Comparison of Gene Expression Profile in Eutopic Endometria with or without Endometriosis: A Microarray Study / 대한불임학회지

OBJECTIVE: Pathogenesis of the endometriosis is very complex and the etiology is still unclear. Our hypothesis is that there may be some difference in gene expression patterns between eutopic endometriums with or without endometriosis. In this study, we analyzed the difference of gene expression profile with cDNA microarray. METHODS: Endometrial tissues were gathered from patients with endometriosis or other benign gynecologic diseases. cDNA microarray technique was applied to screen the different gene expression profiles from early and late secretory phase endometria of those two groups. Each three mRNA samples isolated from early and late secretory phase of endometrial tissues of control were pooled and used as master controls and labeled with Cy3-dUTP. Then the differences of gene expression pattern were screened by comparing eutopic endometria with endometriosis, which were labeled with Cy5-dUTP. Fluorescent labeled probes were hybridized on a microarray of 4,800 human genes. RESULTS: Twelve genes were consistently overexpressed in the endometrium of endometriosis such as ATP synthase H transporting F1 (ATP5B), eukaryotic translation elongation factor 1, isocitrate dehydrogenase 1 (NADP+), mitochondrial ribosomal protein L3, ATP synthase H+ transporting (ATP5C1) and TNF alpha factor. Eleven genes were consistently down-regulated in the endometriosis samples. Many extracellular matrix protein genes (decorin, lumican, EGF-containing fibulin-like extracellular matrix protein 1, fibulin 5, and matrix Gla protein) and protease/protease inhibitors (serine proteinase inhibitor, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase 1), and insulin like growth factor II associated protein were included. Expression patterns of selected eight genes from the cDNA microarray were confirmed by quantitative RT-PCR or real time RT-PCR. CONCLUSION: The result of this analysis supports the hypothesis that the endometrium from patients with endometriosis has distinct gene expression profile from control endometrium without endometriosis.

Trocar-site metastasis after laparoscopic gynecologic oncologic surgery / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the incidence of abdominal-wall tumor implantation after laparoscopic procedure in patients with gynecologic malignancies. METHODS: The records of 184 patients who had a laparoscopic operations or laparotomy after laparoscopic diagnostic procedures from Aug. 1994 to Aug. 2003 in our hospital were reviewed. The presence of metastasis at trocar site of laparoscopic surgery and incision site of laparotomy was examined. RESULTS: Abdominal-wall tumor implantations were developed at two port site in one patient. This result showed an incidence of 0.24% (2/819), as 2 ones in 819 abdominal trocar sites and 0.5% (1/184), as 1 in 184 procedures. This patient had a FIGO stage III a, grade2 adenocarcinoma of endometrium and underwent laparoscopic modified radical hysterectomy with both pelvic lymphadenectomy. In addition, tumor implantation was occurred at laparotomy skin incision site in one patient, a incidence of 2.2% (1/45), as 1 in 45 laparotomy procedures. This patient had a stage II, squamous cell carcinoma of the vagina, who had received second courses of Ifosfamide-Cisplantin neoadjuvant chemotherapy and open laparotomy with radical hysterectomy with upper vaginectomy was followed by laparoscopic pelvic lymphadenectomy due to fixed grossly metastatic nodes. CONCLUSION: Recently, the use of laparoscopic procedure in oncology was increased, the new complication such as abdominal-wall implantation at trocar site was introduced. The abdominal-wall implantation at trocar site could be prevented by patients selection, intraperitoneal and port-site lavage, surgical modification. And all patients should have careful follow up with special attention to the trocar sites. Port site implantation was rare, but could be occurred in the incidence of 0.5% per procedure.

A differential gene expression profiles by cDNA microarrays in endometrioid endometrial carcinoma: a preliminary study / 부인종양

OBJECTIVE: Endometrial carcinoma is the most common gynecological malignant disease in industrialized countries. However, the molecular bases for endometrial tumoriogenesis are not clearly elucidated. Our hypothesis is that there may be some difference in gene expression patterns between normal endometrium and endometrial cancer lesion. In this study, we analyzed the difference of gene expression profile with cDNA microarray. METHODS: Normal endometrial tissues and cancer lesions were gathered from three patient with endometrioid endometrial cancer. cDNA microarray technique (KNU 4.8K chip) was applied to screen the different gene expression profiles. RESULTS: Many genes such as interleukin-1 receptor-associated kinase 1 (IRAK1), bifunctional apoptosis regulator (BFAR), paraneoplastic antigen MA2 (PNMA2), zinc finger protein 257 (ZNF257), ras homolog gene family, member F (in filopodia) (ARHF), cell division cycle 27 (CDC27) were over-expressed in the endometrial cancer tissue. The genes were down-regulated in the endometrial cancer samples included fibronectin 1 (FN1), meiotic checkpoint regulator (MCPR), transforming growth factor beta-stimulated protein TSC-22 (TSC22), programmed cell death 4 (neoplastic transformation inhibitor) (PDCD4), transcript variant 2, matrix metalloproteinase 2 (MMP2), insulin-like growth factor binding protein 4 (IGFBP4), retinoblastoma binding protein 7 (RBBP7), insulin-like growth factor binding protein 3 (IGFBP3), downregulated in ovarian cancer 1 (DOC1). CONCLUSION: The result of this analysis supports the hypothesis that the endometrial cancer tissue has distinct gene expression profile from normal endometium. But, the vaildation of gene expression with RT-PCR and the further study are needed.

A case of severe hydronephrosis due to ureteral stricture from endometriosis / 대한산부인과학회지

Endometriosis is a relatively common disease, affecting 5-10% of women of reproductive age. But, endometriosis affecting the urinary tract is very rare entity. Involvement of urinary tract by endometriosis occurs in about 1% of women with pelvic endometriosis. Ureteral endometriosis is mostly asymptomatic for a long time, and associated with nonspecific symptoms at clinical presentation and difficult preoperative diagnosis. The involvement of the ureter is rarely intrinsic by implantation of endometrial tissue in the wall of the ureter, but rather due to external compression by adjacent endometriosis and its attendant inflammation and fibrosis. We have experienced a case of right severe hydroureteronephrosis due to ureteral stricture from endometriosis. Laparoscopic nephrectomy was done due to renal atrophy. At the same time, laparoscopic total hysterectomy with right salpingo-oophorectomy was performed because of the uterine adenomyosis and right ovarian endometrioma. So, we report that with a brief review of literatures.

A Clinicopathological Study in patients with Granulosa Stromal Cell Tumor of the Ovary / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to know the pathological and clinical characteristics of granulosa stromal cell tumor of the ovary. METHODS: From January 1996 to December 2005, patients with granulosa cell tumor of ovary and ones with thecoma, which are included in granulosa stromal cell tumor of the ovary, treated in the Obstetrics and Gynecology, College of Medicine, the Kyungpook National University Hospital of Korea were identified and reviewed retrospectively for patient profiles, mode of therapy, length of survival and so on. RESULTS: There were 14 granulosa cell tumors, and 55 thecomas. The mean age of patients with granulosa cell tumor was 46.8 years old, and 7 women (50.0%) were menopausal. Bilaterality was absent, and mean size of tumor was 11.1 cm. The chief complaints of patients were 3 cases (21.4%) of abdominal discomfort or pain, 3 cases (21.4%) of vaginal bleeding and 4 cases (28.6%) of no symptom. Of 14 cases, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 5 cases (35.7%). Chemotherapy was performed in 5 cases (35.7%), and regimen was combination of BEP (bleomycin+etoposide+cisplatin). According to FIGO staging, 10 cases (71.4%) were stage I. Second look operation was done in one case (7.1%). Among 14 patients of follow-up, one patient (7.1%) was expired. Surgical staging was associated with survival rate of patients. The mean age of patients with thecoma was 49.6 years old, and 28 women (50.9%) were menopausal. Bilaterality was 3 cases (5.4%), and mean size of tumor was 8.5cm. The chief complaints of patients were 14 cases (25.4%) of abdominal discomfort or pain, and 19 cases (34.5%) of no symptom. Of 55 cases, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 21 cases (38.2%). Among 55 patients of follow-up, all patients survived. CONCLUSION: Thecomas are regarded as benign tumors but granulosa cell tumors are characterized by a long natural history with a significant capacity to recur years after apparent clinical cure. The patients with granulosa cell tumor should be followed up indefinitely.

Two Cases of Malignant Melanoma in Vulva / 대한산부인과학회잡지

Vulvar melanomas are account for 4-10% of all malignant tumors of the vulva and are the second most common cause of the vulvar malignancy with the highest frequency in the sixth and seventh decades and rare with incidence of 0.1 to 0.19 per 100,000 women. The most common presentation is a vulvar mass, although pruritis and bleeding also are frequent. In some cases, the melanoma has arisen from a pre-existing benign or atypical pigmented lesion. Vulvar melanomas appear to behavior as other cutaneous melanomas. Both the level of invasion of a malignant melanoma and its thickness have prognostic significance. Vascular space invasion and tumor necrosis also are associated with a poorer prognosis. Recently the radical vulvectomy dose not appear to improve survival when compared to wide local excision with bilateral inguinofemoral lymphadenectomy. We had 2 cases of vulvar melanoma treated with wide local excision and laparoscopic inguinofemoral lymphadenectomy.