A Clinical Study of 25 Cases of Uterine Papillary Serous Carcinoma / 대한산부인과학회지

OBJECTIVE: Uterine papillary serous carcinoma (UPSC) has been recognized as an aggressive tumor characterized by deep myometrial invasion and reported high recurrence and low survival rates. METHODS: We retrospectively investigated the clinicopathologic findings and analyzed the survival rate and prognostic factors in 25 patients with UPSC who were surgically staged at the oncology department between January 1994 and December 2003. RESULTS: The mean age of the cases was 55.8 (range: 45-69) years. The most frequent presenting symptom was abnormal uterine bleeding (88%). According to FIGO staging, seven of the cases were stage I, six of the cases were stage II, eleven of the cases were stage III, and one case was stage IV. Mean follow up period is 42.7 months (range: 9-123 months). Overall survival rate was 80 percent. The recurrence was seen in 5 patients (25%). CONCLUSION: Univariate analysis showed that invasion of uterine serosa, ovarian and tubal metastasis, and positive peritoneal washing cytology were significantly associated with prediction of prognosis. In multivariate analysis, tubal metastasis was an independent prognostic factor for overall survival.

A clinical study of 15 cases of primary carcinoma of the fallopian tube / 부인종양

OBJECTIVE: The aim of the study is to determine the clinical characteristics and management of primary fallopian tube malignancies together with the results there unto that had been diagnosed and treated in Samsung Cheil Hospital oncology department retrospectively. METHODS: The fifteen cases of fallopian tube malignancies, of a total of 3495 gynecologic malignancies (0.043%) that has been diagnosed in or referred to our hospital between January 1993 and December 2004 were evaluated retrospectively. We investigate the clinicopathologic findings and analyze the survival period for 15 patients with primary fallpian tube malignancies who were surgically operated. RESULTS: The mean age of patients is 53.47 years. Most frequent application symptoms of the cases are pelvic mass (46.7%) and abnormal uterine bleeding (40%). The staging laparotomy was done in 12 patients. According to FIGO staging, seven of the cases are stage I, six of the cases are stage III, and one of the cases is borderline malignancy. Adjuvant chemotherapy was applied 13 cases and adjuvant radiotherapy was applied one case. Mean follow up period of the cases is 27.8 months. CONCLUSION: Primary fallopian tube malignancies are very rare malignancies. Diagnosis can be made generally peri or postoperatively. More extensive clinical research must be performed in order to have definite etiologic diagnostic management modalities and prognostic markers.

Clinical Outcomes of Patients treated for Cervical Pregnancy with or without Methotrexate

The objective of this study is to describe the clinical outcomes of patients treated for cervical pregnancy with or without methotrexate (MTX) and to evaluate the effects of MTX in the treatment of cervical pregnancy. Between January 1993 and February 2000, 31 patients were diagnosed with cervical pregnancy. Twenty-two patients were treated with MTX chemotherapy and nine patients were treated with surgical procedures without MTX treatment. In the non-MTX treatment group, three patients underwent total abdominal hysterectomy, five required adjuvant procedures to control the bleeding during dilatation and curettage (D&C) and only one patient was treated with a simple D&C. In the MTX treatment group, fourteen (63.6%) patients were treated with only MTX and eight (36.4%) cases underwent concomitant procedures (simple curettage, curettage and Foley catheter tamponade, cer-vical cerclage, ligation of the descending branches of uterine arteries, or ligation of hypogastric arteries). The uterus was preserved in all cases and three women delivered healthy babies in their subsequent pregnancy. In conclusion, early diagnosis, appropriate MTX regimen in combination of necessary adjuvant conservative procedures could contribute to successful treatment with preservation of the uterus and future reproductive ability.

Clear Cell Carcinoma of the Vulva Arising in Endometriosis / 대한산부인과학회잡지

Since Sampson first described the development of ovarian carcinoma in endometriosis in 1925, numerous case reports have documented the development of malignancies arising from foci of endometriosis. Clear cell carcinoma arising from endometriosis is very rare in the vulva. To date only two cases that originated in the vulva have been reported. We report a case of clear cell carcinoma in the vulva arising from endometriosis with a brief review of literatures.

Clinico-pathologic Profiles and 5-year Survival Rate of 2209 Patients with Invasive Cancer of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the clinico-pathologic characteristics and to analyze the 5-year survival rate and prognostic factors for invasive cancer of the uterine cervix. METHODS: From May 1982 to October 2000, 2209 patients with invasive cancer of the uterine cervix were diagnosed and treated at Samsung Cheil Hospital. In this retrospective study, we studied the clinico- pathologic characteristics (age, resident area, delivery type, FIGO stage, histologic type, nodal metastasis, lymph-vascular space invasion, endometrial extension), treatment modalities and 5-year survival rate. RESULTS: The mean age was 50.3 years (24-85) and the median age was 50.0 years old. The most common subsets of patients were found in the group of FIGO stage I b (41.9%) and age between 41 and 50 (30.0%). Surgery was the main treatment in stage I a, I b, II a and radiation in stage II b or more. Pelvic and para-aortic nodal metastasis were surgically identified in 1.9% and 0% of stage I a, 18.1% and 4.4% of stage I b, 22.6% and 5.7% of stage II a, 51.4% and 17.1% of stage II b, 14.3% and 0% of stage III/IV. Overall 5-year survival rate was 85.7%; stage I a (93.9%), I b (91.5%), II a (80.7%), II b (68.5%), III/IV (53.7%). The 5-year survival rate according to pelvic lymph node status in surgically confirmed patients were 95.4% in negative patients and 78.1% in positive patients respectively (P=0.0000). 5-year survival rate was significantly different according to age (P=0.0000), FIGO stage (P=0.0000), lymph-vascular space invasion (P=0.0001), endometrial extension (P=0.0199), pelvic (P=0.0000) and para-aortic nodal metastasis (P=0.0000). However, resident area, delivery type, histologic type did not show any significant differences in survival. CONCLUSION: Overall 5-year survival rate of 2209 patients with invasive cancer of the cervix who were diagnosed at Samsung Cheil Hospital from May 1982 to October 2000 was 85.7%. Five-year survival rate was different according to age, FIGO stage, lymph-vascular space invasion, endometrial extension, pelvic and para-aortic nodal metastasis.

Surgical Management of Adnexal Mass during Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The objective of this study was to evaluate the safety and timing of the surgery and fetal outcome of pregnancy complicated by a persistent adnexal mass that was required surgical intervention METHODS: We retrospectively reviewed 171 cases of adnexal masses during pregnancy that were required surgery at Samsung Cheil Hospital and Women's Healthcare Center between 1996 to 2001. We analysed medical records for characteristics of tumor, indication and timing of surgery and the effect of pregnancy outcome. Adverse pregnancy outcome is defined as preterm delivery, spontaneous abortion, intrauterine fetal death and perinatal death. The obtained data were analysed using t-test and Fisher's exact test by SPSS. RESULTS: The incidence of adnexal masses during pregnancy that required surgical management was 1 in 292.3 live births. A malignant tumor or a tumor of low malignant potential was found in 7% of cases. A total of 43 patients underwent surgery under emergency condition, 31 (72%) of which were done due to torsion. There were 14 preterm delivery, 3 spontaneous abortion, 1 intrauterine fetal death, 1 perinatal death and 2 artificial abortion in this study. There was a significant difference in adverse pregnancy outcome between elective and emergency group (7/118 [5.9%] versus 11/43 [25.6%] P=.001), and surgery group that before 20 week's gestation and those of after 20 week's gestation (12/145 [8.3%] versus 6/16 [37.5%] P=.004). CONCLUSION: When necessary and feasible, surgery should be scheduled for the early portion of the second trimester, when organogenesis is complete and most spontaneous abortion have occurred, but before later risks of technical difficulties and premature labor. Also we recommend early diagnostic evaluation and immediate surgical intervention of adnexal masses as problematic adnexal mass diagnosed during pregnancy to prevent the risk of emergency surgery associated with adnexal complication (torsion, rupture and hemorrhage) and the risk of delayed diagnosis of malignancy.

Extramammary Paget's Disease of the Vulva, Underwent Radical Vulvectomy with Gluteal Thigh Flap / 대한부인종양콜포스코피학회잡지

Extramammary Paget's disease of the vulva is a rare intraepithelial neoplasm which is most commonly seen in postmenopausal Caucasian females. The most common presenting complaint is pruritis, vulvar pain, red eczematoid skin change. Treatment of Paget`s disease of the vulva requires wide local excision and if there is an underlying adenocarcinoma, radical vulvectomy with ipsilateral inguinal femoral lymphadenectomy is required. We experienced a case of extramammary Paget`s disease of the vulva, underwent radical vulvectomy with gluteal thigh flap and present with a brief review of literature.