Robot-Assisted Laparoscopic Myomectomy versus Abdominal Myomectomy for Large Myomas Sized over 10 cm or Weighing 250 g

Purpose@#Here, we compared the operative and perioperative outcomes between robot-assisted laparoscopic myomectomy (RALM) and abdominal myomectomy (AM) in patients with large (>10 cm) or heavy myomas (>250 g). @*Materials and Methods@#We included 278 patients who underwent multi-port RALM (n=126) or AM (n=151) for large or heavy myomas in a tertiary care hospital between April 2019 and June 2020. The t-test, chi-square, Bonferroni’s test, and multiple linear regression were used. @*Results@#No differences were observed in age, body mass index, parity, or history of pelvic surgery between the two groups. Myoma diameters were not different (10.8±2.52 cm vs. 11.2±3.0 cm, p=0.233), but myomas were lighter in the RALM group than in the AM group (444.6±283.14 g vs. 604.68±368.35 g, respectively, p=0.001). The RALM group had a higher proportion of subserosal myomas, fewer myomas, fewer large myomas over >3 cm, lighter myomas, and longer total operating time. However, the RALM group also had shorter hospital stay and fewer short-term complications. Estimated blood loss (EBL) was not different between the two groups. The number of removed myomas was the most significant factor (coefficient=10.89, p<0.0001) affecting the EBL. @*Conclusion@#RALM is a feasible myomectomy technique even for large or heavy myomas. RALM patients tend to have shorter hospital stays and fewer postoperative fevers within 48 hours. However, RALM has longer total operating time.

Feasibility and safety of fertilitysparing surgery in epithelial ovarian cancer with dense adhesion: a longterm result from a single institution / 부인종양

Objective@#We investigated the feasibility and safety of fertility-sparing surgery (FSS) in patients with epithelial ovarian cancer (EOC) with dense adhesions. @*Methods@#Patients were divided into cases with and without dense adhesions in this retrospective study. @*Results@#Of the 95 eligible patients, 29 patients had dense adhesions. Mean age, proportion of staging procedure, distribution of histologic type, and co-presence of endometriosis were different (p=0.003, 0.033, 0.011, and 0.011, respectively). The median follow-up period was 57.8 (0.4–230.0) months. There were no differences in the rates of recurrence (21.2% vs.20.7%, p=1.000) or death (16.7% vs. 6.9%, p=0.332) between the 2 groups. There was no difference in the pattern of recurrence or in disease-free survival (DFS) and overall survival (OS) between the 2 groups. In multivariate analysis, pretreatment cancer antigen-125 >35 U/mL and International Federation of Gynecology and Obstetrics stage IC were significant factors of worse DFS and OS, while dense adhesion was not a prognostic factor for both DFS (hazard ratio [HR]=0.9; 95% confidence interval [CI]=0.3–2.7; p=0.792) and OS (HR=0.2; 95% CI=0.1–1.8; p=0.142), nor were age, proportion of staging procedure, histologic type, and co-presence of endometriosis. Moreover, the distribution of those 2 significant prognostic factors was not different between the 2 groups. Dense adhesions were subgrouped into nontumor and tumor associated dense adhesions for further analysis and the results were same. @*Conclusion@#FSS is feasible and safe in EOC, regardless of the presence of dense adhesions.

Feasibility and safety of fertilitysparing surgery in epithelial ovarian cancer with dense adhesion: a longterm result from a single institution / 부인종양

Objective@#We investigated the feasibility and safety of fertility-sparing surgery (FSS) in patients with epithelial ovarian cancer (EOC) with dense adhesions. @*Methods@#Patients were divided into cases with and without dense adhesions in this retrospective study. @*Results@#Of the 95 eligible patients, 29 patients had dense adhesions. Mean age, proportion of staging procedure, distribution of histologic type, and co-presence of endometriosis were different (p=0.003, 0.033, 0.011, and 0.011, respectively). The median follow-up period was 57.8 (0.4–230.0) months. There were no differences in the rates of recurrence (21.2% vs.20.7%, p=1.000) or death (16.7% vs. 6.9%, p=0.332) between the 2 groups. There was no difference in the pattern of recurrence or in disease-free survival (DFS) and overall survival (OS) between the 2 groups. In multivariate analysis, pretreatment cancer antigen-125 >35 U/mL and International Federation of Gynecology and Obstetrics stage IC were significant factors of worse DFS and OS, while dense adhesion was not a prognostic factor for both DFS (hazard ratio [HR]=0.9; 95% confidence interval [CI]=0.3–2.7; p=0.792) and OS (HR=0.2; 95% CI=0.1–1.8; p=0.142), nor were age, proportion of staging procedure, histologic type, and co-presence of endometriosis. Moreover, the distribution of those 2 significant prognostic factors was not different between the 2 groups. Dense adhesions were subgrouped into nontumor and tumor associated dense adhesions for further analysis and the results were same. @*Conclusion@#FSS is feasible and safe in EOC, regardless of the presence of dense adhesions.

Development of Web-Based Nomograms to Predict Treatment Response and Prognosis of Epithelial Ovarian Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Discovery of models predicting the exact prognosis of epithelial ovarian cancer (EOC) is necessary as the first step of implementation of individualized treatment. This study aimed to develop nomograms predicting treatment response and prognosis in EOC. MATERIALS AND METHODS: We comprehensively reviewed medical records of 866 patients diagnosed with and treated for EOC at two tertiary institutional hospitals between 2007 and 2016. Patients’ clinico-pathologic characteristics, details of primary treatment, intra-operative surgical findings, and survival outcomes were collected. To construct predictive nomograms for platinum sensitivity, 3-year progression-free survival (PFS), and 5-year overall survival (OS), we performed stepwise variable selection by measuring the area under the receiver operating characteristic curve (AUC) with leave-one-out cross-validation. For model validation, 10-fold cross-validation was applied. RESULTS: The median length of observation was 42.4 months (interquartile range, 25.7 to 69.9 months), during which 441 patients (50.9%) experienced disease recurrence. The median value of PFS was 32.6 months and 3-year PFS rate was 47.8% while 5-year OS rate was 68.4%. The AUCs of the newly developed nomograms predicting platinum sensitivity, 3-year PFS, and 5-year OS were 0.758, 0.841, and 0.805, respectively. We also developed predictive nomograms confined to the patients who underwent primary debulking surgery. The AUCs for platinum sensitivity, 3-year PFS, and 5-year OS were 0.713, 0.839, and 0.803, respectively. CONCLUSION: We successfully developed nomograms predicting treatment response and prognosis of patients with EOC. These nomograms are expected to be useful in clinical practice and designing clinical trials.

Androgen receptor as a prognostic biomarker and therapeutic target in uterine leiomyosarcoma / 부인종양

OBJECTIVE: To investigate the expression of androgen receptor (AR) and its correlation with disease status and survival outcome in uterine leiomyosarcoma with other hormone receptors. METHODS: The medical records and paraffin blocks of 42 patients were reviewed. The immunohistochemical expression of AR, estrogen receptor (ER), progesterone receptor (PR), gonadotropin releasing hormone (GnRH), and cytochrome P450, family 19, subfamily A, polypeptide 1 (CYP19A1) were assessed using tissue microarray. RESULTS: In total, AR expression was observed in 11 patients (26.2%). International Federation of Gynecology and Obstetrics (FIGO) stage and AR were independent factors for disease-free survival (DFS) in multivariate regression analysis (odds ratio [OR]=5.8; 95% confidence interval [CI]=1.2–28.4 and OR=0.2; 95% CI=0.05–0.90; p=0.029 and 0.032, respectively). There were no deaths in the AR expression group, whereas the 5-year overall survival (OS) was 54.8% in the no expression group (p=0.014). Co-expression of ER and/or PR with AR was associated with significantly better 5-year DFS and OS than those with negative AR (72.7% vs. 28.6% and 100% vs. 64.3%; p=0.020 and 0.036, respectively). AR may be an independent prognostic marker regardless of ER/PR. CONCLUSION: AR can be a potential prognostic biomarker in uterine leiomyosarcoma.

Comparing and evaluating the efficacy of methotrexate and actinomycin D as first-line single chemotherapy agents in low risk gestational trophoblastic disease / 부인종양

OBJECTIVE: The aim of this study was to compare responses to single-agent chemotherapies and evaluate the predictive factors of resistance in low risk (LR) gestational trophoblastic disease (GTD). The chemotherapy agents included methotrexate (MTX) and actinomycin D (ACT-D). METHODS: We conducted a retrospective study of 126 patients with GTD who were treated between 2000 and 2013. A total of 71 patients with LR GTD were treated with MTX (8-day regimen or weekly regimen, n=53) or ACT-D (bi-weekly pulsed regimen or 5-day regimen, n=18). The successful treatment group and the failed treatment group were compared and analyzed to identify prognostic factors. RESULTS: The complete response rates were 83.3% for ACT-D and 62.2% for MTX, with no statistically significant difference. There was no severe adverse effect reported for either group. Longer interval durations from the index pregnancy (>2 months, p=0.040) and larger tumor size (>3 cm, p=0.020) were more common in non-responders than in responders; these results were statistically significant. CONCLUSION: Based on our results, ACT-D may be a better option than MTX as a first-line single chemotherapy agent for LR GTD. The bi-weekly pulsed ACT-D regimen had minimal, or at least the same, toxicities compared with MTX. However, due to the lack of strong supporting evidence, it cannot be conclusively stated that this is the best single agent for first-line chemotherapy in LR GTD patients. Further larger controlled trials will be necessary to establish the best guidelines for GTD treatment.

Erratum: Author correction

The Editorial Office of Obstet Gynecol Sci would like to correct the author list.

The efficacy and safety of pegylated liposomal doxorubicin monotherapy and combination therapy with carboplatin in Korean patients with recurrent ovarian, fallopian tube, or primary peritoneal cancer: a single-institution experience

OBJECTIVE: This study aimed to evaluate the efficacy and safety of pegylated liposomal doxorubicin (PLD) with or without carboplatin in Korean patients with recurrent ovarian cancer (ROC), fallopian tube, or primary peritoneal cancer. METHODS: This retrospective study included 52 patients with ROC, fallopian tube, or primary peritoneal cancer who received PLD (50 mg/m²) between 1(st) December 2014 and 31(th) July 2016. RESULTS: The mean number of chemotherapy cycles was 3.8 (range, 2 to 9) in the PLD monotherapy group and 7 (range, 2 to 13) in the PLD combined with carboplatin (PLD-C) group. In overall response rates and clinical beneficial rates, PLD monotherapy group shows 5.0% and 17.5%, and PLD-C group shows 33.3% and 75.0%. The mean progression-free survival (PFS) was 5 and 13 months in the PLD monotherapy and PLD-C groups, respectively. At 6 months after treatment initiation, absence of disease progression was confirmed in 6 (15%) and 10 (83.3%) patients in the PLD monotherapy and PLD-C groups. Hematological adverse events (e.g., neutropenia and thrombocytopenia) were more common in the PLD-C group (P<0.001, P=0.004). The incidence of anemia and non-hematological adverse events, including mucositis, hand-foot syndrome, and allergic reactions, was similar in both groups. CONCLUSION: This study demonstrated the efficacy and safety of PLD monotherapy and PLD-C combination in Korean patients with ROC. This study would be helpful to consider the degree of worry about side effects and treatment expectations after treatment. Further retrospective studies with larger samples are required to confirm the efficacy of PLD monotherapy in Asian patients with platinum-resistant ROC.

Laparoendoscopic single-site versus conventional laparoscopic surgery for ovarian mature cystic teratoma

OBJECTIVE: To compare the intraoperative and postoperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery in women with ovarian mature cystic teratoma. METHODS: A retrospective review of 303 women who underwent LESS (n=139) or conventional laparoscopic surgery (n=164) due to ovarian mature cystic teratoma was performed. Intra- and postoperative outcomes were compared between the two groups. RESULTS: There was no intergroup difference in age, body weight, height, body mass index, comorbidities, tumor size, bilaterality of tumor, or the type of surgery. However, more patients in the LESS group had a history of previous abdominal surgery (19.4% vs. 6.7%, P=0.001). Surgical outcomes including operating time (89 vs. 87.8 minutes, P=0.734), estimated blood loss (69.4 vs. 68.4 mL, P=0.842), transfusion requirement (2.2% vs. 0.6%, P=0.336), perioperative hemoglobin level change (1.3 vs. 1.2 g/dL, P=0.593), postoperative hospital stay (2.0 vs. 2.1 days, P=0.119), and complication rate (1.4% vs. 1.8%, P=0.999) did not differ between LESS and conventional groups. Postoperative pain scores measured using a visual analogue scale were significantly lower in the LESS group at 8 hours (P=0.021), 16 hours (P=0.034), and 32 hours (P=0.004) after surgery, and 32 of 139 patients (23%) in the LESS group and 78 of 164 patients (47.6%) in the conventional group required at least one additional analgesic (P<0.001). CONCLUSION: LESS was feasible and showed comparable surgical outcomes with conventional laparoscopic surgery for women with ovarian mature cystic teratoma. LESS was associated with less postoperative pain and required less analgesia.

Peritoneal Carcinosarcoma and Ovarian Papillary Serous Carcinoma Are the Same Origin: Analysis of TP53 Mutation and Microsatellite Suggests a Monoclonal Origin

No abstract available.

Reproductive outcomes after laparoscopic radical trachelectomy for early-stage cervical cancer / 부인종양

OBJECTIVE: The objective of this study was to estimate the reproductive outcome of young women with early-stage cervical cancer who underwent fertility-sparing laparoscopic radical trachelectomy (LRT). METHODS: We performed a retrospective review of the medical records of patients with early-stage cervical cancer who underwent LRT. Clinicopathological data were obtained from patient medical records, and reproductive outcome data were obtained from patient medical records and telephone interviews. RESULTS: Fifty-five patients who underwent successful LRT were included in this study. The median age of patients was 32 years (range, 22 to 40 years), and the median follow-up time after LRT was 37 months (range, 3 to 105 months). Menstruation resumed in all patients after LRT, with fifty patients (90.9%) and five patients (9.1%) reporting regular and irregular menstruation, respectively. Six patients (10.9%) presented with cervical stenosis, which was manifested by regular but decreased menstrual flow and newly-developed dysmenorrhea. These patients underwent cervical cannulation and dilatation. Eighteen patients (32.7%) attempted to conceive, with six out of 18 patients receiving fertility treatments. Fourteen pregnancies (i.e., four missed abortions, six preterm births and four full-term births) occurred in 10 patients after LRT. Nine out of 10 patients gave birth to 10 healthy babies. The pregnancy rate after LRT was 55.6% (10/18). The spontaneous abortion rate and live birth rate were 28.6% (4/14) and 71.4% (10/14), respectively. The preterm birth rate was 60% (6/10). CONCLUSION: Pregnancy and live birth rates after LRT were promising; however, the preterm birth rate was relatively high. Cervical stenosis also occurred in a small percentage of patients.

Hexamethylmelamine as Consolidation Treatment for Patients with Advanced Epithelial Ovarian Cancer in Complete Response after First-Line Chemotherapy

The aim of this study was to assess the efficacy of consolidation therapy with hexamethylmelamine (HMM) in patients with advanced epithelial ovarian cancer (EOC). Patients treated at our hospital between January 1997 and November 2006 and in documented clinical complete response from advanced ovarian cancer following front-line platinum-based therapy were retrospectively analyzed. The patients treated with HMM were compared to the patients of matched counterpart without consolidation therapy. Of 102 patients enrolled, 49 were treated with HMM and 53 received no consolidation treatment. For patients with HMM and observed patients, the mean age were 54.6 and 55.6 yr; the distribution of stage was similar (P=0.977); the optimal surgery was performed in 36 (73.5%) and 44 (83%) (P=0.336); the recurrence rate were 27 (55.1%) and 33 (62.3%) (P=0.463); and the median progression-free survival were 38 months and 21 months for patients with HMM and observed patients (P=0.235). No treatment-related adverse events were reported during the follow-up period. Although this study failed to show the significant survival benefit of consolidation therapy with HMM in patients with advanced EOC, we consider that our study can contribute data to investigate the effectiveness of consolidation therapy in epithelial ovarian cancer.

The efficacy and toxicity of topotecan in combination with platinum in patients with recurrent epithelial ovarian cancer and primary peritoneal carcinomatosis / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the efficacy and toxicity of topotecan, camptothecin analogue topoisomerase I inhibitor, as the combination therapy with platinum in patients with recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis. METHOD: In this study, patients who were treated with topotecan between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Fifty-one patients with recurrent ovarian carcinoma and peritoneal carcinomatosis were included. These patients' data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria for patients with measurable disease and CA-125 response criteria for patients with non-measurable disease. The toxicities were evaluated according to NCI CTC (Common Toxicity Criteria) version 3.0. RESULTS: The mean age of patients was 53.4 years (ranged between 37 and 69). Forty-four patients had been evaluated by RECIST criteria. The overall response rate was 22.8% (10/44). Platinum-sensitive patients showed more favorable response rate (26.9%) than platinum-resistant patients (16.7%), however, it was not significant statistically (p=0.425). Platinum-sensitive group had significantly longer response duration (12.14 vs. 3.33 months, p=0.022) and time-to-progression (11.34 vs. 7.33 months, p=0.042) than platinum-resistant group. Heavily pretreated group, three or more prior regimens were used, had no significant differences from another group. The most common adverse effect of topotecan in combination with platinum was hematologic toxicity; grade 3/4 neutropenia was 30.6%, anemia was 42.7%, and thrombocytopenia was 8.37% in total 265 cycles of chemotherapy, however, it was tolerable. CONCLUSION: Topotecan in combination with platinum is considered as effective regimen with acceptable toxicity in treating recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis who have failed previous treatment with platinum-containing chemotherapy.

Effectiveness and safety of oral capecitabine in patients with gynecologic cancers / 부인종양

OBJECTIVE: To determine the efficacy and safety of capecitabine in patients with gynecologic cancers as adjuvant chemotherapy or maintenance treatment. METHODS: In this study, patients who were treated with capecitabine between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Thirty-one patients with gynecologic cancers were included 16 patients with recurrent ovarian cancer, 9 patients with cervical cancer after initial treatment, and 6 patients with recurrent cervical cancer. These patients' data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by both RECIST criteria for patients with measurable disease and CA 125 criteria in patients with ovarian cancer and National Cancer Institute criteria for progression, response, and toxicity were utilized in cervical cancer. RESULTS: Capcitabine was given at a dosage of 2,000-2,500 mg/m2/day orally in a divided dose daily for 14 days followed by a 7-day rest period in all patients. Nine patients with ovarian cancer were treated with more than 2 cycles and their median age was 49 years (43-67). Two patients showed a partial response and the median progression free survival was 3 months. Nine patients with cervical cancer after initial treatment were in the complete response state and their median progression free survival was 24.5 months. No partial or complete responses were seen in 6 patients with recurrent cervical cancer. There was no severe toxicity. CONCLUSION: Although capecitabine is a well-tolerated regimen, as a single agent, it produces minimal benefit in recurrent ovarian and cervical cancer population.

Treatment efficacy of high dose progestin in young women with early stage of endometrial carcinoma / 대한산부인과학회지

OBJECTIVE: The aim of this study is to investigate the effectiveness of high dose progestins in young patients with early stage of endometrial cancer. METHODS: Between April 1998 and December 2005, 10 women with early stage of endometrial carcinoma were treated with high dose progestins as primary therapy for the purpose of saving fertility. RESULTS: They took 80~160 mg of megestrol acetate or 500~1,000 mg of medroxyprogesterone acetate per day, and then followed up with the endometrial curettages. Seven patients (70.0%) responded to the treatment. Three patients didn't respond and so underwent hysterectomy as definite treatment. Four patients were able to become pregnant after completing treatment. No patients died of their disease. CONCLUSION: The majority of patients with well-differentiated endometrial adenocarcinoma who underwent conservative treatment with a progestational agent responded to the treatment. High-dose progestin therapy can be used as primary therapy in selected young women with early stage of endometrial carcinoma.

Effect of prostaglandin- and nitric oxide-synthase inhibitors on the lipopolysaccharide-induced adrenomedullin productions in cultured murine macrophage cells / 대한산부인과학회지

OBJECTIVE: Adrenomedullin (AM), a potent vasorelaxing agent associated with the maintenance of pregnancy, is synthesized in response to inflammation, which is also associated with the biosynthesis of prostaglandin (PG) and nitric oxide (NO). To clarify the interrelationships of PG, NO and AM in the inflammatory process, we tested the effects of the PG synthase inhibitor indomethacin and the NO synthase inhibitor N omega-nitro-L-arginine methyl ester (L-NAME) on AM production in lipopolysaccharide (LPS)-stimulated cultured rat macrophages. METHODS: RAW 257.8, rat macrophages were incubated with LPS, and AM production was measured by ELISA. Cells were pretreated with indomethacin, L-NAME, or both, and the effect on LPS-induced AM production was assayed. To exclude the effect of cell death, a cell viability test on these cultures was performed. RESULTS: The largest increase of AM was seen between 1 microgram (36.33+/-2.05 pg/ml) and 10 microgram (89.33+/-6.02 pg/ml) of LPS concentration (p<0.01), making the latter the optimal LPS dose to stimulate AM production. AM secretion was proportional to time in culture (p<0.006). Addition of indomethacin, L-NAME, or both 1 hr before LPS stimulation decreased AM production 2 hr later, with the AM decrement greatest in cells pretreated with both indomethacin and L-NAME, followed by L-NAME alone and then indomethacin. CONCLUSION: These findings indicate that PG and NO increase AM synthesis in rat macrophages with the presence of LPS. These results suggest that the biosynthetic pathways of PG, NO, and AM may be linked.

Clinical significance of surgical staging and lymphadenectomy in patients with borderline ovarian tumors / 부인종양

OBJECTIVE: To compare the outcome of patients with borderline ovarian tumors who had been surgically staged with those who were not staged. METHODS: Between 1997 and 2004, there were 204 patients who underwent surgery and were diagnosed as borderline ovarian tumors. A retrospective review was performed. Two groups were identified: patients who underwent surgical staging (n=98) versus those who were not staged (n=106). Clinical outcomes were compared between the two groups. RESULTS: Between the two groups, there were no differences of the mean age of the time of diagnosis, parity, BMI, family history, pretreatment CA 125 level, tumor size, and disease recurrence, but were significant differences of FIGO stage (p=0.04), histologic types (p<0.01), operation time (p<0.01), length of hospital stay (p<0.01), and adjuvant chemotherapy (p<0.01). The lymph node positivity rate were 3.5% and 7.1% in patients with pelvic and para-aortic lymphadenectomy respectively. All patients with postive lymph nodes showed the micropapillary serous carcinoma. The 5 year disease-free survival rate was 90%. The overall disease-free survival was significantly found to be decreased in patients with advanced FIGO stage (p<0.01). There was no significant difference of overall disease-free survival regard to pretreatment CA 125 level (p=0.72), histologic types (p=0.78), adjuvant chemotherapy (p=0.45), and surgical staging with lymphadenectomy (p=0.79). CONCLUSION: Disease-free survival was not significantly different between staged and unstaged patients who had surgery with borderline ovarian tumors. It seems that routine pelvic and para-aortic lymphadenectomy is not necessary in the majority of women with borderline ovarian tumors.

The Relationship between Expression of 1-Cys Peroxiredoxin and Resistance to Cisplatin in Epithelial Ovarian Cancer Cell Lines / 대한산부인과학회지

OBJECTIVE: To investigate the relationship between expression of 1-Cys peroxiredoxin (Prx) and resistance to cisplatin in epithelial ovarian cancer cell lines. METHODS: Immunohistochemistry of 1-Cys Prx was performed on both normal ovarian tissues and the tissues of epithelial ovarian cancer. Western blot was performed to measure the expression of 1-Cys Prx in SKOV-3, OVCAR-3 and SNU-8 after treatment with cisplatin. Expression of 1-Cys Prx in SKOV-3 was also measured according to both time after treatment with cisplatin and concentration of cisplatin. The generation of reactive oxygen species (ROS) was measured with and without antioxidants in SKOV-3. SKOV-3 was transfected with 1-Cys Prx green fluorescent protein plasmid to overexpress 1-Cys Prx and TUNEL assay was performed after treatment with cisplatin to examine apoptosis. RESULTS: 1-Cys Prx was strongly expressed in both stroma and epithelium of both normal ovary and epithelial ovarian cancer, especially in the cytoplasm of epithelial cells. SNU-8 and OVCAR-3 exhibited about 1.5 fold higher expression than SKOV-3. SKOV-3 showed the peak expression at 48 hours after treatment with cisplatin and in 3 microgram/mL concentration of cisplatin. The generation of ROS was increased after treatment with cisplatin to SKOV-3 and the survival of SKOV-3 against cisplatin was correlated with the concentration of antioxidants (p<0.001). No apoptosis occurred in 1-Cys Prx overexpressed SKOV-3 cells. CONCLUSION: 1-Cys Prx was shown to increase the resistance to cisplatin in epithelial ovarian cancer cell line. The result suggests that the resistance may be due to overexpression of 1-Cys Prx, which is responsible for removal of ROS generated by cisplatin.

Clinical Usefulness of Cytokeratin 7 and 20 Expression in Metastatic Ovarian Tumors / 대한산부인과학회지

OBJECTIVE: To investigate the pattern of Cytokeratin (CK) 7 and 20 expression and evaluate its clinical usefulness in the differential diagnosis of metastatic ovarian carcinoma. METHODS: One hundred eighty nine cases pathologically diagnosed as having metastatic ovarian carcinoma were reviewed from January 1990 to December 2003 at Asan Medical Center. Immunohistochemistry for CK7 and CK20 was performed in 92 cases. RESULTS: One hundred seventy five cases were originated from non-gynecologic organs. The most common primary site was stomach (88 patients) followed by colon (53 patients). Fourteen cases were originated from gynecologic organs, such as uterine cervix, endometrium, and fallopian tube. 82.5% (33/40) of the stomach cancers was CK7 positive, whereas only 23.5% (8/34) of the colorectal cancers was CK7 positive. 82.5% (33/40) of the stomach cancers and 100% (34/34) of the colorectal cancers was CK20 positive. CK7+/CK20+ pattern was the most frequent in stomach cancer (70.0%, 28/40). In colorectal cancer, CK7-/CK20+ pattern had the largest portion (76.5%, 26/34) and there was no CK7+/CK20- pattern in contrast to primary ovarian carcinoma. CONCLUSION: CK7 and CK20 expression patterns in primary gastric carcinomas vary considerably. The CK7-/CK20+ expression pattern is specific for metastatic colorectal carcinomas to the ovary and expression pattern of CK is one of the useful methods to differentiate primary ovary cancers from metastatic ovarian carcinomas from colon, especially in left side colon cancer.

Applicable Indications and Effectiveness of the Selective Arterial Embolization in the Management of Obstetrical Hemorrhage / 대한산부인과학회잡지

OBJECTIVE: To describe the angiographic embolization as a safe and an effective alternative treatment in the management of obstetrical hemorrhage and in preserving fertility. METHODS: Between March 1999 and May 2003, 43 patients at Asan Medical Center underwent angiographic embolization for the management of obstetrical hemorrhage. All cases received arterial embolization because of obstetrical hemorrhage unresponsive to conservative management or prophylaxis for massive obstetrical hemorrhage. Medical records were reviewed and detailed to collect adequate clinical data such as clinical status, underlying conditions, amount of transfusion, embolization sites, materials of embolization, duration of the procedure, complications associated with embolization, hospital stay, and the success rate. Patients were contacted by telephone to obtain long-term outcome for menstruation, desire for conception, and subsequent pregnancies. RESULTS: We have experienced the clinical successful embolization in 37 (86.0%) of 43 patients of obstetrical hemorrhage resulting from various causes. The main cause of hemorrhage was atony of uterus (n=17), followed by abnormal placentation (n=6), genital tract laceration (n=5). The average amount of blood transfusion was 7.0 units (range; 0-36 units). The average length of the time for the procedure was 68.2 minutes (range; 30-150 minutes). The average duration of hospitalization was 6.4 days (range; 3-20 days). The main complication after embolization was numbness and pain on right lower extremities in 5 cases and vessel dissection occurred in 1 case. But there was no major complication related to the procedure. We were able to follow up 28 patients. In all cases menses resumed spontaneously soon after the procedure. Seven cases of long-term follow-up became pregnant, and 3 cases of them completed gestations giving birth to healthy babies. CONCLUSION: The results suggest that angiographic embolization is a relatively noninvasive and highly effective method for the management of obstetrical hemorrhage and a useful technique for preserving fertility.