Robotic Single-Site Hysterectomy versus Robot-Assisted Multiport Hysterectomy in Benign Gynecologic Diseases: A Retrospective Comparison of Clinical and Surgical Outcomes

OBJECTIVE: The purpose of this study was to compare clinical and surgical outcomes of robotic single-site hysterectomy (RSSH) and robot-assisted multiport hysterectomy (RH) in benign disease. METHODS: We retrospectively reviewed the medical records of 38 women who underwent RSSH (N=12) or RH (N=26) for the treatment of benign uterine disease between June 2015 and November 2017. RESULTS: There were no intergroup differences in parity, comorbidities, and number of previous abdominal surgery. Mean age was older (49.5±5.05 years vs. 44.4±3.54 years, P=0.001) and mean body mass index was higher (27.4±2.47 kg/m2 vs. 25.3±3.12 kg/m2, P=0.045) in RSSH group than RH group. Surgical outcomes, including operative time (165.0 minutes vs. 159.2 minutes, P=0.727), estimated blood loss (115.8±33.15 mL vs. 108.1±56.42 mL, P=0.662), uterus weight (445.9±157.21 g vs. 374.5±197.91 g, P=0.291), postoperative hospital stay (5.4±0.51 days vs. 5.8±1.20 days, P=0.289), postoperative hemoglobin change in day 1 (1.8±0.89 g/dL vs. 1.4±1.53 g/dL, P=0.431) and day 3 (2.1±1.32 g/dL vs. 1.7±1.83 g/dL, P=0.601), and perioperative complications did not significantly differ between two groups. The use of additional analgesics after 6 hours, 24 hours, and 48 hours, and mean NRS score after 6 hours, 24 hours, and 48 hours were not significantly different between two groups. CONCLUSION: RSSH might be an effective and safe alternative to RH, even if in older and/or obese women with large uteri.

Malignant Perivascular Epithelioid Cell Tumor of the Uterus with Lung Metastasis

No abstract available.

Two cases of immature teratoma / 대한산부인과학회지

About 20~30% of benign or malignant tumors of ovarian origin arise from embryonic cells, and only 3% represent malignancy. But under age of 20, 70% of ovarian tumors arise from embryonic cells, and over 1/3 of them are malignant tumors. Over all the ovarian tumors arising from embryonic cells, immature teratoma is germ cell tumor, components include immature tissues and cells derived from ectoderm, mesoderm, and endomermal origins. Most of the immature tissues are from neuroectodermal origins. The immature teratoma of the ovary is a rare tumor, representing less than 1% of all ovarian neoplasm. These tumors typically present in young age woman (mean age 10~20 years) with pelvic and abdominal pain. Nowadays newly developed combination chemotherapeutic agents such as bleomycin, etoposide, cisplatin give us great survival and disease free prognosis than before. We have experienced two cases of immature teratoma so we report them with a brief review of concerned literatures.

Follicular stimulating hormone enhances Notch 1 expression in SK-OV-3 ovarian cancer cells / 부인종양

OBJECTIVE: Notch is known as a transmembranous receptor family with four homologous forms - Notch 1, Notch 2, Notch 3, and Notch 4 and related to cell fate regulation and angiogenesis. The purpose is to investigate the effect of follicular stimulating hormone (FSH) on the Notch 1 expression and proliferation in ovarian cancer cells. METHODS: Human ovarian cancer cell line, SK-OV-3 and FSH were used. XTT cell proliferation and cell migration assay were carried out with FSH 100 mIU/mL and Notch 1 siRNA. Western blots and reverse transcriptase-polymerase chain reactions (RT-PCR) were carried out to determine the expression level of the Notch 1 protein and mRNA with FSH treatment in 0, 1, 5, 10, 100, 200, 300 mIU/mL concentrations. Immunofluorescent (IF) stains were performed in SK-OV-3 cell cultures with FSH 100 mIU/mL. Student-t tests were used in statistical analyses. RESULTS: The SK-OV-3 have Notch 1 receptors in their natural status. FSH stimulated SK-OV-3 cells in XTT cell proliferation and cell migration assays and notch 1 siRNA inhibited. The expression level of Notch 1 protein and mRNA were increased in a dose dependent pattern according to FSH concentrations compared to untreated cells. IF stains also showed brighter Notch1 expressions in the FSH treated cells compared to the control cells. CONCLUSION: FSH enhances proliferation & migration and Notch 1 signaling in SK-OV-3 cells. The Notch signaling probably supports one of the cell proliferating mechanisms of FSH in ovarian cancer cells.

A clinical study of ectopic pregnancy during recent 8 years / 대한산부인과학회지

OBJECTIVE: The study was designed to ascertain a proper method of early diagnosis and treatment of ectopic pregnancy by analyzing its clinical and epidemiological characteristics. METHODS: The medical records of patients who were diagnosed to ectopic pregnancy at Hallym medical center during the period from January 1, 2000 to December 31, 2007 have been reviewed. RESULTS: The incidence of ectopic pregnancy was 7.3% (1,067) out of 14,519 deliveries. The most frequent age group was 26~30 (29.5%). Risk factors they had were previous histories of abdominal or pelvic surgery (37.0%), artificial abortion (30.8%), pelvic inflammatory disease (12%), and tubal sterilization (9.6%). Most frequent clinical symptoms were amenorrhea (88.7%), lower abdominal pain (81.2%), and vaginal spotting (60.0%). Percentage of patients with hemoglobin level over 10.0 gm/dL was 79% and below 8.0 gm/dL 3.9%. The clinical symptoms of ectopic pregnancy most commonly occurred after 6~8 weeks from last menstrual period (47%). Ectopic gestation was implanted on the fallopian tube in 89%, cornus in 7.2%, ovary in 1.1% and the cervix in 2.7%. Laparosopic surgeries were performed in 755 cases (71.6%) and laparotomies in 273 cases (25.9%) and dilatation and curettages in 26 cases (2.5%). Salpingectomy was performed most frequently (82.4%). Methotrexate (MTX) treatment was successful in 13 cases (1.21%). CONCLUSION: The early diagnosis of ectopic pregnancy is most useful when serum beta-hCG and vaginal sonography are used together. Laparoscopy would be a preferred method because of its short hospitalization period and low complication rate compared with laparotomy in ectopic pregnancy treatment.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

A case of Meigs' syndrome with elevated serum CA 125 level / 대한산부인과학회지

Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated CA 125 in Meigs'syndrome is unusual clinical condition reported in few cases. We report here, a 49-year-old postmenopausal woman with right ovarian fibrothecoma with ascites, right pleural effusion and high serum levels of CA 125. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA 125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.

Solitary mesenteric recurrence of ovarian cancer / 대한산부인과학회지

In epithelial ovarian cancer, solitary metastasis to mesentary is rare in the absence of apparent disease in other sites. We experienced one patient who developed isolated, solitary mesenteric metastasis of epithelial ovarian adenocarcinoma and underwent segmental resection of small bowel including mesentary to remove the recurrent disease. Rising CA125 heralded the recurrence and the patient was subsequently documented by computed tomography (CT) and PET-CT of the abdomen and pelvis with a high signal density noted only in the mesentery. There was no major postoperative complicathion. Solitary recurrence of epithelial ovarian cancer can occur in the absence of other demomstrable metastasis, so we report with brief review of literature.

A Case of Vaginal Bleeding after Cesarean Section due to Arteriovenous Malformation (AVM) of Uterus / 대한주산의학회잡지

Uterine arteriovenous malformations are very rare but potentially life threatening lesions. These lesions may be congenital or acquired, but especially occur in patients with a history of curettage, abortion or pregnancy. Color doppler ultrasonography is the preferred method of diagnosing of arteriovenous malformations. In many cases, hysterectomies are performed. But if patients want pregnancies, embolization therapy and conservative treatment are effective therapy. We have experienced a clinical case of uterine arteriovenous malformation, which is presented with a brief review of literature.

A Case of Synchronous Existence of Endometrial cancer and Cervical cancer / 대한산부인과학회지

The synchronous existence of endometrial cancer and cervical cancer is very rare. The reported frequency of concurrent gynecologic neoplasms has ranged from 0.7% to 4.3%, synchronous primary tumors of the female genital tract are relatively rare, comprising only 0.49% to 1.7% of all genital neoplasms. The majority of synchronous multiple primary neoplasm of female reproductive tract are of endometrial and ovarian origin. Multiple primary neoplams involving uterine cervix and endometrium were regarded as rare entity. We experienced a rare case of multiple primary neoplasm involving uterine cervix and endometrium and report with brief review of literatures.

VEGF (Vascular Endothelial Growth Factor) Expression and Angiogenesis in Invasive Cervical Cancer / 대한산부인과학회지

OBJECTIVE: A large body of evidence suggests that vascular endothelial growth factor (VEGF) is important to tumor growth and angiogenesis in cancers. This study was designed to determine the relationship between tumor vascularity and VEGF expression in invasive cervical cancer. Furthermore, we also compared the clinical factors with VEGF expression. METHODS: We examined the expression of VEGF and microvessel density (MVD) by immunohistochemical staining in 20 specimens collected from invasive cervical cancer patients. Thereafter, we compared the results with several clinical factors. We used the Chi-square test and One way Anova test for statistical analysis. RESULTS: All specimens showed weak and strong immunoreactivity. Microvessel counts were high in the strong (median 157.6) VEGF immunoreactivity and low in the weak (median 90) VEGF immunoreactivity (P=0.000). In addition, parametrium invasion showed statistically significant correlation with VEGF expression extent (p=0.021) but age, SCC, CEA, lymphovascular invasion, lymph node invasion and invasion depth of cervix showed no correlation. CONCLUSION: The overexpression of VEGF may play an important role in the promotion of angiogenesis in cervical cancer and may have relation to prognosis.

A Case of Intravenous Leiomyomatosis / 대한산부인과학회지

Intravenous leiomyomatosis (IVL) is rare and it is characterized by intravascular nodular masses of histologically benign smooth muscle that may extend along the inferior vena cava or reaching the right-sided cardiac chamber, and eventually the lung. Although histologically benign, IVL might be malignant in its mode of behavior. We report a case of IVL that grew in a vessel of myometrium of uteri.

A case of retroperitoneal huge smooth muscle tumor misleading to ovarian cancer / 부인종양

Smooth muscle tumors are very common tumors in the uterus and related adjacent structures but occur rarely in the retroperitoneum. Traditionally, most retroperitoneal smooth muscle tumor are believed to be malignant. But well-differentiated smooth muscle tumors with lack of atypia, necrosis, and significant mitotic activity appear to have a benign behaviors. Laparotomy revealed a huge solid tumor in the retroperitoneal space, about 50 cm in diameter, and histologically diagnosed as a smooth muscle tumor of uncertain malignant potential (STUMP). We report a case of primary retroperitoneal smooth muscle tumor with a brief review of literatures.

A Case of Transitional Cell Carcinoma of the Ovary / 대한산부인과학회잡지

Ovarian transitional cell carcinoma (TCC) resembles transitional cell carcinoma of the bladder. As a very rare type of tumor, it accounts for less than 2% of the total incidence of ovarian cancer. Though more aggressive than malignant Brenner tumor, it shows more favorable prognosis because of better response to the chemotherapy than other epithelial ovarian carcinomas. We experienced a case of ovarian TCC in a menopausal woman with a chief complaint of palpable pelvic mass, who underwent staging operation and platinum based (carboplatin-cyclophosphamide) chemotherapeutic treatment, and herein report the case with a brief review of related literatures.

The Effects of Gonadotropins on the Development of Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: We performed immunohistochemistry for the evaluation of follicle stimulating hormone receptor (FSHR), luteinizing hormone receptor (LHR) expression in the ovarian tumors and examined the blood level of the gonadotropins in ovarian cancer patients to investigate ovarian carcinogenesis process related to gonadotropins. METHODS: Between January 2002 and July 2003, 25 patients with ovarian tumors were treated in the Hallym University Sacred Heart Hospital. 25 ovarian tumors including 7 borderline tumors, 1 sex cord stromal tumor, 1 germ cell tumor, and 16 carcinomas were examined for FSHR, LHR expression by immunohistochemistry. Serum gonadotropins were collected from 13 cases of 25 ovarian tumors who were not taking hormones at the time of blood collection. RESULTS: Followings are results summarized. 1. Mean FSH levels were lower among cases compared with controls. LH levels were lower among cases than controls, but the difference was not statistically significant. 2. The steady decline of FSHR, LHR expression from borderline tumor (86%, 100%) to carcinoma (56%, 43%) is observed. 3. Patients showing significant gonadotropins receptors expression showed lower serum FSH and LH levels when compared with patients with no detectable gonadotropins receptors. CONCLUSION: The presence of FSHR, LHR in ovarian tumors provide additional evidence supporting the relation of gonadotropins and ovarian carcinogenesis. But, this study did not support the hypothesis that pituitary goandotropins increase the risk of ovarian cancer. The decline of receptor expression from borderline tumors to carcinoma suggests that FSH, LH may be needed in early ovarian cancer development. If further studies of gonadal peptides and gonadotropins are done, we can suggest the cut-off value of gonadotropins on ovarian carcinogenesis.

Efficacy of Loop Electrosurgical Excision Procedure (LEEP) in CIS (Carcinoma in Situ) of Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: The purpose of this retrospective study is to evaluate the efficacy of Loop Electrosurgical Excision Procedure (LEEP) in the diagnosis and in the treatment of CIS (carcinoma in situ). METHODS: Between Jan. 1999 and Apr. 2000, 94 patients with CIS were treated in the Hallym University Sacred Heart Hospital. Three procedures were performed: cytology, punch biopsy and LEEP (loop electrosurgical excision procedure). And the results of cervical cytology, punch biopsy, phathologic diagnosis of LEEP specimens were evaluated in comparison with the pathologic diagnosis of hysterectomy specimens. RESULTS: Followings are results summarized. 1. The concordance rate of LEEP histology with punch biopsy was 60% (53 cases). In comparison to punch biopsy, the higher LEEP histologic rate was 22% (19 cases), and lower LEEP histologic rate was 18% (16 cases), respectively. 2. 67 patients were diagnosed CIS and among them 58 patients underwent hysterectomy. In histologic comparison between LEEP and hysterectomy, there were on 1 (1.7%) patient who had more advanced diagnosis after operation. 3. 67 patients were diagnosed CIS and among them 58 patients underwent hysterectomy. The residual lesion was identified in 19 of 58 patients (33%). CONCLUSION: LEEP was useful diagnostic tool in CIS. But, in therapeutic efficacy, simple LEEP seems to be incomplete. Therefore, when we use LEEP for CIS as therapeutic tool, additional procedure, such as wide excision or endocervical deep resection may be asked. And careful follow up asked in therapeutic LEEP.

A Case of Alpha-Fetoprotein producing Sertoli-Leydig Cell Tumor / 대한산부인과학회잡지

The Sertoil-Leydig cell tumor (SLCT) is gonadal tumor of sex-cord type, similar to that seen in the various phase of testicular development in the male. It is the most common type of all virilizing ovarian tumors and account for less than 0.5% of all ovarian tumors. A 26-year-old woman had an ovarian SLCT associated with an elevated level of serum AFP. The tumor had a heterologous element of intestinal-type mucinous epithelium, retiform and intermediately differentiated tubules of the Sertoli cell, and AFP-producing Leydig cells. After surgery, the serum AFP level of the patient fell to the normal range. We experienced a case of AFP producing SLCT, so we present it with a brief review of literature.

Cyclooxygenase-2 Expression and Angiogenesis in Invasive Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumor growth and angiogenesis of gastrointestinal and other cancers. This was the study to determine the relationship between tumor vascularity and COX-2 expression in invasive cervical cancer. METHODS: We examined the expression of COX-2 and microvessel density (MVD) by immunohis- tochemical staining in 21 specimens collected from invasive cervical cancer patients. RESULTS: All specimens showed weak and strong immunoreactivity, with 52.4% strong reactivity. Microvessel count was higher (median 136) in the strong COX-2 immunoreactivity specimens than the weaks (median 90), and MVD was significantly correlated with the COX-2 immunoreactivity (P=0.002). CONCLUSION: These preliminary data indicate that overexpression of COX-2 may play an important role in carcinogenesis of cervical cancer and this could be partially attributable to modulation of angiogenesis by COX-2. COX-2 maybe a target for future research in the tumorigenesis of the invasive cervical cancer.

The efficacy of nuchal translucency with free beta-hCG, PAPP-A as a screening test for detection of chromosomal anomaly in the first trimester of pregnancy / 대한산부인과학회잡지

OBJECTIVES: The aim of this study is to determine the efficacy of nuchal translucency in combination with free beta-hCG, PAPP-A in the first trimester screening for chromosomal anomaly in general population. METHODS: Between April 1998 and December 1999, we evaluated 263 pregnant women undergoing first trimester screening test for fetal chromosomal anomaly using nuchal translucency combined with free beta-hCG, PAPP-A. We confirmed the pregnancy outcomes through chorionic villi sampling, amniocentesis or term delivery. We excluded 15 pregnant women because of their obscure pregnancy outcomes. Statistical analysis was considered significant when P value was lower than 0.05. RESULTS: With a risk cut-off of 1 in 400, 24 pregnancies(9.7%) of 248 cases were screen positive and 224 pregnancies(90.3%) were screen negative. 2 cases of Down syndrome and 1 case of Turner syndrome were detected in screen positive group. No chromosomal anomalies were detected in screen negative group. CONCLUSION: In this study, 8.57% of false positive rate and 12.5% of positive predictive value were obtained in the first trimester screening for chromosomal anomaly using nuchal translucency and serum markers.