The accuracy of frozen section in the diagnosis of ovarian tumors / 부인종양

OBJECTIVE: As frozen sections play the role of determining the method or scope of operation for ovarian tumors, the present study examined the accuracy, limitations and clinical utility of frozen sections. METHODS: Among 1583 cases of ovarian tumor surgery conducted during the period from January 1999 to September 2005, 372 for which frozen sections were sent to the Department of Pathology were analyzed through comparison between their frozen section diagnosis and final histopathological diagnosis. RESULTS: Among the ovarian tumor cases, the accuracy of frozen section diagnosis was 91.1% and its sensitive to final diagnosis was highest as 96.0% for benign tumors, and 85.7% for malignant tumors, and as low as 62.9% for borderline?tumors (p<0.01). The positive predictive value was 87.1% for malignant tumors, 68.8% for borderline tumors, and 94.6% for benign tumors. Among the 33 cases for which frozen section did not agree with final diagnosis, 15 cases were false positive and 18 cases were false negative. Among them, 14 cases were mucinous tumors (15.4%, 14/91), showing difficulty in diagnosis compared to non-mucinous tumors (6.8%, 19/281) (p=0.018). CONCLUSION: Despite its limitations, frozen section is a very useful method of high accuracy in diagnosing ovarian tumors. Thus, gynecologists and pathologists need to make efforts to understand the limitations and problems of frozen section, which is not highly sensitive to borderline tumors and mucinous tumors, and to make accurate diagnosis.

A case of right femur-ulna-radius complex diagnosed by prenatal ultrasonography / 대한산부인과학회지

The birth prevalence of limb reduction defect is 6 per 10,000 births. Most common type of limb reduction defect is terminal transverse defect and its birth prevalence is 1.6 per 10,000 births. Genetic variation, environmental teratogen, genetic-environmental interactions are known to causes of congenital limb defect. But, its exact causes are not known. Especially, congenital limb deficiency of right upper and lower limb has a very low incidence. We experienced one case of right femur-ulna-radius complex among recently delivered fetuses. So, we report this case with review of the literatures.

Significance of morphologic score and vascular index in the diagnosis of ovarian malignancy using ultrasonography / 대한산부인과학회지

OBJECTIVE: The aim of this study was to know whether we can distinguish benign from malignant ovarian tumors according to morphologic scoring system (MS), blood flow characteristics (Resistance index (RI), Pulsatility index (PI)) using color doppler sonography and a combination of both in patients undergoing laparotomy or laparoscopy for a clinically diagnosed ovarian mass. METHODS: From January 2001 to December 2003, 99 patients with ovarian tumors scheduled for laparotomy or laparoscopy were studied at our institute. Ultrasound was carried out to study the ovarian morphology followed by color doppler sonography. A score of > or =9 on MS, a PI or =9 on MS as indicative of malignancy was associated with the following statistical parameters: sensitivity 69.6%, specificity 69.8%, positive predictive value (PPV) 75.0%, negative predictive value (NPV) 63.8%. A mean score of malignant tumor (9.8+/-2.64) is significantly higher than that of benign tumor (7.5+/-2.44). This was statistically significant (p[t]<0.05). A resistance index (RI) < or =0.4 was associated with sensitivity 19.6%, specificity 97.6%, PPV 91.6%, NPV 48.2%. A pulsatility index (PI) < or =1.0 was associated with sensitivity 44.6%, specificity 81.3%, PPV 75.7%, NPV 53.0%. A mean of RI in malignancy (0.64+/-0.277) is lower than that of RI in benign tumor (0.79+/-0.299). A mean of PI in malignancy (1.34+/-0.982) is lower than that of PI in benign tumor (2.06+/-1.310). These was statistically significant (p[t]<0.05). The addition of RI or PI to MS did not improve the accuracy in predicting ovarian malignancy. CONCLUSION: Although RI or PI achieved better specificity and PPV compared to MS, the addition of RI or PI to MS did not increase its accuracy in the discrimination between benign and malignant ovarian tumors.

A Clinical Study on Malignant Germ Cell Tumor of Ovary / 대한산부인과학회지

OBJECTIVE: to evaluate the clinicopathologic characteristics of patients with ovarian malignant germ cell tumor. METHODS: We reviewed records of women who had malignant germ cell tumors of the ovary from 1991-2000. RESULTS: Thirty-seven women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Twenty-five women (68%) presented with stage I disease, and 12 (32%) had more advanced disease. Histology subtypes were: immature teratoma (n=16), dysgerminoma (n=9), yolk sac tumor (n=8), choriocarcinoma (n=2), embryonal carcinoma (n=1), and mixed germ cell tumor (n=1). The frequency of positive tumor markers were aFP, CA-125, beta-hCG, CA 19-9 and LDH in decreasing order. The mean age of the patients at presentation was 23.9 years (4-58). Surgical management of the 32 patients consisted of unilateral oophorectomy, or salpingo-oophorectomy, 1 woman with stage III disease underwent bilateral salpingo-oophorectomy and 4 women underwent total abdominal hysterctomy, bilateral or unilateral adnexectomy. Thirty-two women were treated with adjuvant combination chemotherapy (BEP, VAC, VBP) according to indications. The 5-year survival rate was 100%, and 5-year disease-free rate was 91.8%. Among twelve patients who attempted pregnancy, 8 succeeded in it and delivered normal full term babies. CONCLUSION: Current therapeutic strategies can allow most women with ovarian malignant germ cell tumors to have conservative surgery without compromising survival and to preserve their reproductive potential.