The Risk Factor for Recurrence after Neoadjuvant Chemotherapy and Radical Hysterectomy in Cervical cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVE: This study was done to assess long-term survival and risk factors for recurrence after neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer patients. METHODS: Between August 19S3 and May 1990, 80 cervical cancer stage IB-IIB patients with tumor diameter 4cm or more received neoadjuvant VBP chemotherapy and radical hysterectomy. After follow-up more than 10 years for these patients, survival rate and risk factors for recurrence were analyzed. RESULTS: Seventy eight of SO patients were followed for 10 years. During this period, 20,5% patients(16/78) had recurrences and all of them died of recurrence. Five and 10 year survival rates were 82%(64/78) and 79.4%(62/78), respectively. High risk factor for recurrence was pelvic lymph node invasion. However, clinical stage, initial tumor mass size, number of neoadjuvant chemotherapy, clinical response, or residual tumor size were not clinically significant risk factors for recurrence. Initial tumor size was correlated with pelvic lymph node metastasis. In recurrent patients, site of recurrence was not different according to pelvic lymph node status. For node positive patients, combination of chemotherapy and radiation seemed to be more effective in reducing recurrence compared to chemotherapy or radiation only. CONCLUSION: For locally advanced stage IB-IIB cervical cancer patients who received neoadjuvani chemotherapy and radical hysterectomy, pelvic lymph node metastasis was high risk factor for recurrence and initial tumor size was closely correlated with pelvic lymph node invasion even after neoadjuvant chemotherapy.

Accuracy of Cervical Pap Smear / 대한부인종양콜포스코피학회잡지

BACKGROUND: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. OBJECTIVE: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. STUDY DESIGN: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, RESULTS: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cerbix were not associated. There were no clinical factors that were associated with false-positive rate. CONCLUSION: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyand university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.

Neoadjuvant Chemotherapy for the Bulky-endophytic or Barrel-shaped Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVES: This retrospective study was conducted to analyze the hypothesis that with neoadjuvant chemotherapy of vinblastine, bleomycin, and cisplatin followed by radical hysterectomy or radiation therapy and concurrent chemoradiation with cisplatin based regimen would improve survival in patients with barrel-shaped or bulky-endophytic (Diameter > 4cm) cervical carcinomas than those of radiation alone or combined radiation and surgery. STUDY DESIGN: Eighty-eight patients with barrel-shaped or bulky-endophytic cervical carcinomas, treated at the Hanyang University Hospital from 1983 to 1997, were the subjects of this investigation. Fifty-six of these patients were treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy ( Stage I b2, 8; IIa, 15; IIb, 20; III- IV, 13), twelve patients were treated by neoadjuvant chemotherapy followed by radiation therapy ( Stage Ilb, 4; IIJ-IV, 8), and twenty patients were treated by concurrent chemo-radiotherapy ( Stage IIb, 2; III-IV, 18). RESULTS: The incidence of parametrial extension and pelvic lymphnode metastases was higher in patients with barrel-shaped or bulky-endophytic cervical carcinomas than non-barrel-shaped cervix (p .025: .001). 5-years disease free survival rate was determined for patients treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy was 73.3 %. For patients treated by neoadjuvant chemotherapy followed by radiation therapy it was 45.7%. For patients treated by concurrent chemo-radiotherapy it was 46.1%. CONCLUSION: These data support an improvement in survival of patients with barrel-shaped or bulky-endophytic cervical carcinomas treated by neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy and concurrent chemo-radiotherapy.

Predictability of the Survival using Prognostic Index (PI) of Patients with Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVES: To predict of the survival of patients with epithelial ovarian cancer, multivariable analysis was done to identify variables with independent prognostic factors. Based on materials from 191 clinical trials performed by Department of Obstetrics and Gynecology, Hanyang University Hospital, we constructed a prognostic index (Pp with considerable predictive power for long-term survival of patients with epithelial ovatian cancer treated with cis-platin based combination chemotherapy, METHODS: On identifying variables with independent prognostic value, statistical analysis were performed with clinicopathologic variables including age, FIGO stage, histologic subtype, histologic grade, residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor markers(CA 125, CA 19-9). We also analyzed biological variables using immunohistochemical staining for GST-pie (glutathione-s-transferase-pie), p-glycoprotein, and MT (metallothinein) as a drug resistance and uPA (urokinase type plasminogen activator), PAI-1 (plasminogen activator inhibitor-l), nm23 (nonmetastatic gene 23) as a tumor invasion and metastasis. In addition, univariable analysis was performed followed by multivariable analysis using Coxs proportional hazards model to identify variables predictive of poor prognosis. Prognostic index (PI) was calculated based on sum of individual beta-coefficient of the most important independent prognostic value. RESULTS: With univariable analysis, age, FIGO stage, histologic grade, histologic subtype, presence of ascites, residual tumor, initial value of CA 125, MT, uPA, and PAI-1 were found to predict of patients survival. In the multivariable analysis and proportional hazard model, the pretreatment characteristics needed for the calculation of the PI are the age, the site of metastases expressed as stage, the histologic subtype, the size of residual tumor, the histological grade, and the presence of ascites. In the subgroup comprising the 10% of the patients with the best prognosis, 5-year survival rate was 78.9%, whereas in the subgmup comprising the 10% with the poorest prognosis, 5-year survival rate was 7.1%, which illustrates the large variability of the prognosis among patients. CONCLUSIONS: The PI was found to retain its value after response was achieved. The information provided by the PI can be expected to be useful in treatment planning and the proper stratification of patients in clinical trials.

Clinico-Pathologic Study on Borderline Epithelial Tumors of the Ovary / 대한부인종양콜포스코피학회잡지

Twenty six cases of borderline ovarian tumor(BOT) were treated between Jan. 1985 and Dec. 1997 at the Department of Obstetrics and Gynecology, Hanyang University. The clinical records were reviewed for all patients including histopathology, clinical features, and follow-up. The frequency of BOT was 12%(26/214) of epithelial ovarian malignancies, and patients with these tumors tend to present at a younger age(36 yrs) than those with invasive carcinomas. In terms of histologic type, mucinous type(21/26: 81%) were more prevalent than serous tumor(5/21: 19%) in this study. The positive rate of CA 125 was 20% in serous, and the positive rate of CA 19-9 was 24% in mucinous tumor. The size of mucinous was larger than that of serous tumors(17.1 cm vs 9,3 cm). Almost all of these tumor categorized as early stage(stage I: 96%), however, only one patient with serous tumor had advanced stage of disease(stage III: 4%), Therefore BOT tend to be diagnosed as earlier than invasive carcinoma. About 2/3 of patients were treated as conservative surgery(unilateral salpingooophorectomy or enuclation). Postoperative adjuvant chemotherapy was not given about half of cases(13/26). Median follow-up was 43 months and recurrent case was found only one in serous tumor, All patients in this study are still alive and free of disease except one, 5-year survival rate was 100%. But large number of study and long-term follow-up are needed to make a decision to treat and manage of BOT.

Small Cell Neuroendocrine Carcinoma of the Uterine Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study was to analyze the clinical characteristics and prognosis of small cell uterine cervical carcinoma with neuroendocrine differentiation. METHODS: Patient's medical records were reviewed retrospectively who were diagnosed as small cell carcinoma of uterine cervix and were treated at Hanyang University Hospital between 1972 and 1997. RESULTS: Between 1972 and 1997, of 1164 patients who were diagnosed as invasive cervical cancer, there were 10 cases of small cell carcinoma of uterine cervix in the department of obstetrics and gynecology, Hanyang University Hospital. The incidence of small cell carcinoma in invasive cervical cancer was 0.9% (10/1164). Of 10 small cell carcinoma, seven(70%) were neuroendocrine types which were identified with several kinds of immunohistochemical stains (Chromogranin, Grimelius, and/or NSE). The age of these 7 patients ranged from 34 to 63 years (mean 49). Two were in stage Ib, 3 in stage lla, I in stage IIIb, and 1 in stage IVb. Patients with stage Ib-IIb (n 5) received 3-5 courses of neoadjuvant VBP chemotherapy (vinblastine, bleomycin and cis-platinum) followed by radical hysterectomy with pelvic and paraaortic node dissection. One IIIb patient was managed with concurrent chemo-radiation(3 cycles of cis-platinum & 5-FU) followed by 6 courses of chemotherapy. One IVb patient was treated by palliative chemotherapy with 8 cycles of VBP chemotherapy. Of 5 paticn(s who underwent surgery, none showed pelvic lymph node metastases. These 7 patients were folk>wed for 8 - 62 months (average: 20 months). During this period, 5 patients died of disease hetween 8 and 62 months later and 2 patients are still alive for 12 (stage Ib) and 26 months (stage Ib), respectively. In the contrary, of 3 patients without neuroendocrine differentiation, who underwent neoadjuvant VBP chemotherapy followed by radical hysterctomy with pelvic and paraaortic node dissetion or concurrent chemo-radiation, two stage IIb patients are still alive for 58 and 74 months, and one IIIb patient died of disease 12 months later. CONCLUSION: In summary, neuroendocrine differentiation seemed to adversely affect the prognosis and longterm survival of small cell carcinoma of uterine cervix. So, for this high risk group, more aggressive therapy would be need to improve outcome. However, as the number of patients were small in our study, further study with large number of patients are warranted.

Prediction of the Diagnosis of Adnexal Masses According to the Ultrasonographic Morphologic Scoring System and Doppler Velocity Wave Form / 대한부인종양콜포스코피학회잡지

OBJECTS: The purpose of this study was to evaluate the relative usefulness of the morphologic scoring system and spectral doppler ultrasonographic analysis in differentiating between benign and malignant adnexal masses. METHODS: All patients scanned between July 1995 and June 1998 with sonographically identified and pathologically confirmed adnexal masses formed the study group. The adnexal masses were scored as benign or malignant on the basis of their sonographic appearance. Specific categories included inner wall structure, wall thickness, septal structure, and echogenicity. Women whose morphologic findings were suspicious for malignancy underwent doppler sonography. A threshold pulsatility index of 1.0 and resistance index of 0.4 were used to differentiate benign from malignant lesions. The findings were correlated with the presence of malignancy. RESULTS: Two hundred fifty one patients formed the study group; 215 patients were benign and 36 patients were malignant pathologically. Using the morphologic scoring system, 31 of the 36 malignant masses were classified as suggestive of malignant tumor, and 147 of the 215 benign masses were classified as not suggestive of malignant tumor (sensitivity, 86%; specificity, 68%; positive predictive value, 31%; negative predictive value, 97%). Doppler velocimetry was performed on a total of 62 patients, 19 patients with malignant tumors and 43 patients with benign tumors. A mean PI value of 0.85 and RI value of 0.52 for malignant tumors and mean PI value of 2.00 and RI value of 0.75 for benign tumors was shown. The PI value was significantly lower (p 0.001) in malignant than that of in benign masses, but RI value was not significant (p 0.184). The sensitivity and specificity in the detection of malignancy combined with doppler velocimetry was 86% and 67%, respectively. CONCLUSION: Doppler velocimetry studies did not add substantially to the prediction of malignancy using the morphologic scoring system.

Expression of Urokinase-type Plasminogen Activator(uRA), Plasminogen Activator Inhibitor-1(PAI-1) and nm23 protein, as Prognostic Factors in Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

The prognosis of ovarian cancer remains poor, and there is a need to identifiy patients who are less likely to respond to treatment, in the hope that the identification of these patients with a poorer prognosis may allow the administration of more intensive or different treatment. But, most clinical and pathological factors were considered to lack satisfactory predictive power. Recently, essential role of protease in tumor cell invasion and metastasis have been elucidated in tumor biology. Urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), play a key role in tumor-associated proteolysis. Thus, the presence of both uPA and PAI-1 modulates the invasive and metastatic phenotype of cancer cells. Genetically, nm23 protein from chromosome 17q may act independently as a metastasis suppressor. The purpose of this study was to determine the relative predictive power of some of those prognostic variables such as uPA, PAI-1 and nm23 protein in a selected group of patients of ovarian cancer. Immunohistochemical staining was used to determine the overexpression of uPA, PAI-1 and nm23 protein. Specimens were rated positive and negative. Then, scored '1' in case of positive for uPA, PAI-1, and negative for nm23, and '0' in case of negative for uPA, PAI-1, and positive for nm23, respectively. The sum of scores were divided into three groups (I, II and III groups), and compared with clinico-pathologic parameters, clinical response, lymph node metastasis, recurrence and 5-year survival rate, retrospectively. In univariate analysis, the positive rate of uPA was 36% (29/80), that of PAI-1 was 35% (28/80), and the negative rate of nm23 was 43% (34/80). The overexpression of uPA was higher in the low-grade tumor (p=0.0053), the overexpression of PAI-1 was positively correlated with the advanced stage of tumor (p=0.0001), more malignant histologic type (serous) of tumor (p=0.0013) and larger residual tumor mass (>2 cm)(p=0.0480). The overexpression of nm23 protein was negatively correlated with advanced stage of tumor (p=0.0068) and low-grade tumor (p=0.011). In scoring system, the number of patients with first group (I: score 0) was 24, II group (score: 1~2) was 49, and III group (score: 3) was 7. The mean age of patients was 46.4 years and mean follow-up time was 59 months. The rate of lymph node metastasis were 16.7%, 37%, and 75% respectively(p=0.0632). With increasing score in each group, the less clinical response rate was found (75% vs 71% vs 29%, p=0.0532). The 5-year survival rate of each group were 70% in I group, 65% in II group, and 14% in III group(p=0.0096). In conclusion, the scoring system using immunohistochemical staining with rating of overexpression uPA, PAI-1 and nm23 protein may be useful as an important and powerful predictive prognostic indicator in patients with epithelial ovarian cancer.

Expression of Urokinase-type Plasminogen Activator(uRA), Plasminogen Activator Inhibitor-1(PAI-1) and nm23 protein, as Prognostic Factors in Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

The prognosis of ovarian cancer remains poor, and there is a need to identifiy patients who are less likely to respond to treatment, in the hope that the identification of these patients with a poorer prognosis may allow the administration of more intensive or different treatment. But, most clinical and pathological factors were considered to lack satisfactory predictive power. Recently, essential role of protease in tumor cell invasion and metastasis have been elucidated in tumor biology. Urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), play a key role in tumor-associated proteolysis. Thus, the presence of both uPA and PAI-1 modulates the invasive and metastatic phenotype of cancer cells. Genetically, nm23 protein from chromosome 17q may act independently as a metastasis suppressor. The purpose of this study was to determine the relative predictive power of some of those prognostic variables such as uPA, PAI-1 and nm23 protein in a selected group of patients of ovarian cancer. Immunohistochemical staining was used to determine the overexpression of uPA, PAI-1 and nm23 protein. Specimens were rated positive and negative. Then, scored '1' in case of positive for uPA, PAI-1, and negative for nm23, and '0' in case of negative for uPA, PAI-1, and positive for nm23, respectively. The sum of scores were divided into three groups (I, II and III groups), and compared with clinico-pathologic parameters, clinical response, lymph node metastasis, recurrence and 5-year survival rate, retrospectively. In univariate analysis, the positive rate of uPA was 36% (29/80), that of PAI-1 was 35% (28/80), and the negative rate of nm23 was 43% (34/80). The overexpression of uPA was higher in the low-grade tumor (p=0.0053), the overexpression of PAI-1 was positively correlated with the advanced stage of tumor (p=0.0001), more malignant histologic type (serous) of tumor (p=0.0013) and larger residual tumor mass (>2 cm)(p=0.0480). The overexpression of nm23 protein was negatively correlated with advanced stage of tumor (p=0.0068) and low-grade tumor (p=0.011). In scoring system, the number of patients with first group (I: score 0) was 24, II group (score: 1~2) was 49, and III group (score: 3) was 7. The mean age of patients was 46.4 years and mean follow-up time was 59 months. The rate of lymph node metastasis were 16.7%, 37%, and 75% respectively(p=0.0632). With increasing score in each group, the less clinical response rate was found (75% vs 71% vs 29%, p=0.0532). The 5-year survival rate of each group were 70% in I group, 65% in II group, and 14% in III group(p=0.0096). In conclusion, the scoring system using immunohistochemical staining with rating of overexpression uPA, PAI-1 and nm23 protein may be useful as an important and powerful predictive prognostic indicator in patients with epithelial ovarian cancer.

A Significance of Insulin-like Growth Factors (IGFs) and Insulin-like Growth Factor Binding Proteins (IGFBPs) in Ascites of Ovarian Cancer Patients / 대한부인종양콜포스코피학회잡지

Based on the facts that expression of insulin-like growth factors(IGFs), their receptors, and insulin-like growth factor binding proteins(IGFBPs) have been found in many different types of malignancies including human ovarian cancer and their potent mitogenic effects in vitro, a role for IGFs mediated autocrine loop in oncogenesis and growth regulation of human malignancies was suggested. Since ascites support the biological environment for advanced ovarian cancer, it seemed to be resonable to measure the level of growth factors or cytokines in ascites for understanding precise mechanism of those factors in tumor biology. To investigate their roles and to evaluate prognostic significance in ovarian cancer, the IGFs/IGFBPs system were studied in the ascites, not in sera or cystic fluids, from 22 patients with ovarian cancer, who underwent surgical staging and subsequent cis-platinum based systemic chemotherapyery at the Department of Obstetrics and Gnecology, Hanyang University Hospital from Jan. 1989 through Dec. 1994. Ascites from 7 patients with benign disease were used as the control. IGF-I, II, IGFBP-1, and 3 were measured by immunoradiometric assay. The IGF-I level was significantly higher in ascites with ovarian cancer compared with those of benign disease(63.3-/+11.1 vs 17.9-/+6.2ng/ml, p=0.0098), but the level of IGF-II was not significantly different(70.5-/+13.9 vs 70.8-/+31.5 ng/ml, p=0.2827). IGFBP-1 levels were tend to be lower in ascites of patients with ovarian cancer than that of control(25.2-/+9.5 vs 58.6-/+28.2ng/ml, p=0.0637). However, IGFBP-3 levels had no statistically significant difference between two groups(779.7-/+110.6 vs 674.7-/+175.1ng/ml, p=0.8328). Although growth hormone levels were significantly higher in ascites with metastatic ovarian cancer than those of primary epithelial ovarian cancer, the levels of IGF-I, II, IGFBP-1 and 3 in ascites were not significantly different between two groups. IGF-I levels were correlated with the levels of IGFBP-3 in ascites with ovarian cancer(Y=8.83X-2.0, r=0.745, p=0.0000). High level of IGF-I in ascites of patients with ovarian cancer in this study was suggested that IGF-I had an important role on growth regulation of ovarian cancer. As majority of ascites were obtained from advanced and poorly differentiated ovarian cancer patients, IGF-I in ascites seemed to be related with intraperitoneal metastasis. Further large number of study including data from sera or cystic fluid will be needed to elucidate the role of the IGFs and IGFBPs in ascites of patients with ovarian cancer.

Prognostic Significance of Bcl-2 Expression in Ovarian Cancers / 대한산부인과학회잡지

The protein encoded by the Bcl-2 proto-oncogene has been shown to prolong cell su-rvival by preventing cell death(Apoptosis) induced by many insults including cancer therap-eutic drugs. Recently many researches have elucidated the bcl-2 expression in several hu-man solid cancers. However, there is still a few avaiable data to determine the role of Bcl-2 expression in the ovarian carcinogenesis and its prognostic significance in ovarian can-cers. Hence, we examined the expression of Bcl-2 in 68 ovarian epithelial cancers using immunohistochemistry and determined whether Bcl-2 expression has prognostic significance in the ovarian epithelial cancers. We found Bcl-2 expression(>5% positive cell) in 31 patients(40%). Bcl-2 expression were exclusively negative in the mucinous type of the ovarian epithelial cancer. Bcl-2 exp- ression was not correlated with tumor stage(stage I & II vs III & IV, p=0.63). The patients with Bcl-2 positivity had lower recurrence rate than the patients with negativity at the se- cond look operation(p0.05). These results sug- gest the Bcl-2 expression appears an early event in the ovarian carcinogenesis and has an inhibiting role in progression of ovarian tumor.

A Case Successive Ovulation Induction with an Extended Therapy of Clomiphene in a Patient with Clomiphene-resistant Anovulatory Disorders / 대한산부인과학회잡지

Clomiphene citrate is the simplest and least expensive from of ovulation induction therapy. In most cases, women who fail to ovulate in response to maximal doses of clomiphene became candidates for treatment with gonadotropins or pulsatile GnRH. Recently, as an alternative to the use of gonadotropins and ovarian surgery, there are some studies of the effectiveness of extended duration clomiphene among the anovulatory women who were resistant to a standard 5-day course of treatment with clomiphene. We have experienced a case of successive ovulation induction and pregnancy with an extended 10-day course of clomiphene in women with clomiphene-resistant anovulatory disorders and reproted with brief reviews of related literatures.

A Case of Malignant Mesothelioma of the Uterus / 대한암학회지

Malignant mesothelioma of the serosal surface of the uterus body is very rare and almost invariably malignant. Their diagnosis is made postoperatively in most instances.Various treatments have been described for malignant mesothelioma but effective method is still not known. A case of malignant mesothelioma of the uterus body with post-surgical pelvic persistence is presented. The diagnosis of carcinomatous mesothelioma was made postoperatively by pathologic examination and immunohistochemical reaction of the tumor cells.

A Case of Ovarian Mullerian Mucinous Papillary Cystadenoma of Borderline Malignancy / 대한암학회지

Ovarian mucinous cystadenoma of borderline malignancy was consisted of intestinal mucinous cystadenomas of borderline malignancy and Mullerian mucinous papillary borderline tumors. Mullerian mucinous papillary tumors was lined by mucinous epithelium of endocervical type and characterized by papillae architecturally similar to those of serous borderline tumors. These tumors have clinical and pathologic differences from those of intestinal mucinous cystadenomas of borderline malignancy.We report a case of ovarian Mullerian mucinous papillary cystadenomas of borderline malignancy with review of literature.

A Case of Pregnancy Complicated with Korean Hemorrhagic Fever / 대한산부인과학회잡지

No abstract available.

Detection of the c-m c Oncogene Amplification in Ovarian Carcinomas by Differential Polymerase Chain Reaction

The amplification of c-myc oncogene was evaluated in 42 cases of ovarian carcinomas to correlate with clinical parameters. Using oligonucleotide primers, sequences from the c-myc exon-3 gene and from a control gene, tissue plasminogen activator (tPA), were amplified simultaneously by polymerase chain reaction (PCR). After the products of differential PCR (d-PCR) were electrophoresed, slot blot hybridization was performed, and hybridized with P32 dATP-labeled myc and tPA oligonucleotide probes and then autoradiographed. The signal intensities of the two products were quantitated by densitometry and the ratios of two products (c-myc/tPA) were measured. The ovarian carcinomas showed significantly increased amplification of c-myc oncogene Oligonucleoti compared to normal control group (p<0.05). 15 of 42 cases (35.7%) showed various degrees of the MYC gene amplification up to 27 folds in various histologic types of ovarian carcinomas. No significant differences of the MYC gene amplification according to histologic subtypes, tumor action) grades and clinical stages of ovarian carcinomas were present.

Significance of Interleukin-2(IL-2), Interleukin-6(IL-6), and Tumor Necrosis Factor-a(TNF-a) in the Ascites of Ovarian Cancer / 대한부인종양콜포스코피학회잡지

Previous studies have shown that the cancer cell lines secrete multiple cytokines, such as macrophage colony-stimulating factor(M-CSF), granulocyte-macrophage colony stimulating factor(GM-CSF), interleukin-l(IL-1), interleukin-2(IL-2), interleukin-6(IL-6), and tumor necrosis factor-alpha(TNF-alpha). We evaluated the levels of IL-2, IL-6, and TNF-alpha in the ascites of 23 patients with ovarian cancer. These levels were then compared with cytokine concentration found in 10 patients who had benign ascites and also studied the relation between levels of cytokines and clinical parameters. Enzyme-linked immunosorbent assay(ELISA) was used to determine the levels of cytokines in ascitic fluids. The median age of the group was 56, and the median follow-up time was 24 months. The levels of IL-2 was not elevated in ascites of ovarian cancer(30.5 vs 37.2 pg/ml, p=0.083), 1 he levels of TNF-alpha in the ascites with ovarian cancer were higher when compared with ascites of benign disease and was nearly approached statistically significant(91.0+/-20.7 vs 440.2+/-117.9pg/ml, p=0.058). Significantly higher IL-6 levels were detected in patients ascites compared with ascites with benign disease(354.3+/-42.9 vs 5,605+/-1,137pg/ml, p=0.006). IL-6 and TNF-a levels in ascites did not correlate statistically with tumor volume, histologic type or with survival time. IL-6 levels did not correlated statistically with volume of ascites. IL-6 and TNF-a levels did not correlated either. Circulating platelet counts in patients with ovarian cancer were significantly higher than in patients with benign conditions (282.6+/-5 vs 388.4+/-21.2x-10(9)/l, p=0.003). Thrombocytosis(platelet counts>400x10(9)/l) occured in 35%(8/23) of the cases with ovarian cancer. IL-6 levels in ascites correlated signi-ficantly with circulating platelet counts(R=0.427, p=0.042). This study showed that the patients with ovarian cancer have elevated levels of IL-6 in ascites. IL-6 levels were not correlate with disease status in patients with ovarian cancer. However, the correlation was found between IL-6 levels and thrombocytosis. This observation suggest a role for IL-6 in the development of tumor-associated thrombocytosis. A larger study would help in evaluating the potential biological roles and use of cytokines as tumor markers in ovarian cancer.

Epithelial ovarian cancer:comparison of serous and mucinous cystadenocarcinoma / 대한산부인과학회잡지

No abstract available.

A Case of Primary Adenocarcinoma of the Fallopian Tube / 대한부인종양콜포스코피학회잡지

Primary adenocarcinoma of the fallopian tube is an extremely rare malignancy of the female genital tract. We had experienced a case of primary adenocarcinoma of the left fallopian tube which diagnosed ineidentally on the basis of the biopsy findings, and reported the case with a brief review of the concerned literatures.

Three Cases of Repeated Mole / 대한부인종양콜포스코피학회잡지

Three patients(1%) with recurrent molar pregnancy were managed arnong 317 registered molar pregnancies at the department of Obstetrics and Gynecology, Hanyang University Hospital between 197S and 1991. Reeurrent molar pregnancy seemed to be oaiated with a worsening histology and an increased incidence of proliferative trophoblastic sequelae in the successive episodes of hydatidiform mole. The treatment of recurrent mole is discussed and the literature regardmg recurrent rnolar pregnancy is reviewed.