A case of clear cell carcinoma arising from the endometriosis of the paraovarian cyst / 부인종양

Malignant transformation of endometriosis is an infrequent complication. Clear cell carcinoma from endometriosis is very rare in the paraovarian cyst. To date no cases have been reported. We report a case of clear cell carcinoma arising from endometriosis of the paraovarian cyst with a brief review of literature.

Contralateral Prophylactic Mastectomy and Prophylactic Salphingo-Oophorectomy in a BRCA1-Positive Breast Cancer Patient: A Case Report / 한국유방암학회지

Risk-reducing surgery is known as the most powerful preventive strategy for BRCA mutation carriers. This current case report represents the first documentation of the contralateral prophylactic mastectomy (CPM) and bilateral salphingo-oophorectomy (BSO) in a carrier of BRCA mutation in Korea. The patient was a 39-year-old woman who was seen in at a genetic counseling clinic for discussing of risk-reducing strategies for the breast and ovarian cancer. She presented at the age of 38 year with a 1.5 cm sized, grade 3, and ER/PR/HER2 negative infiltrating ductal carcinoma of the right breast. She was treated with wide local excision of the right breast and sentinel lymph node biopsy of the axilla. She was then treated with CAF (Cyclophosphamide+Doxorubicin+5-Fluorouracil) chemotherapy and radiation therapy. She was initially counseled at the time of surgery due to the family history of her mother, who suffered with breast cancer at the age of 58. After the completion of chemotherapy, we received the genetic test results and it was positive for the BRCA1 mutation (3746_3747insA). After a long discussion of cancer surveillance and risk-reducing options, she decided to undergo ipsilateral mastectomy and CPM and BSO. Before surgery, psychiatric consultation was done and questionnaires evaluating her depression, anxiety, body image, quality of life, and psychological distress were filled out. After discussion with the plastic surgeon, she decided to undergo delayed reconstruction of the breast. We performed endoscopic bilateral skin-sparing mastectomy and a laparoscopic bilateral salphingo-oophorectomy. There was no complication after surgery and the pathologic examination revealed no evidence of cancer in both breasts and ovaries. We think that CPM and BSO are feasible risk-reducing options for the breast cancer patients with the BRCA mutation in Korea.

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients / 부인종양

OBJECTIVE: To investigate the effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients. METHODS: A retrospective review was performed on the 207 patients who had taken tamoxifen or anastrozole, as adjuvant hormonal therapy after breast cancer surgery between January 2003 and December 2006. Gynecologic surveillance constituted of ultrasonographic exam of the endometrial thickness and ovarian cyst formation. The patients were classified into three groups and analyzed; premenopausal/postmenopausal women receiving tamoxifen and women receiving anastrozole. RESULTS: Mean duration of follow up was 20.6+/-6.6 months. There was no difference of mean endometrial thickness before hormonal therapy among the three groups (p=0.327). In women receiving tamoxifen, the endometrium was continuously thickened in proportion to the duration of the therapy irrespective of menopausal status while it remained unchanged in women receiving anastrozole (p<0.05). Endometrial biopsies were performed in 28 patients receiving tamoxifen. The most common histologic finding was proliferative endometrium in premenopausal women (7/21) and atrophic endometrium in postmenopausal women (6/7). There was no case of endometrial cancer in both groups. Ovarian cyst was found in 32 women and the most were developed in premenopausal women receiving tamoxifen (30/32). All of them showed benign nature on transvaginal ultrasonographic findings. CONCLUSION: Women undergoing adjuvant hormonal therapy after breast cancer surgery exhibited changes in the endometrium and ovary. However most changes were not a serious problem in this study and frequent gynecologic surveillance in these patients needs further investigation.

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients / 부인종양

OBJECTIVE: To investigate the effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients. METHODS: A retrospective review was performed on the 207 patients who had taken tamoxifen or anastrozole, as adjuvant hormonal therapy after breast cancer surgery between January 2003 and December 2006. Gynecologic surveillance constituted of ultrasonographic exam of the endometrial thickness and ovarian cyst formation. The patients were classified into three groups and analyzed; premenopausal/postmenopausal women receiving tamoxifen and women receiving anastrozole. RESULTS: Mean duration of follow up was 20.6+/-6.6 months. There was no difference of mean endometrial thickness before hormonal therapy among the three groups (p=0.327). In women receiving tamoxifen, the endometrium was continuously thickened in proportion to the duration of the therapy irrespective of menopausal status while it remained unchanged in women receiving anastrozole (p<0.05). Endometrial biopsies were performed in 28 patients receiving tamoxifen. The most common histologic finding was proliferative endometrium in premenopausal women (7/21) and atrophic endometrium in postmenopausal women (6/7). There was no case of endometrial cancer in both groups. Ovarian cyst was found in 32 women and the most were developed in premenopausal women receiving tamoxifen (30/32). All of them showed benign nature on transvaginal ultrasonographic findings. CONCLUSION: Women undergoing adjuvant hormonal therapy after breast cancer surgery exhibited changes in the endometrium and ovary. However most changes were not a serious problem in this study and frequent gynecologic surveillance in these patients needs further investigation.

The efficacy of uterine balloon ablation therapy in patient with menorrhagia / 대한산부인과학회지

OBJECTIVE: Menorrhagia is defined as a complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles and approximately 30% of women suffer from it. Recently uterine balloon ablation therapy (UBT) system has been used widely as a safe and easy surgical option for this cumbersome symptom. The aims of this study were to determine the safety and the efficacy of UBT system in the management of menorrhagia, and to identify the possible factors for a successful outcome. METHODS: From August 2003 to May 2004, 77 patients with menorrhagia were enrolled. Demographic information, diary score for menorrhagia, and size of uterus were checked before treatment. All patients were treated with UBT system under IV anesthesia at day-surgery unit and followed up post-operatively. The change of diary score, and the change of hemoglobin/hematocrit were recorded. And the change of quality of life was assessed. RESULTS: Medical records of 73 patients who completed scheduled follow up were analyzed. Mean age was 43.7 years old, pre-operative mean diary score was 255.9+/-98.0 and pre-operative mean hemoglobin was 10.67+/-1.67. After the operation, the diary score significantly decreased to 53.3+/-27.5, and the hemoglobin significantly increased to 12.67+/-1.53. Multiple logistic regression analysis showed that success of treatment was influenced by the indication of UBT, patient age, uterine depth, and adequate intra-operative balloon pressure. An improvement in self-reported quality of life scores was also observed. CONCLUSION: The UBT system is a safe and effective method to treat menorrhagia and can be easily done under outpatient basis. Thus, it is a good alternative to hysterectomy or hysteroscopic endometrial ablation with a comparable success rate and minimal risk.

A case of microinvasive squamous cell carcinoma on the mucosal surface of pedunculated submucous leiomyoma protruding through cervix / 부인종양

Recently, a case of cervical cancer on the mucosal surface of a pedunculated cervical leiomyoma had been reported. We experienced a similar but distinct case of microinvasive squamous cell carcinoma on the mucosal surface of a pedunculated submucous leiomyoma. A 45-year-old Korean woman underwent type I hysterectomy for heavy bleeding from pedunculated submucous leiomyoma. Histopathological examination revealed that the leiomyoma of which mucosa was covered focally by microinvasive squamous cell carcinoma. During the management of pedunculated leiomyoma protruding through cervix, caution must be taken because of, although rare instance, a possible coexisting malignancy.

Cyclooxygenase expressions and response to radiation therapy in uterine cervix cancer / 부인종양

OBJECTIVE: The aim of this study is to clarify the relationship between COX expressions and radioresistance in cervical cancer. METHODS: Patients with cervical cancer treated by primary radiotherapy were selected from the tumor registry of our institution. According to the response to radiotherapy during and after a month of radiation, poor responder and good responder was defined. Immunohistochemical staining was performed by the ABC method using formalin-fixed, paraffin-embedded tissue sections and monoclonal anti-COX-1,2 antibodies. Correlation of COX expression and response to radiation was analyzed. Cell lines derived from human cervical tumors were used: HeLa, HT3, and C33A. Using western blot, COX-1,2 expressions were identified in each cell line. The sensitivity of the cervix cancer cells to radiation was measured using a clonogenic assay. RESULTS: COX-1 and COX-2 expressions were higher in poor responders than good responders. The difference of COX-1 expression between two groups had marginal statistical significance (p=0.099, Fisher's exact test) and COX-2 expression was significantly higher in poor responders (p=0.034, Fisher's exact test). In the clonogenic assay, survival fraction of HeLa and HT-3 cell lines, which have COX-1 and COX-2 activity, was significantly higher than C33A cell line which has no COX activity (p<0.001). CONCLUSION: Our results suggest that the expression of COX in cervical cancer might be deeply associated with the effect of radiation therapy.

Normal Reference Range for Cervical Length in Twin Pregnancy using transvaginal ultrasound / 대한산부인과학회지

OBJECTIVE: We performed prospective longitudinal study to establish reference range for cervical length and evaluate the change in cervix throughout pregnancy in twin pregnancy. METHODS: Fifty-four women of twin pregnancy without history of preterm labor, preterm delivery, cervix cerclage, that delivered at or after 36 weeks were included in this study. Serial measurements of cervical lengths by transvaginal ultrasound exam were performed at 20 weeks of gestation and every 4 weeks (until 28 weeks), every two weeks (until 36 weeks) and every week until delivery. Linear regression analysis was done for statistical analysis. RESULTS: The reference range for cervical length in twin pregnancy was presented as mean, standard deviation and 95% confidence interval of the mean. Cervical length gradually decreased as the gestational age progressed. There was a significant correlation between cervical length measurements and gestational age (Y=71.361-1.336X, r2=0.384, p<0.05). CONCLUSION: We presented the reference range for cervical length in twin pregnancy and evaluated the association between gestational age and cervical length. These results can be used as reference guideline in consecutive assessments of cervical lengths during twin pregnancy.

Effects of the GnRH agonist therapy before laparoscopic myomectomy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the effectiveness of GnRH agonist therapy prior to the planned myomectomy for the women who want to preserve their fertility. METHODS: We reviewed 20 patients who had GnRH agonist therapy prior to the planned myomectomy from October 2003 to September 2004. RESULTS: Mean age of the patients was 37.8+/-4.5 y and nulliparous women were 7 (35%) among 20. Average 3.05 (range 1-4) times of GnRH agonist injection was done prior to a surgery. Indications of myomectomy were menorrhagia (13/20, 65%), dysmenorrhea (7/20, 35%), and palpable pelvic mass (6/20, 30%). Average of the longest diameter of the largest myoma was 79.8 mm at first visit ultrasonography, and reduced to 60.8 mm after the completion of GnRH agonist treatment. This means that average 55.8% of volume reduction was achieved by GnRH agonist. Among 20 patients, 18 (90%) had laparoscopic myomectomy and 2 (10%) had laparotomy. Of the 2 patients who had laparotomy, one had severe adhesion caused by prior pelvic surgery and another had very large myoma which was refractory to the GnRH agonist therapy. The global mean operative time was 125+/-51 min. Average hemoglobin drop after operation was 1.6 g/dL and no patient had transfusion. Total hospital stay was 3.9+/-1.1 days for patients who had laparoscopic myomectomy and 8.5+/-2.1 days for patients who had laparotomy. CONCLUSION: The use of GnRH agonist prior to the planned myomectomy was effective in reducing myoma volume and it enables surgeons to choose less invasive surgical approach.

Effect of oligohydramnios and intrauterine infection on fetal blood vessels and umbilical artery blood flows in patients with preterm premature rupture of membranes / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to establish the effect of oligohydramnios and intrauterine infection on fetal and umbilical blood flows in patients with preterm premature rupture of membranes (PPROM). METHODS: Pulsed-wave Doppler imaging was used to determine the pulsatility index (PI) in the fetal renal, descending aorta, middle cerebral and umbilical arteries in 62 patients with PPROM. Amniocentesis was performed in 38 patients with PPROM. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasma. The patients with PPROM were divided into two groups according to the presence (n=21) or absence (n=41) of oligohydramnios and the presence (n=14) or absence (n=24) of intrauterine infection. Oligohydramnios was defined as the largest single pocket that measured <2 cm in the vertical plane. Data was expressed as multiples of the median (MOM) adjusted for gestational age, and statistical analysis was conducted with nonparametric statistics. RESULTS: 1) Fetuses with the presence of oligohydramnios had significantly lower MOM of PI of the fetal renal artery and higher MOM of PI of the fetal descending aorta than those without this condition (MOM of PI of the fetal renal artery: median [range]; 0.030 [-0.532, 0.404] vs. 0.167 [-0.357, 2.81] p=0.03. MOM of PI of the fetal decending aorta: median [range]; 0.085 [-0.160, 0.470] vs. -0.120 [-0.587, 0.548] p=0.004). 2) There was a significantly negative relationship between the largest single vertical pocket and MOM of PI of the fetal descending aorta (r=-0.283, p=0.03). 3) There were no significant differences in the MOM of PI of the fetal middle cerebral artery and umbilical artery between the two groups of patients. 4) Amniotic fluid culture was positive in 37% (14/38). 5) There were no significant differences in the MOM of PI of the fetal middle cerebral, renal artery, descending aorta and umbilical arteries between patients with and without the intrauterine infection. CONCLUSION: Blood flow of the fetal renal artery and descending aorta, but not the middle cerebral and umbilical arteries, were affected by oligohydramnios in patients with PPROM but intrauterine infection did not affect the blood flow of the fetal and umbilical arteries in fetuses with PPROM.

The accuracy and cost-effectiveness of triple screening tests in cervical neoplasia / 부인종양

OBJECTIVE: Ideal cancer screening program should be not only accurate but also cost-effective. However, in Korea, the two aspect of cervix cancer screening program was not yet evaluated. Thus we conducted this study to evaluate the cost-effectiveness and accuracy of various screening methods for detecting uterine cervical neoplasia. METHODS: We used various methods (conventional Pap smear, cervicography and HPV test) to detect cervical neoplasia on 255 women who visited the Seoul National University Hospital from Dec. 1996 to Jul. 1997 and analyzed the accuracy and cost-effectiveness of each method along with various combinations of methods using Bayesian theorem. The accuracy was judged by the final histopathologic diagnosis. RESULTS: Sensitivity (SE) and specificity (SP) of each method to detect cervical intraepithelial neoplasia (CIN) 1 or above were 83.0% and 69.4% in Pap smear, 53.7% and 85.2% in cervicography, and 57.8% and 80.6% in HPV test, respectively. The combination of Pap smear with cervicography or with HPV test for detecting CIN 1 or above had same SE and SP of 89.1% and 62.0% respectively. The combination of cervicography and HPV test had SE of 78.9% and SP of 70.4%. Three methods combination showed 93.9% SE and 54.6% SP. The estimated cost per method was highest in three methods combination (117,000 won) and lowest in Pap smear alone (12,000 won). The cost for detection of one case of cervical neoplasia was highest in combination of cervicography and HPV test (241,907 won) and lowest in Pap smear alone (25,385 won). CONCLUSION: The combinations of each method showed increased SE. These combinations, however, had low SP and high cost than individual method. Cervicography or HPV test alone should not be considered as an alternative to Pap smear for cervical cancer screening because its cost-effectiveness is not significantly better than that of Pap smear.

Preliminary report on Comparison of Tension-free Vaginal Tape and Transobturator Tape in the Surgical Management of Stress Urinary Incontinence / 대한산부인과학회지

OBJECTIVE: The aim of this study is to compare the efficacy of the TVT and TOT which have been widely used in the surgical management of stress urinary incontinence. METHODS: The study was carried on 22 patients with stress urinary incontinence who had operation at Seoul National University Bundang Hospital from April to December 2004. Review of medical records was done and clinical characteristics were compared according to the operation procedure. RESULTS: The TVT was done on 11 patients and TOT on 11 patients. There were no significant differences in patients' age, parity, body mass index, menopausal status, and severity of incontinence. The operation time was significantly shorter in TOT than in TVT. Complication rate and hospital stay were not significantly different between TVT and TOT. The cure rate (patients' satisfaction) was 90.9% in TVT, 100% in TOT. CONCLUSION: The TVT and TOT are both effective surgical treatment for stress urinary incontinence. The TOT is simple and time saving procedure because it can be done without cystoscope.

Analysis of the attitude to the LLETZ as a treatment of CIN according to the subspecialty / 대한산부인과학회지

OBJECTIVE: The aim of this study is to compare the clinician's attitude to the large loop excision of transformation zone (LLETZ) according to the subspecialty; gynecologic oncology or not. METHODS: Eighty-one patients who had LLETZ at Seoul National University Bundang Hospital from June 2003 to September 2004 were reviewed. The pathologic reports for LLETZ were compared with the results of punch biopsy according to the operator's subspecialty. RESULTS: Gynecologic oncologist had 38 patients (GO group) and non-gynecologic oncologist had 43 patients (NGO group). The age distribution was not different between two groups (40.3 +/- 8.3 in GO group, 42.4 +/- 9.4 in NGO group; p=0.301). The histopathology of punch biopsy and LLETZ correlated well each other in both groups (p=0.01 in both groups). In NGO group, 11 patients (25.6%) had chronic cervicitis or mild dysplasia on punch biopsy while only a patient (2.6%) had mild dysplasia on punch biopsy in GO group. CONCLUSION: This study shows that the non-gynecologic oncologist used LLETZ more frequently in the management of low-grade cervical intraepithelial neoplasia than gynecologic oncologist.

A Case of Vaginal Tuberculosis presenting as Vaginal Cyst / 대한산부인과학회지

A rare case of vaginal tuberculosis is reported. A 42-year-old woman referred to our hospital for surgical treatment of a cystocele presented with vaginal mass for 2 months. Pelvic examination revealed a cystic mass at anterior vagianl wall. Her initial diagnosis was urethral diverticulum. Surgical excision was performed and pathological analysis of the specimen revealed tuberculosis. She was treated with antituberculous drugs. We emphasize the need to maintain a high index of suspicion and to biopsy any suspicious vaginal lesion in the diagnosis of vaginal tuberculosis.

CpG island methylation and gynecolgic malignancy / 부인종양

No abstract available.

Comparison of clinical findings associated with the treatment of elderly versus younger patients with epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: To evaluate the differences in the surgical and chemotherapeutic outcomes of elderly versus younger patients with epithelial ovarian cancer. METHODS: We compared clinical characteristics, operative factors and outcomes of chemotherapy of elderly patients 65 years old or over (n=26) with those of younger patients aged 41-49 years (n=47). All subjects underwent their primary surgical therapy and following adjuvant chemotherapy at Seoul National University Hospital, from January 1996 to June 2003. RESULTS: As for tumor characteristics (tumor stage, histology etc.), there were no differences between two groups. Medical comorbidities were more frequent in the elderly group, primarily due to hypertension (50.0% vs. 28.3%; p=0.02). Optimal surgical treatment and adjuvant chemotherapy were performed less frequently in the elderly group (54.2% vs. 78.3; p=0.012). Perioperative and postoperative variables (operation time, intraoperative bleeding, postoperational complications and duration of hospitalization etc.) showed no differences except episode of transfusion in the elderly group. Residual mass, diameter less than 2 cm, showed difference between two groups with marginal significance (30.4% vs 55.6%, p=0.072). Chemotherapeutic dosage reduction was more frequent in elderly group (23.1% vs. 8.5%; p=0.003), but the occurrences of the chemotherapeutic cycle delay and toxicity profiles, were similar in the two groups. Response rate to adjuvant chemotherapy and the number of recurrence were not different between two groups (p=0.119 and p=0.587). CONCLUSION: Elderly women who present the same distribution of stages as their younger counterparts are likely to be treated more conservatively than younger ovarian cancer patients.

A Case of Reconstruction of Utero-neovaginal Continuity / 대한산부인과학회잡지

Vaginal and cervical agenesis is an uncommon Mullerian anomaly. Total hysterectomy and vaginoplasty remains the classical treatment of this malformation. We present a case of reconstruction of utero-neovaginal continuity in the patient with normal functioning uterus and previously constructed neovagina by McIndoe method. She experienced two episodes of withdrawal bleeding during 2 months after surgery and fully satisfied with the results.

Prevalence and Genotyping of HPV in Cervical Cancer of Korean Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the prevalence and genotype of high risk HPV infection with oligonucleotide microarray based DNA chip in cervical cancer. METHODS: The presence of HPV and its type were tested with oligonucleotide microarray based DNA chip in 84 specimen from cervical cancer (squamous cell carcinoma; 58, adenocarcinoma; 22, adenosquamous carcinoma and small cell carcinoma; 4). RESULTS: The overall detection rate of high risk HPV infection was 84.5% (71/84). In squamous cell carcinoma and adenocarcinoma, the detection rate were 79.3% (46/58) and 100% (22/22) respectively. The distribution of HPV types in squamous cell carcinoma and adenocarcinoma was as follows; HPV 16 (60.3%, 59.1%), HPV 18 (1.7%, 27.3%). CONCLUSION: The most common type of high risk HPV detected in squamous cell carcinoma and adenocarcinoma of cervix was HPV 16 followed by HPV 18. In contrast with squamous cell carcinoma, HPV 18 was more frequently detected than HPV 16 in adenocarcinoma. HPV DNA chip seems to be effective in the detection and typing of HPV in tissues from cervical cancer.

A Case of Postpartum Ovarian Vein Thrombosis After Vaginal Delivery / 대한산부인과학회잡지

When patients revisit hospital after delivery because of fever and lower abdominal pain, the diagnosis of ovarian vein thrombosis should be considered. If fever dose not fall promptly even with aggressive intravenous antibiotics therapy, a ultrasound or a CT scan should be obtained for prompt diagnosis and therapy. We report a case of postpartum ovarian vein thrombosis that detected by a CT scan and treated successfully with anticoagulation therapy.

Comparison of MRI's Prediction of Myometrial, Cervical Invasion and Surgical Staging in Endometrial Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was accuracy evaluation of MRI in prediction of myometrial, cervical invasion in endometrial carcinoma by comparing with histopathologic findings and to find causes of inaccurate MRI readings. METHOD: Fifty patients with endometrial carcinoma who were evaluated with MRI imaging prior to surgery were reviewed. And then, we compared MRI findings and histopathologic findings in view of myometrial, cervical invasion. RESULTS: Overall accuracy of MRI in prediction of myometrial invasion was 48%. Sensitivity/specificity/ PPV/NPV in prediction of no myometrial invasion were 100%/42.9%/42.9%/100% respectively, in prediction of superficial myometrial invasion were 20.0%/86.7%/50.0%/61.9% respectively, in prediction of deep myometrial invasion were 33.3%/94.3%/71.4%/76.7%, respectively. Accuracy in prediction of cervical invasion was 84% and sensitivity/specificity/PPV/NPV were 50.0%/88.6%/37.5%/92.9% respectively. Among the probable causes of inaccurate MRI readings, polypoid tumor occupies large portion. CONCLUSION: MRI has some value in pre-operative evaluation of patients with endometrial carcinoma. We should cautiously accept the MRI readings when tumor shows polypoid growth.