Development and validation of novel digitalized cervicography system

OBJECTIVE: Digital cervicography systems would be expected to reduce the costs of film cervicography, and provide the opportunity for "telemedicine-based" screening. We aimed to develop web-based digital cervicography system, and validate it compared with conventional film cervicography. METHODS: A hundred cases from five centers were prospectively included, and cervical images (analogue, digitalized by scanning analogue, and digital) were taken separately using both analogue (Cerviscope) and digital camera (Dr. Cervicam) in each patient. Nine specialists evaluated the three kinds of images of each case with time interval between evaluations of each image. To validate novel digitalized system, we analyzed intra-observer variance among evaluation results of three kinds of images. RESULTS: Sixty-three cases were finally analyzed after excluding technically defective cases that cannot be evaluable on analogue images. The generalized kappa for analogue versus digital image was 0.83, for analogue versus scanned image 0.72, and for digital versus scanned image was 0.71; all were in excellent consensus. CONCLUSION: Digitalized cervicography system can be substituted for the film cervicography very reliably, and can be used as a promising telemedicine tool for cervical cancer screening.

Neural Axis Metastasis from Metachronous Pulmonary Basaloid Carcinoma Developed after Chemotherapy & Radiation Therapy of Uterine Cervical Carcinoma / 대한신경손상학회지

Multiple primary or secondary malignancies after anticancer therapy were recently reported to be increasing in frequency. The authors describe a case of metachronous metastatic pulmonary basaloid carcinoma to the central nervous system that was discovered after chemotherapy and radiation therapy for cervical uterine carcinoma. Two different types of cancer developed within some interval. There's the possibility that a secondary pulmonary neoplasm developed after the chemotherapy and radiotherapy conducted as cervical cancer treatment.

A case of solitary fibrous tumor in the pelvis presenting massive hemorrhage during surgery

Solitary fibrous tumors (SFTs) are unique soft-tissue tumors of submesothelial origin. These tumors are mainly located in the pleural space but they can be originated within a variety of sites, including the abdomen, the pelvis, the soft tissues and the retroperitoneum. SFTs from all sites are usually benign, and the surgical resection is curative in almost all cases. According to the review of literatures, during the surgical resection, massive hemorrhage could occur due to the hypervascular nature of SFTs. This is a case report on SFT in the pelvis presenting great vessel injury, which resulted in life threatening hemorrhage during the resection of tumor. We wish this paper alerts gynecologists about the risk of massive bleeding during the resection of tumor located at adjacent to great vessels in the pelvis.

Pseudoaneurysm of uterine artery causing intra-abdominal and vaginal bleeding after cervical conization

Uterine arterial pseudoaneurysm is a very rare condition usually associated with postpartum hemorrhage. It almost never occurs after cervical conization; however, since ruptured pseudoaneurysm could be life threatening, we should consider the possibility of vascular injury such as pseudoaneurysm when we find a patient with vaginal bleeding after the process of surgical operation. Emergency arterial embolization is a well established therapeutic option to control the ruptured pseudoaneurysm. This is a case report of uterine arterial pseudoaneurysm causing intra-abdominal bleeding followed by cervical conization, which was successfully treated by uterine artery embolization.

Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman

Multicystic benign mesothelioma (MBM) of the peritoneum is a very rare condition. Since the first description of MBM in 1979, approximately 100 cases have been reported. This is a case report of MBM of the pelvic peritoneum presenting as acute abdominal pain in a young woman. Laparoscopy confirmed multiple grapelike clusters of cysts that originated in the peritoneum of the rectouterine pouch and histopathologic diagnosis was confirmed as MBM of the pelvic peritoneum. We hope to alert gynaecologists of the diagnostic and therapeutic approaches to MBM which can be accomplished by laparoscopy.

Hysteroscopic management of cornual pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study introduces a safe, effective method for treating cornual pregnancy. METHODS: Between April 2005 and December 2008, seven patients with cornual pregnancy underwent hysteroscopic surgery at a minimally invasive surgery clinic. An 18F Foley catheter was inserted after dilating the cervix; then, the uterine cavity was irrigated with 300 mL of H2O2 solution to prevent excessive bleeding. The cornual gestation was removed by hysteroscopy without complications under ultrasonographic guidance. RESULTS: The serum beta-human chorionic gonadotropin levels were monitored postoperatively and decreased optimally in all patients. All tissues removed from the uterus were confirmed to be gestational products. The estimated blood loss was less than 30 mL. All patients were discharged on the first or second postoperative day. CONCLUSION: Hysteroscopic removal of a cornual pregnancy with H2O2 is very practical and safe.

A case of pelvic retroperitoneal benign schwannoma presenting as a gynecologic malignancy with pulmonary thromboembolism / 대한산부인과학회지

Retroperitoneal schwannomas are rare tumors difficult to diagnose preoperatively. It may originate at the cranial nerves or nerves of the upper extremities, but origin along the nerves of the retroperitoneal space is very rare. Most of the retroperitoneal schwannomas are benign neoplasm. These tumor can be misdiagnosed as adnexal mass or carcinoma. Venous thromboembolism or pulmonary embolism is increasingly recognized as a common complication in patients with malignant disease. We report a 37-year-old woman presented with pulmonary thromboembolism and a pelvic mass which was incidentally found and misdiagnosed as ovarian cancer. Histopathologic results of the extirpated mass turned out to be a benign schwannoma.

Minimal Deviation Endometrioid Adenocarcinoma of the Uterine Cervix: A Case Report

We describe here a case of minimal deviation endometrioid adenocarcinoma (MDEA) of the uterine cervix that was initially suspected according to the abnormal cytologic findings in a 39-year-old woman. The Papanicolaou (pap) smear showed many neoplastic glandular cells in monolayered sheets, rosettes, and clusters with palisading and feathering borders. The tumor cells had oval, hyperchromatic nuclei, with chromatin clumping and small nucleoli. Histologic examination disclosed endometrial-type glands with a bland, isolated, mainly rounded appearance and these glands were widely scattered deep into the cervical stroma with only scant stromal reaction. An association of MDEA with tubo-endometrioid metaplasia or cervical endometriosis has been suggested by identifying the tubo-endometrioid glands in the vicinity of the MDEA.

Sister Mary Joseph's nodule from advanced ovarian carcinoma / 대한산부인과학회지

Umbilical metastasis may be the first presenting sign of the disease, or an indication of a recurrence from a previous malignancy. We recently encountered a 19-year-old woman with advanced ovarian adenocarcinoma whose first sign was having a Sister Mary Joseph's nodule. This patient only presented an umbilical nodule with slight lower abdominal discomfort, without any other subjective symptom. The lesion was fresh red, firm, ulcerating and has 1.5 cm in diameter. A punch biopsy from the lesion revealed metastatic adenocarcinoma and a PET-CT scan showed hypermetabolism on the umbilicus. After a systemic evaluation, she had a laparotomy including right salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy, appendectomy, and extirpation of the umbilicus. The patient received a postoperative combination of chemotherapy with paclitaxel and carboplatin, and still remains alive. This case demonstrates the importance of careful evaluation of any umbilical lesion and pathologic examination.

Rupture of mucinous adenocarcinoma of ovary and pseudomyxoma peritonei with pregnancy: Case report / 대한산부인과학회지

The occurrence of ovarian cancer during pregnancy is a very rare, and the incidence is 1:10,000 to 1:50,000. However, this number is likely to increase since childbearing is more and more frequently delayed. The clinical outcome of patients with ovarian cancer is the same regardless of whether the diagnosis of ovarian carcinoma is done during pregnancy or in non-pregnant women; therefore, the same surgical staging procedures are recommended in the two groups. However, it should be considered to performed a diagnostic operation and preservation of pregnancy, advantage of the administration of chemotherapy, what time give birth to, what time perform a staging operation. We here report our experience with a case of advanced ovarian carcinoma during pregnancy, which was managed conservative surgery with chemotherapy until delivery.

Massive hemoperitoneum from spontaneous venous rupture overlying a uterine myoma: A case report / 대한산부인과학회지

Spontaneous intraperitoneal hemorrhage from uterine leiomyomas is rarely encountered. The cause of hemorrhage is mainly trauma and torsion of myoma. Massive intraperitoneal hemorrhage from spontaneous rupture of a superficial uterine vein overlying a subserous myoma is extremely rare. A 48-year-old woman complained general weakness, lower abdominal discomfort and lower back pain. On admission to the hospital, hypovolemic shock, severe anemia and ascites were noticed. Ultrasonography and CT scan showed huge pelvic mass and much amount of fluid in the pelvic cavity. During emergent laparotomy, 3,500 mL of blood were drained from the abdominal cavity and a ruptured superficial vein was noted, located on the serosal surface of a fundal myoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to spontaneous rupture of a superficial uterine vein overlying a subserous myoma.

A Case of Preeclampsia Complicating a Pregnancy with Malignant Neurofibromatosis / 대한주산의학회잡지

Neurofibromatosis type 1 (NF-1) is one of the most common genetic disorders, occurring once in every 4000 births. The prevalence of neurofibromatosis associated with pregnancy was one in 5000~18500 deliveries. Higher rates of maternal and neonatal complications have been reported in NF-1 patients including as hypertension, intrauterine growth restriction (IUGR), preterm labor, stillbirth and cesarean section rates. Thus, pregnant patients with NF-1 are required close antenatal observation at high risk tertiary centers in order to detect complication early. We report a case of malignant neurofibromatosis associated with pregnancy with a review of literature.

Application of experion(TM) assay system for discovery of ovarian cancer serum biomarkers / 대한산부인과학회지

OBJECTIVE: The discovery of new biomarkers for ovarian cancer is clearly necessary for the detection and monitoring of the disease. Experion(TM) automated electrophoresis system can be employed in the identification of differentially expressed proteins in cancer cells. The objective of this study was to discover potential diagnostic serological biomarkers for ovarian cancer. METHODS: We performed protein expression difference analyses for 14 healthy women and 28 ovarian cancer patients with stage I, III and IV using Experion(TM) system. And then we checked the protein expression as silver staining after loading at 8~16% gradient gel for comparison with Experion(TM) gel image. The candidate biomarkers were purified and determined using MALDI-TOF mass spectrometer. RESULTS: The distinctive polypeptide peaks were detected at 115.40, 15.96, 14.8, 11.66, and 10.69 kDa and these five peaks were identified as ceruloplasmin, hemoglobin beta chain, hemoglobin sigma chain, serum amyloid A4, and amyloid related serum protein SAA, respectively. These proteins were significantly different between the sera of normal healthy women and ovarian cancer patients. CONCLUSIONS: Five proteins were found to be significantly different between the sera of normal healthy women and ovarian cancer patients. In addition, Experion(TM) assay system can provide high performance for analysis of ovarian cancer-related proteins by increasing the throughput while maintaining a high level of accuracy.

A new scoring system for differentiation between benign and malignant ovarian masses / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to design a new scoring system for differentiation between benign and malignant ovarian masses and to assess effectiveness of new scoring system comparing other scoring systems. METHODS: This study was based on 199 women who visited Soonchunhyang Hospital for surgery of ovarian mass. Ultrasonography and scoring system based on De Priest, Sassone, Ferrazi and Alcazar was performed the day before operation. Pathologic diagnosis after operation was directly compared with diagnosis of scoring system. The cut-off level of the new index is 11 points. This study was evaluated by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: Parameters of new scoring system were wall thickness, number of septum, volume of mass, irregularity, vascularity and echogenicity. The new scoring system had sensitivity 73.9%, specificity 97.7% and negative and positive predictive values of 96.6% and 80.9% respectively. CONCLUSION: Sensitivity of new scoring system was similar to previous ones but specificity of that is higher. Our new scoring system shows better to differentiate benign from malignant ovarian mass than four other scoring systems.

Immunohistochemical analysis of pelvic lymph node micrometastases in cervical cancer patients with histologically negative nodes / 부인종양

OBJECTIVE: The purpose of this study was to identify, by immunohistochemistry, possible micrometastasis in the pelvic lymph nodes previously considered free by conventional histopathological examination, and to assess their influence on the survival of patients with cervical cancer. METHODS: This retrospective study included patients (n=51) operated on between February 2001 and May 2004 for cervical cancer without histopathologic lymph node involvement. Lymph nodes (n=282) from 51 patients with histologically node-negative cervical cancer were evaluated for micrometastasis. These were submitted to immunohistochemical study using AE1/AE3 anti-cytokeratin monoclonal antibodies to identify neoplastic epithelial cells. RESULTS: The mean age of the patients was 45.3 years (range, 27-72). Lymph node micrometastases were immunohistochemically detected in 3 of the 51 patients (5.9%), comprising 3 of 282 (1.1%) pelvic lymph nodes examined. One patient (Ib2) had adenocarcinoma and others (Ib1,Ib2), squamous cell carcinoma. All of them had negative lymph-vascular space invasion. In three patients, there were recurrences (66.7%, 2/3), and one patient (Ib1) died from the pelvic recurrence. CONCLUSION: We recommend an immunohistochemical examination for lymph node micrometastases in cervical cancer patients with histologically negative nodes. This immunohistochemical method can be employed successfully in the detection of neoplastic cells in lymph nodes previously considered free. Micrometastasis could provide important information for further treatment strategies and follow up. Its clinical significance in cervical cancer warrants further study.

The diagnostic value of saline infusion sonohysterography in evaluation of patients with abnormal uterine bleeding / 대한산부인과학회지

OBJECTIVE: To evaluate saline infusion sonohysterography (SIS) as an investigative modality in abnormal uterine bleeding of premenopausal and postmenopausal women. METHODS: Eighty eight patients, 74 premenopausal women and 14 postmenopausal women, with abnormal uterine bleeding were selected. After complete work-up, transvaginal examination were performed followed by SIS. The final surgical-pathologic findings were compared with the results obtained from transvaginal sonography (TVS) and SIS. The sensitivity, specificity, positive and negative predictive value were calculated for each procedure. RESULTS: The SIS was perfomed in 85 cases. It couldn't be done in one premenopausal woman and two postmenopausal women. The uterine cavity was normal in 28 women, 57 cases displayed abnormalities. Seventeen had endometrial polyp, 17 had submucosal myoma, 23 had irregular endometrium. We found that SIS missed five endometrial polyp and mislabeled 14 (38.9%) false positive endometrial growth. On comparing SIS, transvaginal sonography missed nine endometrial polyp and mislabeled 22 (55%) false positive endometrial growth. The sensitivity, specificity, positive predictive value and negative predictive value of TVS were 72.9%, 45%, 61.4% and 58.1%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of SIS were 87.8%, 61.1%, 75.4% and 78.6%, respectively. Sensitivtity and negative predictive value were significantly higher with SIS than TVS. CONCLUSION: The SIS is a safe, convenient, time conserving, cost effective, easily accessible and acceptable investigative modality. It definitely enhance the diagnostic potential of TVS in accessment of endometrium and intracavitary pathologies in women with abnormal uterine bleeding.

Protein Expression Profile using Two-Dimensional Gel Analysis in Squamous Cervical Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Screening in cervical cancer is now progressing to discover candidate genes and proteins that may serve as biological markers and that play a role in tumor progression. We examined the protein expression patterns of the squamous cell carcinoma (SCC) tissues from Korean women with using two-dimensional polyacrylamide gel electrophoresis (2-DE) and matrix assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometer. MATERIALS AND METHODS: Normal cervix and SCC tissues were solubilized and 2-DE was performed using pH 3~10 linear IPG strips of 17 cm length. The protein expression was evaluated using PDQuest 2-D software(TM). The differentially expressed protein spots were identified with a MALDI-TOF mass spectrometer, and the peptide mass spectra identifications were performed using the Mascot program and by searching the Swiss-prot or NCBInr databases. RESULTS: A total of 35 proteins were detected in SCC. 17 proteins were up-regulated and 18 proteins weredown-regulated. Among the proteins that were identified, 12 proteins (pigment epithelium derived factor, annexin A2 and A5, keratin 19 and 20, heat shock protein 27, smooth muscle protein 22 alpha, alpha-enolase, squamous cell carcinoma antigen 1 and 2, glutathione S-transferase and apolipoprotein a1) were protein previously known to be involved in tumor, and 21 proteins were newly identified in this study. CONCLUSION: 2-DE offers the total protein expression profiles of SCC tissues; further characterization of these differentially expressed proteins will give a chance to identify the badly needed tumor-specific diagnostic markers for SCC.

Correlation of adenoassociated virus type 2 and high-risk human papillomavirus type 16 and 18 infection in the cervix of Korean women / 대한산부인과학회지

OBJECTIVE: Previous studies were showed that adenoassocited virus (AAV) infection was had negative effects on human papillomavirus (HPV) infection and that the cervical cancer cell growth is inhibited by AAV infection. We detected of AAV 2 and high-risk HPV infection and researched correlation with AAV 2 and HPV in cervical cell. METHODS: Cell of normal cervix (49 persons), infected HPV cervix (45 persons), cervical intraepithelial neoplasm (CIN) I (31 persons), II (20 persons), III (35 persons), and invasive cancer (30 persons) were investigated by PCR using AAV-2 and HPV type 16 and 18 specific primers. RESULTS: AAV 2 was detected in 8 out of 49 normal cervix (16.3%), 2 out of 45 infected HPV cervix (4.4%), 3 out of 31 CIN I (9.7%), 4 out of 20 CIN II (20%), 8 out of 35 CIN III (22.8%), and 3 out of 30 invasive cervical cancer cases (30%). However, HPV 16 was detected in 5 out of 49 normal cervix (10.2%), 20 out of 45 infected HPV cervix (44.4%), 13 out of 31 CIN I (42%), 11 out of 20 CIN II (55%), 19 out of 35 CIN III (54.3%), and 21 out of 30 invasive cervical cancer cases (70%). HPV 18 was detected in 6 out of 49 normal cervix (12.2%), 18 out of 45 infected HPV cervix (40%), 16 out of 31 CIN I (51.6%), 10 out of 20 CIN II (50%), 22 out of 35 CIN III (62.8%), and 13 out of 30 invasive cervical cancer cases (43.3%). CONCLUSION: AAV 2 was detected in normal and infected HPV cervix, CIN (I, II, III) and invasive cervical cancer. As compared to normal, CIN I and CIN II, suggesting significant correlation between AAV 2 and HPV type 16. Further, researches continue to be done relationship to AAV 2 and HPV infection in cervix.

Search for Gene Expression in Cervical Squamous Cell Carcinoma using GeneFishing(TM) DEG PCR Technique / 대한산부인과학회지

OBJECTIVE: The aim of this study was to investigate the gene expression profiles using GeneFishing(TM) DEG kit in Korean women with cervical squamous cell carcinoma. METHODS: Cervical cancer biopsies were obtained from patients at the Department of Obstetrics and Gynecology, St. Mary's hodpital. In this study, we used a common reference that was mixed with an equal amount of RNA extracted from non-cervical cancer patients. The profiles of expression genes between cervical normal and squamous cell carcinoma tissue were identified using GeneFishing(TM) DEG Kit and screened by BLAST search. RESULTS: Almost 100 differential expressed genes were identified in universal control and cervical squamous cell carcinoma, 53 of differential expressed genes, up-regulated expression of 32 and 21 down-regulated expression was sequenced. Up-regulated genes were calcylin, calgranulin A, TRK oncogene, HLC5, fibrillarin, collagene type I alpha1 etc. and down-regulated genes were galectin 1, PRP8 pre-mRNA precessing factor 8 homology, clusterin etc. CONCLUSION: We identified gene expression profile in cervical squamous cell carcinoma using GeneFishing(TM) Kit in Korean women. The functional genomics of these genes should be further studied.

A Case of Fetal Bilateral Reanl Agenesis Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

Fetal bilateral renal agenesis is a lethal congenitlal anomaly. An early and prenatal diagnosis is extremely important, because it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossae. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present a case of fetal bilateral renal agenesis diagnosed by ultrasonography at 21 weeks gestation.