A Clinical Study of the Management of Malignant Gestational Trophoblastic Disease (1981-2001) / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to compare and analyze the effectiveness of different regimens in the treatment of malignant gestational trohphoblastic disease from 1981 to 2001. MATERIALS AND METHODS: This study included 307 patients with malignant gestational trophoblastic disease, who were admitted in Chonnam National University Hospital from 1981 to 2001. Remission rate, remission induction period, toxicity of chemotherapeutic agents depending on risk group and stages were analyzed. RESULTS: While stage I and II showed 100% of remission rate, stage III and IV showed 99.2%, 64.7% of remission rate respectively, resulting in 99.7% of overall remission rate. From 1981 to 1988, average number of cycle and periods for complete remission were 3.4 cycles and 80.3 days for low risk GTT, 6.2 cycles and 144.8 days for high risk GTT. From 1989 to 2001, average number of cycle and remission induction period were 4.1 cycles and 69.9 days, 5.3 cycles and 88.9 days, 6.6 cycles and 162.2 days for low, middle, and high risk GTT, respectively. As adjuvant therapy, 3 cases of hysterectomy and 2 cases of lobectomy were done. And radiation therapy was done on 2 cases of lung lesions and 1 cases of brain lesion. Etoposide and Actinomycin D caused less hepatotoxicity than Methotrexate did. EMA regimen shortened the overall period of treatment and caused less side effect, showing effectiveness equivalent to that of EMA CO regimen. With same therapeutic effect, less side effect and shortened administration period, EMA regimen might be able to substitute EMA CO regimen in high risk GTT. However, there should be more clinical trials before confirmation of its superior therapeutic efficacy over EMA CO regimen. CONCLUSION: When chemotherapy combined with adjuvant therapy such as operation and irradiation was done on appropriate patient group, which were selected based on risk factors and stage, it produced higher remission rate. For better therapeutic outcome, there should be further study on early detection technique and therapeutic effect of other chemotherapeutic agents.

A Case of Intestinal Type Mucinous Adenocarcinoma and Strumal Carcinoid Tumor arising in One of Bilateral Mature Cystic Teratoma of the Ovary / 대한산부인과학회잡지

Malignant transformation of mature cystic teratoma (MCT) is an uncommon complication occuring in approximately 1-3%. Any of the constituent tissues of a teratoma has the potential to undergo malignant transformation; squamous cell carcinoma is the most commonly associated cancer, however, adenocarcinomas or carcinoid tumors arising in mature cystic teratoma are uncommon, especially simultaneously. We present an unusual case of postmenopausal women having mucinous adenocarcinoma and strumal carcinoid tumor simultaneously arising in one of bilateral mature cystic teratoma of the ovary. We suggest malignant transformation of MCT should be treated according to the management of the worst histologic diagnosis of the transformations if there are 2 or more malignancies are arised in MCT of the ovary.