Bcl-2 Expression in Endometrial Hyperplasia and Carcinoma / 대한암학회지

PURPOSE: To speculate the role of bcl-2 protooncogene in endometrial carcinogenesis by determination of the expression of bcl-2 in endometrial hyperplasia and carcinoma. MATERIALS AND METHODS: We studied bcl-2 expression by an immunohistochemical method in the paraffin-embedded blocks of 78 patients with endometrial hyperplasia, 64 with simple hyperpasia, 9 with complex hyperplasia and 5 with atypical hyperplasia respectively, and 33 endometrial carcinoma treated at Asan Medical Center from June, 1989 to May, 1997. Intensity of bcl-2 staining was scored on a scale of 0 to 4, calibrated by comparison with stromal lymphocytes, which always received a score of 4. RESULTS: The results of this study showed that bcl-2 was relatively highly expressed in simple (n= 64), complex (n=9) and atypical hyperplasias (n=5) with mean staining scores of 2.95+/-1.09 (Mean+Standard Deviation), 2.78+/-1.20 and 3.60+/-0.89 respectively, which showed no difference among histologic types. In endometrial carcinoma, the expression of bcl-2 was significantly down regulated (mean score=1.76+/-1.35) compared with that of hyperplasia, and did not conelate with FIGO surgical stage. However, grade III tumor showed significantly lower expression that grade I or II tumor. CONCLUSION: Bcl-2 expression is down regulated in endometrial carcinoma than endo- metrial hyperplasia, and correlates with tumor grade, which suggest that bcl-2 expression might be the result of carcinogenesis or bcl-2 plays only an adjunctive role in the endometrial carcinogenesis.

The Effect of Neoadjuvant Chemotherapy in Uterine Cervical Cancer / 대한산부인과학회잡지

Neoadjuvant chemotherapy is used as a new therapeutic modality in the treatment of locally advanced cervical cancer, but limited information is available regarding the effectiveness and survival. The aim of this study is to identify the factors concerning chemoresponsiveness and survival, and to evaluate the efficacy of neoadjuvant combination chemotherapy(NAC) for the patients with locally advanced cervical cancer in terms of 2-year disease-free survival (DFS). Between June 1987 and May 1992, 77 patients with bulky or locally advanced cervical cancer(FIGO Stage IB-III) received two or three courses of NAC. Sixty patients were treated with FP chemotherapy regimen consisting of 5-FU 1000mg/m2(day 1~day 5), CDDP 60mg/m2(day 1) and remaining 17 patients received EP chemotherapy consisting of Epirubicin 110mg/m2(day 1), CDDP 60mg/m2(day 1). After chemotherapy, patients were treated with surgery or radiotherapy according to feasibility. The effectiveness of NAC was evaluated for response by using World Health Organization criteria. Factors related to chemores ponse and survival were analyzed. The overall clinical response rate was 61%, which included a complete response(CR) in 16 patients(20.8%) and a partial response(PR) in 27 patients (40.2%). Mass size but none of the other parameters studied(age, stage, histologic type, chemotherapy regimen) was related to chemoresponsiveness. This therapy rendered radical surgery feasible in 58 evaluable cases(75.3%). Pretereatment characteristics were analyzed for response to NAC. Significantly lower response rates(38.2%) and lower 2-year DFS rates(48.7%) were found in stage II or III patients with tumor size more than 4 cm in diameter. Patients achieving CR or PR had a significantly improved 2-year DFS rate compared with those who did not respond. Lymph-node metastases were found after chemotherapy in 34.5%(20/58) of the surgically treated patients and less than 3 lymph node were involved in 10 patients. Pathologic parametrial involvement was found to be the most significant prognostic factor for recurrence. A 2-year DFS of 72% and 48.7% for stage IB-IIA, I IB-III, respectively, was found. According to chemoresponsiveness, these rate was 78% for responders and 31.6% for nonresponders, respectively. Poor chemoresponsiveness and uncertain survival benifits in stage II, III with bulky mass necessitate more effective therapeutic modalities in this group of patients.

Prediction of Size of Residual Discase after Initial Surgery by Postoperative Decline of Serum CA 125 Levels in Patients with Advanced Epithelial Ovarian Cancer / 대한산부인과학회잡지

In this retrospective study, we assessed the clinical usefulness of postoperative decline of serum CA 125 level after initial surgery to predict the size of residual disease in patients with advanced epithelial ovarian cancer. Between June 1989 and December 1995, sixty-three patients with advanced epithelial ovarian cancer (FIGO stage II-IV) were evaluated, who were managed at Asan Medical Center by cytoreductive surgery followed by chemotherapy. All patients had elevated preoperative serum CA 125(>35U/ml) and had another serum CA 125 assay 7~10 days after surgery. Preoperative CA 125 levels were similar in patients with residual disease below 2 cm and in those with larger residuum. The postoperative decline of serum CA 125 was significantly higher in patients with smaller residual disease only if preoperative serum CA 125 value was over 400U/ml. By taking 70% as the cutoff of CA 125 decline for discriminating patients with residual disease above 2 cm, the specificity and positive predictive value of this parameter improved when we considered patients with increasing preoperative serum levels. Hence, in the subset of patients with preoperative serum CA 125 level over 400U/ml, 95.2% (20/21) of patients with residual disease below 2 cm showed postoperative decline of serum CA 125 level over 70%, and 91.7%(11/12) of patients with postoperative decline of serum CA 125 level below 70% had residual disease over 2 cm. In conclusion, postoperative decline of serum CA 125 level after initial surgery does not exactly reflect the size of residual disease, but shows limited clinical usefulness in subset of patients with preoperative serum CA 125 level over 400 U/ml.

Clinical Profiles of Gestational Trophoblastic Tumor with High-Risk Site Metastases / 대한산부인과학회잡지

Gestational trophoblastic tumor(GTT) is one of the most curable malignancies, but metastatic GTT involving high-risk sites(brain, liver, kidney etc.) have been recognized as an adverse prognostic factor. Most centers have treated these patients using multiagent chemotherapy with radiotherapy and/or surgery, but there is still no consensus concerning the optimal treatment strategies. We present our clinical experience in GTT patients with high-risk sites metastases with review of the literatures. We retrospectively reviewed the records of GTT patients treated at the Seoul National University Hospital between 1980 and 1994, and identified 22 GTT patients with high-risk site metastases and analysed prognostic factors which influence the survival. The patients ranged in age from 19 to 57 years(mean, 32 years). All 22 patients had concurrent lung involvement and 15 patients with brain metastases presented with neurologic symptoms. There was 9 cases with metastases to brain only, 5 with metastases to liver only, 3 to metastases to brain and liver, and 5 cases with metastases to multiple sites respectively, All Patients received chemotherapy with MAC(methotrexate, actinomycin D, chlorambucil) or etopodside-based regimens, A radiotherapy to the whole brain was given to patients with brain metastases, and splenic artery embolization was done to control the bleeding from the spleen metastasis in on case. With the use of multimodal therapy, 66.7%(6/9) of patients with brain metastases only, and 60%(3/5) of patients with hepatic metastases only achieved one year survival. Overall l year survival rate was 54%. Patients with high-risk sites metastases did not exhibit any statistically significant relationship between known prognostic factors and survival. Unitl now, combination chemotherapy with adjuvant therapy is the standard treatment approach in GTT patients with high-risk site metastases. A search for more effective treatment modality in this group of patients should be continued.

Quantitative Pathologic Variables as Prognostic Factors in Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

No abstract available.

Significance of Thrombocytosis in Patients with Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

Thrombocytosis(a platelet count>400,000/mm3) is found to be frequently in association with malignant disease and recently has been suggested to be a poor prognostic indicator in patients with certain cancers. The objective of this retrospective study was to determine the relevance of a preoperative platelet count in ovarian cancer with a possible prognostic significance of thrombocytosis in this disease. Between June 1989 and December 1995, eighty-five patients with epithelial ovarian cancer were evaluated, who were managed at Asan Medical Center by cytoreductive surgery and chemotherapy, and had at least 6 months' follow-up. Prevalence of thrombocytosis was 22.4% and significantly correlated with FIGO stage(p=0.003), histologic subtype(p=0.002), tumor grade(p=0.040), performance status of patient(p=0.006) and preoperative serum CA 125 level(p=0.002). And the linear regression analysis revealed a significant correlation(p<0.001) between platelet count and preoperative serum CA 125 level, which suggested that platelet count was positively associated with tumor volume. No difference in survival between patients with or without thrombocytosis was found(p=0.68), whereas residual tumor size and serum CA 125 level after 2nd chemotherapy were found to be independent prognostic factors. In conclusion, thrombocytosis is not a useful prognostic factor in epithelial ovarian cancer, but significantly associated with tumor volume.

Immunohistochemical Study for Expression of p53, bcl-2 and Bax in Uterine Sarcoma / 대한부인종양콜포스코피학회잡지

Uterine sarcomas are rare tumors with unpredictable prognosis, comprising about 3% of uterine cancers. Little is known of epidemiologic risk factors and similarly, little work has been performed assessing molecular alterations in sarcomas. Proteins encoded by p53, bcl-2 and bax genes are important regulators of programed cell death, hence apoptosis. Alterations in the expression of these apoptosis-related genes can contribute to the development of most of human cancers, as well as possibly influence the prognosis of the cancer patients. Using antibodies specific for the p53, bcl-2 and bax proteins in combination with immunohistochemical methods, we examined for the first time the expression of these genes in 19 cases of uterine sarcoma, managed at Asan Medical Center between June, 1989 and December, 1996, including 13 leiomyosarcomas, 4 endodermal stromal sarcomas and 2 malignant mixed mullerian tumors. Twelve patients had stage I disease and 7 stage III, and 9 patients had tumors with mitoses less than 10 per 10 HPF, and the others had those with mitoses equal to or more than 10 per 10 HPF. The results were evaluated by semiquantitative analysis as non-(0%), low(1~25%), moderate(26~75%) and high expressors(>76%), and the latter two were defined as tumors with overexpression. The immunoreactivity of bcl-2 and bax appeared in the cytoplasm, while that of p53 was localized solely in the nuclei. p53 immunostaining revealed 4 non-expressors, 7 low, 3 moderate and 5 high expressors, showing 42.1% rate of overexpression. Immunostaining of bcl-2 showed 13 non-expressors, 2 low, 1 moderate and 3 high expressors, resulting 21.1% rate of overexpression and that of bax showed 1 non-expressors, 4 low, 6 moderate and 8 high expressors, resulting 73.7% rate of overexpression. We could not find any significant correlation among the degrees of the expressions of these three proteins. The overexpression of these three proteins did not show any significant association with stage of disease or mitotic count of tumor. In conclusion, although apoptosis-related factors such as p53, bcl-2 and bax are strongly suggested to play a certain role in tumorigenesis of uterine sarcoma, the correlation among them and prognostic implications need further investigation.

Two Cases of Small Cell Carcinoma of the Ovary / 대한부인종양콜포스코피학회잡지

Small cell carcinoma of the ovary is a rare, distinctive, highly malignant, and undifferenciated carcinoma of unknown cullular lineage. It tends to occur in young women, and there is an associated paraneoplastic hypercalcemia in as many as two-thirds of reported cases. It has very poor prognosis and has been exceedingly difficult to treat. Thus a proven regimen of adjuvant therapy is not defined yet. We report here the two cases of primary small cell carcinoma of the ovary, which is presented with a brief review of the literature.

Assessment of Ovarian Malignancy by Positron Emission Tomography(PET) / 대한부인종양콜포스코피학회잡지

One of the moot important goals of modem gynexologic oncology is the adequate management of ocarian cancer. This includes early detection and differenciation of recurrence or residurd turnur. A promising method is availaible today with the use of mctabolic suubstrates used by tumor cells that are labeled with positron emittillg isotopes and a special instrument capable of detecting the radiations in vivo. Measuring tumor metabolic characteristics appear also to diffnencinte tumor recurrence or reeidual tumor from surgical or irradiation changes which is important since this wil1 not be defferentiaited by other modalities such ac CT or MRI. The goal of this study was to rletennine the potential utility uf whole-body PET using the giucose malogue 2-(18F)-fluoro-2-deoxy-D-glucoae(F-18-FDO for the detection of primey, metastatic, and recurrent ovarian cancer. Six patients had imaging studies prior to laparotomy for suspected ovarian cancer. PET(Positron Emission Tomogrnphy) scans were done with an ECAT 921(Emission Computed Axial Tomograpy 921, Sieinens/CTI. The result of this study show good correla- tion between PET nnd pathological findirs. The tumor detection rate of CT, MRI, CA-125, PET for ocarian cancer was 50%, 75%, 25%, 100% respectively. In summary, this work indicates that PET may be useful in the rnanagement of patients with ovwrian cancers by idengying occult foci of rnetabolically active tumor that do not appear on morphological studies.

A Case of Clear Cell Adenocarcinoma of the Vagina / 대한부인종양콜포스코피학회잡지

Vaginal clear cell adenocarcinoma is a very rare malignant disease and it has been known to be associated with in utero exposure to DES. We expreienced a case of clear cell adenocarcinoma of the cagina in 40 years ole woman, and present the case with a brief review of related literatures.

Hereditary Ovarian Cancer: Report of 6 Families / 대한부인종양콜포스코피학회잡지

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.

Assessment of Ovarian Malignancy by Positron Emission Tomography(PET) / 대한부인종양콜포스코피학회잡지

One of the moot important goals of modem gynexologic oncology is the adequate management of ocarian cancer. This includes early detection and differenciation of recurrence or residurd turnur. A promising method is availaible today with the use of mctabolic suubstrates used by tumor cells that are labeled with positron emittillg isotopes and a special instrument capable of detecting the radiations in vivo. Measuring tumor metabolic characteristics appear also to diffnencinte tumor recurrence or reeidual tumor from surgical or irradiation changes which is important since this wil1 not be defferentiaited by other modalities such ac CT or MRI. The goal of this study was to rletennine the potential utility uf whole-body PET using the giucose malogue 2-(18F)-fluoro-2-deoxy-D-glucoae(F-18-FDO for the detection of primey, metastatic, and recurrent ovarian cancer. Six patients had imaging studies prior to laparotomy for suspected ovarian cancer. PET(Positron Emission Tomogrnphy) scans were done with an ECAT 921(Emission Computed Axial Tomograpy 921, Sieinens/CTI. The result of this study show good correla- tion between PET nnd pathological findirs. The tumor detection rate of CT, MRI, CA-125, PET for ocarian cancer was 50%, 75%, 25%, 100% respectively. In summary, this work indicates that PET may be useful in the rnanagement of patients with ovwrian cancers by idengying occult foci of rnetabolically active tumor that do not appear on morphological studies.

A Case of Clear Cell Adenocarcinoma of the Vagina / 대한부인종양콜포스코피학회잡지

Vaginal clear cell adenocarcinoma is a very rare malignant disease and it has been known to be associated with in utero exposure to DES. We expreienced a case of clear cell adenocarcinoma of the cagina in 40 years ole woman, and present the case with a brief review of related literatures.

Hereditary Ovarian Cancer: Report of 6 Families / 대한부인종양콜포스코피학회잡지

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.

Clinical efficacy of thymomodulin on neutropenia induced by chemotherapy in the patients with gynecologic cancer / 대한암학회지

No abstract available.