A case of torsion of a subserosal leiomyoma / 대한산부인과학회지

Uterine leiomyoma is the most frequent gynecologic tumor, but acute torsion of uterine leiomyoma is extremely rare. We report a case of a patient who had suffered lower abdominal pain for 2 weeks. Ultrasonogram showed a subserosal uterine leiomyoma. Laparoscopic surgery confirmed the diagnosis of acute torsion of a subserosal uterine leiomyoma.

Comparison of concurrent chemoradiotherapy with cisplatin plus 5-fluorouracil versus cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma / 부인종양

OBJECTIVE: The aim of this study was to compare survival outcomes and toxicities between concurrent radiotherapy with cisplatin plus 5-fluorouracil and that with cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma. METHODS: We retrospectively reviewed data from 93 locally advanced cervical carcinoma patients (stage IB to IVA) who had been treated by concurrent radiotherapy with cisplatin plus 5-fluorouracil (CF, n=45) vs. cisplatin plus paclitaxel (CP, n=48) as primary therapy. Toxicities and survival outcomes were compared. RESULTS: In the CP group, there were higher frequencies of severe (grade 3 or 4) leukopenia (79.2%, as compared to 11.1% in the CF group), severe neutropenia (77.1%, as compared to 8.9% in the CF group) and severe peripheral neuropathy (12.5%, as compared to 2.2% in the CF group). In the CF group, there were higher frequencies of severe nausea (33.3%, as compared to 14.6% in the CP group) and severe hyponatremia (11.1%, as compared to 0% in the CP group). Five-year DFS of the CF and CP groups was 67.4% and 79.1%, respectively (p=NS). Five year OS of the CF and CP groups was 79.6% and 80.9%, respectively (p=NS). CONCLUSION: Concurrent radiotherapy with cisplatin plus paclitaxel showed increased leukopenia, neutropenia and peripheral neuropathy, but less gastrointestinal toxicity (nausea) than that with cisplatin plus 5-fluorouracil. Survival outcome between these two groups was not statistically different in this study. Large prospective randomized controlled studies will be needed to confirm this result.

Relation between HPV and cyclooxygenase 2 overexpression in cervical carcinoma in situ and carcinoma / 대한산부인과학회지

OBJECTIVE: The aim of this study was to identify the relation between HPV infection and cyclooxygenase 2 (COX-2) overexpression in cervical carcinoma in situ (CIS) and carcinoma. METHODS: Fourteen patients with CIS, 14 patients with invasive cervical carcinoma, and 14 patients with myoma as control were enrolled. Polymerase chain reaction was used to detect high risk types of HPV, and immunohistochemistry was used to detect COX-2 expression. RESULTS: The frequencies of high risk types of HPV infections in CIS or carcinoma were significantly higher than control [CIS: 11 (78.6%), carcinoma: 14 (100%), control: 1 (7.1%), P-value>0.001]. COX-2 expressions in CIS were higher than control (P=0.037), and those in carcinoma were higher than CIS (P=0.002). Three patients with CIS did not show HPV infection and showed lower COX-2 expression than the other patients with HPV infection in CIS group (P=0.013). There was strong correlation between COX-2 expression and HPV infection (P>0.001). However, in multivariate analysis, disease progression from normal to invasive carcinoma was the only independent factor to affect COX-2 overexpression. CONCLUSION: Disease progression from normal to invasive carcinoma might be more important factor to affect COX-2 overexpression than high risk types of HPV infection.

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.