Comparison of the Effects of Hormone Replacement Therapy on Bone Mineral Density, Lipid Profiles, and Biochemical Markers of Bone Metabolism / 대한폐경학회지

OBJECTIVES: To assess the effects of hormone replacement therapy on bone mineral density (BMD), biochemical markers of bone turnover, and lipid profiles in postmenopausal women. METHODS: We retrospectively reviewed the medical records of 199 postmenopausal women who had received care at the Department of Obstetrics and Gynecology of Catholic University Seoul St. Mary's Hospital between January 1994 and December 2008. The patients were divided into the following three groups: group 1 received combined estrogen and progesterone therapy (n = 91); group 2 received estrogen only (n = 65); and group 3 received tibolone (n = 43). We compared the changes in biochemical markers of bone turnover, lipid profiles, and BMD during therapy. RESULTS: The BMD of the lumbar spine increased in groups 1 and 3 by 2.0% and 1.2%, respectively, and the BMD of the total femur increased in groups 1 and 2 by 2.3% and 0.5% from the initial values after 3 years, respectively. However, the BMD of the femoral neck and total femur decreased significantly in group 3 by 4.8% and 1.9%, respectively, 3 years after treatment initiation (P < 0.05). Serum osteocalcin and urinary deoxypyridinoline decreased in all groups 1 year after treatment. In groups 1 and 3, the total cholesterol level decreased and the triglycerides level increased. However, there were no definite changes in the total cholesterol and triglycerides levels in group 2. The high density lipoprotein cholesterol (HDL)-cholesterol level increased in groups 1 and 2, but decreased in group 3. As a result, the BMD of the lumbar spine increased and the total cholesterol level decreased in the combined therapy and tibolone groups. Tibolone had no beneficial effect on the BMD of the femoral neck. CONCLUSION: Our results suggest that each therapy has different effects on BMD, biochemical markers of bone metabolism, and lipid profiles. A prospective study involving a larger group, and considering multiple factors, will be required to obtain more clinically meaningful conclusions.

Comparison of the Effects of Hormone Replacement Therapy on Bone Mineral Density, Lipid Profiles, and Biochemical Markers of Bone Metabolism / 대한폐경학회지

OBJECTIVES: To assess the effects of hormone replacement therapy on bone mineral density (BMD), biochemical markers of bone turnover, and lipid profiles in postmenopausal women. METHODS: We retrospectively reviewed the medical records of 199 postmenopausal women who had received care at the Department of Obstetrics and Gynecology of Catholic University Seoul St. Mary's Hospital between January 1994 and December 2008. The patients were divided into the following three groups: group 1 received combined estrogen and progesterone therapy (n = 91); group 2 received estrogen only (n = 65); and group 3 received tibolone (n = 43). We compared the changes in biochemical markers of bone turnover, lipid profiles, and BMD during therapy. RESULTS: The BMD of the lumbar spine increased in groups 1 and 3 by 2.0% and 1.2%, respectively, and the BMD of the total femur increased in groups 1 and 2 by 2.3% and 0.5% from the initial values after 3 years, respectively. However, the BMD of the femoral neck and total femur decreased significantly in group 3 by 4.8% and 1.9%, respectively, 3 years after treatment initiation (P < 0.05). Serum osteocalcin and urinary deoxypyridinoline decreased in all groups 1 year after treatment. In groups 1 and 3, the total cholesterol level decreased and the triglycerides level increased. However, there were no definite changes in the total cholesterol and triglycerides levels in group 2. The high density lipoprotein cholesterol (HDL)-cholesterol level increased in groups 1 and 2, but decreased in group 3. As a result, the BMD of the lumbar spine increased and the total cholesterol level decreased in the combined therapy and tibolone groups. Tibolone had no beneficial effect on the BMD of the femoral neck. CONCLUSION: Our results suggest that each therapy has different effects on BMD, biochemical markers of bone metabolism, and lipid profiles. A prospective study involving a larger group, and considering multiple factors, will be required to obtain more clinically meaningful conclusions.

A case of endometrioma at the uterine incision scar of previous cesarean section / 대한산부인과학회지

Endometriosis is defined as condition, which is ectopic location of endometrial tissue other than uterus and cause many clinical symptoms. Among extrapelvic endometriosis, scar endometriosis secondary to surgery or procedure is very rare condition. We have experienced one interesting case of endometrioma in uterine wall cesarean section scar. The diagnosis was confirmed by histopathologic examination of the scar tissue taken after total abdominal hysterectomy.

A case of abdominal pregnancy implanted on uterosacral ligament / 대한산부인과학회지

Abdominal pregnancy, a rare type of ectopic pregnancy is difficult to be suspected at its first presentation. The diagnosis of this rare disease may often be delayed, since early symptoms are usually non-specific. In some cases, delayed diagnosis of abdominal preganacy can be associated with catastrophic hemorrhage secondary to placental separation. A 24-year old woman visited our emergency unit, presenting with a sudden-onset low abdominal pain. She had undergone uterine curettage 3 weeks before. Transvaginal sonogram of the cul-de-sac revealed complex fluid consistent with blood. On diagnostic laparoscopic operation, we found a ruptured cystic, conception-like structure near the right uterosacral ligament. Histology of the resected structure finally showed chorionic villi consistent with abdominal pregnancy. In this report, we present an unusual case of abdominal pregnancy. This case underscores the careful ultrasonic determination of gestational location at early pregnancy.

A case of cystolithiasis after intravesical migration of Copper T intrauterine device / 대한산부인과학회지

An intrauterine device (IUD) is one of the most commonly used contraceptive method in the world. One of the major complications of intrauterine contraception is the perforation through the uterine wall into the pelvic or abdominal cavity. The incidence is 0.9 people per 1000. However, bladder perforation is even more rare. It happens mostly at the time when it was inserted. The symptom varies from no symptom at all to low abdominal pain, massive bleeding, et cetera. We report a case with displaced intrauterine device in bladder, producing the bladder stone which was managed with cystoscopic lithotripsy and intrauterine device removal, followed by a review of the literature.

Prognosis of Threatened Abortion according to Embryonic Heart Rate / 대한주산의학회잡지

OBJECTIVE: The purpose of our study was to investigate the relationship between prognosis of threatened abortion and embryonic heart rate at diagnosis. METHODS: The study group included 86 patients in which a singleton fetus with cardiac activity was initially documented. The study population was divided into successful pregnancy group (73 cases, pregnancy was maintained above 20 weeks of gestation) and spontaneous abortion group (13 cases). We compared the embryonic heart rate, age of mother, gestational age at diagnosis between two groups. RESULTS: A significant difference of embryonic heart rate was noted between the successful group and the spontaneous abortion group (153.1+/-22.9 vs 134.6+/-18.8 beats/min, p=0.0076). There was no statistical difference in the gestational age at diagnosis (8.0+/-1.9 vs 7.5+/-1.9 weeks), the age of mother, and primi para proportion. CONCLUSION: The prognosis of threatened abortion was related to the embryonic heart rate. Embryos with slow heart rates had a greater risk of spontaneous abortion. All cases with slow embryonic heart rate (<110 beats/min) had occurred spontaneous abortion. Therefore, these case were needed more information and aggressive treatment.

Diagnosis of an Interstitial Pregnancy with 3-dimensional Transvaginal Sonography / 대한주산의학회잡지

Interstitial pregnancy is an ectopic pregnancy which is located in the intramural portion of the tube covered by myometrium. Rupture usually results in catastrophic hemorrhage, since there is an anastomosis of uterine artery and tuboovarian vessels. Therefore, the early diagnosis is important to decrease maternal morbidity. However, the diagnosis using the conventional 2-dimensional transvaginal sonography has some difficulties in differentiation from corneal pregnancy. In this case, we diagnosed an interstitial pregnancy using the 3-dimensional sonography in a woman with amenorrhea for 7 weeks and 1 days, which was resected through laparoscopic operation. The 3-dimensional sonography has a potential role to define the location of pregnancy implanted on the outer site of uterine fundus.

Diagnosis of an Interstitial Pregnancy with 3-dimensional Transvaginal Sonography / 대한주산의학회잡지

Interstitial pregnancy is an ectopic pregnancy which is located in the intramural portion of the tube covered by myometrium. Rupture usually results in catastrophic hemorrhage, since there is an anastomosis of uterine artery and tuboovarian vessels. Therefore, the early diagnosis is important to decrease maternal morbidity. However, the diagnosis using the conventional 2-dimensional transvaginal sonography has some difficulties in differentiation from corneal pregnancy. In this case, we diagnosed an interstitial pregnancy using the 3-dimensional sonography in a woman with amenorrhea for 7 weeks and 1 days, which was resected through laparoscopic operation. The 3-dimensional sonography has a potential role to define the location of pregnancy implanted on the outer site of uterine fundus.

The expression of BH3-only Bcl-2 family members in mouse ovary and influence of gonadotropin on Nix expression in granulosa cells / 대한산부인과학회지

OBJECTIVE: In the ovary apoptosis eliminates granulosa cells (GC) during follicle atresia. While we identified many cell death regulatory molecules not yet characterized in the ovary, of particular interest were members of the Bcl-2 family which contain only the Bcl-2 homology (BH)-3 domain. The objectives of this study was to investigate and compare the expression patterns of BH3-only Bcl-2 family members in various organs and evaluate their function in ovarian granulosa cells. METHODS: Total RNA was extracted from GC, ovaries, uteri, hearts (low rate of cell turnover) and livers (high rate of cell turnover) of prepubertal female mice. BH3-only Bcl-2 family members were cloned to make riboprobe. The expression patterns in the tissues evaluated by Northern blot analysis. Nix mRNA expression in ovarian granulosa cells after gonadotropin treatment also compared by Northern blot analysis. RESULTS: Bad, Bid, Bim, Bmf, Map-1 and Nix were expressed in granulosa cells. Nix was most abundantly expressed in GC. In contrast, Blk was expressed in the ovary, liver, heart and uterus, but not in GC. Bmf, a sensor or microfilament disassembly, was expressed in GC, ovary and uterus, with limited to no expression in non-reproductive tissues. Nix mRNA expression was not regulated by gonadotropin after 42 hour. CONCLUSION: These studies will help to complete a molecular blueprint of the regulatory network that controls GC death during follicular atresia. In addition, these data, which show a tissue/cell-selective profile of BH3-only expression, may also explain the known variation in the in vivo apoptotic response of different tissues/cells to generic stimuli that should be globally lethal.

A Case of Harlequin Ichthyosis / 대한주산의학회잡지

Harlequin ichthyosis, which is one of lamellar ichthyosis, is a severe and fatal congenital keratinization disorder with autosomal recessive inheritance. The cause of this disorder is not clear but related to transglutaminase-1 gene mutation. It is characterized by an extremely thickened keratin layer of skin, flattened ears and diffuse platelike scales. Pathologic findings include prominent hyperkeratosis and severe acanthosis. Prenatal sonographic diagnosis has been described, with findings of a persistantly open mouth, echogenic amnionic fluid and fixed flexion of the extremities. We experienced a case of Harlequin infant who showed typical clinical and pathologic findings but non-specific antenatal studies performed in other hospital. We report the case of Harlequin ichthyosis with a brief review of the literature.

Obstetric Outcome after Threatened Abortion / 대한산부인과학회잡지

OBJECTIVE: Threatened abortion, one of the most common problems of pregnancy, develops 15-20% of pregnant women and progresses into the abortion in 20-50%. It is related to many obstetrical sequelae. We analyzed the prevalence of complication, disruption of pregnancy and the effect of recent treatments. In ultrasonographic examination, we divided all cases into two groups according to existence of hematoma. We compared the difference of two groups about the prognosis of pregnancy and maternal serum concentration of FP. METHODS: A total 88 cases of threatened abortion and 5741 cases of normal pregnancy were studied from Jan., 1999 through Dec., 2003 at St. Paul Hospital in Seoul, Korea. We analyzed age, gestational age of menstruation and ultrasonogram, parity, results of triple test, existence of hematoma, efficacy of treatment. In all cases, we carried out ultrasonic examination with LogiQ-400 (General Electronics Medical System, Tokyo, Japan). We checked the concentration of FP from triple test. RESULTS: The mean gestational age at diagnosis was 9.2 +/- 3.4 weeks. After threatened abortion, successful cases were 71 and mean gestational age at diagnosis was 9.6 +/- 3.6 weeks. In comparison with 17 unsuccessful cases, whose mean gestational age at diagnosis was 6.6 +/- 1.8 weeks, it was thought to be significant differences (p=0.001). The success rates of pregnancy prolongation between groups of different treatments modalities are nearly similar. Existence of hematoma seems to have little impact on prognoses of pregnancy outcome and there were no meaningful differences of maternal serum FP concentration. CONCLUSION: In this study, we could find no difference between the groups those were treated with various methods. We thought that more systematic analysis about the treatment of threatened abortion would be needed. In the cases that were diagnosed threatened abortion at later gestational age, we could find obvious improvement of the pregnancy outcome. So we conclude that gestational age at the diagnosis is potential parameter of prognosis.

Expression of Mullerian Inhibiting Substance Type II Receptor during Follicular Development in the Human Ovary / 대한산부인과학회잡지

OBJECTIVES: This study was aimed to obtain information on the ontogeny of the production profile of MIS type II receptor (MISR II) and the pattern of its localization according to follicular development METHODS: Expression of MISR II were studied in 21 ovarian specimens from adult normal cycling women by RT-PCR and in situ hybridization of the MISR II mRNA and immunohistochemical staining of the MISR II. RESULTS: The first staining for MISR II and MISR II mRNA were detected in the granulosa cells in primary follicles. The granulosa cells of multiple layered growing follicles showed strong specific staining for MISR II and MISR II mRNA. Among the growing follicles, large follicle stained more intensely than small one. Expression of the MISR II and MISR II mRNA were also seen in the granulosa cells and theca cells of antral follicles. The expression levels of MISR II and MISR II mRNA in mature follicles were lower than those in growing follicles and were even further reduced, but still detectable, in corpus luteum. There was a decreased level of MISR II and MISR II mRNA expression when follicles become atretic. Both expressions were eventually lost from atretic follicles. And the MISR II and MISR II mRNA staining were not found in primordial follicles, oocytes, interstitial cells, ovarian epithelium, and corpus albicans. CONCLUSION: The production and localization of MISR II in granulosa cells, theca cells, and corpus luteum in normal reproductive ovary indicate that actions of MIS via MISR II are autocrine and paracrine in nature. The pattern of MISR II and MISR II mRNA expression according to follicular development indicate that MIS function in the ovary is turned on in primary follicles, increases to maximal levels in large growing follicles, and decreases just before ovulation. These experiments suggest that MIS may play an important role in follicle maturation and follicle selection during the adult reproductive cycle. And this study may yield important information to direct the development of newer contraceptive strategies.

A Case of Vaginal Prolapse after McIndoe Operation Managed by Transvaginal Sacrospinous Colpopexy / 대한산부인과학회잡지

McIndoe procedure using the colonic segment has been used in treatment of patients with Mullerian agenesis. Prolapse of a colonic neovagina is rare condition and its treatment is not yet standardized. We experienced a case of neovaginal prolapse following McIndoe procedure using colonic segment. A 51-year-old woman developed prolapse of a neovagina 17 years after the McIndoe operation. She had been diagnosed to have Mullerian agenesis and was managed by McIndoe operation using colonic segment. The prolapse was successfully managed with transvaginal sacrospinous colpopexy. She has no sign of recurrent prolapse and is satisfied with sexual intercourse. Patients with neovaginal prolapse following McIndoe procedure can be treated successfully with transvaginal sacrospinous colpopexy.

Regulation of the apoptosis on the rat granulosa cell: effects of EGF, TGF-alpha / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effect of the epidermal growth factor (EGF) and the transforming growth factor-alpha (TGF-alpha) on the apoptosis of the rat granulosa cells. METHODS: For this study, granulosa cells were isolated from female rats, and granulosa cells were cultured in the presence or absence of different autocrine/paracrine factors such as EGF and TGF-alpha. In order to investigate the apoptotic process, the number of apoptotic cells were counted using Annexin V staining via flow cytometry. In addition, the expression levels of the Bcl-2, ICE and BAX genes were checked. RESULTS: c-AMP induced apoptosis was inhibited neither by EGF nor by TGF-alpha, but FSH induced apoptosis was inhibited by EGF and TGF-alpha. Both EGF and TGF-alpha decreased the rate of apoptosis in the serum free cultured media in a time dependent manner by inducing survival gene expression such as Bcl-2 and suppressing death gene expression such as ICE and BAX. CONCLUSION: EGF and TGF-alpha can be used to decrease the apoptotic rate of the rat granulosa cells. It is hoped to conduct a similar study on the function of these growth factors in the human granulosa cells, and to use EGF and TGF-alpha for reducing the apoptosis rate of the human granulosa cells in IVF.

Serum Levels of Inhibin A and Inhibin B During Menstrual Cycle / 대한산부인과학회잡지

OBJECTIVE: To understand the physiologic effects and secretion pattern of inhibin A and inhibin B throughout menstrual cycle in the normal reproductive women, serum values of inhibin A and inhibin B were measured. METHODS: Inhibin A and inhibin B levels were measured in 320 serum samples from 160 normal reproductive women by solid phase sandwich ELISA. RESULTS: In the normal reproductive women, inhibin A is secreted in low serum levels until the mid- proliferative phase, begins to increase in the late proliferative phase (16.53+/-1.57 pg/ml), reaches the peak in the early secretory and mid-secretory phase (45.56+/-2.37 and 45.85+/-2.08 pg/ml), and subsequently decreases in the late secretory phase. We found that inhibin B begins to increase in the early proliferative phase (65.40+/-4.08 pg/ml), is secreted in high concentration in the proliferative phase, reaches the peak in the ovulatory phase (110.74+/-9.83 pg/ml), and thereafter declines rapidly to the lowest level in the mid-secretory phase (29.59+/-2.08 pg/ml). CONCLUSION: In conclusion, serum inhibin A levels peak during the luteal phase, indicating the greatest production by the corpus luteum and serum inhibin B levels increase during the follicular phase, indicating the greatest production by follicles in early stage of development. Inhibin A is associated with the luteal function and inhibin B, the follicular function. Both inhibins are associated with the follicular maturation and development.

Serum Levels and Expressions of Inhibin A and Inhibin B in the Ovaries of Perimenopausal Women / 대한산부인과학회잡지

OBJECTIVE: To understand the physiologic effects and secretion pattern of inhibin A and inhibin B during menstrual cycle and menopausal transition, inhibin A and inhibin B levels were measured. And to detect any changes in expression of inhibins in human ovary with age, we examined immunohistochemical staining of alpha, beta A, and beta B subunits of inhibin in ovarian tissues. This study was also designed to investigate whether or not inhibin is an early marker for menopausal transition. METHODS: Inhibin A and inhibin B levels were measured in 320 samples from normal reproductive women, in 60 from perimenopausal women, and in 20 from menopausal women by ELISA. And we examined the immunohistochemical staining of alpha, beta A, and beta B subunits of inhibin in ovarian tissues of 35 normal reproductive, 20 perimenopausal, and 5 menopausal women, respectively. RESULTS: In the normal reproductive women, inhibin A begins to increase in the late proliferative phase (16.53 +/- 1.57 pg/ml), reaches the peak in the mid-secretory phase (45.85 +/- 2.08 pg/ml), and subsequently decreases. Inhibin B begins to increase in the early proliferative phase (65.40 +/- 4.08 pg/ml), reaches the peak in the ovulatory phase (110.74 +/- 9.83 pg/ml), and thereafter declines rapidly. In the perimenopausal women, mean inhibin A serum concentration was 6.68 +/- 0.53 pg/ml during proliferative phase and 21.78 +/- 3.61 pg/ml during secretory phase, which were significantly lower than that of the same phase in the normal reproductive women (P<0.01). Mean inhibin B serum concentration was 52.16 +/- 7.46 pg/ml during proliferative phase and 22.41 +/- 6.73 pg/ml during secretory phase, which were significantly lower than that of the same phase in the normal reproductive women (P<0.01, P=0.025). In the menopausal women, both inhibin A and inhibin B were not detected. In the normal reproductive women, we observed strong immunostaining for alpha subunit in granulosa cells, theca cells, and corpus luteum. Immunostaining for beta A subunit was observed in corpus luteum, but not in growing follicles. Immunostaining for beta B subunit was observed in primary follicle, granulosa and theca cells of growing follicle, and mature follicle, but less strong than immunostaining for alpha subunit. No staining for beta B subunit was observed in the corpus luteum. In the perimenopausal women, immunostaining for inhibin subunits were observed in the same pattern as that of the normal reproductive women, but weaker. Stronger immunostaining was observed in theca cells than in granulosa cells. In the menopausal women, none of the immunostaining of inhibin subunits were observed. CONCLUSION: It is concluded that inhibin A is associated with the luteal function and inhibin B, the follicular function. The secretion of inhibins decreased rapidly in the perimenopausal transition period and were not detected in the menopausal period. Inhibin A and inhibin B are associated with the follicular maturation and development. It suggests that the inhibin A and inhibin B are good candidates as markers for perimenopausal transition.

The risk factors of residual disease after conization / 대한산부인과학회잡지

OBJECTIVE: Conization is used for diagnosis and treatment of cervical neoplasia. Our purpose of this investigation is to determine the efficacy of loop conization for the treatment of cervical dysplasia and the significance of the clinical and histological factors used to predict residual dysplasia after loop conization. METHODS: We reviewed the charts of patients who were received conization and subsequently total hysterectomy at Kangnam St Mary Hospital during 1989 and 2000. Logistic regression and Chi-square test were used for analysis. RESULTS: Total 257 patients were included. The mean age of the patients was 44.7 years. Of these patients, 87 (33.8%) had residual disease in the hysterectomy specimens. Age, the involvement of cut surface of endocervix and exocervix, severity and extent of the lesion, and scattering lesion were associated with the residual disease. But preoperative HPV infection, which is known as the cause of cervical neoplasia was not associated with the residual disease. CONCLUSION: When the high risk factors are present, the validity of conservative treatment should be considered and more careful follow up with pap smear, HPV test and colposcopy is necessary. Because about one thirds of patient has residual disease after conization, LEEP conization should be used for diagnosis of cervical neoplasia rather than treatment.

Two Cases of Primary Carcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary fallopian tube carcinoma is a rare tumor, accounting for approximately 1% of all female genital tract malignancies. Its histologic appearance and clinical behavior resemble that of primary ovarian carcinoma, with a reported 5-year survival rate of about 30% to 50%. Presenting symptoms are variable, so pre-operative diagnosis of fallopain tube carcinoma is seldom made. Evaluation and treatment are also essentially the same as that of ovary cancer. Two postmenopausal women presented with pelvic mass and vaginal bleeding. One case was initially diagnosed as endometrioma, the other as endometritis but postoperatively pathologic examination of resected specimen revealed primary adenocarcinoma of the fallopian tube in debulking operation. We have experienced two cases of primary carcinoma of fallopian tube and reported with brief review of literature.

A case of de novo ring (13) chromosome with deletion 13q32.2-->qter / 대한산부인과학회잡지

We report a case of ring chromosome 13 with a distal deletion of 13q32.2-->qter observed in a fetus who was referred to our institution at term due to severe growth restriction and multiple congenital malformations on ultrasonographic examination.This boy was born by vaginal delivery at 39 weeks in gestation. His weight, head circumference and height were less than the 3 percentile of gestational age. Apgar score was 7 at 1 minute and 9 at 5 minutes. He showed microcephaly, large forehead, low set ears, hypertelorism, flat nasal bridge, and micrognathia. The genitalia was ambiguous, showing severe hypoplasia of the penis. The anus was ectopic, displaced anteriorly from its normal position but with a normal opening and function. Neurologic examination was normal. Echocardiogram done at 2 weeks of life showed a persistent foramen ovale and a ventriculoseptal defect (type II) with increased pulmonary hypertension. MRI examination of the brain showed poorly demarcating corpus callosum suspecting agenesis of corpus callosum. Also, cerebellar vermis was small and hypoplastic, mimicking a variant form of Dandy-Walker malformation. MRI of the pelvis showed a tubular structure in pelvic cavity, suspicious of uterine remnant, between urinary bladder and rectum, and a inguinal hernia was noted in the left side. In the abdominal cavity enlarged adrenal glands were noted, and hormonal study showed elevated 17-alpha-OH-progesterone (168.9 ng/ml) with normal 17-KS and 17-OHCS levels. Gastrointestinal and urogenital system were otherwise normal. Cytogenetic analysis of the parents were both normal but the newborn showed 46, XY, r (13), de novo, with deletion points q32.2-->qter. Our findings are in line with previous reports about chromosome 13 deletions, in which loss of the "critical point" leads to major malformations like brain anomalies and ambiguous genitalia.

Clinical Significance of Sentinel Lymph Node Detection in Vulvar Cancer / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the validity of sentinel lymph node detection and the possibility of clinical application in treatment of vulvar cancer patients. PATIENTS AND METHODS: From March 2001 to January 2002, four patients with vulvar cancer were eligible for this study. All the patients were preoperative technetium-99 m colloid albumin and intraoperative isosulfan blue dye injection intradermally at the junction of tumor mass and normal skin. Superficial lymphatic channels and groin lymph node dissections were made to detect sentinel lymph node and then complete inguinofemoral lymph nodes dissection was performed. All the sentinel lymph nodes were sent to pathologic department for frozen biopsy. RESULTS: Ten sentinel lymph nodes were identified in one-hundred and ten groin lymph nodes. All the ten sentinel lymph nodes showed benign. There was no case that non-sentinel lymph nodes were positive in the presence of negative sentinel lymph nodes by frozen biopsy (negative predictive value was 100%). CONCLUSION: Sentinel lymph nodes detection by combination use of technetium-99 m colloid albumin and isosulfan blue dye injection was simple and accurate in our preliminary study. To reduce postoperative morbidity, lymphedema and to minimize extensive inguinofemoral lymph nodes dissection, sentinel lymph node frozen biopsy may be a reasonable alternatives and a suitable method for limited control of vulvar cancer. This preliminary study showed the possibility of clinical application of sentinel lymph node detection in vulvar cancer surgery.