Meconium peritonitis: prenatal diagnosis and postnatal outcome / 대한산부인과학회지

OBJECTIVE: To detect meconium peritonitis for the fetal period is important for prenatal counseling. The aim of this study was to evaluate prenatal ultrasound finding for diagnosing meconium peritonitis and postnatal clinical course and outcomes. METHODS: The prenatal and postnatal medical records of all patients to our institutions with confirmed meconium peritonitis were reviewed, with emphasis on prenatal ultrasound findings, postnatal investigations, operative findings, outcomes of meconium peritonitis. RESULTS: Fourteen fetuses were confirmed to have meconium peritonitis at birth by operation. Eight cases were diagnosed correctly because of prenatal ultrasound showing ascites and calcification/dilated or hyperechoic bowel loops. In the other 6 cases, prenatal ultrasound showed only ascites. One patient was operated on first day of life and its intra-operative finding was malrotation of small bowel, volvulus with strangulation, perforation and jejunal atresia. Most cases were operated on 2nd or 3rd day of life. Intra-operative findings were ileal atresia and perforation in 11 cases and jejunal atresia and perforation in 3 cases. Four patients underwent ileostomy but all patients survived and prospered. CONCLUSION: All patients do not present typical prenatal ultrasound findings of meconium peritonitis. Therefore, even in pregnancies associated with isolated ascites, meconium peritonitis should be taken into consideration. Favorable outcome of intrauterine meconium peritonitis is reassuring in prenatal counselling and stems from multidisplinary team approach.

One case of vulva metastasis from cervical squamous cell carcinoma / 대한산부인과학회지

Metastasis to the skin occurs rarely in gynecologic cancer. Although carcinoma of the cervix is the fifth most common malignancy in Korean women, cutaneous involvement originating from cervical cancer is unusual. Common pattern of occurrence is multiple nodule in abdomen, vulva, lower extremities. We report a case of metastasis from squamous cell carcinoma of cervix to vulva. The patient was diagnosed with cervical cancer IIA. The extensive skin lesion on the vulva occurred 3 months after neoadjuvant chemotherapy, radical hysterectomy and concurrent chemoradiation. We have experienced such a case and report the case with brief review of literatures.

Predictors for lumbar bone mineral density in premenopausal and postmenopausal women in Korea / 대한산부인과학회지

OBJECTIVE: The need for early and correct prescription for bone densitometry led to the research for decision model useful for clinicians to address women to bone densitometry. there are few studies that have focused on both pre- and postmenopausal groups simultaneously in healthy pre-and postmenopausal Korean women. METHODS: The authors analyzed the easily obtained biometrical variables such as factors used at clinical decision rules for BMD testing and evaluated predictive values and robustness of a decision model for prediction of lumbar BMD in total , pre-and postmenopausal Korean women. RESULTS: After stepwise multiple regression analysis, Lumbar BMD in total population is 1.083-0.153 (status of menopause)-0.007 (age of menopause)+0.0039 (body weight) (R2=0.52). Postmenopausal women is 0.563-0.0077 (duration after menopause)+0.0054 (body weight) (R2=0.30) and premenopausal women is 0.23+0.0048 (height) (R2=0.05). Although its validity (52%) in total population was sufficiently high for the prediction of lumbar BMD in clinical settings, In postmenopausal women only 30% of the decision model can be explained by the predictors of bone demineralization which is not completely satisfactory in determining lumbar BMD and in premenopausal women 5% is the very low explanatory value which is necessary for identifying possible factors influencing BMD. CONCLUSIONS: Because of difference in underlying risk, as well as differences in the distribution of different risk factors according to menopausal status, this study present different robustness of prediction models according to menopausal status and suggest that it be need to design prediction models divided by menopausal status. More research is needed for computer-based screening aids useful to clinician which overcome some limitation of our study.

Endometrial pathologies in tamoxifen-treated breast cancer patients / 대한산부인과학회지

OBJECTIVE: Tamoxifen is a nonsteroidal hormone that functions as a selective estrogen-receptor (ER) modulator in breast tissue. It is the first-choice drug for the postoperative treatment of ER-positive breast cancer patients. However, tamoxifen, if administered for a prolonged duration, has estrogen-like effects on the uterus, leading to an increased risk for the development of endometrial diseases such as endometrial hyperplasia, endometrial polyp, and endometrial cancer. This study was designed to investigate the effects of tamoxifen treatment on endometrium in breast cancer patients. METHODS: Fifty-five tamoxifen-treated breast cancer patients visited an outpatient gynecology clinic. We analyzed the endometrial pathology with consideration to the duration of tamoxifen treatment the patient symptoms and the endometrial thickness, as measured by transvaginal ultrasonography. Endometrial polypectomy was performed to obtained polyps from women presenting with abnormal bleeding (17 polyps from postmenopausal women who had not been treated with tamoxifen and 14 from women who had been treated with this drug). To investigate the effects of tamoxifen treatment on the endometrial polyps, we performed immunohistochemical staining for ER, the progesterone receptor (PR), and Ki67 on the polyps obtained from both groups of women. RESULTS: In 29 (52.7%) of 55 tamoxifen-treated breast cancer patients, the endometrium was more than 10 mm thick, and in 19 (65.5%) of these patients, the abnormalities noted comprised 11 endometrial polyps, 5 endometrial carcinomas, 2 submucosal myomas, and 1 endometrial hyperplasia. The incidence of endometrial proliferation was significantly higher in patients who had been treated with tamoxifen for less than 1 year (P=0.037) than in those who had been treated for more than 1 year. Although the endometrial carcinomas, submucosal myomas, and endometrial hyperplasia were found in the patients who had been treated for more than 1 year, this result was not statistically significantwhen compared with the other group. As compared to the endometrial polyps obtained from women who had not received tamoxifen treatment, those obtained from patients who had received the treatment exhibited significantly lower levels of ER expression (P=0.000) in the glands and increased levels of PR (P=0.031) and Ki-67 expression (P=0.000) in the stroma. CONCLUSIONS: During tamoxifen treatment for breast cancer, the endometrial pathology should be investigated if transvaginal ultrasonography reveals the tissue to be more than 10 mm thick. Although tamoxifen has significant effects on the expression of hormone receptors, the mechanism underlying the development of endometrial polyps does not appear to be mediated by the ER.

Malignant lymphoma of the uterine cervix treated by neoadjuvant chemotherapy / 부인종양

Non-Hodgkin's lymphoma presented as a malignancy of the uterine cervix is exceedingly rare disease and accounts for approximately only 0.12-0.6% of extranodal lymphomas. There is no consensus on the management and prognosis of the disease because of its extreme rarity. Previously, treatment of this disease has been radiation therapy, surgery or chemotherapy either alone or in combination. We present the case of a 45-year-old woman diagnosed with diffuse, large B-cell non-Hodgkin's lymphoma of the uterine cervix. We administered neoadjuvant chemotherapy according to CHOP protocol (cyclophosphamide, adriamycin, vincristine, and prednisone) followed by hysterectomy and bilateral salpingo-oophorectomy. The patient is alive 20 months after the initial diagnosis. We report the case with a brief review of literature.

A case report of Extragonadal endodermal sinus tumor occurring in the appendix and mesentery / 대한산부인과학회지

Endodermal sinus tumor (EST) is a rare malignant germ cell tumor arising usually in the gonads such as the testis or ovary. However, 10-15% of EST cases may arise in the extragonadal sites, such as sacrocoxygeal area, mediastinum, vagina, brain and retroperitoneum in a frequent occurring order. To our knowledge there are only 2 case reports of extragonadal EST, one originating from the omentum in 1998, and another which was localized in the pelvis in 2003. We report one case of extragonadal sinus tumor which arose in appendix and mesentery in the 19-year-old female with a review of the literature.

Distribution and Role of Ovarian Follicle Macrophage in Rat Ovarian Follicular Atresia / 대한산부인과학회지

OBJECTIVE: Ovarian follicular atresia is initiated from ovarian granulosa cell apoptosis and macrophages exert their effects directly and/or indirectly on follicular atresia by phagocytosis of apoptotic bodies and secretion of various cytokines. In spite of the abundant data on ovarian macrophages, the presence of these cells within the follicles (i.e., among granulosa cells) remains controversial and the elimination methods of apoptotic bodies of atretic follicles, and the time and methods of penetration of macrophages into the follicles are not known completely. The aim of the present study is to demonstrate the presence of macrophage within the ovary as related to follicular atresia and the process of elimination of apoptotic granulosa cells by light and electron microscopy. METHODS: Using rat ovaries, immunohistochemical studies with rat macrophage monoclonal antibody ED1 for macrophages, and light and transmission electron microscopic observations were performed. RESULTS: In the rat, follicular atresia was initiated by the granulosa cell apoptosis which occured randomly within the all granulosa layers. Macrophages were observed within normal follicles, in antrum, granulosa and theca cell layers of atretic follicels, in interstium and in corpus luteum. Ultrastructurally, apoptotic granulosa cells showed characteristics, pyknotic nucleus and apoptotic body formation. Apoptotic bodies were eliminated by intact neighboring granulosa cells and macrophages. Intact granulosa cells ingested apoptotic bodies transiently, soon after they fell into the apoptosis. Finally, apoptotic bodies and degenerating oocytes were phagocytosed by macrophages. Macrophages entered the ovarian follicle at the time of initiation of granulosa cell apoptosis, and migrated with the progression of apoptosis. By elimination of theca cells, macrophages contributed the completion of follicular atresia. CONCLUSION: This study demonstrates both intact neighboring granulosa cells and macrophages in the elimination of apoptotic bodies in atretic follicles of the rat ovary. Macrophages are present within normal follicles, in atretic follicles such as antrum, granulosa and theca cell layers and in corpus luteum but are in different appearances according to their location in ovary. A number of macrophages appearing in atretic follicles and in corpora lutea suggest a role for macrophages in follicular atresia and corpus luteum differentiation. The function of macrophage according to their location in follicular development should be further studied.

Changes of Macrophages in Rat Corpus Luteum: Immunohistochemical and Transmission Electron Microscopy Studies / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to assess morphologically the changes of macrophages during various developmental periods of the corpus luteum in the rat ovary. METHODS: The female rats (Sprague-Dawley strain) at age 8 weeks, ovulatory period; 6 days of gestation, early pregnancy period; 19 days of gestation, late pregnancy period; and postpartum 5 days, postpartum period were used. Removed ovaries were dissected and used for TdT-mediated dUTP biotin nick end labelling (TUNEL), macrophages immunohistochemistry, and Transmission Electron Microscopy (TEM). RESULTS: Macrophages were observed in all the developmental periods. The number of apoptotic bodies and macrophages was highest at the ovulatory period, and decreased at postpartum period, early pregnancy period and late pregnancy period in order. The immunoreactivity of macrophages was high at ovulatory period, moderate at late pregnacy and postpartum period, and low at early pregnancy period. In TEM observations, two types of macrophages were observed. One was non-phagocytic macrophage which has slender cell body and long cytoplasmic processes and contained no apoptotic bodies, and the other was phagocytic macrophage which contained apoptotic bodies, phagocytic vacuoles and many lipid droplets and located near the capillaries. CONCLUSION: In the rat corpus luteum, the number and the degree of immunoreactivity of macrophages changed according to the functional developmental periods of the corpus luteum. The functions of the macrophages were suggested as the elimination of apoptotic bodies at the ovulatory and postpartum periods, and luteotropic action at the early and late pregnancy periods. Ultrastructurally, two types of macrophages, phagocytic and non-phagocytic, were confirmed.

PTEN and p53 Mutations in Endometrial Carcinomas

BACKGROUND: Endometrial carcinomas are pathogenetically classified into two major types; endometrioid carcinoma (EC) and serous carcinoma (SC). The most frequently altered gene in EC is the PTEN tumor suppressor gene (TSG). SC is usually associated with mutations in the p53 TSG. METHODS: To further determine the role of PTEN and p53 mutation in endometrial carcinogenesis, the analysis of 33 endometrial carcinomas, including 28 ECs and 5 SCs, for loss of heterozygosity (LOH) on 10q23 and for mutation in all 9 coding exons of PTEN and the 5-8 exons of p53, using SSCP-PCR methods was carried out. RESULTS: LOH was detected in at least one marker in 12 (54.5%) of 22 ECs, but in only one (20.0%) of 5 SCs. Somatic PTEN mutations were detected in 10 (35.7%) of 28 ECs. PTEN was altered in 67.9% of ECs and in 20.0% of SCs, including those with 10q23 LOH. No PTEN mutations were found among the SCs. Somatic p53 mutations were detected in 2 (7.1%) of 28 ECs and 3 (60.0%) of 5 SCs. CONCLUSIONS: PTEN gene alterations contribute to the pathogenesis of an endometrioid subtype of endometrial carcinoma, but not to the serous type. In contrast, p53 plays an important role in the pathogenesis of SCs.

Incidence of Congenital Anomalies and Diagnosis of Congenital Anomalies by Antenatal Ultrasonography / 대한산부인과학회잡지

OBJECTIVE: To determine the incidence and types of congenital anomalies and evaluate the efficiency of antenatal ultrasonography for detection of congenital anomalies METHODS: This was a retrospective study, undertaken on 157 cases with congenital anomalies among 5,554 delivered newborns at Chungnam National University Hospital from Jan. 1, 1998 to Dec. 31, 2002. For statistical evaluation, Chi-square test were used. RESULTS: Among the total 5,554 newborns, the overall incidence of congenital anomalies was 2.8%. The incidence of congenital anomalies in birth weights less than 2,500 gm was 9.2% which was 7.5 times higher than that of birth weights more than 2,500 gm. The incidence of congenital anomalies in stillbirth was 19.3% which was 8.2 times higher than that of the live birth. When classified according to the type of congenital anomalies, the incidence of congenital anomalies were 26.5%, 21.0%, 19.8%, 13.0%, 7.4%, 6.2%, 3.7%, and 2.5% respectively in urogenital system, central nervous system, digestive system, cardiopulmonary system, dermatologic system, musculoskeletal system, chromosomal anomaly syndrome, and fetal tumor. Among 157 cases of congenital anomaly babies, anomaly babies were detected antenatally by ultrasonographic examination in 122 cases, and then the rate of antenatal ultrasonographic detection was 77.7%. CONCLUSION: The overall incidence of congenital anomalies was 2.8%. The most common congenital anomalies were urogenital anomalies. The rate of antenatal ultrasonographic detection for congenital anomalies was 77.7%.

Comparison of Apoptosis and Bcl-2 Expression in Normal Pregnancy, Pregnancy Induced Hypertension and Intrauterine Growth Restriction / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the incidence of apoptosis and expression of bcl-2 in the placenta of normal pregnancy, Pregnancy Induced Hypertension, and Intrauterine Growth Restriction. METHODS: Placenta samples were collected from 15 cases of normal full-term pregnancies, 15 cases of second trimester pregnancies, 17 cases of Pregnancy Induced Hypertension, and 13 cases of Intrauterine Growth Restriction. Hematoxylin and eosin staining and TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate marker nick end-labeling) staining were used to quantify the incidence of apoptosis and the electron microscopy was used to confirm it. Expression of bcl-2 was confirmed by using immunohistochemical stain in relation to apoptosis. RESULTS: 1. In TUNEL staining, quantification of apoptosis was 1.05 in 2nd trimester (n=15), 3.65 in pregnancy induced hypertensive pregnancy (n=17), 2.92 in intrauterine growth restrictive pregnancy (n=13) and 1.93 in normal full-term pregnancy (n=15). The incidence of apoptosis was significantly higher in placental tissues from full-term pregnancies than second trimester pregnancies (p0.05, t test), and between intrauterine growth restriction and normal full-term pregnancy (p>0.05, Mann-Whitney U test). CONCLUSION: These data suggest that apoptosis increases with gestational age, and in pathophysiologic states such as pregnancy induced hypertension and intrauterine growth restriction, and that bcl-2 expression is lower with gestational age.

Comparison of Apoptosis and Bcl-2 Expression in Normal Pregnancy, Pregnancy Induced Hypertension and Intrauterine Growth Restriction / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the incidence of apoptosis and expression of bcl-2 in the placenta of normal pregnancy, Pregnancy Induced Hypertension, and Intrauterine Growth Restriction. METHODS: Placenta samples were collected from 15 cases of normal full-term pregnancies, 15 cases of second trimester pregnancies, 17 cases of Pregnancy Induced Hypertension, and 13 cases of Intrauterine Growth Restriction. Hematoxylin and eosin staining and TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate marker nick end-labeling) staining were used to quantify the incidence of apoptosis and the electron microscopy was used to confirm it. Expression of bcl-2 was confirmed by using immunohistochemical stain in relation to apoptosis. RESULTS: 1. In TUNEL staining, quantification of apoptosis was 1.05 in 2nd trimester (n=15), 3.65 in pregnancy induced hypertensive pregnancy (n=17), 2.92 in intrauterine growth restrictive pregnancy (n=13) and 1.93 in normal full-term pregnancy (n=15). The incidence of apoptosis was significantly higher in placental tissues from full-term pregnancies than second trimester pregnancies (p0.05, t test), and between intrauterine growth restriction and normal full-term pregnancy (p>0.05, Mann-Whitney U test). CONCLUSION: These data suggest that apoptosis increases with gestational age, and in pathophysiologic states such as pregnancy induced hypertension and intrauterine growth restriction, and that bcl-2 expression is lower with gestational age.

Morphological Study on the Radiation-induced Follicular Atresia and the Follicular Macrophage / 대한산부인과학회잡지

OBJECTIVE: It is well known that X-ray induces follicular atresia, but the exact mechanism of atresia is not still unveiled completely. In addition, the role of macrophage related with clean-up the dead granulosa cells and other functions within the ovarian follicle is emphasized recently. The aim of this study is to assess the radiation-induced morphological changes of ovarian follicles and follicular macrophages. METHODS: 8 Gy X-ray irradiated on the 3-week old rats (Sprague-Dawley strain), sacrificed at 6, 12, and 24 hours after irradiation, and performed morphological studies with light and transmission electron microscopy, TUNEL, and macrophage immunohistochemistry. RESULTS: Follicular atresia increased significantly (p<0.01) at 6 hours after X-irradiation, and it was decreased significantly (p<0.01) at 12 and 24 hours after irradiation. X-ray induced chromatin condensation in the nucleus and nuclear fragmentation of granulosa cells, which were the typical features of apoptosis. Apoptotic granulosa cells were phagocytosed by the neighboring normal granulosa cells and the macrophages. During atresia of follicles, radioresistant granulosa cells were found in some follicles, which showed similar features morphologically with the granulosa cells of normal follicles. Macrophages were found both within the antrum and at the follicular granulosa layer. CONCLUSION: X-radiation induced follicular atresia by means of granulosa cell apoptosis, and radioresistant granulosa cells which have similar features morphologically with the granulosa cells of normal follicles were observed in some follicles. And the macrophages which phagocytose the apoptotic granulosa cells were located within the follicular antrum and at the follicular granulosa layer.

What is the risk factor of preeclampsia?: Hospital-based case-control study / 대한산부인과학회잡지

OBJECTIVE: To assess several variables that are known as the risk factor of preeclampsia. METHODS: We have studied with 279 pregnant women who were diagnosed with preeclampsia and went through delivery in Chungnam University from January, 1998 to December, 2002. For control group, we chose 364 non-hypertensive pregnant women who went through delivery from January, 2002 to December, 2002 through random process. Through reviewing each patient's chart, we collected data regarding age, parity, past medical history, past obstetric history, family history, presence of gestational diabetes, height, body weight, before and at the time of delivery, delivery mode and neonatal outcomes. Statistical analysis was performed using x2-test, Student t-test. A value of p below 0.05 was considered to show statistical significance. RESULTS: During the study period, 298 women had preeclampsia so that the incidence of preeclampsia was 6.0%. Age and past medical history were not related to preeclampsia. The primiparous women in this study are likely to show a higher incidence of preclampsia (OR 1.35, 95% CI 1.16-1.5, p=0.017). In addition, women whose BMI are ranged from 25.0 kg/m2 to 30.0 kg/m2 (p=0.027), and ranged from 30.0 kg/m2 to 40.0 kg/m2 (p=0.027) had a higher incidence of preeclampsia. By using a multiple logistic regression analysis about the BMI changes, we found out that there was a higher rate of preeclmapsia among pregnant women with over 7.11 kg/m2 BMI increasement compared with BMZ before pregnancy (OR=2.97, 95% CI 2.22-3.99, por=25.0 kg/m2, previous preeclampsia, family history of chronic hypertension, twin gestation showed an increased risk of preeclampsia.

Clinical and Cytogenetic Analysis of Midtrimester Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To analyze the indications, clinical features, cytogenetic results and complications of amniocentesis and to determine the efficacy of antenatal genetic amniocentesis. METHODS: We analyzed retrospectively maternal age, gestational age, indications, transplacental puncture, frequency, discoloration of amniotic fluid, karyotype and complications in 325 cases of prenatal genetic amniocentesis performed at Chungnam National University Hospital from January 2000 to December 2002. RESULTS: The most common age group was from 30 to 34 (31.4%) and mean age was 32.7 years old. 85.3% of cases were performed at 16th-20th gestational weeks. Abnormal maternal serum markers were the most common indication of amniocentesis (56.0%) and the second most common indication was maternal age over 35 (33.2%). Abnormal karyotypes were found in 12 cases (3.6%) and normal variants were 21 cases (6.5%). Numerical aberration were 9 cases (2.7%) and structural aberration were 3 cases (0.3%). Among the autosomal aberrations, Down syndromes were 5 cases and Edward syndrome was 1 case. Among the sex chromosomal aberrations, 47,XXX were 2 cases and Turner syndrome was 1 case. As the increasing maternal age, the incidence of abnormal karyotype was increased. Procedure-related complications occurred in 11.7% of cases and fetal loss rate was 7.4%. No significant associations were found between procedure-related complications and maternal age, gestational age, transplacental puncture, frequency, discoloration of amniotic fluid, and antibiotic treatment. CONCLUSION: Amniocentesis is useful for prenatal genetic diagnosis in pregnancies with increasing risk of chromosome aberrations, such as advanced maternal age, abnormal maternal serum markers or abnormal US findings. Further studies are necessary to identify risk factors of complications after invasive procedure.

Expression of the Tissue Inhibitor of Matrix-Metalloproteinase (TIMP-2) in Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The present study was conducted to evaluate the tissue inhibitor of matrix-metalloproteinase (TIMP-2), which leads to tumor proliferation, invasion and metastasis and which can be used as a prognostic factor for cervical carcinoma, and to correlate TIMP-2 with recurrence in cervical carcinoma. METHODS: Thirty-three cases of cervical carcinoma and ten control cervices were analysed for expression of TIMP-2 by immunohistochemical staining. Results were analysed for possible correlation with prognostic factors. RESULTS: Lymph node metastasis, lymphovascular invasion, and recurrence groups showed a lower expression tendency of TIMP-2 in tumor cells (0.67 vs 0.88, 0.77 vs 0.93, 0.78 vs 0.91) (p>0.05). However, there was no statistical significance in the correlation of TIMP-2 expression with tumor variables. On the other hand, in stromal cells, deep invasion (>or=5 mm), squamous cell carcinoma groups showed a higher expression tendency of TIMP-2 (0.80 vs 0.67, 0.74 vs 0.40) (p>0.05) but, there was no statistical significance. However, recurrence group showed a significantly lower expression of TIMP-2 in stromal cells (0.33 vs 0.83) (p<0.05). CONCLUSION: In spite of no statistically significant correlation in tumor cells, recurrence group showed a significantly lower expression of TIMP-2 in stromal cells. Therefor there was an inverse correlation between expression of TIMP-2 in stromal cell and recurrence. These results indicate that expression of TIMP-2 in stromal cells is closely correlated with the recurrence of cervical carcinoma.

Human Papillomavirus Type 16, 18, and 33 Infection in Adenocarcinoma of the Uterine Cervix: Analysis of the p53 Gene Mutation and the Clincopathologic Correlation

BACKGROUND: Current evidence implicates specific types of the human papillomavirus (HPV) are involved in the development of cervical cancer. In HPV-negative cervical carcinomas, p53 mutation is thought to be a mechanism of oncogenesis. The purpose of this study was to evaluate the prevalence of p53 mutations in cervical adenocarcinomas and to investigate their correlation with HPV status and clinicopathologic parameters. METHODS: A series of 38 primary cervical adenocarcinomas was analyzed for both HPV infection and p53 mutations. The HPV 16, 18, and 33 status was investigated by PCR amplification. The point mutations of the p53 gene were detected by the PCR-SSCP technique. RESULTS: The prevalence of HPV 16, 18, or 33 infection was 73.7% (28/38). HPV 16 was present in 12 cases, HPV 18 was present in 15 cases, and HPV 33 was positive in one case. There was only one case that was positive for 18 as well as a p53 mutation in exon 6. CONCLUSIONS: Our results indicate that HPV 18 infection was more common in cervical adenocarcinomas than HPV 16 infection. Mutant p53 was rarely found in cervical adenocarcinomas regardless of the type of HPV infection. There was no correlation between HPV infection and clinical stage or pathologic type of tumor.

Placental apoptotic change in 2nd trimester and full-term of normal pregnancies / 대한산부인과학회잡지

OBJECTIVE: The study aims were to demonstrate apoptosis in the placenta of normal pregnancy, and to identify its change and quantify its incidence by gestational age. METHODS: Placenta samples were collected from 25 normal full-term pregnancies and 20 second trimester pregnancies undergoing termination due to medical and social reasons. Hematoxylin and eosin staining and TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) staining were used to quantify the incidence of apoptosis and the electron microscopy was used to confirm it. Mann-Whitney U test and ANOVA test were used for statistical analysis. RESULTS: 1. Apoptosis was demonstrated by variable cytopathologic methods, and especially TUNEL staining and electron microscopy are found to be confirmatory methods. 2. In TUNEL staining, quantification of apoptosis was as follows: 2nd trimester (n=20) 1.05+/-0.69, full- term (n=25) 1.92+/-1.00. The incidence of apoptosis was significantly higher in full-term than in 2nd trimester (p0.05, Mann-Whitney U test). 4. There was no statistical significance in the incidence of apoptosis by maternal age, parity, cause of termination during 2nd trimester, and mode of delivery in each group. 5. In the electron microscopy, apoptotic cells were observed to have membrane blebbing, loss of microvilli, chromatin condensation and localization in the border of nuclear membrane, and cell shrinkage and increase in granularity. This method was conformatory in identifying apoptosis. CONCLUSION: Placental apoptosis increased significantly with increased gestational age, and this result suggests that it may play a role in the normal development and aging of the placenta.

Cyclooxygenase-2 Expression and it's Usefulness as a Prognostic Factor in Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: Recent epidemiologic studies indicate that use of nonsteroidal anti-inflammatory drugs that inhibit cyclooxygenase (COX) activity reduce the risk of colorectal cancer. COX-2 expression has been identified in cancers of many organs. There are also many reports that identify COX-2 expression and its possible role in tumorigenesis in cervical cancers. This study was performed to determine wether COX-2 is expressed in cervical cancer and to evaluate the value of COX-2 as a predictor of treatment results. PATIENTS AND METHODS: The study included 34 cases of stage IB to IVA cervical cancer and 22 cases of normal cervical specimens obtained through biopsy or surgery at the Chungnam National University Hospital. A COX-2 immunohistochemical stain was performed on these specimens. RESULTS: There was a statistically significant difference of COX-2 positivity between the cervical cancer group and a control group (p=0.01, Fisher's exact test), between the well controlled group and the treatment failure group (p=0.00, Fisher's exact test) and among stages (p=0.01, linear-by-linear association). The COX-2 positive group had a mean overall survival time of 55 months compared with 80 months for COX-2 negative group (p=0.00, log-rank test). The Locally advanced cervical cancer group (stage IIB-IV A) had a mean overall survival time of 46 months compared with 84 months for early stage disease group (stage IB, II A) (p=0.00, log-rank test). A Cox regression model showed that COX-2 positivity and clinical stages retained independent roles in predicting treatment results and prognosis. CONCLUSION: Evaluation of COX-2 expression in cervical cancer patients is valuable for predicting the treatment results and prognosis.

Loss of Heterozygosity in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: Endometriosis is a very common gynecological condition in which tissue similar to endometrium proliferates at sites outside the uterine cavity. Although it generally remain a benign condition, malignant transformation has been documented, and it is commonly found in association with endometrioid subtype ovarian carcinoma. In order to identify the genomic change in those areas possibly involved in the pathogenesis of endometriosis, we performed LOH analysis. METHODS: Twenty seven cases of endometriosis were analyzed for the detection of LOH using 5 microsatellite markers. LOH analysis was performed by PCR, capillary electrophoresis and gene scan analysis using DNA from sections of tumor and normal tissue pairs. RESULTS: Twenty two of 27 (81.5%) cases demonstrated LOH at one or more loci. The frequency of LOH was 37.0% (D18S69), 25.9% (D22S274), 14.8% (D22S283), 7.4% (D6S286), 7.4% (D13S160). CONCLUSION: The frequencies of LOH was increased in higher stage of endometriosis. Most notable findings were found at chromosome 18 and 22 loci (D18S69, D22S274). These region might involve the some candidate genes closely related with the pathogenesis of endometriosis.