Two cases of torsion of subserosal leiomyoma and literature review / 대한산부인과내시경학회지

Leiomyoma is the most common benign uterine tumor, but acute torsion of myoma is extremely rare. We experienced two patients admitted to our hospital for acute abdominal pain, who diagnosed with torsion of subserosal myoma. Although ultrasonogram revealed a subserosal myoma in both cases, it could not confirm torsion of uterine fibroid. Laparoscopic surgery confirmed the diagnosis of acute torsion of myoma and resected the lesion successfully.

A Case of Twin Pregnancy with One Anencephalic Dead Fetus / 대한주산의학회잡지

Twin Pregnancies are increasing these days due to recent development of the technology in treating infertility. twin pregnancies tend to cause more congenital anomalies than singleton pregnancies do. Especially when twin pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling are difficult. We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one, after close counseling we decided to continue the pregnancy. At 35 weeks 6 days of gestation, an anencephalic fetus was dead, so we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 2160 gm and 600 gm, respectively. The anencephalic fetus was combined with scoliosis, absent left upper limb, and nuchal skin defect, but the healthy one showed good crying and movement and its Apgar score was 8 in 1 minute and 9 in 5 minute. Although the infant needed intensive care for 21days in the nursery room, she was finally discharged in good condition. We present this case with a brief review of the literature.

Expression pattern of Aromatase Cytochrome P450 in Adenomyosis / 대한산부인과학회잡지

OBJECTIVE: To determine whether local estrogen production takes place in adenomyosis and in normal endometrium. METHODS: The study included 23 cases of adenomyosis and 17 cases of normal uterine endometrium obtained through hysterectomy or curettage at Kangnam Cha Hospital. The frozen tissue specimens were examined by immunohistochemistry using P450 arom. RESULTS: P450 arom was immunolocalized exclusively in the cytoplasm of glandular cells of adenomyotic tissue. However, no apparent staining was observed in stromal cells. Aromatase was expressed in the ectopic glands (82.6%), but also in the eutopic endometrium of patients with adenomyosis (23.5%). In the case of normal endometrium, P450arom was not detected. CONCLUSION: These results suggest that the aromatase activity is correlated to the pathophysiology of adenomyosis.

Cervicography and HPV DNA Testing as Triage Criteria for Women with Abnormal Pap Smear by Primary Care Clinicians / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to determine the predictive values of cervicography and HPV DNA test for histologic CIN diagnoses among women with abnormal cervical cytology so as to use as an intermediate triage criteria by primary care clinicians. METHODS: All 129 patients with abnormal cervical cancer screening tests underwent simultaneous or consecutive cervicography, HPV DNA test, colposcopically directed punch biopsy and/or LEEP. The results of single or combination screening tests were compared with final histopathologic findings. 71 among 129 patients were referred from other clinics, and remainders from mine between July 2000 and June 2001. RESULTS: Sensitivity/Specificity/PPV/NPV/Efficiency and FPR/FNR of single or combination tests were calculated. Following results were obtained. 1) Sensitivity : Triple combined test was 100%, double combined test by cytologic test plus either cervicography or HPV DNA test (97.8%), cytologic test (94.6%), HPV DNA test (88.4%), and cervicography (56.0%) followed. 2) Specificity : Cervicography was 61.1%, HPV DNA test (45.9%), cytologic test (30.6%), double combined test by cytologic test plus HPV DNA test (22.9%), double combined test by cytologic test plus cervicography (8.3%), and triple combined test (7.9%) followed. 3) PPV : No statistically significant differences were shown among single, double and triple combined tests, and it ranged between 72.2% and 80.8%. 4) NPV : Triple combined test was 100%, double combined test by cytologic test plus HPV DNA test (80.0%), HPV DNA test (68.0%), double combined test by cytologic test plus cervicography (60.0%), and cervicography (34.9%) followed. 5) Efficiency : Larger than 70% of efficiency in all screening methods (either single or combined) except single cervicography (57.4%). 6) FPR : Triple combined test was 92.1%, double combined test by cytologic test plus cervicography (91.7%), double combined test by cytologic test plus HPV DNA test (78.4%), cytologic test (69.4%), HPV DNA test (54.1%), and cervicography (38.9%) followed. 7) FNR : Cervicography was 44.1%, HPV DNA test (8.7%), cytologic test (5.4%), double combined test by cytologic test plus cervicography (2.2%), double combined test by cytologic test plus HPV DNA test (1.1%), and triple combined test (0%) followed. CONCLUSION: Even though the optimal clinical management of cervical cytologic abnormality remains still problematic, this study demonstrates that additional HPV DNA test and/or cervicography have much value in predicting histologic CIN diagnoses. Primary care clinicians can easily perform these tests at their clinics as an intermediate triage criteria to prevent overreferral for colposcopy without compromising the detection of significant disease underlying cytologic atypia.

Clincal Analysis of Placenta Previa / 대한산부인과학회잡지

OBJECTIVE: To review the outcome of pregnancies complicated by placenta previa and to describe in detail the antenatal course and the events leading to delivery, assessing whether there are clinical features predictive of outcome. METHODS: Hospital records of women with a pregnancy complicated by placenta previa at Kangnam- CHA General Hospital between Jan. 1998 and June 2001 were analysed retrospectively. RESULTS: There were 22,323 deliveries in the study period. Two hundred and fifty women were complicated by placenta previa. Following results were obtained. 1. The overall frequency of placenta previa observed in the study was 1.12% annually (1 in 89 deliveries). 2. The most frequent subtype was totalis (48.4%), then low lying (20.8%), marginal (18.4%), partialis (12.4%) in order. 3. Gestational age at delivery was after 33 weeks in 96.8% of cases. Half (49.6%) of the cases experienced vaginal bleeding. First bleeding episode occurred after 29 weeks in 79 cases (31.6%). Labor pain was accompanied in 40.3% of bleeding cases. 4. Significant difference was noticed between women with total placenta previa and those with low lying. Blood was transfused in 101 cases (40.4%), and 3.5 pints in average. 5. The fetal malpresentation rate was 8.8% (22 cases). 6. No association emerged with the male/female ratio (p>0.05). 7. Perinatal mortality was 2.4% and no maternal death occurred. 8. Higher (est) incidence of placenta previa was noticed. 1) in women with ages between 36 and 40 (2.35%) and significant trend in risk was observed with advancing age (p<0.0001). 2) in pregnant women by assisted reproductive technology (ART) than those with natural pregnancy (4.09% vs. 1.04%, p<0.05). 3) in multipara than nullipara (1.36% vs. 0.98%, p=0.0089) but non-significant trend in risk was observed with increasing parity (p=0.0923). 4) in women who had experienced abortions than women who hadn't (1.37% vs. 0.95%, p=0.0038) and significant trend in risk was observed with increasing number (p=0.0093). 9. In parous women, there was no significant difference of incidence between women with history of C/S and women without (1.34% vs. 1.37%, p=0.9123), but associations was noticed with the women more than two prior C/S (p=0.3862). 10. 69 cases (27.6%) had antepartum admission episodes due to bleeding and/or pain. Among them, 22 cases (8.8%) had more than 2 episodes. This study showed that the more antepartum admission episodes, the poorer perinatal outcomes. But an multiple regression under the condition of dummy variable's control proved that only the transfusion has significant relevance to the antepatum admission episodes. CONCLUSION: This study suggests that there are no obvious clinical features that are sensitive in predicting the clinical outcome of women with placenta previa. Patients with the history of antepartum admission due to recurrent bleeding and/or pain, are considered as extremely high risk group and predicted to have much poorer perinatal outcomes. Careful antenatal, and intrapartum management is warrented in this group.

A Case of Granulosa Cell Tumor of the Ovary Associated with Pregnancy / 대한산부인과학회잡지

5% of ovarian neoplasms consist of granulosa cell tumors. 10% of cases coexist with pregnancy2. We report on delivery of normal infant in young woman with granulosa cell tumor diagnosed and treated during pregnancy. At laparotomy a large right ovarian granulosa cell tumor was found and right salpingo- oophorectomy was performed. A normal infant was delivered by cesarean section at full term.

Detection of disseminated tumor cells using reverse transcriptase PCR for cytokeratin 20 in peripheral blood isolates from gastric cancer patients / 대한내과학회지

BACKGROUND: The development of metastasis in cancer is one of the main problems after primary tumor resection. The identification of metastases is only possible in the follow-up investigation when there is already a solid tumor mass. Subclinical tumor cell dissemination can be detected by immunocytological staining of cells or by other molecular biological methods, like PCR. We investigated 22 peripheral blood isolates from gastric cancer patients with a cytokeratin (CK) 20 specific nested reverse transcriptase PCR (RT-PCR) for the detection of disseminated tumor cells at the time of diagnosis. METHODS: Fresh heparinized peripheral bloods (about 10 mL) were obtained from 22 gastric cancer patients and 10 healthy doctors as controls. Nucleated cells were isolated by a density gradient method. RNA was isolated and then subjected to RT-PCR with CK 20 specific primers. RESULTS: In gastric cancer, 3 of 22 (13.6%) peripheral blood isolates yielded a CK 20 mRNA positive result in a stage undependent manner. CONCLUSION: We detected disseminated tumor cells in the peripheral blood isolated using CK 20 specific nested RT-PCR method. Studies on a larger scale are needed for further investigation on the relationship between positive rates of CK 20 mRNA and survival rates of stomach cancer, according to cancer stages.

The Expression of phospholipase C-lambda1 and p53 in Endometrial Carcinoma / 대한부인종양콜포스코피학회잡지

PLC-gamma1 plays a central role in the signal transduction for cellular activity, such as proliferation and differentiation. However, the significance of their expressions in endometrial cancer is yet to be determined. The current study examined the expression prevalence of phospholipase C-gamma1(PLC-gamma1) , and studied its relationship with p53 expression in endometrial carcinomas of varying stages and grades. Expressions of PLC-gamma1 and p53 were determined using immunohistochemical taining of paraffin embedded tissues from 21 endometrial specimens; Specimens included 10 cases of grade I, 8 cases of grade II, and 3 cases of grade III lesions. While there were few PLC-gamma1 expressions in the control group, 60% (6/10) of grade I carcinomas showed obvious PLC-gamma1 expression, 50%, and 30% of Grade II and III cases did respectively. In addition, PLC-gamma1 expression was restricted to the tumor lesions and the intensity of the PLC-lambda1 was the strongest in well differentiated cancers. P53 expression was identified in 7 of 21 (33%) cases, and there was no relationship between PLC-gamma1 expression and p53 overexpression. Our studies revealed that levels of PLC-gamma1 play important roles in the occurrence of ndometrial carcinomas, though factors that might influence them still remain obscure. And also further studies about correlation between PLC-gamma1 and p53 are needed to elucidate that in tumorigenesis.