Clinicopathologic characteristics of granulosa cell tumors of the ovary: a multicenter retrospective study / 부인종양

OBJECTIVE: To evaluate the clinicopathologic characteristics and prognostic factors of ovarian granulosa cell tumors. METHODS: Medical records of 113 patients presenting between January 1995 and December 2007 were retrospectively reviewed. RESULTS: One-hundred two patients had adult type disease, with a mean age of 46.2 years (range, 18 to 83 years) and a mean follow-up period of 54.7 months (range, 1 to 155 months). The distribution of FIGO stages was 86 patients at stage I, 11 at stage II, and 5 at stage III. During follow-up, ten patients recurred at a mean time of 48 months (range, 4 to 109 months). Among them, three patients died after a mean of 57 months (range, 25 to 103 months). In recurrence analysis, advanced stage (p=0.032) and presence of residual disease (p=0.012) were statistically significant, and age<40 years, premenopause and positive washing cytology were marginally significant (p<0.1). In multivariate analysis, stage was the only factor associated with recurrence; adjuvant chemotherapy and fertility-sparing surgery were not statistically significant. Among 36 patients with fertility-sparing operations, eight patients had nine pregnancies and delivered seven babies. Eleven patients had juvenile type tumors; the mean age was 20.0 years (range, 8 to 45 years) and the mean follow-up period was 69.8 months (range, 20 to 156 months). The distribution of FIGO stage was nine patients at stage I and two at stage III. There were no recurrences or deaths reported. Four patients had seven pregnancies and delivered six babies. CONCLUSION: Stage is the only factor associated with disease-free survival, and fertility-sparing surgery may be a treatment option for women with early-stage disease who want to retain fertility.

Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population / 한국역학회지

OBJECTIVES: The aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea. METHODS: A total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN. RESULTS: With regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial. CONCLUSION: Improvements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.

Survival benefit of laparoscopic surgical staging-guided radiation therapy in locally advanced cervical cancer / 부인종양

OBJECTIVE: This study was designed to evaluate the survival benefit of laparoscopic surgical staging (LSS)-guided tailored radiation therapy (RT) in locally advanced cervical cancer (LACC). METHODS: We retrospectively reviewed 89 LACC patients' medical records who primarily received non-surgical treatment, of which pretreatment LSS was performed in 20 (LSS group) and primary chemoradiation therapy (CCRT) without LSS (CCRT group) was carried out in 69 from January 2000 to January 2006. We analyzed clinical characteristics, pretreatment imaging study results and survival outcomes including disease free survival (DFS) and overall survival (OS) to compare them between the two groups. RESULTS: There were as many as eight cases (40%) of LSS related complications. The mean time interval between LSS and RT or CCRT was 26.6 days (+/-18.8 days). Six out of twenty (30%) in LSS group and 10 out of 69 (14.5%) in CCRT group received extended field RT when paraaortic lymph nodes (LNs) were positive based on the pathologic findings after LSS and the results of imaging studies, respectively. Three-year DFS and OS were both better in 33 imaging-negative CCRT group patients than those in 4 imaging-negative/pathology-positive (false negative) patients after LSS (3-year DFS, 50% vs. 87%, p=0.022; 3-year OS, 50% vs. 84%, p=0.033). The 5-year DFS rates were 52% and 55% in LSS group and in CCRT group, respectively (p=0.28). The 5-year OS rates were 68% in LSS group and 62% in CCRT group without significant difference between the two groups (p=0.79). CONCLUSION: We found that LSS-based RT tailoring did not show survival benefit in LACC despite inaccuracy of imaging-based RT tailoring. Further studies are required to find new method to overcome this inaccuracy and improve survival outcomes.

Pregnancy outcomes of IgA nephropathy / 대한산부인과학회지

OBJECTIVE: We performed this study to evaluate maternal and fetal outcomes of pregnancies with IgA nephropathy. METHODS: We reviewed 20 pregnancies occurred in 14 women who were diagnosed as IgA nephropathy with the method of renal biopsy between 1997 and 2006. We used clinical and laboratory data from medical records and statistic analysis using SPSS 15.0. RESULTS: Of 20 prenancies, there were 17 live births and 3 spontaneous abortions. There was no stillbirth and congenital anomaly. We found severe preeclampsia in 47%, low birth weight in 53% and preterm birth (comprising medical indications) in 59%. But most were late preterm birth and all were alive. Blood pressure was elevated after delivery compared with pre-pregnancy. CONCLUSION: Although pregnancy is not contraindicated in IgA nephropathy, it is associated with significant complications comprising preeclampsia, preterm birth and low birth weight.

A case of massive serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy for cervical adenocarcinoma stage IB2 / 부인종양

Ascites following radical hysterectomy with retroperitoneal lymphadenectomy for invasive cervical cancer has been reported previously. Most of these reports described chylous ascites. The chylous ascitic fluid is milky; further, chylous ascites leads to nutritional problems. Authors present the case of a patient who developed serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy. The amount of ascites was approximately 18,000 ml over 52 days. The patient had no nutritional problems or complications. Although the etiology could not be determined, Authors surmise that the ascites may have been due to massive drainage from injured lymphatic channels below the cisterna chyli. Authors could not found any literatures which described massive serous ascites following surgery in gynecologic malignancy and reports this case with review of literatures.

Evaluation of risk prediction model for stroke risk based on Cox's and Weibull model in Korea / 한국역학회지

OBJECTIVE: The objective was to compare Cox proportional hazards model and Weibull model for predicting long-term probabilities for stroke risk in the Korean Cancer Prevention Study(KCPS). METHODS: The subjects comprised of 385,279 Korean aged 55 to 64 years who received health insurance from the National Health Insurance Corporation and who had medical examinations in 1992 and 1995. 70% of the subjects were used for model building and the rest for model evaluation. The final prediction model for stroke includes age, systolic blood pressure, diabetes, total cholesterol and smoking. Subjects were follow-up for identification of incident stroke cases between 1993 and 2005. Comparisons included predicted coefficients of stroke risk factors, incidence probabilities over 10 years, and the area under a receiver operating characteristics (ROC) curve for both Cox's proportional hazard model and Weibull model. RESULTS: The average age of study population was 55.5 years in men and 56.3 years in women, respectively. Percentage of men and women in study population were 58.0% and 42.0%, respectively. The study findings satisfied proportionality according to the two models. There was no significant difference in coefficients between the two models of prediction models in men and in women. Moreover, there was no difference in incidence probabilities of stroke and c-statistics. C-statistics were 0.68 for men as same as for women. CONCLUSION: There was no difference for the prediction of the stroke risk in the Korean population using Cox's proportional hazard model and Weibull model, thus the two models were found to be efficient for this purpose.

The detection rate of Ureaplasma urealyticum and Mycoplasma hominis in patients with impending preterm birth and mid-trimester cervical swab / 대한주산의학회잡지

PURPOSE: The purpose of this study was to examine the risk of preterm birth in pregnant women with Ureaplasma urealyticum and/or Mycoplasma hominis infection and the prevalence of these organisms in normal pregnancy. METHODS: Between February 2002 and July 2002, we included 43 pregnant women prior to 37 weeks of gestation with definite gross leakage of amniotic fluid (n=16) (group 1), 47 healthy women without any obstetric problems between 18 and 24 weeks of gestation (group 2) and 64 women who delivered fullterm fetuses who had taken cervical swabs around 36 weeks gestation (group 3). Cervical swabs (Dacron(R)) were taken on admission in group 1 and at outpatients in group 2 and 3. Detections of U. urealyticum and M. hominis were done using commercial kits (MYCOFAST(R) Evolution 2, International Microbio Signes, France). RESULTS: There was no significant difference between mid-gestation (group 2) and fullterm (group 3) in cervical swab result. In group 1, the detection rate of Ureaplasma uealyticum was higher in impending preterm birth over 32 weeks of gestational age (15/20, 75%) than 32 weeks or less (10/ 23, 43.4%) (p<0.05). In group 2, there was no significant difference in preterm birth rate between the exposed and the non-exposed to U. urealyticum and/or M. hominis in middle of 2nd trimester. CONCLUSION: U. urealyticum does not seem to be a predictor of preterm birth, and there seems to be some different mechanism according to gestational age. We couldn't varify that M. Hominis and U. urealyticum were related to preterm birth, although U. urealyticum was highly detected in impending preterm birth.

The prevalence of endometriosis in cases of total hysterectomy / 대한산부인과학회지

OBJECTIVE: We investigated whether surgical methods, age, parity and obesity were correlated to endometriosis in patients who had hysterectomy. METHODS: This research was surveyed and reviewed of patients who underwent total abdominal hysterectomy, laparoscopic hysterectomy and vaginal hysterectomy in Kyungpook National University Hospital from 1999 to 2006, based on clinical recordings and pathologic reports. Based on these data, we investigated whether age, parity, obesity and pathologic diagnosis were correlated to prevalence rate of endometriosis. Also we investigated the correlations with anatomic lesion of endometriosis and surgical methods. SPSS version 12.0 chi- square test was conducted as the statistical data. RESULTS: The total 4,830 cases of hysterectomy were undergone. Out of these, endometriosis was found at 125 cases (2.5%). Among them, 76 cases of endometriosis were found at 2,260 cases of abdominal hysterectomy (3.3%). 31 cases of endometriosis were found at 1,589 cases of vaginal hysterectomy (1.95%), and 18 cases of endometriosis were found at 981 cases of laparoscopic hysterectomy (1.83%). The correlation with laparoscopic hysterectomy and endometriosis had the statistically significant high rate (P0.05). CONCLUSION: Even the prevalence of endometriosis was low (2.5%) in total cases of hysterectomy, laparoscopic hysterectomy had more prevalence rate of endometriosis than other types of hysterectomy. because suspicious lesions were inspected carefully, Magnified laparoscopic view make us to identify suspicious endometriotic lesion more clearly than other type of hysterectomy.

PTEN expression and single nucleotide polymorphisms in epithelial tumors of the ovary / 부인종양

OBJECTIVE: Phosphate and tensin homolog deleted on chromosome 10 (PTEN) is a potent tumor suppressor gene, localized to chromosome 10q23, and shows extensive homology with auxilin and tension. PTEN has variety roles involved in cell proliferation, invasion, and migration in tumorigenesis of solid tumors. In this study, the expression of the PTEN in the ovarian epithelial tumors, including benign, borderline malignancy, and adenocarcinomas was investigated. METHODS: Immunohistochemical expression of PTEN were analyzed in formalin fixed tumor tissues of 20 benign cystadenomas, 22 borderline tumors, and 49 malignant ovarian cancer. In the same tissue extracts, single nucleotide polymorphism were studied. RESULTS: Most of benign and borderline ovarian tumors revealed strong positive reaction, but a few cases showed negative reaction or weak positive reaction. In adenocarcinomas, 33% of cases was negative, and 43% was focal weakly staining, grade 1. The remainder of adenocarcinomas showed strong nuclear staining. In SNP assay, A/A allele of rs1234213 shows low frequency, but A/G allele reveals high frequency. C/C allele of rs701848 shows high frequency, and rs9651492 is not detected polymorphism. CONCLUSION: These results suggest that loss of PTEN expression is associated with tumorrigenesis of ovarian epithelial tumors, and is related with single nucleotide polymorphism.

Trocar-site metastasis after laparoscopic gynecologic oncologic surgery / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the incidence of abdominal-wall tumor implantation after laparoscopic procedure in patients with gynecologic malignancies. METHODS: The records of 184 patients who had a laparoscopic operations or laparotomy after laparoscopic diagnostic procedures from Aug. 1994 to Aug. 2003 in our hospital were reviewed. The presence of metastasis at trocar site of laparoscopic surgery and incision site of laparotomy was examined. RESULTS: Abdominal-wall tumor implantations were developed at two port site in one patient. This result showed an incidence of 0.24% (2/819), as 2 ones in 819 abdominal trocar sites and 0.5% (1/184), as 1 in 184 procedures. This patient had a FIGO stage III a, grade2 adenocarcinoma of endometrium and underwent laparoscopic modified radical hysterectomy with both pelvic lymphadenectomy. In addition, tumor implantation was occurred at laparotomy skin incision site in one patient, a incidence of 2.2% (1/45), as 1 in 45 laparotomy procedures. This patient had a stage II, squamous cell carcinoma of the vagina, who had received second courses of Ifosfamide-Cisplantin neoadjuvant chemotherapy and open laparotomy with radical hysterectomy with upper vaginectomy was followed by laparoscopic pelvic lymphadenectomy due to fixed grossly metastatic nodes. CONCLUSION: Recently, the use of laparoscopic procedure in oncology was increased, the new complication such as abdominal-wall implantation at trocar site was introduced. The abdominal-wall implantation at trocar site could be prevented by patients selection, intraperitoneal and port-site lavage, surgical modification. And all patients should have careful follow up with special attention to the trocar sites. Port site implantation was rare, but could be occurred in the incidence of 0.5% per procedure.

A differential gene expression profiles by cDNA microarrays in endometrioid endometrial carcinoma: a preliminary study / 부인종양

OBJECTIVE: Endometrial carcinoma is the most common gynecological malignant disease in industrialized countries. However, the molecular bases for endometrial tumoriogenesis are not clearly elucidated. Our hypothesis is that there may be some difference in gene expression patterns between normal endometrium and endometrial cancer lesion. In this study, we analyzed the difference of gene expression profile with cDNA microarray. METHODS: Normal endometrial tissues and cancer lesions were gathered from three patient with endometrioid endometrial cancer. cDNA microarray technique (KNU 4.8K chip) was applied to screen the different gene expression profiles. RESULTS: Many genes such as interleukin-1 receptor-associated kinase 1 (IRAK1), bifunctional apoptosis regulator (BFAR), paraneoplastic antigen MA2 (PNMA2), zinc finger protein 257 (ZNF257), ras homolog gene family, member F (in filopodia) (ARHF), cell division cycle 27 (CDC27) were over-expressed in the endometrial cancer tissue. The genes were down-regulated in the endometrial cancer samples included fibronectin 1 (FN1), meiotic checkpoint regulator (MCPR), transforming growth factor beta-stimulated protein TSC-22 (TSC22), programmed cell death 4 (neoplastic transformation inhibitor) (PDCD4), transcript variant 2, matrix metalloproteinase 2 (MMP2), insulin-like growth factor binding protein 4 (IGFBP4), retinoblastoma binding protein 7 (RBBP7), insulin-like growth factor binding protein 3 (IGFBP3), downregulated in ovarian cancer 1 (DOC1). CONCLUSION: The result of this analysis supports the hypothesis that the endometrial cancer tissue has distinct gene expression profile from normal endometium. But, the vaildation of gene expression with RT-PCR and the further study are needed.

Expression of c-Met in ovarian epithelial tumor / 부인종양

OBJECTIVE: This study was performed to evaluate the expression of c-Met in epithelial ovarian carcinoma. METHODS: Paraffin-embedded tissues from 50 epithelial ovarian adenocarcinomas were stained immunohistochemically for c-Met expression. The expression of c-Met was correlated with clinicopathologic parameters including, histologic type, tumor size, and tumor stage. RESULTS: c-Met expression was found in 29 cases (58%) among 50 ovarian cancers. In clinicopathologic study, c-Met expression of epithelial ovarian carcinomas did not show the correlation with clinicopathologic parameters such as histologic type, tumor size and stage. CONCLUSION: c-Met expression might be a potential prognostic marker for patients with advanced stage epithelial ovarian cancers. However, larger population-based studies should be performed to determine the prognostic potential of c-Met expression in advanced ovarian carcinoma.

A Clinicopathological Study in patients with Granulosa Stromal Cell Tumor of the Ovary / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to know the pathological and clinical characteristics of granulosa stromal cell tumor of the ovary. METHODS: From January 1996 to December 2005, patients with granulosa cell tumor of ovary and ones with thecoma, which are included in granulosa stromal cell tumor of the ovary, treated in the Obstetrics and Gynecology, College of Medicine, the Kyungpook National University Hospital of Korea were identified and reviewed retrospectively for patient profiles, mode of therapy, length of survival and so on. RESULTS: There were 14 granulosa cell tumors, and 55 thecomas. The mean age of patients with granulosa cell tumor was 46.8 years old, and 7 women (50.0%) were menopausal. Bilaterality was absent, and mean size of tumor was 11.1 cm. The chief complaints of patients were 3 cases (21.4%) of abdominal discomfort or pain, 3 cases (21.4%) of vaginal bleeding and 4 cases (28.6%) of no symptom. Of 14 cases, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 5 cases (35.7%). Chemotherapy was performed in 5 cases (35.7%), and regimen was combination of BEP (bleomycin+etoposide+cisplatin). According to FIGO staging, 10 cases (71.4%) were stage I. Second look operation was done in one case (7.1%). Among 14 patients of follow-up, one patient (7.1%) was expired. Surgical staging was associated with survival rate of patients. The mean age of patients with thecoma was 49.6 years old, and 28 women (50.9%) were menopausal. Bilaterality was 3 cases (5.4%), and mean size of tumor was 8.5cm. The chief complaints of patients were 14 cases (25.4%) of abdominal discomfort or pain, and 19 cases (34.5%) of no symptom. Of 55 cases, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 21 cases (38.2%). Among 55 patients of follow-up, all patients survived. CONCLUSION: Thecomas are regarded as benign tumors but granulosa cell tumors are characterized by a long natural history with a significant capacity to recur years after apparent clinical cure. The patients with granulosa cell tumor should be followed up indefinitely.

Microsatellite instability analysis on epithelial ovarian tumor / 부인종양

OBJECTIVE: Some genetic alterations are involved in ovarian carcinogenesis. Since some benign and borderline tumors may represent early steps in ovarian carcinogenesis, analysis of precursor lesions could provide evidence that an accumulation of genetic events is required in order for normal ovarian epithelium to generate benign, borderline, malignant tumors. Few pre-invasive ovarian tumors have been studied so far. METHODS: 60 cases of ovarian epithelial tumors, including benign, borderline, and malignant tumors, were analyzed for microsatellite instability (MSI) by gel analysis of paired germ line and tumor DNA. PCR amplification was performed using the panel of 5 microsatellite markers recommended by the NCI (BAT25, BAT26, D2S123, D5S346, D17S250) and 6 additional markers (D1S160, D1S162, D7S522, D11S860, D17S855, D17S932). RESULTS: In this study, D2S123 and D5S346 were the most frequently altered markers in malignant ovarian tumors and D11S860 locus showed MSI in 4 adenomas, 4 boderline tomors, and 10 malignant tumors. Other markers displayed instability with only one or two tumors showing MSI. On the basis of NCI criteria, most benign tumors demonstrat microsatellite stable (MSS). In the borderline tumors, 10 tumors revealed MSS, 8 tumors had low-frequency MSI (MSI-L), and two tumors had high frequency MSI (MSI-H). In the malignant tumors, 6 tumors revealed MSS, 2 tumors had MSI-L, and 12 tumors had high MSI-H. CONCLUSION: According to the results, MSL-H is more frequently seen in the malignant tumors. D2S123 and D5S346 were the most frequently altered markers in the malignant tumors, and D11S860 locus may be involved in early step of carcinogenesis.

Expression of Matrix Metalloproteinase and Urokinase-type Plasminogen Activator in Epithelial Tumors of the Ovary / 부인종양

OBJECTIVE: The most important biologic characters of malignant tumor are invasion and metastasis, and extracellular matrix is first barrier in metastatic process. Therefore, proteases are linked to the malignant phenotype of different solid tumor. METHODS: In this study, the expression of the matrix metalloproteinase (MMP)-2 and MMP-9 and of the serine protease urokinase-type plasminogen activator (uPA) and its inhibitor plasminogen activator inhibitor type 1 (PAI-1) in the ovarian epithelial tumors was investigated. Immunohistochemical expression of MMP-2, MMP-9, uPA, and PAI-1 were analyzed in formalin fixed tumor tissues of 20 benign cystadenomas, 20 low malignant potential (LMP) tumors, and 20 malignant ovarian cancer, including 10 FIGO stage I cancer and 10 stage III cancer. In the same tissue extracts, DNA levels of MMP-2, MMP-9, uPA, and PAI-1 were determined by PCR. RESULTS: The immunohistochemical expression and DNA level of MMP-2, MMP-9, uPA, and PAI-1 were low in benign ovarian tumors but significantly increased LMP tumors and malignant ovarian cancers. The highest values of all of the proteolytic enzymes were detected in stage III ovarian cancers with omentum metastases. There are significant correlations between expression of uPA and MMP. CONCLUSION: These results suggest that high expression of MMP-2, MMP-9, and uPA is associated with activity of tumor invasion and metastasis, and expressions of MMP-2 and MMP-9 are correlated with uPA activity.

A Case of Leiomyomatosis Peritonealis Disseminata / 대한산부인과학회지

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by multiple subperitoneal nodules of benign smooth muscle. Wilson and Peale were the first to describe the multiple peritoneal leiomyomas, while Taubert et al. clearly delineated the features of the lesion and named it LPD. Approximately 100 cases of this disease have been reported in the world literature. High levels of exogenous and endogenous female gonadal steroids is associated with LPD, it suggests that estrogen and progesterone play important role in the pathogenesis of LPD. We report a case of leiomyomatosis peritonealis disseminata with review of literature.

Two Cases of Malignant Melanoma in Vulva / 대한산부인과학회잡지

Vulvar melanomas are account for 4-10% of all malignant tumors of the vulva and are the second most common cause of the vulvar malignancy with the highest frequency in the sixth and seventh decades and rare with incidence of 0.1 to 0.19 per 100,000 women. The most common presentation is a vulvar mass, although pruritis and bleeding also are frequent. In some cases, the melanoma has arisen from a pre-existing benign or atypical pigmented lesion. Vulvar melanomas appear to behavior as other cutaneous melanomas. Both the level of invasion of a malignant melanoma and its thickness have prognostic significance. Vascular space invasion and tumor necrosis also are associated with a poorer prognosis. Recently the radical vulvectomy dose not appear to improve survival when compared to wide local excision with bilateral inguinofemoral lymphadenectomy. We had 2 cases of vulvar melanoma treated with wide local excision and laparoscopic inguinofemoral lymphadenectomy.

A Clinical Study on Adnexal Tumors in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinicopathologic features and clinical outcomes of adnexal tumors in pregnancy. METHODS: After review of charts of 51 patients managed at Kyungpook National University Hospital from January 1996 to June 2002, data including clinical findings, treatments and outcomes were analyzed. RESULTS: The mean age of pregnant women with adnexal tumors was 28.5 years old and the adnexal tumors were more common in nulliparous pregnant women (74.5%) than parous those. There were asymptomatic or no signs in 40 cases (78.4%), lower abdominal pain in 9 cases (17.6%), vaginal bleeding in 1 case (2.0%) and palpable mass by patient herself in 1 case (2.0%). The surgical treatments were performed at first trimester in 9 cases (19.1%), second trimester in 31 cases (66.0%) and third trimester in 7 cases (14.9%). Postoperative histopathologic diagnoses of adnexal tumors were 22 cases (43.1%) of benign cystic teratoma, 7 cases (13.8%) of functional cyst, 6 cases (11.8%) of serous cystadenoma, 4 cases (7.8%) of mucinous cystadenoma, 4 cases (7.8%) of endometrioma, 3 cases (5.9%) of parovarian cyst and 4 cases (7.8%) of malignancy including 2 cases of mucinous cystadenocarcinoma and 2 cases of mucinous tumor, borderline. The complication resulting from adnexal tumors was torsion of 6 cases (11.8%). The outcome of pregnancy was available in 30 cases, term delivery in 25 cases (83.3%), preterm delivery in 3 cases (10%) and spontaneous abortion in 2 cases (6.7%). CONCLUSION: Although the incidence of adnexal tumors with pregnancy is variable according to the reports, the detection rate is more and more increasing due to a widespread application of ultrasound. Thus, obstetricians must always consider adnexal tumors combined with pregnancy and try to minimize the complications of surgery during pregnancy to prevent adverse fetal outcome and maternal morbidity.

A Clinical Study on Adnexal Tumors in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinicopathologic features and clinical outcomes of adnexal tumors in pregnancy. METHODS: After review of charts of 51 patients managed at Kyungpook National University Hospital from January 1996 to June 2002, data including clinical findings, treatments and outcomes were analyzed. RESULTS: The mean age of pregnant women with adnexal tumors was 28.5 years old and the adnexal tumors were more common in nulliparous pregnant women (74.5%) than parous those. There were asymptomatic or no signs in 40 cases (78.4%), lower abdominal pain in 9 cases (17.6%), vaginal bleeding in 1 case (2.0%) and palpable mass by patient herself in 1 case (2.0%). The surgical treatments were performed at first trimester in 9 cases (19.1%), second trimester in 31 cases (66.0%) and third trimester in 7 cases (14.9%). Postoperative histopathologic diagnoses of adnexal tumors were 22 cases (43.1%) of benign cystic teratoma, 7 cases (13.8%) of functional cyst, 6 cases (11.8%) of serous cystadenoma, 4 cases (7.8%) of mucinous cystadenoma, 4 cases (7.8%) of endometrioma, 3 cases (5.9%) of parovarian cyst and 4 cases (7.8%) of malignancy including 2 cases of mucinous cystadenocarcinoma and 2 cases of mucinous tumor, borderline. The complication resulting from adnexal tumors was torsion of 6 cases (11.8%). The outcome of pregnancy was available in 30 cases, term delivery in 25 cases (83.3%), preterm delivery in 3 cases (10%) and spontaneous abortion in 2 cases (6.7%). CONCLUSION: Although the incidence of adnexal tumors with pregnancy is variable according to the reports, the detection rate is more and more increasing due to a widespread application of ultrasound. Thus, obstetricians must always consider adnexal tumors combined with pregnancy and try to minimize the complications of surgery during pregnancy to prevent adverse fetal outcome and maternal morbidity.

Usefulness of Phosphorylated Insulin-like Growth Factor Binding Protein-1 for Prediction of Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate whether the presence of phIGFBP-1 in cervical secretion of patients with symptoms suggestive of preterm labor predicts preterm delivery. METHODS: Patients who were examined at the Department of Obstetrics and Gynecology, Daegu Fatima hospital between 24 weeks' and 34 weeks' gestation with intact membrane, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilatation or=10 microgram/L. Tocolysis and corticosteroids were used when clinically indicated after specimen collection. RESULTS: phIGFBP-1 was detected in 21 patients among 50 patients analysis. Compared with patients who had negative results, patients who had positive results for phIGFBP-1 were more likely to deliver before 37 weeks (p<0.001), before 34 weeks (p=0.008) and within 7 days (p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value were 77.3%, 85.7%, 81.0%, and 8.28%. Patients with positive results were also treated more with tocolysis and corticosteroids use than patients with negative results. Gestational age at delivery (p<0.001) and birthweight (p<0.001) were lower for patients with positive results. CONCLUSION: In a population of patients with symptoms, the presence of phIGFBP-1 in cervical secretions defines a subgroup at increased risk for preterm delivery.