Stratification of clinical and inflammatory phenotypes according to the urinary leukotriene E4 level in adult asthmatics

Purpose@#Cysteinyl leukotrienes (CysLTs) have been recognized as key mediators associated with type 2 inflammation in the airways of asthmatic patients. CysLTs are associated with airway constriction, eosinophil recruitment/activation, and airway remodeling. The study aimed to understand the role of CysLTs in adult asthmatics in a real-world clinical setting. @*Methods@#One hundred five adult asthmatics who had maintained antiasthmatic medications were enrolled. Asthmatic subjects were classified into 2 groups according to urinary leukotriene E4 (uLTE4) levels, and their clinical parameters and inflammatory mediators, including forced expiratory volume in 1 second (FEV1) %, fractional exhaled nitric oxide (FeNO), blood eosinophil count, serum periostin (sPON), and urinary eosinophil derived neurotoxin (uEDN) were compared between the high-uLTE4 and low-uLTE4 groups. @*Results@#The prevalence of chronic rhinosinusitis (CRS), severe asthma, and aspirin-exacerbated respiratory disease (AERD) were significantly higher in the high-uLTE4 group than in the low-uLTE4 group. The high-uLTE4 group had lower FEV1% and maximal midexpiratory flow %, but higher FeNO levels than the low-uLTE4 group. In addition, blood eosinophil count, sPON, and uEDN levels were significantly higher in the high-uLTE4 group than in the low-uLTE4 group. The presence of AERD and levels of FeNO, sPON, and uEDN were significantly associated with higher uLTE4 levels in asthmatics. @*Conclusion@#CysLTs are associated with type 2 inflammation in the airways of asthmatic patients, contributing to the development of AERD, CRS, and asthma severity. The stratification of clinical phenotypes according to the uLTE4 level could support optimizing anti-inflammatory therapy for better control of asthma.

Asian Society of Gynecologic Oncology International Workshop 2018 / 부인종양

The Asian Society of Gynecologic Oncology International Workshop 2018 on gynecologic oncology was held in the Ajou University Hospital, Suwon, Korea on the 24th to 25th August 2018. The workshop was an opportunity for Asian doctors to discuss the latest findings of gynecologic cancer, including cervical, ovarian, and endometrial cancers, as well as the future of fertility-sparing treatments, minimally invasive/radical/debulking surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy. Clinical guidelines and position statement of Asian countries were presented by experts. Asian clinical trials for gynecologic cancers were reviewed and experts emphasized the point that original Asian study is beneficial for Asian patients. In Junior session, young gynecologic oncologists presented their latest research on gynecologic cancers.

A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

Women in the reproductive age group diagnosed with cervical cancer can receive radical trachelectomy for fertility preservation. Extremely short cervix following radical trachelectomy could result in cervical incompetence. Although prophylactic cervicoisthmic cerclage is placed at the time of radical trachelectomy, it might not be sufficient to prolong pregnancy. We present a successful term pregnancy after laparoscopic radical trachelectomy and concurrent cervicoisthmic cerclage for early stage cervical cancer.

Epigenetic inactivation of RUNX3 in colorectal cancer

PURPOSE: Emerging evidence indicates that runt-related transcription factor 3 (RUNX3) is an important tumor suppressor gene in several cancer types, including colorectal cancer (CRC). However, the clinical significance of RUNX3 inactivation in CRC remains unclear. The aim of this study was to examine the correlation between clinicopathologic factors and RUNX3 hypermethylation/expression in CRC. METHODS: Sixty-two CRC patients who were treated at the Soonchunhyang University College of Medicine were recruited in this study. The hypermethylation of CpG islands in the RUNX3 promoter and the expression of RUNX3 mRNA were identified by methylation-specific polymerase chain reaction (PCR) and reverse transcriptase-PCR, respectively. The expression of RUNX3 was determined by immunohistochemical staining. RESULTS: Of the 62 CRC tissue samples, 20 (32.3%) presented hypermethylated RUNX3 promoters. Aberrant RUNX3 hypermethylation was found to be associated with vascular (P = 0.006) and lymphatic (P = 0.002) invasion. Hypermethylation of RUNX3 was associated with poor survival outcomes (P = 0.038). However, expression of RUNX3 was not a prognostic factor (P = 0.363). CONCLUSION: Hypermethylation of RUNX3 may be a predictor of a poor prognosis in CRC.

CORRIGENDUM: Correction of funding statement in ACKNOWLEDGEMENTS section: Epigenetic inactivation of RUNX3 in colorectal cancer

Correction of funding statement in ACKNOWLEDGEMENTS section.

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers / 부인종양

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers.

Ovarian Squamous Cell Carcinoma Associated with Endometriosis: Poor Response to Chemotherapy

The occurrence of ovarian squamous cell carcinoma associated with ovarian endometriosis is extremely rare. Several studies revealed poor prognosis for ovarian squamous cell carcinoma especially when associated with endometriosis. We report a case of ovarian squamous cell carcinoma that invades the parametrium that is also associated with ovarian endometriosis. A 41-year-old woman with stage IIB ovarian squamous cell carcinoma was treated with debulking surgery followed by six courses combination chemotherapy composed of paclitaxel and carboplatin. Twenty months after the last course of chemotherapy (3 months after normal positron emission tomography–computed tomography [CT] scanning), upper abdominal pain developed and abdomen CT scan revealed multiple metastasis in liver and paraaortic lymph node. Although two cycles of paclitaxel and cisplatin was administrated, she died of disease three months after the recurrence.

Pseudoaneurysm of uterine artery causing intra-abdominal and vaginal bleeding after cervical conization

Uterine arterial pseudoaneurysm is a very rare condition usually associated with postpartum hemorrhage. It almost never occurs after cervical conization; however, since ruptured pseudoaneurysm could be life threatening, we should consider the possibility of vascular injury such as pseudoaneurysm when we find a patient with vaginal bleeding after the process of surgical operation. Emergency arterial embolization is a well established therapeutic option to control the ruptured pseudoaneurysm. This is a case report of uterine arterial pseudoaneurysm causing intra-abdominal bleeding followed by cervical conization, which was successfully treated by uterine artery embolization.

A case of solitary fibrous tumor in the pelvis presenting massive hemorrhage during surgery

Solitary fibrous tumors (SFTs) are unique soft-tissue tumors of submesothelial origin. These tumors are mainly located in the pleural space but they can be originated within a variety of sites, including the abdomen, the pelvis, the soft tissues and the retroperitoneum. SFTs from all sites are usually benign, and the surgical resection is curative in almost all cases. According to the review of literatures, during the surgical resection, massive hemorrhage could occur due to the hypervascular nature of SFTs. This is a case report on SFT in the pelvis presenting great vessel injury, which resulted in life threatening hemorrhage during the resection of tumor. We wish this paper alerts gynecologists about the risk of massive bleeding during the resection of tumor located at adjacent to great vessels in the pelvis.

Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman

Multicystic benign mesothelioma (MBM) of the peritoneum is a very rare condition. Since the first description of MBM in 1979, approximately 100 cases have been reported. This is a case report of MBM of the pelvic peritoneum presenting as acute abdominal pain in a young woman. Laparoscopy confirmed multiple grapelike clusters of cysts that originated in the peritoneum of the rectouterine pouch and histopathologic diagnosis was confirmed as MBM of the pelvic peritoneum. We hope to alert gynaecologists of the diagnostic and therapeutic approaches to MBM which can be accomplished by laparoscopy.

Early human papillomavirus testing predicts residual/recurrent disease after LEEP / 부인종양

OBJECTIVE: The purpose of this study was to determine the predictive factors for residual/recurrent disease and to analyze the timing for Pap smears and human papillomavirus (HPV) testing during follow-up after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2 or worse. METHODS: We retrospectively analyzed 183 patients (mean age, 39.3 years) with CIN 2/3 who were treated with LEEP. Post-LEEP follow-up was performed by Pap smear and HPV hybrid capture2 (HC2) testing. The definition of persistent/recurrent disease was biopsy-proven CIN 2 or worse. RESULTS: Among 183 patients, punch biopsies were CIN 2 in 31 (16.9%) and CIN 3 in 152 (83.1%). HPV HC2 tests before LEEP were positive in 170 (95.5%) of 178 patients. During follow-up, 12 patients (6.6%) had residual/recurrent CIN 2+. LEEP margin status was a significant predictive factor for persistent/recurrent disease. Other factors such as age, HPV HC2 viral load (> or =100 relative light units), and HPV typing (type 16/18 vs. other types) did not predict recurrence. Early HPV HC2 testing at 3 months after LEEP detected all cases of residual/recurrent disease. The sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both 100% at 3 and 6 months. CONCLUSION: Margin involvement in conization specimens was a significant factor predicting residual/recurrent disease after LEEP. HPV test results at 3 and 6 months after treatment were comparable. Early 3-month follow-up testing after LEEP can offer timely information about residual/recurrent disease and alleviate patient anxiety early about treatment failure.

Early human papillomavirus testing predicts residual/recurrent disease after LEEP / 부인종양

OBJECTIVE: The purpose of this study was to determine the predictive factors for residual/recurrent disease and to analyze the timing for Pap smears and human papillomavirus (HPV) testing during follow-up after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2 or worse. METHODS: We retrospectively analyzed 183 patients (mean age, 39.3 years) with CIN 2/3 who were treated with LEEP. Post-LEEP follow-up was performed by Pap smear and HPV hybrid capture2 (HC2) testing. The definition of persistent/recurrent disease was biopsy-proven CIN 2 or worse. RESULTS: Among 183 patients, punch biopsies were CIN 2 in 31 (16.9%) and CIN 3 in 152 (83.1%). HPV HC2 tests before LEEP were positive in 170 (95.5%) of 178 patients. During follow-up, 12 patients (6.6%) had residual/recurrent CIN 2+. LEEP margin status was a significant predictive factor for persistent/recurrent disease. Other factors such as age, HPV HC2 viral load (> or =100 relative light units), and HPV typing (type 16/18 vs. other types) did not predict recurrence. Early HPV HC2 testing at 3 months after LEEP detected all cases of residual/recurrent disease. The sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both 100% at 3 and 6 months. CONCLUSION: Margin involvement in conization specimens was a significant factor predicting residual/recurrent disease after LEEP. HPV test results at 3 and 6 months after treatment were comparable. Early 3-month follow-up testing after LEEP can offer timely information about residual/recurrent disease and alleviate patient anxiety early about treatment failure.

A case of laparoscopic treatment of collision tumor: Huge serous cystadenoma and dermoid cyst arising in the same ovary / 대한산부인과학회지

Collision tumor means the coexistence of two adjacent, but histologically distinct tumors without histologic admixture in the same tissue and is rare incidence involving ovary. Because of their incidence of occurrence, benign cystic teratomas often occur coincidentally with other abnormalities of the ovary. Most common histologic combination of collision tumor in the ovary is coexistence of teratoma with mucinous tumors. But its association with serous tumor has been noted rare and incidence is unknown. We have experienced a case laparoscopic treatment of a huge serous cystadenoma combined with ovarian benign cystic teratoma in right ovary, and report it with a brief review of literature.

Acute renal failure associated with ureteral stone of the unilateral kidney and uterus didelphys with hemivaginal obstruction / 대한산부인과학회지

The unique clinical syndrome of the uterus didelphys, a unilateral partially or completely obstructed vagina, and ipsilateral renal agenesis is quite rare, and observed on the right side in greater frequency than on the left. The case of fifteen year old girl with uterus didelphys, unilateral partially obstructed vagina and acute renal failure associated with ureteral stone in unilateral kidney is described. Extracorporealshock wave lithotripsy (ESWL) and evacuation of the hematocolpos and excision of the vaginal septum were done. Aware of this relatively rare condition is mainstay of prompt diagnosis which will prevent permanent renal failure and unnecessary and destructive surgery.

Factors associated with HPV persistence after conization in patients with negative margins / 부인종양

OBJECTIVE: The clearance rate of human papillomavirus (HPV) after conization is generally high, although some HPV infections persist. We investigated the factors that affect the clearance of HPV after conization in patients with negative margins. METHODS: We retrospectively analyzed 77 patients (mean age 39.9 years, range 25 to 51 years) with CIN 2/3 who underwent loop electrosurgical excision procedure (LEEP) conization with negative margins. All patients had a Pap smear and high-risk (HR) HPV testing using Hybrid Capture II system and HPV DNA chip before conization. We used> or =1 relative light units (RLUs) as the cutoff for persistence of HPV after conization. RESULTS: High-risk HPV was detected in 73 of 77 (94.8%) patients before conization. At the 6-months follow-up, the high-risk HPV was eliminated in 60 of 73 (82.2%) patients. The HPV persistence rate after conization was 17.8% (13/73). Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/positive control >100 (p=0.027) and the HPV was type 16 (p=0.021). Logistic regression analysis showed that preoperative HPV type 16 infection was the only significant independent factor (p=0.021) for HPV persistence out of age, cytology, punch biopsy histology, HPV viral load, and conization histology. CONCLUSION: Conization effectively removes HR-HPV infection. HPV type 16 infection before conization was significantly related to HR-HPV persistence after conization with negative margins. Therefore, patients with HPV 16 infection before conization need to be followed closely.

A case of unusual premature ovarian failure with 46,X,dup(Xq) / 대한산부인과학회지

Premature ovarian failure (POF) is defined as the complete cessation of menses less than 40 years of age. The criteria are more than four months of amenorrhea, with serum follicle stimulating hormone value of >40 mIU/mL and the frequency of POF is about 1% of all women. Although the etiologies of POF remain unknown, suggested factors are genetic, autoimmune, chemotherapy, radiotherapy and environmental toxins. The cytogenetic abnormalities predominantly concern the X chromosome, including Turner syndrome, Fragile X syndrome and deletion, translocation, or duplication of X chromosome. We report a very rare case of premature ovarian failure with the following karyotype: 46,X,dup(Xq), and report it with a brief review of literature.

Cornual pregnancy diagnosed at 9 weeks of atypical ultrasonographic findings / 대한산부인과학회지

A cornual pregnancy occurs when the conceptus implants at the cornus of the uterus which is the junction between the fallopian tube and uterine cavity. Cornual pregnancy is a rare form of ectopic pregnancy and its diagnosis is difficult. It accounts for 2 to 4% of tubal pregnancy and rupture usually occurs between 8 weeks and 16 weeks of gestation. The rich vascularity in this location makes the rupture particularly dangerous, resulting in higher maternal mortality. We have experienced a case of unruptured cornual pregnancy at 9 weeks of atypical ultrasonographic findings, which was hourglass appearance. We present this case with a brief review of the literature.

A case of cystic change of adenomyosis in adolescent girl complaining acute pelvic pain / 대한산부인과학회지

Cystic adenomyosis is a rare form of adenomyosis of the uterine myometrium that has been described in older adults. This condition has not frequently been reported in the adolescent girl. The adenomyotic cyst was located within the myometrium of a 15-year-old adolescent girl suffering from acute lower abdominal pain, not dysmenorrhea. After laparoscopic operation, patients's symptoms improved. On pathology finding, the cyst diagnosed adenomyotic cyst. We report a case of adenomyotic cyst of the uterus in adolescent girl with a brief review of literatures.

Uterine prolapse complicating pregnancy / 대한산부인과학회지

Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications such as urinary tract infection, voiding difficulty, abortion, and preterm labor may develop. Conservative management consisted of bed rest and use of a pessary. An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. We present a case of a patient developing uterine prolapse at 12 weeks of gestation, treated with bed rest and use of a pessary. A repeat cesarean section was performed at 38 weeks of gestation and report with a brief review of literatures.

Two cases of complete chorioamniotic membrane separation / 대한산부인과학회지

As chorion and amnion fusion usually occurs between 14 and 16 weeks of gestation, sonographic identification of chorion and amniotic membrane separation is a normal finding before 14 weeks. However, persistent separation after 16 weeks of gestation is considered rare and abnormal findings. Complete chorioamniotic membrane separation (CMS) may occur spontaneously, but has also been described as a complication of all invasive intrauterine procedures, including amniocentesis. Complete CMS have a significant morbidity and mortality due to intrauterine fetal death, cord complications, and preterm delivery. Aggressive treatment with hospitalization is necessary. We now report 2 cases of complete CMS identified by prenatal ultrasound; 1 in spontaneous complete CMS diagnosed at 24 weeks of gestation, and health premature child was born at 29+3 weeks of gestation, who was alive and well at present; 1 in complete CMS diagnosed at 21 weeks of gestation after amniocentesis, and fetal demise at 24 weeks of gestation due to cord strangulation by an amniotic band. We experienced two cases of complete CMS and report with a brief review of literatures.