The Differences in Second Trimester Quad Test Markers in Patients with Severe Preeclampsia Depending on the Disease Onset Time and the Presence of Fetal Growth Restriction / 대한주산의학회잡지

OBJECTIVE: To compare the differences in the second trimester Quad test markers in patients who subsequently developed preeclampsia depending on the disease onset time and the presence of fetal growth restriction (FGR). METHODS: A retrospective study was carried out on 66 women with severe preeclampsia and 345 controls who were delivered at Dong-A University hospital and Ilsin Christian Hospital from January 2006 to December 2008. Severe preeclampsia patients were grouped according to with (n=30) or without (n=36) FGR. Severe preeclampsia patients were also grouped according to early onset (n=16) or late onset (n=50) The levels of the second trimester human chorionic gonadotropin (hCG), inhibin-A, unconjugated estriol (uE3), alpha-fetoprotein (AFP) were compared in each group. RESULTS: In the pregnancies that subsequently developed severe preeclampsia, the second trimester hCG, inhibin-A and AFP were significantly higher than the controls. We found that levels of hCG, inhibin-A in severe preeclampsia complicated by FGR were significantly higher than those without FGR. We also found that levels of AFP and inhibin-A in early onset severe preeclampsia were significantly higher than late onset severe preeclampsia. CONCLUSION: The levels of second trimester Quad test markers in patients that subsequently developed severe preeclampsia were different according to with or without FGR and onset time.

Two cases of malignant mesothelioma of the peritoneum and pericardium / 대한산부인과학회지

Malignant mesothelioma is a rare neoplasm and arises from the serosal lining of the pleural, peritoneal and pericardial cavities. The median survival rang from 5 to 12 months, mainly because of lack of effective treatment. The incidence is approximately one per 1,000,000 and peritoneal mesothelioma represents one fourth of all mesotheliomas. There is a relationship between mesothelioma and asbestos exposure, but non-asbestos related cases were reported. Treatments of malignant mesothelioma are cytoreductive surgery and adjuvant chemotherapy, but current treatment options are unsatisfactory. We report two cases of malignant mesothelioma of the peritoneum and pericardium treated by operation and adjuvant chemotherapy with a brief review of literature.

Two cases of malignant mesothelioma of the peritoneum and pericardium / 대한산부인과학회지

Malignant mesothelioma is a rare neoplasm and arises from the serosal lining of the pleural, peritoneal and pericardial cavities. The median survival rang from 5 to 12 months, mainly because of lack of effective treatment. The incidence is approximately one per 1,000,000 and peritoneal mesothelioma represents one fourth of all mesotheliomas. There is a relationship between mesothelioma and asbestos exposure, but non-asbestos related cases were reported. Treatments of malignant mesothelioma are cytoreductive surgery and adjuvant chemotherapy, but current treatment options are unsatisfactory. We report two cases of malignant mesothelioma of the peritoneum and pericardium treated by operation and adjuvant chemotherapy with a brief review of literature.

A case of successfully resected suburethral endometriosis with dysuria / 대한산부인과학회지

Urinary tract endometriosis is rare, especially suburethral endometriosis with symptoms of dysuria and urgency is very rare. We report a case of successful surgically treated suburethral endometriosis through the Retzius space.

A case of successfully resected retroperitoneal hemangiopericytoma / 대한산부인과학회지

Hemangiopericytoma is a rare mesenchymal neoplasm, accounting for about 1% of vascular tumor. Hemangiopericytoma is known to be derived from the vascular pericyte and occurs most commonly lower extremities, pelvis and retroperitoneum. Surgical radical excision is the treatment of choice. Because of malignant features of hemangiopericytoma, long term and close follow-up is important. We report a case of successfully resected retroperitoneal hemangiopericytoma.

Validation of a nomogram for predicting outcome of vulvar cancer patients, primarily treated by surgery, in Korean population: multicenter retrospective study through Korean Gynecologic Oncology Group (KGOG-1010) / 부인종양

OBJECTIVE: Regarding vulvar cancer, a nomogram has been suggested for the prediction of relapse-free survival (RFS). While the nomogram has been developed and validated in a Western study, there was no validation in Korean population. Thus, we have undertaken the study to assess the applicability of nomogram for predicting RFS in Korean patients with vulvar cancer. METHODS: A total of 204 cases newly diagnosed as vulvar cancer between 1982 and 2006 were identified. Among them 70 cases were not eligible due to inappropriate cell type (40 cases) and radiation as primary therapy (30 cases). Forty-four cases were not evaluable due to inadequate data and persistent disease. Finally a total of 90 patients primarily treated by surgery were included for analysis. Variables including age and the characteristics of primary tumor, nodal status, and surgical margin were collected for predicting RFS based on nomogram, which was compared with actual RFS. A calibration plot was drawn showing the actual versus predicted probability for 6 groups of patients segregated according to their predicted probabilities. In addition, discrimination of the nomogram was quantified with the concordance index. RESULTS: Patients' mean age was 58 years and mean follow-up period was 47.9 months. Observed 2y- and 5y-RFS rates were 81% and 68%, respectively, corresponding to 79% and 72% in the original cohort. The trend line in calibration plot showed comparable concordance with an ideal line, having a slope of 1.04 for 2y-RFS (R(2)=.35) and 0.98 for 5y-RFS (R2=.80), respectively. The concordance index was 0.79 in the KGOG data set, which was improved to 0.82 with the data set limited to squamous cell carcinoma. CONCLUSION: The nomogram provides the predictive capacity for relapse-free survival in Korean patients with vulvar cancer.

The efficacy of concurrent cisplatin and 5-flurouracil chemotherapy and radiation therapy for locally advanced cancer of the uterine cervix / 부인종양

OBJECTIVE: To evaluate the efficacy of concurrent chemoradiation (CCRT) using 5-flurouracil (5-FU) and cisplatin for locally advanced cervical cancer. METHODS: We reviewed the medical records of 57 patients with locally advanced cervical cancer (stage IIB-IVA and bulky IB2-IIA tumor) who underwent the CCRT at Dong-A University Hospital from January 1997 to June 2007. The CCRT consisted of 5-FU, cisplatin and pelvic radiation. Every three weeks, 75 mg/m(2) cisplatin was administered on the first day of each cycle and 5-FU was infused at the dose of 1,000 mg/m(2)/d from the second day to the fifth day of each cycle. Radiation was administered to the pelvis at a daily dose of 1.8 Gy for five days per week until a medium accumulated dose reached to 50.4 Gy. If necessary, the radiation field was extended to include paraaortic lymph nodes. Consolidation chemotherapy was performed using 5-FU and cisplatin. RESULTS: Fifty-seven patients were enrolled and the median follow-up duration was 53 months (range 7-120 months). The overall response rate was 91.5% (74% complete response and 17.5% partial response). The 5-year overall survival and 3-year progression free survival rates were 69.4% and 74.9%, respectively. During the follow-up period (median 23 months, range 7-60 months), fourteen patients were diagnosed as recurrent disease. CONCLUSION: CCRT with 5-FU and cisplatin which is the primary treatment for patients with locally advanced cervical cancer was effective and well tolerated.

Two cases of thromboembolism in clear cell ovarian adenocarcinoma / 대한산부인과학회지

High incidence of deep venous thrombosis after radical pelvic surgery is well known. Among gynecologic malignancies, ovarian cancer, especially clear cell adenocarcinoma is likely to develop thromboembolism. We report 2 cases of pulmonary thromboembolism and deep vein thrombosis in ovarian clear cell carcinoma with endometriosis and history of IVF-ET during cislatin-irinotecan chemotherapy following the surgery.

The efficacy of MRI to diagnosis the bladder and rectal invasion in cervical cancer / 부인종양

OBJECTIVE: To evaluate the efficacy of MRI in bladder or rectal invasion of cervical cancer. METHODS: Between January 2000 and December 2005, 106 cervical cancer patients who underwent cystoscopy or sigmoidoscopy examination retrospectively compared with results of the MRI finding. A 5-point invasion score was used to determine bladder or rectal invasion in MRI (1 = no invasion, 3 = serosal invasion, 5 = definite mucosal invasion). Score of 3 or above was suspicious for both rectal and bladder invasion. RESULTS: Eighty one patients with negative for both rectal and bladder invasion in MRI were normal in cystoscopy and sigmoidoscopy. MRI identified 17 patients with suspected bladder invasion, 7 patients had confirmed bladder invasion in cystoscopy. MRI identified 11 patients with suspected rectal invasion, 1 patients had confirmed rectal invasion in sigmoidoscopy. The detection of rectal and bladder invasion by MRI had a negative predictive value of 100%. CONCLUSION: The use of a 5-point scoring system for predicting rectal or bladder invasion in MRI is accurate in detecting cervical cancer patients with no evidence of rectal or bladder invasion. The cervical cancer patients with no evidence of rectal or bladder invasion in MRI can obviate invasive cystoscopy and sigmoidoscopy.

Intensity Modulated Whole Pelvic Radiotherapy in Patients with Cervix Cancer: Analysis of Acute Toxicity / 대한방사선종양학회지

PURPOSE: To evaluate acute toxicities in cervix cancer patients receiving intensity modulated whole pelvic radiation therapy (IM-WPRT). MATERIALS AND METHODS: Between August 2004 and April 2006, 17 patients who underwent IM-WPRT were analysed. An intravenous contrast agent was used for radiotherapy planning computed tomography (CT). The central clinical target volume (CTV) included the primary tumor, uterus, vagina, and parametrium. The nodal CTV was defined as the lymph nodes larger than 1 cm seen on CT and the contrased-enhanced pelvic vessels. The planning target volume (PTV) was the 1-cm expanded volume around the central CTV, except for a 5-mm expansion from the posterior vagina, and the nodal PTV was defined as the nodal CTV plus a 1.5 cm margin. IM-WPRT was prescribed to deliver a dose of 50 Gy to more than 95% of the PTV. Acute toxicity was assessed with common toxicity criteria up to 60 days after radiotherapy. RESULTS: Grade 1 nausea developed in 10 (58.9%) patients, and grade 1 and 2 diarrhea developed in 11 (64.7%) and 1 (5.9%) patients, respectively. No grade 3 or higher gastrointestinal toxicity was seen. Leukopenia, anemia, and thrombocytopenia occurred in 15 (88.2%). 7 (41.2%), and 2 (11.8%) patients, respectively, as hematologic toxicities. Grade 3 leukopenia developed in 2 patients who were treated with concurrent chemoradiotherapy. CONCLUSION: IM-WPRT can be a useful treatment for cervix cancer patients with decreased severe acute toxicities and a resultant improved compliance to whole pelvic irradiation.

A Case of Ovarian Mucinous Borderline tumor in Postoperatively Diagnosed Dermatomyositis accompanying Colon Cancer / 대한산부인과학회지

Dermatomyositis is rare inflammatory condition of the skin and muscles that the incidence is 5 cases per million population per year. This disease was strongly associated with malignant disease, particularly ovarian, lung, pancreatic, stomach and colorectal cancers, and non-Hodgkins lymphoma. A 56-year-old female patient had a ovarian tumor, thereafter she presented with typical skin lesions and muscle weakness. And then we found she had a colon cancer. Here we present the case with brief review of literature.

Differences of EDR Chemoresistance Assay and Prognosis between Recurrent Micropapillary Serous Ovarian Carcinoma and Serous Ovarian Carcinoma / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to identify chemoresistance and prognosis differences between recurrent micropapillary serous ovarian carcinoma (MPSC) and serous ovarian carcinoma. METHODS: The Extreme drug resistance (EDR) assay was performed in 13 recurrent micropapillary serous ovarian carcinoma and 56 recurrent serous ovarian carcinoma. RESULTS: Mean age of MPSC and Serous ovarian cancer were 41.1 and 58.0 respectively (p<0.05). Etoposide and Doxil were the two least resistance chemotherapeutic agents to recurrent MPSC but the most resistance agents to recurrent serous ovarian cancer. Taxol and cisplatin were the two most resistance agents to MPSC. The mean follow up was 42 months (range 1-173) The five-year overall survival rate of MPSC and serous ovarian carcinoma were 71.6% and 33.9% respectively. The mean survival were 136 months in MPSC compared with 72 months in serous ovarian carcinoma (p<0.035). CONCLUSION: In this retrospective analysis, MPSC showed very different in EDR results and favorable prognosis compare to serous ovarian carcinoma.

Efficacy of loop conization with right-angled triangular shaped excisor in patients with cervical intraepithelial neoplasia 3 / 부인종양

OBJECTIVE: To evaluate the therapeutic value of conization using right-angled triangular shape loop cone biopsy excisor in patients with CIN 3 who want preserve the uterus. METHODS: A retrospective review of 64 patients was performed who underwent therapeutic conization for CIN 3 by using right-angled triangular shape loop cone biopsy excisor from January 2000 to August 2005. RESULTS: The mean duration of 64 follow-up patients who had conization for therapeutic purpose was 21.5 months (range 10-68). Their mean age was 41.1 years old and mean parity was 1.7. Two of 64 patients had CIN 3 on exocervix margin. During the followed up period, only one person (1/64) had relapse of CIN 3, hence, a simple hysterectomy was done. CONCLUSION: Right-angled triangular shape loop cone biopsy excisor is more effective than U-shaped loop with low rate of margin positive and recurrent rate in conservative treatment in CIN 3 patients who want to preserve uterus or fertility.

A Case of Premature Ovarian Failure in Patient with Unbalanced translocation on the X chromosome / 대한산부인과학회지

Premature ovarian failure (POF) is defined as the complete cessation of menses less than 40 years of age. The criteria are more than four months of amenorrhea, with serum follicle stimulating hormone value of >40 mIU/mL and the frequency of POF is about 1% of all women. Although the etiologies of POF remain unknown, suggested factors are genetic, autoimmune, chemotherapy and environmental toxicants. The cytogenetic abnormalities predominantly concern the X chromosome, including Turner syndrome, Fragile X syndrome and deletion or translocation of X chromosome. We report a case of premature ovarian failure with the following karyotype: 46,X,der(X), t(X;11)(q28;p13).

The Histologic Features of the Uterus and Adnexa Extirpated from Gender Identity Disorder Patients with Depot Androgen Injection / 대한불임학회지

OBJECTIVE: To investigate the histologic features of the uterus and adnexae extirpated from gender identity disorder (GID) patients that received depot androgen injection. METHODS: We reviewed the histologic findings of the uterus and adnexae removed from sixteen GID patients, who had taken depot androgen injection for 5~168 months. RESULTS: Fourteen patients (87.5%) showed the atrophied epithelium of exocervix and all of 16 patients (100%) showed the atrophy of endometrium. Seven patients (43.7%) showed multiple cystic follicles in the ovarian cortex and 6 patients (37.5%), 3 patients (18.7%) showed corpus albicans and corpus luteum, respectively. CONCLUSIONS: Exogenous androgen induced atrophy of cervix and endometrium. This effect was more prominent in the endometrium. In addition, PCO-like histologic features were observed in the ovary.

Analysis of prognostic factor and survival in patients with epithelial ovarian cancer treated with combination chemotherapy / 부인종양

OBJECTIVE: The purpose of this retrospective study is to identify and to discuss the clinical relevance of prognostic factors and survival rate in patients with epithelial ovarian cancer treated with combination chemotherapy. METHODS: A total of 98 histologically verified patients with epithelial ovarian cancer who were treated at Dong-A Medical Center between 1997 and 2002 were used for analysis. The 30 patients having borderline tumor were excluded. Kaplan-Meier survival curves were computed and tested statistically by the log rank test. A multivariable Cox proportional hazard model was applied to access the prognostic significance of the different covariates. RESULTS: The median age of the patients with epithelial ovarian cancer was 46.6 years and FIGO stage distribution was 38.2% for stage I, 5.9% for stage II, 44.1% for stage III, 11.8% for stage IV. The histopathologic type distribution were serous type (45.6%), mucinous type (36.8%), endometriod type (8.8%), clear cell type (7.4%), mixed type (1.4%). Residual tumor volume size of less than 1 cm or 1 cm was identified in 50 patients (73.5%) and more than 1 cm in 18 patients (26.5%) after primary cytoreductive surgery. The overall 5-year survival rate was 55.7%. According to univariate analysis, FIGO stage (p<0.0001), residual volume (p<0.0001), ascitic fluid volume (p=0.0001), menopause (p=0.0021), CA125 (p=0.0058), tumor size (p=0.0099), age (p=0.0113) were significant prognostic factors affecting survival. However, multivariate analysis in this study demonstrated that FIGO stage (p=0.011), residual tumor volume (p=0.026), ascitic fluid volume (p=0.031) were found to be the most significant independent prognostic factors. CONCLUSION: In this retrospective study, the overall 5-year survival rate of patients with epithelial ovarian cancer treated with combination chemotherapy was 55.7% and 5-year survival rate of stage I/II was 95.8%, stage III 28.4%, stage IV 0%. The overall survival of stage I/II were 90 months, stage III 39 months, stage IV 17 months. In multiple analysis, FIGO stage, residual volume, ascitic fluid volume were identified as three most significant independent prognostic factors.

Three cases of Twin-to-Twin Transfusion Syndrome which were managed with maternal digitalization / 대한산부인과학회잡지

Twin-to-twin transfusion syndrome (TTTS) is one of the complications showing high mortality rate in monochorionic twins with vascular communication in the placenta. Clinical manifestations of TTTS are usually characterized by polyhydramnios, circulatory overload, cardiac failure and fetal hydrops in the recipient twin and symmetrical fetal growth restriction, oligohydramnios, hypovolemia and anemia in the donor twin. TTTS occurres in 10-35% of monochorionic twins. We report three cases of TTTS with fetal hydrops in which amnioreduction was serially attempted and maternal digoxin treatment was tried for the therapeutic purpose.

The Changes of Serum Nitric Oxide and Platelet Activating Factor Concentrations in Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: The aim of this study is to determine whether any association exists between preeclampsia and the maternal serum level of nitric oxide (NO) and platelet activating factor (PAF). METHODS: NO concentrations were measured using Stuehr's method and PAF concentrations were measured with [3H]PAF scintillation proximity assay (SPA) system (Amersham Pharmacia Biotech). Data were analyzed with SAS windows version 6.12, with significance established at p<0.05. RESULTS: The mean (+/-SD) maternal serum concentrations of NO were significantly higher in the group with severe preeclampsia (5.535+/-0.343 ug/ml) and mild preeclampsia (5.891+/-0.481 ug/ml) than in the normotensive pregnancy group (2.036+/-0.744 ug/ml) (p<0.05). The mean (+/-SD) maternal serum concentrations of PAF were significantly higher in the group with severe preeclampsia (928.9+/-32.3 ng/ml) and mild preeclampsia (789.1+/-63.9 ng/ml) than in the normotensive pregnancy group (435.8+/-59.5 ng/ml) (p<0.05). The mean birth weight was lower in the mild and severe preeclampsia groups than in the normotensive pregnancy group (p<0.05). CONCLUSION: Maternal serum NO and PAF concentrations were more increased in preeclampsia than normotensive pregnancy group. NO may therefore serve as compensatory mechanism for vasoconstriction of preeclampsia and PAF as a marker for the risk of preeclampsia.

A Case of Multiple Placental Chorioangioma Combined with Oligohydramnios / 대한산부인과학회잡지

Chorioangioma is the most common benign tumor of the placenta and associated with adverse perinatal outcome. The prevalence of chorioangioma of the placenta is about 1 percent. The most placental chorioangioma has no clinical significance. But the uncommon large (greater than 5 cm in diameter) chorioangioma may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal heart failure, hydrops fetalis, fetal growth restriction, fetal microangiopathic hemolytic anemia, fetal thrombocytopenia, toxemia of pregnancy, maternal thrombocytopenia, and maternal coagulopathy. The ultrasonography and Color Doppler are used for diagnosis of these lesions. If chorioangioma is suspected, Color Doppler study is informative to confirm the presence of the vascular channels. We report a case of multiple chorioangioma combined with oligohydramnios and discuss the noxious effects of this benign tumor on the mother and the fetus.

A Case of Spontaneously Regressed Hyperreactio Luteinalis Occurred in Normal Pregnancy / 대한산부인과학회잡지

Hyperreactio luteinalis rarely occurs in normal single pregnancy. About 50 such cases have been published. It is usually occurs in trophoblastic disease. This case is a huge hyperreactio luteinalis that detected in gestational age 16 weeks. The patient delivered a normal female infant at 41th week of gestation without any mass related problems. The hyperreactio luteinalis was a benign condition in itself with normal spontaneous remission in two months after delivery. Also the level of elevated human chorionic gonadotropin became normal. The conservative management was appropriated. This case is noteworthy because it resulted in spontaneous regression without surgical intervention and conserved ovarian tissue.