Krukenberg tumors of gastric origin versus colorectal origin

OBJECTIVE: The aim of this study is to compare the each clinical manifestation related with its mean survival time of Krukenberg tumors (KTs) of gastric origin versus with that of colorectal origin. METHODS: A total of 156 consecutive patients diagnosed with KTs of the ovary who underwent surgical treatment at a single institution between 2001 and 2010 were retrospectively evaluated. Each clinical manifestation related with its mean survival time compared two different groups. Survival analyses and comparisons were performed using the Kaplan-Meier method. RESULTS: Among the 156 patients with KT, 111 patients with KTs of gastric origin and 45 patients with KTs of colorectal origin were identified. For all patients with KTs, median survival time was 22.7 months. Each mean survival time among all patients with KTs of gastric origin and colorectal origin was 19.2 months and 27.3 months. The results showed that mean survival time of postmenopausal patients was 19.0 months compared with 32.5 months for premenopausal patients (P=0.015). Among all patients, mean survival time of those with metachronous cancer was longer than those with synchronous cancer (P=0.001). In all cases, especially when only one ovary was invaded, the mean survival time was relatively higher (P=0.001). CONCLUSION: Patients with KTs of colorectal origin had a better prognosis than those of gastric origin. In all cases of KT, the mean survival time was significantly longer in postmenoposal patients, metachronous disease and unilateral ovarian involvement. Notably, synchronous, ascites positive, and ovary only metastasis showed more longer mean survival time in the KTs of colorectal origin than KTs of gastric origin.

Promising treatment results of adjuvant chemotherapy following radical hysterectomy for intermediate risk stage 1B cervical cancer

OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy of adjuvant chemotherapy following radical hysterectomy for intermediate risk stage IB cervical cancer. METHODS: From January 1993 to December 2007, a total of 100 patients of stage IB were enrolled in this study who had at least two of the following three intermediate risk factors (deep stromal invasion, lymphovascular space involvement, and large tumor size) after radical hysterectomy and all patients had no high risk factors and no radiotherapy. Of these patients, 22 patients had surgery only and 78 patients had cisplatin-based combination chemotherapy as adjuvant therapy postoperatively to improve survival. Kaplan-Meier survival curves and Cox's proportional-hazards regression model and log-rank test were used for survival analysis and to estimate the impact of prognostic factors on survival. RESULTS: The mean age was 52 years (range, 28 to 76 years). The overall survival rate of all intermediate tumors are 92% (92/100). Surgery only group is 81.8% (18/22) and adjuvant chemotherapy group is 94.9% (74/78). Comparison of survival between two groups revealed significant statistical difference in both univariant and multivariant survival analysis (P<0.05). The main toxicities of adjuvant chemotherapy were bone marrow suppression (18%), nausea and vomiting (5.2%) and alopecia in etoposide-cisplatin chemotherapy group (100%) but most side effects of postoperative adjuvant chemotherapy were transient, reversible and within acceptable limits to all patients. CONCLUSION: Cisplatin based combined adjuvant chemotherapy for intermediate risk tumors after radical hysterectomy is promising with significant improvement of overall survival and with acceptable toxicity profile.

Discrepancy Between the 2007 Korean Medical Licensing Examination and the 2006 Learning Objectives for Medical Students / 한국의학교육

PURPOSE: The purpose of this research was to evaluate the relationship between the 2007 Korean medical licensing examination (KMLE) and the 2006 Learning Objectives for Medical Students (LOMC) produced by the Association of Korean Medical Colleges' Council of Deans. METHODS: A total of 493 questions from the 2007 KMLE and the 2006 LOMC were used. The percentage and the frequency of each LOMC used in the 2007 KMLE were analyzed. The possibility of answering questions guided by the LOMC was analyzed. When questions could not be answered using the LOMC, we further categorized these questions into areas of medicine and specific causes. RESULTS: A total of 669 (14.03%) learning objectives were used to solve questions from the 2007 KMLE. A learning objective was used a maximum of 5 times in the 2007 KMLE, and the percentages of one time, 2 times, 3 times, 4 times, and 5 times were 84.90%, 12.11%, 2.39%, 0.45%, and 0.15%, respectively. Four hundred six of 493 questions were solvable using the learning objectives, and 87 (17.65%) were not. When several steps were needed to solve a question, 15 questions (17.24%) could not be solved due to a lack of learning objectives for some of those steps. Overall, the 87 unsolvable questions were from internal medicine (37.9%), obstetrics & gynecology (14.9%), medical law (12.6%), pediatrics (10.3%), general surgery (9.2%), psychiatry (6.9%), and preventive medicine (1.1%). Questions difficult to solve specifically due to absent learning objectives were in the areas of treatment and procedure (29.67%), test and diagnosis (13.19%), symptoms (9.89%), pathophysiology (7.69%), complications (6.59%), and disease entity (6.59%). CONCLUSION: Discrepancy was observed between the 2007 KMLE and the 2006 LOMC. To solve this problem, the reorganization of both the KMLE and the LOMC based on a clear consensus of a primary care physician's role is believed to be needed.

Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 as prognostic factors in endometrial cancer / 부인종양

OBJECTIVE: Homeostasis of the extracellular matrix (ECM) is maintained by the action of a specific system of proteolytic enzymes known as matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP). The MMP/TIMP system regulates the composition and turnover of ECM to control the site and extent of connective tissue remodeling. In pathologic conditions, MMP play a key role in degradation of basement membrane and extracellular matrix, and is responsible for cancer invasion, progression and metastasis. The aim of this study is to evaluate the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. METHODS: Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 were assessed by immunohistochemistry in a total of 55 endometrial cancers and were analyzed by the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. RESULTS: Expression rates of MMP-2,-9, TIMP-1, and TIMP-2 were 71.7%, 54.9%, 41.2%, and 76.5% respectively. Expression of MMP-2 was correlated with the group of positive lymph node metastasis in endometrial cancer (p=0.04). Specially, coexpression of MMP-2 and TIMP-2 was significantly more frequent in the group of positive lymph node metastasis (p<0.01) and the group of positive peritoneal CONCLUSION: The expressions of MMP and TIMP were not a significant difference in survival analysis, but this study was recognized that the coexpression MMP-2 and TIMP-2 is correlated with lymph node metastasis and positive peritoneal cytology.

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.

A study of support-therapeutic effect and reducing side effect for high-dose vitamin C use of gynecological cancer patients with chemotherapy / 부인종양

OBJECTIVE: The high-dose vitamin C is useful in the cancer. Consequently its use should have become how many help even from gynecological cancer patient who is in chemotherapy. METHODS: The study was performed prospective on 57 patients who is diagnosed initially the gynecological cancer during chemotherapy at Gospel Hospital of Kosin University between January 2005 and October 2006. The study was divided to its use 29 (cervix cancer: 17, ovarian cancer 12) and no high-dose vitamin C use 28 (cervix cancer: 11, ovarian cancer 17). The cervix cancer was treated by FP chemotherapy for all stage and the ovarian cancer was treated by CC chemotherapy for stage 1, CT or PT chemotherapy for advanced stage for 6 times respectively regarding a treatment in tumor marker change aspect and the side effect researched GOG classifications. RESULTS: It evaluated the nausea and vomiting significantly in ovarian cancer (p<0.05). It evaluated for liver enzyme, Hb, WBC, platelet serum creatinine, sensory, motor nervous system and tumor marker with the high-dose vitamin C group does not have the difference from the control group statistically. CONCLUSION: The high-dose vitamin C is a possibility of reducing nausea and vomiting in the ovarian cancer chemotherapy without other side effect. The regarding a tumor marker change it was not significantly but when it analyzed a recurrence a survival rate with more patient and follow up in long period, its use of should have become how many help in gynecological cancer treatment.

A Case of Peritoneal Desmoplastic Small Round Cell Tumor which involved both ovaries / 대한산부인과학회지

Peritoneal desmoplastic small round cell tumor is a very rare malignant neoplasm and has specific clinical features; It is predominant in children and young males and has a well-demarcated large intra-abdominal tumor, which has not been associated with a primary visceral organ, with diffusely scattered multiple small tumors and rarely involves ovaries. It is a very aggressive and fast growing tumor along the peritoneal surfaces of the abdomen and pelvis. It has a typical histologic features and a specific immunohistochemical staining pattern. There is no definite treatment. It responses to surgery and chemotherapy at early period of therapy but relapses soon and rapidly progresses and then causes the death. We have experienced a peritoneal desmoplastic small round cell tumor which involved both ovaries, so we report this case with a brief review of literature.

Clinocopathologic analysis of survival of 98 patients with uterine endometrial cancer / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the clinicopathologic prognostic factors and overall survival in patients with uterine endometrial cancer. METHODS: From Jan, 1995 to Dec. 2000, medical records of 98 patients with endometrial cancer treated in Kosin University Gospel Hospital were reviewed and the overall survival of patients was determined by support of the death statistics of Korea National Statistical Office. Survival rate was analyzed by Kaplan-Meier method and log-rank test was used for curve comparison, Cox proportional hazards model was used for multivariate analysis. RESULTS: The median age of all patients was 53 years. The most common presenting symptom was abnormal vaginal bleeding (65.3%). The most common histological type was endometrioid adenocarcinoma. (85.1%) The overall 5 years survival rate (5YSR) for all 98 patients was 66.8%. The overall 5YSR for premenopause and postmenopause were 80% and 50%, respectively (p=0.08). The overall 5YSR for preop CA-125 level above 35 U/mL, below 35 U/mL were 40%, 80% (p=0.001). The overall 5YSR of stage I, stage II, stage III, stage IV were 86.8%, 76.9%, 39.4%, 14.4% (p=0.001). The overall 5YSR of grade 1, grade 2, grade 3 were 75%, 70%, 45% (p=0.002). The overall 5YSR of myometrium invasion of none, or=1/2, were 84.3%, 80.3%, 57.2% (p=0.004). The overall 5YSR of peritoneal cytology of negative, posivite were 73.4%, 23.8% (p=0.001). The overall 5YSR of lymphnode metastasis negative, positive were 80.1%, 15% (p=0.001). CONCLUSION: The age (>50), preop CA-125 level, FIGO surgical stage, grade, myometrial invasion, lymph node metastasis and peritoneal cytology were significant prognostic factors of uterine endometrial cancer affecting 5YSR by univariate analysis. The myometrium invasion and grade were significant prognostic factors affecting 5YSR by multivariate analysis.

Docetaxel and Carboplatin Combination Chemotherapy against Persistent or Recurrent Ovarian Cancer as 2nd or more line Chemotherapy / 대한산부인과학회잡지

OBJECTIVE: We evaluated the effects and toxicities of docetaxel-carboplatin combination chemotherapy against recurrent or persistent ovarian cancer who were previously heavily treated with one or more lines of chemotherapy. METHODS: Sixteen patients with a recurrent or persistent ovarian cancer, previously received first or more line chemotherapy, had been treated with docetaxel-carboplatin combination chemotherapy at Kosin Medical Center from December 2001 to May 2003. The docetaxel-carboplatin combination chemotherapy consists of docetaxel 75 mg/m2 and carboplatin 450 mg/m2 given i.v. every 3-4 weeks. The response of patients was evaluated with the tumor marker (serum CA-125) and imaging studies (ultrasonogram, CT, MRI). The toxicities were defined according to the WHO toxicity criteria. RESULTS: The overall response rate was 50% (8/16). Eight patients were evaluable for response by WHO criteria. The response rate by WHO criteria was 37.5% (3/8). In detail, complete response was 12.5%, partial response was 25%, stable disease was 37.5% and progressive disease was 25%. The serologic CA-125 response rate was 50% (8/16), in detail serologic partial response was 50%, and serologic stable disease was 31% and serologic progressive disease was 19%. The median response duration was 10 months (3 to 17 months), the median time to response was 1 month (1/2 to 2 months) and the median time to re-progression was 5 months (3 to 7 months). The most common toxicity was gastrointestinal toxicity and the bone marrow suppression was proved as a most serious side effect. CONCLUSION: The docetaxel-carboplatin chemotherapy as a 2nd or more lines regimen against heavily pre-treated recurrent or persistent ovarian cancer is considerable but was associated significant gastrointestinal and bone marrow side effects. Routine premedication is recommended.

One Case of Solitary Metastatic Adenocarcinoma of the Uterus in Patient with Previous Gastric Cancer Treatment / 대한산부인과학회잡지

The uterus is an unusual site for metastasis from an extrapelvic neoplasm. Metastasis of gastric cancer to the uterus is rare. We experienced a patient who underwent a gastrectomy and chemotherapy due to gastric cancer and who subsequently suffered a solitary metastatic adenocarcinoma of the uterus from the primary gastric cancer. Similar to Krukenberg tumors of the ovary, lymphatic dissemination is regarded as the route of metastasis from the stomach to the uterine. We report this case with a brief review of literature.

One Case of Solitary Metastatic Adenocarcinoma of the Uterus in Patient with Previous Gastric Cancer Treatment / 대한산부인과학회잡지

The uterus is an unusual site for metastasis from an extrapelvic neoplasm. Metastasis of gastric cancer to the uterus is rare. We experienced a patient who underwent a gastrectomy and chemotherapy due to gastric cancer and who subsequently suffered a solitary metastatic adenocarcinoma of the uterus from the primary gastric cancer. Similar to Krukenberg tumors of the ovary, lymphatic dissemination is regarded as the route of metastasis from the stomach to the uterine. We report this case with a brief review of literature.

Intravenous Leiomyomatosis with Intracaval Mass, Intracardiac Extension, and Pulmonary Metastasis: A Case Report / 대한산부인과학회잡지

Intravenous leiomyomatosis (IVL) with intracaval mass, cardiac extension, and pulmonary metastasis is rare and it is characterized by nodular masses of smooth muscle proliferation that may extend to variable distances. We experienced a case of the intravenous leiomyomatosis originating from the uterus and extending to the ovarian veins, the iliac veins, the inferior vena cava, the right atrium and the lung. And it was diagnosed from the various preoperative studies and operated successfully through the single-stage approach. So we report it with a brief review of the literature.

A Case of Primary Malignant Mixed M llerian Tumor of the Fallopian Tube / 대한산부인과학회잡지

Malignant mixed m llerian tumor (MMMT) of the fallopian tube is extremely rare with poor prognosis. Primary fallopian tube cancer accounts for approximately 0.3% of all female genital tract malignancies. MMMT of the fallopian tube is extremely rare, accounting for 2.4-5.2% of tubal malignancies. Its clinical behavior resemble that of primary ovarian cancer, so preoperative diagnosis of fallopain tube carcinoma is seldom made. The diagnosis is usually obtained postoperatively. Recently we have experienced a case of MMMT of the fallopian tube, so we report this case with a brief review of literature.

Expression of MAGE in Ovarian Tumor / 대한산부인과학회잡지

OBJECTIVE: Chemotherapy of ovarian cancer has a main role in the post-surgical treatment of ovarian cancer. However, relapsing patients are usually resistant to an additional chemotherapy. The development of immunotherapy is therefore needed to offer other preventive treatment modalities of ovarian cancer. MAGE encoding tumor-rejection antigens recognized by cytotoxic T lymphocytes are expressed at the mRNA level in various malignant tumors. We investigated the possibility of immunotherapy of ovarian cancer of MAGE expression. METHODS: To explore this possibility in ovarian tumors, we investigated the expression of MAGE 1-6 in 44 surgical samples of neoplastic and non-neoplastic tissues from ovaries using a MAGE 1-6 common primer by the nested reverse transcription-polymerase chain reaction (nested RT-PCR) and DNA sequencing after subcloning of PCR products. The material consisted of 5 cases of normal ovaries, 6 cases of non- neoplastic diseases (3 follicular cysts, 2 endometrioses, and 1 tuboovarian abscess), and 8 cases of benign serous, 4 cases of mucinous cystic tumor, 9 teratomas, and 4 cases of malignant serous tumor, 1 case of mucinous tumor, 2 cases of undifferentiated carcinoma, 2 borderline serous and 3 mucinous tumor. RESULTS: MAGE were expressed in 23% of benign ovarian tumors (5/21 cases). In contrast, no expression of these genes was observed in any of the 11 samples of normal and non-neoplastic ovarian tissues. All (92%) malignant tumors except one case of borderline malignant mucinous tumor showed MAGE 1-6 m RNA expression (P<0.05). The isotype of MAGE were confirmed in 5 cases for MAGE-3 (31.2%), 4 cases of MAGE-4 (25%), 2 cases of MAGE A1 (12.5%) and A 4b (12.5%), and one case of MAGE A2, 4a, combined A3 and A6, and A4 and 4b. CONCLUSION: We concluded that the expression of MAGE could be used as a target for tumor specific immunotherapy in ovarian cancer expressing MAGE.

Clinical Trial of IV Etoposide and Carboplatin and Cyclophosphamide Combination Chemotherapy Against Persistent or Recurrent Ovarian Cancer as 2nd or More Line Chemotherapy / 대한산부인과학회잡지

OBJECTIVE: We evaluated the effects and toxicities and cost effectiveness of iv etoposide-carboplatin- cyclophosphamide (ECC) combination chemotherapy against persistent or recurrent ovarian cancer who were previously heavily treated with one or more lines of chemotherapy which included platinum-paclitaxel- cyclophosphamide-topotecan based regimens. METHODS: Fifteen patients with a persistent or recurrent ovarian cancer, previously received first or more line chemotherapy, had been treated with ECC combination chemotherapy at Konsin Medical Center from September 2000 to October 2002. The ECC (iv etoposide-carboplatin-cyclophosphamide) combination chemotherapy consists of 100 mg/m2 etoposide iv and 500 mg/m2 cyclophosphamide iv in first day and 100 mg/m2 etoposide iv, 450 mg/m2 carboplatin iv in second day and 100 mg/m2 etoposide iv in third (and 4th-5th day if necessary) every 3-4 weeks. The response of patients was evaluated with the tumor marker (serum CA-125) and imaging studies (ultrasonogram, CT, MRI). The toxicities were defined according to the WHO toxicity criteria. RESULTS: The overall response rate by WHO criteria is 47%. In detail, partial response is 47%, Stable disease is 40% and progressive disease is 13%. The serologic CA-125 response rate is 64%, in detail serologic partial response is 64%, and serologic stable disease is 22% and serologic progressive disease is 14%. The median response duration is 9 months (4 to 12 months), the median time to response is 1 month (2 weeks to 2 months) and the median time to progression is 9 month (4 to 12 months). The most common side effect is nausea and vomiting and the bone marrow suppression is proved as a most serious side effect (grade 3 or more-13%). CONCLUSION: The iv etoposide-carboplatin-cyclophosphamide chemotherapy as a 2nd or more lines regimen against persistent or recurrent ovarian cancer is considerable.

A Case of Leiomyoma of the Vagina / 대한산부인과학회잡지

The leiomyoma of the uterus is most common benign genital tumor in women of reproductive age but occurs in the vagina rarely and may be confused with a variety of vaginal tumors. A preoperative diagnosis is seldom made. Recently we experienced a case of vaginal leiomyoma arising in the anterior vagina wall and concomitant uterine leiomyoma, so we report this case with a brief review of literature.

Effects of cryopreservative agents of the repair of the temporomandibular joint disk with allogeneic cartilage grafts in rabbits

No abstract available.