type was determined by polymerase chain reaction using type specific primers. E6 oncoprotein expression was analyzed by immunohistochemical staining using C1P5 mouse monoclonal antibody. RESULTS: 1. The positivity of HPV type 16 PCR in invasive cervical carcinoma was 77.1% and it was significantly higher than carcinoma in situ(53.3%), cervical dysplasia(25%), and control (10%). But the positivity of HPV type 18 was not correlated between above groups. 2. The positivity of HPV type 16/18 in cervical carcinoma was not correlated to patient's age. 3. The positivity of HPV in cervical carcinoma was correlated to clinical stage of cervical carcinoma but the positivity of HPV in cervical dysplasia was not correlated to the degree of dysplasia. 4. The positivity of E6 oncoprotein expression was 77.1% in invasive cervical carcinoma, 66.7% in carcinoma in situ and 20% in control group. E6 oncoprotein was not decteted among the cases which negative was for HPV 16/18. The E6 oncoprotein expression in 35 cases of invasive cervical carcinoma was negative in 8, weakly positive in 7, positive in 12, and strong positive in 8 ases. But in 20 cases of normal control group, there was no case of strong positive or posirive E6 oncoprotein expression. 5. The E6 oncoprotein expression was significantly correlated to the clinical stage and lymph node metastasis. The incidence of lymph node metastasis increased and the stage became higher as the E6 oncoprotein expression increased. CONCLUSION: These results suggest that HPV is one of the most important factors in the carcinogenesis of cervical carcinoma and the E6 oncoprotein expression may be associated with biological aggressiveness of cervical carcinoma.

The Changes in the Activity of Oxygen Free Radical Generating and Scavenging System as the Pregnant Period / 대한산부인과학회잡지

OBJECTIVE; This study was conducted to evaluate the effect of pregnancy on the activities of oxygen hee radical generating and scavenging system in the female rats. MATERIAL & METHOD; Rats weighing 200-220 gm were grouped to non-pregnant, 2nd trimester and 3rd trimester of pregnancy. The experiment was carried out following overnight fasting. Animals were anesthetized by administration of pentothal sodium, and blood was drawn via abdominal aorta. After exsanguination, the liver, kidney, heart, lung, with or without placenta tissues were excised immediately. The excised tissue was frozen in liquid nitrogen rapidly, and stored in liquid nitrogen for analysis. RESULTS; The gain in body weight was higher in pregnant rats than in normal rats. Lipid peroxidation was not significantly different among all groups in the liver, kidney, heart, lung, and placenta tissue. Xanthine oxidase activity of the kidney in the 3rd trimester of pregnancy was lower than that of non-pregnant rats. Superoxide dismutase activity of the liver was significantly decreased in the 2nd and 3rd trimester of pegnancy compared with that of non-pregnant rats, and that of lung was also decreased than that of non-pregnant rats. Catalase activity of the kidney was decreased in the 2nd and 3rd trimester of pregnancy compared with that of non-pregnant rats. Glutathione content of the liver was markedly decreased in the 2nd and 3rd trimester of pregnancy compared with that of non-pregnant rats. CONCLUSION; In conclusion, these results suggest that oxygen free radical will not increase in the liver, kidney, heart, lung, and placenta during normal pregnancy, but in the cases of overproduction of oxygen free radical, the liver, kidney, and lung will have me chance of tissue damage because of decreased activity of some anti-oxidant enzymes and/or decreased amount of anti-oxidant materials.

Cervicography as a Screening Test for Cervical Cancer / 영남의대학술지

BACKGROUND: Uterine cervical cancer is the most common malignant tumor of the women in Korea. This study was undertaken to evaluate the usefulness of the cervicography as a screeningg test of cervical cancer. MATERIALS AND METHODS: Cervicography was taken from 482 women at department of obstetrics and gymecology, at Yeungnam University Hospital from March 1, 1998 to October 31, 1999, of the 482 women, 172women were excluded from the study for various reasons, and 310 women completed the study. Three-hundred and ten women had cervical cytology(Papanicolaou smear), cervicography and colposcopy, and punch biopsy was undertaken if any of the test result was abnormal. RESULTS: The most common age group was 35-39, and 40-44, 45-49 in order and most common reason for having a screening test was regular check for cervical cancer. The mean duration from the last Pap smear was 17.1 months, and 64 women(20.4%) never had any prior screening tests. Of the 310 women, 254 women were categorized as normal or having benign disease such as cervicitis, erosion or metaplasia. Biopsy was taken from 56 patients and the results were 26 chromic cervicitis, 4 mild dysplasia, 6 moderate dysplasia, 2 severe dysplasia, 14 carcinoma in situ and 4 invasive carcinoma. The results of cytology and cervicography were well correlated(p<0.05) The sensitivity of cytology and cervicography were 86.7% and 76.9%, respectively and the sensitivity and specificity of cervicography were 56.7% and 96.2%, respectively. False negative rate of cervicography(43.3%) was much higher than those of cytology(13.3%)(p<0.05), but false positive rate of cervicography(3.8%) was much lower than that of cytology(23.1%)(p<0.05). CONCLUSION: It seems inappropriate to use cervicography as a single scerrning test for cervival cancer, but it may be an effective complementary test for cytology to lower the false negative rate of cytology.

A Clinical Study of 20 Uterine Sarcomas / 영남의대학술지

Sarcoma of the uterus is very rare malignant tumor originating from uterine muscle or connective tissue. We have experienced 20 cases of uterine sarcoma from January 1991 to June 1998. The results were as follows: 1. The pathologic types were 13 cases(65.0%) of leiomyosarcoma, 5 cases(25.0%) of malignant mixed Mullerian tumor, 1 case of rhabdomyosarcoma, and 1 case of angiosarcoma. 2. The average age and parity was 50.2 and 3.7. The chief complaints were irregular vaginal bleeding(35.0%), lower abdominal pain(25.0%), and abdominal mass(25.0%). 3. Nine cases(45.0%) were FIGO stage I, 1 case(5.0%) was stage II, 6 cases(30.0%) were stage III, and 4 cases(20.0%) were stage IV. 4. The survival was from 1.5 months to over 130 months(median 16.5 months), and there was no correlation between survival and FIGO stage or pathologic type. The correlation between survival and number of mitotic figure was incalcurable. 5. CA 125 levels were serially measured as a tumor marker in monitoring patients and the positive rate was 40%. Further study was needed to make a conclusion for usefulness of CA 125 as a tumor marker.