Extremely elevated serum CA-125 concentration in patient with unruptured endometrioma A Case Report and Review of the Literature / 대한산부인과학회잡지

CA-125 is an antigenic determinant expressed by more than 80% epithelial ovarian cancer. Although developed for use in the diagnosis and monitoring of epithelial ovarian cancer, elevations of CA-125 concentrations can also be associated with some normal physiologic conditions, various other malignancies and benign conditions. Adnexal cysts are frequently encountered during the reproductive years. 10 to 35% of benign cystic adnexal masses may be an endometrioma. Because endometriomas are not likely to resolve spontaneously, and may enlarge or rupture during period of observation, a test to detect an endometrioma would assist in the evaluation and management of adnexal cysts. Serum CA-125 concentration is seldom >100 U/ml in endometriosis. We reported a patient with endometrioma presenting with a very high CA-125 concentration, which may confuse diagnosis with ovarian cancer.

The Prevalence of HPV Infection in General Population of Korea and Efficacy of HPV DNA Test as an Adjunctive Screening of Cervical Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Our study was performed to assess prevalence of HPV infections in general female population of Korea and efficacy of HPV DNA test as an adjunctive screening of cervical cancer. MATERIALS AND METHODS: From January 2000 to December 2000, a total 689 patients who had undergone Pap smear and HPV DNA test using Hybrid Capture System-II were included in this study. High risk types of HPV included 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68. We performed colposcopic biopsy on 203 patients. RESULTS: High-risk oncogenic HPV infections were found in the 19.4% of the investigated patients. The sensitivity and negative predictive value of Pap smear alone in identifying the lesions more severe than CIN 2 was 72.2% and 83.2%, respectively. The combination of Pap smear and high risk HPV testing increased to 96.3% and 95.3%, respectively. CONCLUSIONS: The prevalence of HPV infection in general population was 19.4%. The use of HPV DNA testing significantly improved the sensitivity or negative predictive value of the diagnosis of high grade CIN or cancer. Thus, we suggest HPV DNA testing appears to be a needed adjunct to the Pap smear and a combined screening test offers the possibility of greater detection or longer screening intervals, which will be able to reduce the overall cost of the screening program.

Epithelioid trophoblastic tumor: A Case Report and Review of the Literature / 대한산부인과학회잡지

Epithelioid trophoblastic tumor (ETT) is an unusual variant of gestational trophoblastic tumor that is closely related to choriocarcinoma and placental site trophoblastic tumor (PSTT) but shows different morphologic, immunohistochemical features. ETT grows in a nodular pattern compared with the infiltrative pattern of PSTT. Histologically the tumor is characterized by uniform population of mononucleate intermediate trophoblastic cells that resemble the trophoblastic cells in the chorionic laeve, so we called them "chorionic-type intermediate trophoblast". Immunohistochemically ETT was positive for cytokeratin, epithelial membrane antigen(EMA) and staining for human placental lactogen (hPL) and human chorionic gonadotrophin (hCG) was generally patchy, focal or negative whereas PSTT contained more hPL-positive cells than hCG-positive cells. ETT can behave in a malignant fashion such as distant metastasis. We experienced a case of ETT by clinical result, pathologic finding, so we report a case with brief literature review.

Combined intrauterine and cervical pregnancy / 대한산부인과학회잡지

Although recently the incidence of heterotopic pregnancies are increasing because of assisted reproduction, heterotopyic pregnancies were rare with an incidence of 1 per 30,000 pregnancies. In this presentation, we describe a case of combined intrauterine and cervical pregnancy after artificial abortion. The patient was treated by local injection of methotrexate directly into gestational sac under the guidance of sonogram after systemic methotrexate treatment. The gestational products were removed by dilatation & currettage due to persistent vaginal bleeding on the next day. So we report a case with a brief review of the literatures.

Amifostine Pretreatment for Protection against Cisplatin-based Combination Chemotherapy in Gynecologic Cancer Patients / 대한산부인과학회잡지

OBJECTIVE: Amifostine (Ethyol(R)), an organic thiophosphate, has shown the ability to protect normal, but not neoplastic, tissues from the damaging effects of chemotherapy and radiotherapy in various kinds of cancers. This study was designed to determine ifostine could reduce the serious hematologic and nephrologic toxicities associated with cisplatin based combination chemotherapy in gynecologic cancer patients. PATIENTS AND METHODS: Forty patients who received cisplatin-based combination chemotherapy were randomized into two groups. They received chemotherapy with or without pretreatment of amifostine before each course. The occurrence of hematologic and renal toxicities were evaluated. Stastical analysis was done by independent t-test and Chi-square test. RESULTS: Hematologic toxicity was evaluated with nadir count of neutrophil and platelet. The nadir count of neutrophil was 2034.2+/-1199.20/microliter in group with pretreatment using amifostine vs 1070.85+/-472.66/microliter in control group (p<0.01). Platelet count was not statistically different. (p<0.16) Grade 3 neutropenia was observed in nine (45%) patients in pretreatment group vs four (20%) patients with control group (p<0.09). Grade 4 neutropenia occurred in one patient only in control group. Renal toxicity was evaluated by serum creatinine and creatinine clearance. Protracted serum creatinine elevation was not significant in both groups. (p<0.14) Reduction of creatinine clearance was less in patients with pretreatment (p<0.01). There were no significant side reactions in subjects using amifostine. CONCLUSION: Pretreatment with amifostine reduces the neutropenia and nephrotoxicity associated with cisplatin-based combination chemotherapy with gynecologic cancer patients.

Amifostine Pretreatment for Protection against Cisplatin-based Combination Chemotherapy in Gynecologic Cancer Patients / 대한산부인과학회잡지

OBJECTIVE: Amifostine (Ethyol(R)), an organic thiophosphate, has shown the ability to protect normal, but not neoplastic, tissues from the damaging effects of chemotherapy and radiotherapy in various kinds of cancers. This study was designed to determine ifostine could reduce the serious hematologic and nephrologic toxicities associated with cisplatin based combination chemotherapy in gynecologic cancer patients. PATIENTS AND METHODS: Forty patients who received cisplatin-based combination chemotherapy were randomized into two groups. They received chemotherapy with or without pretreatment of amifostine before each course. The occurrence of hematologic and renal toxicities were evaluated. Stastical analysis was done by independent t-test and Chi-square test. RESULTS: Hematologic toxicity was evaluated with nadir count of neutrophil and platelet. The nadir count of neutrophil was 2034.2+/-1199.20/microliter in group with pretreatment using amifostine vs 1070.85+/-472.66/microliter in control group (p<0.01). Platelet count was not statistically different. (p<0.16) Grade 3 neutropenia was observed in nine (45%) patients in pretreatment group vs four (20%) patients with control group (p<0.09). Grade 4 neutropenia occurred in one patient only in control group. Renal toxicity was evaluated by serum creatinine and creatinine clearance. Protracted serum creatinine elevation was not significant in both groups. (p<0.14) Reduction of creatinine clearance was less in patients with pretreatment (p<0.01). There were no significant side reactions in subjects using amifostine. CONCLUSION: Pretreatment with amifostine reduces the neutropenia and nephrotoxicity associated with cisplatin-based combination chemotherapy with gynecologic cancer patients.