ABSTRACT
Patients of choriocarcinoma with brain metastases are considered to have a very poor prognosis due to chemo-refractoriness and recurrence. So, selection and individualization of patients then followed by multimodality therapy are very important. We present a case of a patient who experienced twice of craniotomies due to intracranial hemorrhage and an emergent explorative laparotomy due to intestinal perforation of the metastatic sites of choriocarcinoma. She was treated with 12 cycles of high-dose MTX/EMA-CO, intrathecal MTX and WBRT. Eventually she has obtained a complete remission that ongoing for 2 years. So, we report this case with a brief review of the literatures.
Subject(s)
Female , Humans , Pregnancy , Brain , Choriocarcinoma , Craniotomy , Intestinal Perforation , Intracranial Hemorrhages , Laparotomy , Neoplasm Metastasis , Prognosis , RecurrenceABSTRACT
PURPOSE: Although it is now generally accepted that human papillomaviruses (HPVs) are causally related to cervical neoplasia by plentiful epidemioiogic and experimental works, little is known about the direct evidence of sexual transmission of HPV. This study was undertaken to confirm the transmission route and determine the infectivity of HPV by comparison of HPV 16 sequence variations at upstream regulatory region (URR) in the couples of patient with cervical cancer. MATERIALS AND METHODS: HPV DNAs obtained from genital lesions of forty married couples of patients with cervical cancer were evaluated by polymerase chain reaction (PCR) and PCR-directed sequencing. RESULTS: HPV 16 was detected in fourteen (63.6%) of twenty-two male consorts whose wives were positive for HPV 16. Of these, six (42.9%) couples demonstrated identical HPV 16 URR variants between patients and male consorts, and eight had mismatching HPV 16 URR sequences. Among six couples showed matching HPV 16 variants, three couples mamed for 10, 19, 25 years respectively carried variant 7728/7779, two couples married for 15 years each carried variant 7728/7762, and one couple married for 18 years carried variant 7728/7797, CONCLUSION: These data suggest that sexual transmission of HPV 16 does occur. A search for more HPV variants in a large cohort is needed to secure high level of precision in molecular epidemiologic study using HPV variant.
Subject(s)
Humans , Male , Cohort Studies , DNA , Epidemiologic Studies , Family Characteristics , Human papillomavirus 16 , Molecular Epidemiology , Polymerase Chain Reaction , Regulatory Sequences, Nucleic Acid , Spouses , Uterine Cervical NeoplasmsABSTRACT
PURPOSE: It was suggested that immunogenic region of E7 proteins of human papillo- mavirus (HPV) type 16 encompass casein kinase (CK) II phosphorylation site and the resulting negative charge may affect the various biologic function of E7 protein. This study was undertaken to analyze the change of antigenic characteristics of HPV type 16, E7 oncoprotein according to phosphorylation. MATERIALS AND METHODS: We produced two monoclonal antibodies (VD6 and IB10) which showed different reactivities to E7 proteins expressed from bacteria or extracted from CaSki cell. These reaction were analyzed by Western blotting. Also the antigenic sites estimation of these antibodies using nested deletion sets was done. On the basis of above experiments, we performed in vitro phosphorylation assay using CK II and its specific inhibitor, DRB (5, 6-dichloro-l-beta-D-ribofuranosylbenzimidazole), to analyze the IB10 reactivity to E7 oncoproteins according to phosphorylation. RESULTS: In Westem blot analysis, VD6 and IB10 antibodies reacted strongly to bacterially expressed E7 protein. But using E7 extracted from CaSki cell, VD6 reacted to 2.0 kDa E7 protein whereas IB10 showed weak reactivity. The antigenic sites estimation of these antibodies showed that antigenic site of VD6 was located in amino terminal region and that of IB10 in the middle portion in the range of approximate amino acid 25-45. The antigenic site of IB10 might contain the possible phosphorylation sites (Ser-31, 32) in E7. Considering this, the different reactivities of IB10 to E7 proteins expressed in bacteria and extracted from CaSki cell might be due to phosphorylation. In in vitro phosphorylation assay using CK II, the phosphorylation of E7 increased according to reaction time. And this phosphorylation reduced the reactivity of IB10 to E7 protein whereas the reactivity of VD6 did not change. Also the reactivity of IB10 to E7 protein increased in a dose dependent manner with CK II specific inhibitor, DRB treated CaSki cell extracts. CONCLUSION: These result showed the antigenecity is affected by the degree of phosphorylation of E7 protein.
Subject(s)
Humans , Antibodies , Antibodies, Monoclonal , Bacteria , Blotting, Western , Casein Kinases , Cell Extracts , Dichlororibofuranosylbenzimidazole , Human papillomavirus 16 , Oncogene Proteins , Phosphorylation , Reaction TimeABSTRACT
PURPOSE: Cervical neoplasias are known to be preventable. But the outcome of our efforts for early detection in Korea is disappointing. This study was undertaken to determine the level of screening participation in Korean women with cervical cancer and how the early detection of cervical cancer might be improved. MATERIALS AND METHODS: Two hundred and forty-nine women with cervical cancer diag- nosed and treated at Seoul National University Hospital from September 1996 to February 1998 were subjected to this study. Self-reported cervical cancer screening histories, med- ical records obtainable were reviewed and analysed. RESULTS: One hundred forty-seven women (147/249; 59.0%) hadn't got through the screen- ing at proper intervals. Ninety-nine women (39.9%) had never been screened and remain- ing 48 (19.3%) hadn't had their last Pap test 3 years before their diagnosis of nvasive cancer. Of the 150 women (60.1%) who had ever had a Pap test, only 47 (18.9%) had had annual Pap test during recent 5 years and 55 (22.1%) had had routine Pap test with interval between 1-3 years. Among 102 women who had at least one Pap test during recent 3 year, 73 (71.6%) had had a normal Pap report within three years of diagnosis, including 36 (35.3%) whose last normal Pap report was within a year of diagnosis. This results suggest the possibilities of smear-taking and/or reading errors. Women who had had routine Pap with interval less than 3 years had significantfy less chance of advanced tumor (FIGO stage Ib < ) than unscreened population. There was a statistically significant trend for the more younger and educated groups to be participated at the screening program with more shortened interval. All the other factors had failed to show significant correlation with adequacy or regularity of screening interval. CONCLUSIONS: Despite widespread chance of opportunistic cervical cancer screening, non-participants form the main reason for the failure of cervical cancer screening in Korea. So, far much efforts should be aimed at participating more women in cervical cytologic screening program, especially in the old-aged and less-educated groups.
Subject(s)
Female , Humans , Diagnosis , Korea , Mass Screening , Nose , Seoul , Uterine Cervical NeoplasmsABSTRACT
A hospital-based case-control study was carried out to investigate the risk factors of uterine cervical cancer in korea. Information on a wide-range of life-styles, which might be related with uterine cervix cancer, has been routinely collected through a dual application of the self-administered questionnaire and the direct interview by a well-trained nurse at the Department of Gynecology, Seoul National University Hospitals since 1992. The number of cervical cancer cases, histologically confirmed at the hospital, were 284. Included were 939 women as controls, who were free of past history of any malignancies. Adjusted odds ratio and 95% confidence limits were based on the unconditional logistic regression model. The multivariate logistic model was constructed under the consideration of biologic characteristics on the natural history of the malignancy. In the multivariate results, the uterine cervical cancer risk was higher in women of shorter height(P(trend) <0.05), less educated spouse (P(trend) < 0.001), multiple marriages(adjusted OR=2,70,95% C.I. 1.64~4.47), ever had a family history (adjusted OR=2.14., 95 % C.I. l.18~3.89), multiparity (P(trend) < 0.001), and early age at first delivery (P(trend) < 0.001). These results strongly suggest that the uterine cervix cancer might be related to the reproductive factors, and probably with sexual behaviour of both women and men in Korea.
Subject(s)
Female , Humans , Male , Case-Control Studies , Cervix Uteri , Gynecology , Hospitals, University , Korea , Logistic Models , Natural History , Odds Ratio , Parity , Population Characteristics , Surveys and Questionnaires , Risk Factors , Seoul , Spouses , Uterine Cervical NeoplasmsABSTRACT
Prognosis in carcinona of the ulerine cervix appears to be influenced by multiple factors (the size of primary tumor, nodal status, deep invasion into cervical stroma, histologic grade etc) that are frequently in terrelated. Recently other new factors may have been propoeed as prognostic factors in cervical cancer, such as number of cells in S-phase, or act,ivation of c- Ha-ras nnnd c-myc protooncogenes. It has been sug gested that c-myc proto-ancogene is associated with cellular proliferation and that its inappvopriate expression may be involved in carcinogerieais and in tumor progression. But its status as prognostic factor in cervical cancer is controversal. So we studied 42 with normal cervix and 61 wiith cervical carcinorna to investigate the relatiarship betwveer the prognostic variables of the cervical cancer(age, stage, tumor size, depth of invasion, lymph node metastasia) and c-myc gene expression, analyzed uaing immunohistochemical stainirig with formalin fixed paraffin embedded tissues from January 1985 to December 1986. And we assessed the progrioatic signifieance of r, myc gene expression by multivariate analysis. There was, significant, difference in c-myc gene expression between the normal cervix and the invasive cervical carcinama(0%: 34.4%, p<0.001). And the c-myc gene expressian was increased significantly according to clinical stage and depth of invasion. But, no relationship was found between c myc overexpression and other clinical ancl histologic parameters, such as age, primary tunaor size and lymph node metastasis. The 5 year disease free survival rates of the patients whose tumors showed c-myc overexpression were significantly lower(23.1%) than that(50.0%) of Other cancer patients. But only lymph node metastasis was significant]y related to the relative risk of relapse when the multivariate analysis was performed. These results suggested that c-myc gene expression may be associated with the cervieal tumorigenesis, but not useful as an indepenclent pragnoetic factor of the cervical carcinoma.