Analysis of factors to affect on MR assessment of myometrial invasion and cervical involvement in endometrial cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study was to assess the depth of myometrial invasion and cervical involvement by endometrial cancer using magnetic resonance imaging (MRI). METHODS: Forty three patients with histological diagnosis of endometrial cancer were studied with the results of MRI at 1.5T and subsequently underwent staging operation. The MRI results were compared with pathologic results. Presence of large polypoid tumors, leiomyoma, adenomyosis, distension of uterine cavity by large tumor, atrophy of uteri, utetrine anomalies and tumor protruding into the cervical canal were analyzed. RESULTS: On review, the sensitivity for the detection of myometrial invasion was 93.5%, specificity 58.3%, positive predictive value (PPV) 85.3% and negative predictive value (NPV) 77.8%. For the detection of deep myometrial invasion, sensitivity was 87.5%, specificity 85.7%, PPV 58.3% and NPV 96.8%. For the detection of cervical involvement, sensitivity was 100%, specificity 92.9%, PPV 25%, NPV 100%. Distension of uterine cavity by large tumor (p=0.009) and adenomyosis (p=0.041) were associated with incorrect MRI assessment of myometrial invasion. For cervical involvement, tumor protruding into the cervical canal was associated but did not reach statistical significance (p=0.062). CONCLUSION: MRI scans as reported offered some clinical benefit in preoperative assessment of endometrial cancer, but for assessment of cervical involvement, showed low PPV. When present, distension of uterine cavity by large tumor and adenomyosis may make it difficult to assess myometrial invasion at MR imaging.

A Case of Adenoma Malignum of the Uterine Cervix / 대한산부인과학회지

Adenoma malignum (minimal deviation adenocarcinoma) is an extremely well-differentiated adenocarcinoma of uterine cervix. Despite its benign histological appearance, this tumor is thought to be malignant and has a poor prognosis. Because Pap smear and punch biopsy have low sensitivity, accurate diagnosis of the tumor may be difficult. If it is diagnosed, it must be treated same as in cervical cancer. We presented one case of preoperatively diagnosed adenoma malignum by deep cone biposy with a brief review of literature.

A case of congenital retroperitoneal immature teratoma: Prenatally diagnosed as Neuroblastoma / 대한산부인과학회지

Through a routine antenatal ultrasound examination of 37-year-old woman at 38 weeks' gestation, a 6 cm-diameter mixed solid and cystic mass was found in the left suprarenal area of her fetus. The following antenatal magnetic resonance image showed a larger cystic mass with a central solid component. The surgical exploration of the mass was performed in 50 days after delivery and by the pathologic examination a grade III immature teratoma was found. The retroperitoneal immature teratomas are extremely rare in childhood. To our Knowledge this is the first reported case about congenital retroperitoneal immature teratoma. The immature teratoma should be included in the differential diagnosis of fetal suprarenal mass and the serum alpha-fetoprotein level should be included in the initial laboratory examination at birth.

Usefulness of preoperative CA 125 level in decision making of lymphadenectomy in endometrial cancer patients / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate whether the preoperative serum level of CA 125 in patients with endometrial cancer could provide an additional information on determining the extent of surgical staging and which cutoff value might be optimal in this respect. METHODS: CA 125 levels were measured in 42 patients with endometrial carcinoma who underwent surgery at our institution between March 2000 and December 2004. Operative and postoperative pathologic findings were then correlated with preoperative CA 125 values. Statistical analysis was performed using Mann-Whitney U test, Kruskal-Wallis test, chi-square test and logistic regression model to evaluate the association of preoperative CA 125 levels with various factors. Receiver operating characteristic (ROC) curve was used to determine which cutoff value of the preoperative CA 125 was optimal. RESULTS: Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, extrauterine disease, and lymph node metastasis (P30 U/mL whereas lymph node metastasis can be predicted at the CA 125 level of >50 U/mL.