Promoter Methylation of p16 Gene in Cervical Cancer / 부인종양

OBJECTIVE: To investigate the promoter methylation status in the p16 gene in primary cervical cancer and to analyze the relationships between the clinicopathologic parameters and the methylation status of p16 gene. METHODS: Promoter methylation was evaluated by using a methylation-specific polymerase chain reaction in 78 cervical cancer tissues and 24 control non-neoplastic cervical tissues. Clinicopathologic parameters were obtained from medical records and the relationships between the discrete variables and the methylation status were evaluated. RESULTS: The frequency of the promoter methylation of p16 in cervical cancer was 57.0% (45/78). Primary cervical cancer had a significantly higher methylation frequency for p16 gene as compared to a control non-neoplastic cervix (p<0.0001). Higher stage cancers exhibited an increased promoter methylation frequency for p16 (45.6% in stage Ib, 58.3% in stage IIa, 88.2% in stage IIb, and 66.7% in stage IIIb, p=0.0125). CONCLUSION: Our results suggest that promoter methylation of p16 is a frequent event in cervical carcinogenesis and has a potential clinical application as markers for cancer progression and prediction of prognosis.

cDNA Array Analysis of Genes Expressed in the Rat Polycystic Ovary Induced by Dehydroepiandrosterone / 대한산부인과학회잡지

OBJECTIVE: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder. Chronic anovulation, hyperandrogenism, hirsutism, obesity, infertility and polycystic ovaries (PCO) are clinical hallmarks of PCOS. PCO can be induced in prepubertal rats by daily injection of dehydroepiandrosterone (DHEA). The aims of this study is to investigate cDNA array analysis of genes expressed in the rat PCO induced by DHEA. METHODS: To induce the hyperandrogenic PCO condition, 22-day old rats were injected each day s.c. with DHEA for 15 days. Total ovarian RNA was isolated from the DHEA induced rat PCO and control, and used to prepare radiolabeled cDNA probes, which were hybridized to cDNA arrays. Some of selected genes were further analyzed by reverse transcription-polymerase chain reaction (RT-PCR) or in situ hybridization. RESULTS: Quantitative analysis identified differential expression profiles of 31 genes including leukemia inhibitor factor receptor alpha (LIFR-alpha), alpha 1A adrenergic receptor (ADRA1A), heat shock 90-kDa protein A (HSP90A) and platelet-derived growth factor receptor alpha (PDGFR-alpha) genes. RT-PCR analysis was used to validate the changes in above four gene expressions by the cDNA array. The levels of ADRA1A and LIFR-alpha gene expressions were incresed in DHEA induced rat PCO than control, but HSP90A and PDGFR-alpha gene expressions were decresed in PCO. The mRNA of ADRA1A gene was mainly localized in granulosa cells of cystic follicles. CONCLUSION: Rat hyperandrogenic PCO was induced by daily injection of DHEA for 15 days. ADRA1A, LIFR-alpha, HSP90A and PDGFR-alpha gene expressions were differentially expressed in PCO induced by DHEA. The above four genes may be involved in the mechanism of follicular growth and ovulation processes. The precise relationship between the altered gene expressions and PCO is a matter of further investigation.

Correlation between Prognostic Factors and Lymph Node Metastases in Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: To determine the valuable predictors of lymph nodes metastasis by analysing correlation with some prognostic factors in women with endometrial cancer. METHODS: A retrospective study was conducted in 49 women with endometrial cancer who underwent surgery with lymph node dissection or biopsy from 1988 to 2001 at our department. The prognostic factors analysed were age, obesity, histopathologic type and grade, depth of myometrial invasion, cervical invasion, adnexal metastasis, tumor size, hormone receptor, and preoperative CA-125. Univariate analysis was performed by x2 test and Fisher's exact test. RESULTS: Overall incidence of lymph node metastases was 28.6% (14/49). Lymph node metastases were statistically correlated with histopathologic type (P=0.048), depth of myometrial invasion (P=0.036), cervical invasion (P=0.001), and adnexal metastasis (P=0.015), however age, obesity, histopathologic grade, tumor diameter, estrogen and progesterone receptors, and preoperative CA125 were not statistically correlated. CONCLUSION: Histopathologic type, depth of myometrial invasion, cervical invasion, and adnexal metastasis were considered as predictors for lymph node metastases in endometrial cancer. Further studies for a large number of cases with multivariate analysis are needed.

A Case of Huge Primary Intracardiac Tumor Diagnosed by Prenatal Ultrasonography / 대한주산의학회잡지

No abstract available.

A Case of Primary Peritoneal Melanosis with Ovarian Mucinous Cystadenoma / 대한산부인과학회잡지

Peritoneal melanosis is an extremely rare condition characterized by diffuse pigmentation in the peritoneum. Only 7 cases have been reported in the literature, 4 cases in associated ovarian teratoma, 1 case in peritoneal cyst, 1 case in ovarian teratoma and mucinous adenoma, and 1 case in enteric duplication cyst. All occurred in young females and the source of the pigmentation was inconclusive. The authors have experienced one case of primary peritoneal melanosis with mucinous cystadenoma and report our case with a brief review of literature.

A Case of Hepatic Metastasis of Granulosa Cell Tumor of the Ovary / 대한산부인과학회잡지

Ovarian granulosa cell tumors are uncommon low-grade malignancies. They are characterized by their long history and their tendency to recur years after an apparent clinical cure. Only a small percentage of granulosa cell tumors metastasize, and they rarely do so to the liver. In this paper, we present a case of hepatic metastasis treated by surgery and BEP combination chemotherapy, with a brief review of corresponding literatures.

Twa Cases of Sacrococcygeal Teratoma Doagnosed by prenatal Ultrasosography / 대한주산의학회잡지

No abstract available.

Correlation between CD44 Variants Expression, Microvessel Density and VEGF Expression and HPV 16/18 Subtypes in Squamous Neoplasia of the Uterine Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: In the development of squamous neoplasia of the uterine cervix, high risk HPV infection has been followed by CD44 variant expression and angiogenesis. The aim of this study is to evaluate the sequential changes and relatianship of CD44 variant expression, microvessel density (MVD), and VEGF expression in CIN III, microinvasive (MI) and invasive (CA) squamous cell carcinoma. METHODS: The materials were 17 cases of CIN III, 14 cases of MI and 15 cases of CA. In situ PCR for HPV 16/18 and immunohistochemical studies for CD44std, v6, v7/8, CD 31 for MVD, and VEGF were performed. RESULTS: CD44std expression was decreased in squarnous neoplasia compared to normal, and CD44v6 and v7/8 expressions were increased, however, there was no statistical significance. Accentuated staining of CD44v6 and v7/8 along the infiltrating borders was noted in 76.9% and 69.2% of MI and in 71.4% and 42.9% of CA, respectively. High MVD and VEGF 2+ expression were higher in the squamous neoplasia compared to narmal, however, there was no significant difference between the squamous neoplasia and no significant relationship between MVD and VEGF expression. The expression rates of CD44std and CD44v6 were higher in HPV 16/18 negative squamous neoplasia and that of CD44v7/8 was higher in HPV 16/18 pasitive squamous neoplasia, however, their differences were not significant. The incidences of high MVD and VEGF 2+ expression were higher in HPV 16/18 positive suqmaous neoplasia with no statistical significance. CONCLUSIONS: These results suggest that CD44 variants expression and angiogenesis are involved in the development of squamous neoplasia of the uterine cervix, however, HPV 16/18 might not be related to CD44 variant expression and angiogenesis.

A Clinical Experience of Radical Hysterectomy on 398 Cases of Locally Invasive Cervical Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To survey the clinical features, complications, prognostic factors and Five-year survival rates of 398 patients with invasive cervical cancer(stage Ib-IIb), subjected to radical hysterectomy and bilateral pelvic lymphadenectomy. METHODS: Medical records and pathologic reports were reviewed retrospectively on 398 cases, diagnosed and operated on during the period of Jan. 1988 - Dec. 1998. Five-year survival rates were estimated by the Kaplan-Meier method, and prognostic factors were assessed using Wilcoxon test. RESULTS: Of the 398 cases, 285 were in stage Ib(71.6%), 58 in stage IIa(14.5%), and 55 in stage IIb(13.8%). The mean age of patients was 48+/-9.9 years. Neoadjuvant chemotherapy was given to 200 patients(50.2%), Adjuvnat radiotherapy in 160 patients(40.2%) postoperatively. Operative complications occured in 121 patients(30%). Massive blood loss and bladder dysfuction were frequent complications(11.3% and 10.3%, respectively). Others were urinary tract infection(9.3%), wound infection(7.5%), lymphocyst(3.5%) and urinary tract fistula(0.7%), respectively. The Five-year survival rates for stage Ib, IIa, and IIb were 84.2, 82.8%, and 75.8%, respectively. Factors that affect the Five-year survival rates were cell type(small cell Vs other, P=0.0146), tumor size(3cm, P=0.0425), depth of invasion( 5ne, P= 0.0007), response of chemotherapy(poor response Vs other, P= 0.0001), LN metastasis(1 Vs 2 Vs more, P=0.0001). CONCLUSION: Accumulating the clinical experience, we could improve results, reduce complications and speculated that the survival rates could be improved by neoadjuvant chemotherapy and/or adjuvant postoperative radiotherpy. Prospective randomized trials are needed to evaluate our approach and to be compared with concurrent chemoradiotherapy to definite its precise role in locally advanced cervical cancer.

A Case of Skin Metastasis from Uterine Cervical Cancer / 대한부인종양콜포스코피학회잡지

Skin metastasis from carcinoma of uterine cervix is extremely rare and its incidence is reported as 0.1~1.3%. Common pattern of occurrence is multiple nodules in abdomen, external genitalia, or lower extremeties. It is believed that the pathogenesis of skin metastasis is a result of retrograde spread of the tumor secondary to lymphatic obstruction. Treatment of skin metastasis may consist of surgical excision, local irradiation, or chemotherapy, but the prognosis is very poor and median survival is about 3 months. We have experienced such a case and report the case with brief review of literatures.

Two Cases of Retroperitioneal Schwannoma / 대한산부인과학회잡지

Schwannomas are benign nerve sheath tumors that can originate at any anatomic sites. These tumors are usually soitary, benign, and slow-growing masses attached to large nerve trunks. These tumors have been described as arising in the pelvic retroperitoneum. We present two cases of pelvic retroperitoneal Schwannomas with a brief review of literatures.

The outcome of the cervical cancer (stage Ib1) treated by radical surgery with and without neoadjuvant chemotherapy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this retrospective study was to evaluate the effect of neoadjuvant chemotherapy followed by radical surgery compared with conventional radical surgery in stage Ib1 cervical cancer as to operative complications, the rate of lymph node metastasis, recurrence and overall five-year survival rates. METHODS: The study materal (98 cases of stage Ib1 cervical cancer) was divided into two groups; The one group was neoadjuvant chemotherapy (Cisplatin + 5-FU) followed by radical surgery (n = 41) and the other was the conventional radical surgery (n = 57) group. Reviewing records of operative and pathological reports and clinical findings, the outcome was statistically analyzed and compared. RESULTS: As to the complication, bladder dysfuntion was more frequent in neoadjuvant chemotherapy group, statistically significant.(43.9% vs 22.8%, P=0.034). No significant difference was found in the incidence of lymphnode metastasis (17% vs 17.5%, P=0.779) and overall five year survial rates(85.3% vs 87.7%, P=0.735). CONCLUSION: No benefical effect of neoadjuvant chemotherapy could be found on stage Ib1 cervical cancer in this retrospective study. However, well controlled longterm prospective study will be need to get firm conclusion.

Clinical Analysis on the Outcome from the Treatment of Locally Invasive Cervical Cancer-Analysis of 195(Ia-IIb) Cases / 대한산부인과학회잡지

OBJECTIVES: The purposes of this clinical study were 1) to assess 5-year survival rates in 195 patients with locally invasive cervical cancer(stage Ia-IIb) treated by surgery, neoadjuvant chemotherapy+surgery and postoperative radiation in selected cases, 2) to evaluate the prognostic factors affecting the survival rate, and 3) to get helpful information for the better treatment. METHODS: A retrospective analysis was conducted of 195 patients. They were diagnosed and operated on during the period of Jan. 1988 - Dec. 1993 in Dept. of OB/Gyn, Pusan Paik Hospital, Inje Medical School. The 5-year survival rates were estimated using the Kaplan-Meier method, and prognostic factors were assessed using Wilcoxon test. RESULTS: The 5-year survival rates for FIGO stages Ia, Ib, IIa, and IIb were 100, 86.1, 76.9, and 81.1%, respectively. Factors that affect the 5-year survival rates were clinical stage(P=0.0001), cell type(small cell vs other, P=0.0001), depth of invasion(5 mm, P=0.0013), tumor size(3cm, P=0.0035), and lymph node metastasis(0 vs 1 vs more than 2, P=0.0001). There was no difference in 5-year survival rates between without neoadjuvant chemotherapy group and with neoadjuvant chemotherapy group which had poor prognostic factors. The predicted recurrence rate of the postoperative radiation group showed a lower 5-year survival rate than the no postoperative radiation group(P=0.0001). CONCLUSIONS: We conclude that the factors affecting the prognosis were FIGO stage, cell type, depth of invasion, tumor size, and lymph node metastasis, and speculated that the survival rates could be improved by using neoadjuvant chemotherapy for more advanced locally invasive cases properly.

A case of endodermal sinus tumor of ovary ; Complete remission & full-term delivery after conservative surgery and BEP therapy / 대한부인종양콜포스코피학회잡지

The endodermal sinus tumor of ovary is a rare, malignant germ cell tumor. It principally affects children and young adults. Earlier reports before combination chemothery described it was fatal and the prognosis was poor. The advances in treatment of endodermal sinus tumor have been achieved with the development of combination chemotherapy with monitoring tumor marker, serum AFP. The authors experienced a case of endodermal sinus tumor of ovary which showed complete remission following primary conservative surgery and three courses of combination chemotherapy(BEP) with normal full-term spontaneous delivery. With the case report, a brief review was made.

Evaluation of Ovarian Tumors by RMI(risk of malignancy index); -Based on Serum CA-125, Ultrasound Findings and Menopausal Status / 대한산부인과학회잡지

The purpose of this clinical study was to evaluate the efficacy of RMI(risk of malignancy index) as a preoperative predictive screening method in ovarian tumors. The RMI was calculated by the following formula; -RMI=The ultrasonographic score(0, 1, or 3) x serum CA-125 level x menopausal status score(1 or 3). The preoperative RMI was obtained from 69 cases of ovarian tumors operated from July 1993 to March 1996 at the Dept. of Obstetrics and Gynecology, Pusan Paik Hosp. Reviewing the histopathological diagnosis of surgical specimen, using RMI cut-off value of 200, the sensitivity, specificity, positive and negative predictive value of RMI was obtained and compared with CA-125 value and sonographic scores, respectively. The results obtained were as follows; 1. The sensitivity of RMI was 67.7%, it was lower than that of serum CA-125 value(74.0%) and ultrasonographic score(80.6%)(P=0.535). 2. The specificity of RMI was 100%, it was higher than that of serum CA-125 value(81.6 %) and ultrasonographic score(84.2%)(P=0.006). 3. The positive predictive value of RMI was 100%, it was higher than that of serum CA-125 value(76.7%) and ultrasonographic score(80.6%)(P=0.047). 4. The negative predictive value of RMI was 79.2%, it was lower than that of CA-125 value(79.5%) and ultraconographic score(84.2%)(P=0.83). In conclusion, the RMI could be a useful screening method to discriminate a benign from malignant ovarian tumors prior to operation.

A comparative Study for morbidity and Compilication in Total AbdominalHysterectomy ; -Open Versus Closed Vaginal Cuff / 대한산부인과학회잡지

Post-operative morbidity and complication, focused on open versus closed vaginal cuff, were compared. The patients were divided into two groups according to the method of cuff management(open cuff : n=53, closed cuff : n=52). From Jan, 1990 to Dec. 1994 one hundred five cases of total abdominal hysterectomy on the benign uterine disease were carried out by the same operator at the Dept. of Ob/Gyn. Pusan Paik Hospital. The vaginal cuff was opened during the first half periods(1990. 1~1993.3), and it was closed during the later peroids(1993.4 ~ 1994.12). As to the postoperative morbidity and complication(closed : open), urinary tract infection(9.4% : 5.8%), vaginal cuff infection(7.5% : 3.8%), febrile morbidity(3.8% : 3.8%), wound infection(1.9% : 3.8%), pelvic hematoma(0: 1.9%) developed but there were no statistical differences between the two groups. Granulation tissue formation on the vaginal cuff was found in 26 cases(49.1%) of the open cuff and in 18 cases(34.6%) of the closed cuff(p=0.134, X(2) test ) within 6 months after operation. Post operative increased vaginal discharge developed in 7 cases(13.2%) of the open cuff and in 10 cases (19.2%) of the closed cuff group(p=0.516, Fisher's Exact test).

Amniotic Fluid Index and Preinatal Outcome in Postterm Pregnancy / 대한주산의학회잡지

A pregnancy is considered postterm if it is beyond 294 days (42 complete weeks). Several investigators have demonstrated that postterm pregnancy may be accompanied by a rise in perinatal morbidity and/or mortality. Abnormalities such as meconium staining, cringenital anomalies, intrauterine growth retardation, postmaturity syndrome, fetal asphyxia have been reported in some cases of reduced amniotic fluid volume (oligohyramnios) which is commonly observed in postterm pregnancies. Amniotic fluid volume has been shown to decrease significantly as gestational age advances beyond term. Oligohydramnios has particular relevance to postterm pregnancies. Poor perinatal outcomes of oligohydramnios on postterm pregnancy have been reported by several authors. To date, however, the relationship between oligohydramnios in pastterm pregnancy and fetal outcome is debatable. The purpose of this clinical study was to evaluate the relationship between oligohydr- amnios and perinatal outcome in 64 cases of postterm pregnancies. Amniotic fluid index(AFI) values were measured semiweekly in 64 good dated, uncomplicated singleton pregnancies. AFI values were categorized into 2 groups. The group 1; patients whose final AFI value was above 5.0 cm; Group 2, patients whose AFI value fell below 5.0 cm. Adverse fetal outcome was defined by the presence of meconium staining, fetal heart rate decelerations, cesarean delivery for fetal distress, low Apgar score at 1 and 5 minutes, neonatal intensive care unit admission, and perinatal mortality. The fetal outcome was compared group 1 with group 2 and results obtained were as follows: 1. The incidence of oligohydramnios in postterm pregnancy was 54.7 %. The average diminution of amniotic fluid index was from 8.2 1.8 cm to 5.6+2.2 cm/week. 2. The incidence of meconium-staining in amniotic fluid was 40.6 % (Group 1: 20.7 %, Group 2: 57.1 %) and showed statistically significant difference between the two groups(p= 0.003). 3. The incidence of Apgar score less than 7 was 23.4% in 1 minute (Group 1: 13.8 %, Group 2: 31.4 %) and 4.7 % in 5 minutes(Group 1: 3.4%, Group 2: 5.7 %), respectively and showed no statistically significant difference between the two groups (p=0.140, p=1.000). 4. I'he incidence of cesarean delivery due to fetal distress was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). 5. The incidence of admission to NICU was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). Adverse fetal outcome was not uniformly observed in postterm pregnancies with oligohydramnios. Amniotic fluid index in oligohydramnios group as a single independent guide was not enough to predict fetal outcomes in postterm pregnancy without specific pathologic condition of fetus.

Plasma Fibronectin Levels in Preeclampsia / 대한주산의학회잡지

Current concept of the pathogenesis of preeclampsia involves the generalized dysfunction of maternal vascular endothelial cells. Using ELISA (enzyme-linked immunosorbent assay) method, the fibronectin, as a marker of endothelial cell injury, was measured in the group of 35 cases of preeclampsia (mild; 15 and severe; 20 cases) and the control group of 21 cases of normal pregnancy. The clinical profiles, hematologic and renal function test results were compared and correlated with the levels of plasma fibronectin between two groups. The results obtained were as follows 1. The mean age between preeclampsia and control group was not different statistically, but gestational age, birth weight and maternal weight were different significantly between two groups. 2. Compared with normal control group, plasma levels of fibronectin were signifi- cantly elevated in preeclampsia group. As to the differential validity between two groups (control vs preeclampsia), using cutoff value of 380 mg/dl, sensitivity was 95.7 %, specificity was 90.5 %, predictive value was 93.8 %. As to the differential validity between mild and severe preeclampsia, using cutoff value of 742 mg/dl, sensitivity was 65.0 %, specificity was 73.3 %, predictive value was 76.5%. 3. As to the correlationship between plasma fibronectin levels and hematologic test results, uric acid and creatinine levels showed positive correlation in preeclampsia. Based upon these study results, plasma fibronectin could be a useful parameter for the differential diagnostic validity and grade of preeclampsia.

Clinical Significance of DNA Ploidy in Epithelial Ovarian Malignancy / 대한부인종양콜포스코피학회잡지

Prognosis and biologic behavior of malignant ovarian tumors have been assessed by clinical staging, morphological grading and many other variables. Recently DNA ploidy measured by flow cytometry has been suggested as an additional important indicator of the tumor behavior and prognosis. The author measured DNA ploidy, S-phase fraction and DNA Index in 36 patients of epithelial ovarian tumors(17 were malignant, and 19 were borderline) by flow cytometric analysis of paraffin embedded tumor blocks. Comparing with FIGO stage, tumor grade, histologic type and others, the author investigated the clinical significance of the results of flow cytometric analysis. The results obtained as follows : (continue)

Two Cases of Glassy Cell Carcionma of the Cervix, Treated by Neoadjuvant Chemotherapy and Radical Hysterectomy / 대한부인종양콜포스코피학회잡지

Glassy cell carcinoma is a histologic subtype of cervical cancer with distinct pathologic features and it has an aggressive biologic course. It was first described by Glucksmann and Cherry in 1956 as a poorly differentiated adenoquamous carcinoma and commented on its poor prognosis, unresponsiveness to traditional modes of therapy, and often associated with pregnancy. The characteristic histologic features are defined as follows: 1) cells with a moderate amount of cytoplasm resembling ground glass, 2) a fairly distinct cell membrane that stains with eosin or PAS, 3) large nuclei with prominent nucleoli. We present two cases of glassy cell carcinoma of the cervix successfullyl treated by neoadjuvant chemotherapy and radical hyterectorny, with a brief review of literatures.