Collision of Three Histologically Distinct Endometrial Cancers of the Uterus

A collision tumor is defined by the presence of two separate masses in one organ, which are pathologically distinct. We described a 70-yr-old patient who complained of abnormal vaginal bleeding with a collision tumor of the uterine corpus. The patient received total hysterectomy, bilateral salphingo-oophorectomy, bilateral pelvic-paraaortic lymphadenectomy, omentectomy, and intraperitoneal chemotherapy. The uterine corpus revealed three separate masses, which were located at the fundus, anterior and posterior wall. Each tumor revealed three pathologically different components, which were malignant mixed mullerian tumor, papillary serous carcinoma, and endometrioid adenocarcinoma. Among these components, only the papillary serous carcinoma component invaded the underlying myometrium and metastasized to the regional lymph node. Adjuvant chemotherapy and radiation therapy were performed. The patient is still alive and has been healthy for the last 8 yr. We have reviewed previously reported cases of collision tumors which have occurred in the uterine corpus.

The Relationship Between Coronary Artery Calcification and Bone Mineral Density in Patients According to Their Metabolic Syndrome Status

BACKGROUND AND OBJECTIVES: The extent of coronary artery calcification (CAC) is closely related to total atherosclerotic plaque burden. However, the pathogenesis of CAC is still unclear. Conditions such as diabetes mellitus, renal failure, smoking, and chronic inflammation have been suggested to link vascular calcification and bone loss. In the present study, we hypothesized that bone loss can contribute to the pathogenesis of CAC in patients with the chronic inflammatory condition that accompanies metabolic syndrome (MetS). The objective of this study was to investigate the relationship between CAC and bone mineral density (BMD) in patients with MetS and in patients without MetS, by using coronary multidetector-row computed tomography (MDCT). SUBJECTS AND METHODS: Data from 395 consecutive patients was analyzed retrospectively. From the MDCT database, only those patients who underwent both coronary MDCT and dual-energy X-ray absorptiometry within an interval of one month, were selected. The presence of MetS was determined by the updated criteria as defined by the Third Adult Treatment Panel Report of the National Cholesterol Education Program. RESULTS: In patients with MetS, a significant correlation was found between CAC and age {odds ratio (OR)=1.139, 95% confidence interval (CI) 1.080 to 1.201, p<0.001}, CAC and male sex (OR=3.762, 95% CI 1.339 to 10.569, p=0.012), and CAC and T-score of L-spine (OR=0.740, 95% CI 0.550 to 0.996, p=0.047) using a forward multiple logistic regression analysis model including clinical variables of gender, age, lipid profile, body mass index, diabetes mellitus, hypertension, smoking, and BMD. But in patients without MetS, BMD by itself was not found to contribute to CAC. CONCLUSION: BMD was inversely correlated with CAC only in patients with MetS. This finding suggests that low BMD accompanied by MetS, may have significant clinical implications.

The Relationship Between Coronary Artery Calcification and Bone Mineral Density in Patients According to Their Metabolic Syndrome Status

BACKGROUND AND OBJECTIVES: The extent of coronary artery calcification (CAC) is closely related to total atherosclerotic plaque burden. However, the pathogenesis of CAC is still unclear. Conditions such as diabetes mellitus, renal failure, smoking, and chronic inflammation have been suggested to link vascular calcification and bone loss. In the present study, we hypothesized that bone loss can contribute to the pathogenesis of CAC in patients with the chronic inflammatory condition that accompanies metabolic syndrome (MetS). The objective of this study was to investigate the relationship between CAC and bone mineral density (BMD) in patients with MetS and in patients without MetS, by using coronary multidetector-row computed tomography (MDCT). SUBJECTS AND METHODS: Data from 395 consecutive patients was analyzed retrospectively. From the MDCT database, only those patients who underwent both coronary MDCT and dual-energy X-ray absorptiometry within an interval of one month, were selected. The presence of MetS was determined by the updated criteria as defined by the Third Adult Treatment Panel Report of the National Cholesterol Education Program. RESULTS: In patients with MetS, a significant correlation was found between CAC and age {odds ratio (OR)=1.139, 95% confidence interval (CI) 1.080 to 1.201, p<0.001}, CAC and male sex (OR=3.762, 95% CI 1.339 to 10.569, p=0.012), and CAC and T-score of L-spine (OR=0.740, 95% CI 0.550 to 0.996, p=0.047) using a forward multiple logistic regression analysis model including clinical variables of gender, age, lipid profile, body mass index, diabetes mellitus, hypertension, smoking, and BMD. But in patients without MetS, BMD by itself was not found to contribute to CAC. CONCLUSION: BMD was inversely correlated with CAC only in patients with MetS. This finding suggests that low BMD accompanied by MetS, may have significant clinical implications.

Small bowel hernia through 5 mm trocar site with drainage tube in situ and its reduction by laparoscopy: A case report / 대한산부인과학회지

The incisional hernia through trocar site is an uncommon complication of gynecologic laparoscopy. Its incidence is less than 1% and most of them are occurring through 10 mm trocar site. Small bowel herniation through 5 mm trocar site is very rare. Furthermore, 5 mm trocar site bowel herniation with drain tube in situ has not yet been reported. We present a case of small bowel herniation through 5 mm trocar site with drain tube in situ and its reduction by laparoscopy with a brief review of literature.

Study for the clinical efficacy of laparoscopic myomectomy / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. METHODS: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. RESULTS: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67+/-0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07+/-0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89+/-0.10 g/dL vs. 4.03+/-0.23 g/dL) and blood transfusion amount (2.89+/-0.10 pints vs. 4.03+/-0.23 pints) as well as the operation time (137.58+/-4.37 min vs. 193.73+/-9.88 min) showed noticeable increase in the high risk group. CONCLUSION: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.

Preoperative Diagnosis and Medical Treatment of Pelvic Actinomycosis

The diagnosis of the pelvic actinomycosis is seldom made preoperatively because of no reliable or specific clinical manifestation which has tendency to mimic advanced gynecological malignancy and the relative infrequency of the disease. To explore the method for improvement of preoperative diagnosis and possibility of avoiding the surgical management of pelvic actinomycosis, we collected and summarized the data of age, parity, state of menopause, history of intrauterine device (IUD) use, symptoms, laboratory findings, radiologic findings, provisional diagnosis and treatment from 14 cases diagnosed pathologically and treated in Hanyang University Hospital from 2000 to 2007. Eleven (78.6%) of 14 cases were IUD users. Most common complaints were lower abdominal pain (71.4%) and vaginal discharge (57.1%) which were followed by fever (28.6%) and back pain (28.6%). Four cases (28.6%) were identified as pelvic actinomycosis before operation and in 3 cases (21.4%) malignancy was provisional preoperative diagnosis. Pelvic actinomycosis was suspected via abdominal computed tomography (CT) or cervicovaginal cytology and confirmed via endometrial biopsy or fine needle aspiration biopsy. Two cases that were diagnosed before operation and received only antibiotics therapy had no recurrence. It was suggested that pelvic actinomycosis could be suspected via abdominal CT and cervicovaginal cytology in IUD users, and endometrial biopsy and fine needle aspiration biopsy may help establish the diagnosis before the operation. Adequate preoperative antibiotics therapy could make extensive exploratory surgery avoided or conservative surgery feasible.

Expression of immunoreactive leptin and its receptor in epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: Leptin, a secreted protein of the Ob gene by white adipose tissue, plays an important role in the regulation of food intake and energy consumption in the brain and acts as a potential growth stimulator in normal and neoplastic breast cancer cells. However, a potential role of leptin as an endocrine regulator is unknown in ovarian cancer. In the present study, we investigated the expression of leptin and its receptors in various histologic types of ovarian cancer and immortalized ovarian cancer cell lines to find out potential effect of leptin on the cell growth and activation of ovarian cancer cell line. METHODS: The ovarian cancer tissues, serous (n=18), mucinous (n=15), clear cell (n=12) and endometrioid type (n=14), were used for immuno-histochemical staining for leptin (Ob) and leptin-receptors (Ob -R). Ovrian cancer cell lines (non-mucinous: SNU-8, OVCAR-3, and SKOV-3) and mucinous: MUC) were used for RT-PCR, Western blot analysis, and [H3] thymidine incorporation assay for the cell growth and activation of mitogen-activated protein kinase. RESULTS: Both long (Ob-Rb) and short (Ob-Rt) isoforms of leptin receptors are expressed in non-mucinous type of ovarian cancer tissues (serous, clear cell carcinoma and endometrioid cell carcinoma) and in non-mucinous ovarian cancer cell lines (SNU-8, OVCAR-3 and SKOV-3 cells). However, leptin and its receptors are not found in mucinous cancer cells and mucinous cancer cell line (MUC). In immunohistochemical staining, the immunreactive leptin is expressed on the nuclei of the stratified cuboidal-to-columnar epithelial cells whereas its receptor was sparsely expressed on the innermost epithelial cell clusters and cytoplasm in non-mucinous tumor. However, there are no immunoreactive leptin and its receptor expressions in the mucinous tumor. In addition, treatment with leptin resulted in the growth stimulation of ovarian cancer cell line, an activation of ERK 1/2 and inhibition of constitutive phosphorylation of p38 Mitogen-activated protein kinase (MAPK). CONCLUSION: Taken together, our data demonstrates preliminary that the expression of leptin and its receptor is different according to the cell types of the ovarian cancer. Also it canbe thought that leptin immunolocalized on the nuclei in non-mucinous type but not in mucinous possibly acts as a nuclear transcription factor. Further studies are necessary to validate whether leptin may be a potential regulator for ovarian cancer.

Expression analysis of mRNA and proteins related to angiogenesis following management with cytotoxic agents in gynecologic cancer cell lines / 대한산부인과학회지

OBJECTIVE: Angiogenesis is central role to both the proliferation and metastasis of malignant tumor. The intense interest in angiogenesis has also lead to a re-examination of the activity of established cytotoxic agents which are known to be an antiangiogenic effect anecdotally. In this study, anti-angiogenic effect of cisplatin, paclitaxel and thalidomide was evaluated in human ovarian cancer cell lines and cervical cancer cell line. METHODS: Human ovarian cancer cell line A2780, cisplatin resistant human ovarian cancer cell line A2780-CDDP, human breast cancer cell line MCF-7, and squamous cell uterine cervical carcinoma cell line SiHa were used to evaluate the level of mRNA and protein expression of VEGF, bFGF and TSP-1, 2 before and after the treatment with cisplatin, paclitaxel, and thalidomide using RT-PCR, protein extraction, and Western blot. The results were analyzed with Wilcoxon signed rank test in the SAS ver 8.1. RESULTS: Targeted mRNAs were synthesized as 212 bp VEGF, 238 bp bFGF, and 492 bp band sized except mRNA of TSP-2 via RT-PCR. The protein of VEGF and bFGF were appeared as 21KDa and 17 KDa size, however, the protein of TSP-1 was not appeared through western blot. No effect of cisplatin on protein expression was measured in these cell lines, but paclitaxel influenced the expression of bFGF in MCF-7 cell line and the expression of TSP-1 in MCF-7 and SiHa cell lines. TSP-1 expression was influenced by thalidomide in A2780 cell line. The protein expression of VEGF and bFGF were not influenced following treatment with cisplatin, paclitaxel, and thalidomide. CONCLUSION: These results were suggested that bFGF and TSP-1 will be used as a target gene for the assay of antiangiogenic effect of paclitaxel in breast and uterine cervical cancer tissue and TSP-1 will be used as that of thalidomide in ovarian cancer. Furthermore, thalidomide will be tried as an adjunctive agent for the improvement of the survival in the case of the patient with ovarian cancer.

The expression of Ki-67, p63, p53, and p27 as a biological marker for grading cervical intraepithelial neoplasia and cervical carcinoma / 대한산부인과학회지

OBJECTIVE: To determine the pattern of expression of p63, p27, and p53 as well as Ki-67 and its efficacy to discriminate the cervical lesion such as intraepithelial lesion, microinvasive carcinoma, and invasive carcinoma in surgical sample. METHODS: Cervical tissue samples were obtained from 64 patients visited Hanyang University Medical Center via hysterectomy, conization, punch biopsy, and polypectomy from September 2001 to February 2002. The biopsies were stained with Hematoxylin-Eosin (HE) to detect dysplasia (mild, moderate, severe), microinvasive carcinoma, and invasive carcinoma. All samples were stained immunohistochemically for Ki-67, p63, p27, and p53 to determine the location and proportion of positive cells. The differences of expression patterns between each group were analized using Kruskal-Wallis test of SPSS ver. 10.0 and a result of p<0.05 was judged significant. RESULTS: K-67 and p63 positive cells were highly correlated with the grade of dysplasia and invasiveness (p<0.0001). There were no differences of expression proportion between each group in p53 and p27. Ki-67 and p63 expression were increased in LSIL and HSIL groups, but not significant statistically in Ki-67 groups. In ASCUS group, Ki-67 and p63 expression level were higher but not significant statistically in p63 groups. In CIS/SCC groups, Ki-67 and p63 expression levels were higher than any other groups. CONCLUSION: We confirmed the efficacy of Ki-67, the cell proliferation marker for discrimination of CIN. Along with p63 immunohistochemical stain, Ki-67 can be used for auxiliary test to detect microinvasive squamous cell carcinoma and to discriminate CIN. p63 may be helpful in detecting cancer cell invading stromal tissue and can be used as a marker of differentiation of squamous cell for poorly differentiated tumor or mixed type tumor.

P21 and p53 expression in patients with epithelial ovarian carcinoma / 대한산부인과학회지

OBJECTIVE: Mutations in p53 are the most common genetic alterations in human malignancies. Expression of its protein product has been linked to decreased survival rate in ovarian carcinoma. P53 is well known as a pro-apoptotic tumor suppressor gene, but less is known about the importance of p21 expression in patients with epithelial ovarian malignancies. The purpose of this study was to investigate the different expression levels of p53 and p21 in various cell type of epithelial ovarian carcinomas and to determine their clinical significances. METHODS: Fifty eight patients (serous (n=18), mucinous (n=14), clear cell (n=12), endometrioid (n=14) carcinoma) with epithelial ovarian carcinoma were studied using paraffin-embedded tissue specimens. Immunohistochemical staining utilizing monoclonal antibody against p21 and p53 were performed. Amount of their proteins were quantified using western blotting. RESULTS: Mean age was 49.2 years old and advanced stage (III and IV) of cancer were 26 (44.8%). Recurrence rate and death rate were 20.7%, 22.4% respectively. With immunohistochemical staining for p21 and p53, p53 were significantly strongly stained in almost all epithelial ovarian carcinomas. However, p21 expressions were found in 10% of patients with serous carcinoma, 14% of patients with mucinous carcinoma, 38% of patients with endometrioid carcinoma, but 100% of patients with clear cell carcinoma. Among the patients whose tumors showed p21 staining, over expression were found in all clear cell typein western blot. But positive staining for p21 was below 10% in each slides of serous, mucinous and endometrioid type of ovarian carcinoma except clear cell type. This finding suggest that P21 expression was independent pathway in cell cycle regulation and apoptosis to the expression of p53 in serous, mucinous, and endometrioid type of ovarian carcinoma, but showed strongly positive correlation P21 and p53 expression in clear cell carcinoma. CONCLUSION: P21 may be used as a marker for confirmation of diagnosis of clear cell carcinoma due to its unique expressions of p21.

A case of ectopic pregnancy in the previous Cesarean section scar treated by laparoscopic surgery / 대한산부인과학회지

Pregnancy in the previous Cesarean section scar is a very rare form of ectopic pregnancy. This ectopic pregnancy may cause grave complications such as severe vaginal bleeding or spontaneous uterine rupture. Suction curettage, exploratory laparotomy, or systemic or local injection of methotrexate is the treatment method currently performed. In this report, we treat a case of this patient by laparoscopic surgery. By this surgery, we could successfully remove gestational sac from the implantation site and repair the defect by primary suture and preserve uterus.

Risk of malignancy index in the preoperative evaluation of ovarian masses / 부인종양

OBJECTIVE: To assess the ability of risk of malignancy index (RMI) based on ultrasound findings, serum levels of CA 125, and menopausal status to discriminate between benign and malignant ovarian masses for preoperative screening. METHODS: A retrospective study was conducted of 255 women with ovarian masses admitted for operation at the Department of Obstetrics and Gynecology, Hanyang University Hospital between 1999 and 2003. The sensitivity and specificity of serum levels of CA 125, ultrasound findings, and menopausal status were calculated both separately and combined into a RMI to diagnose malignancy. RESULTS: There were significant preoperative differences of ultrasound findings, serum CA 125 level, serum CA 19-9 level, platelet count and menopausal status between benign and malignant ovarian masses (P<0.05). Using a cut-off value of 100 to indicate malignancy, the RMI gave a sensitivity of 81.7%, specificity of 81.9%. The RMI was more accurate in predicting malignancy than each one of its components measured individually. CONCLUSION: The RMI is able to correctly discriminate between malignant and benign ovarian masses. This preoperative evaluation of women with ovarian masses is anticipated to help plan their management.

A case of pelvic splenosis after splenectomy: A cause of pelvic pain / 대한산부인과학회지

Splenosis represents the autotransplantation of splenic tissue, after splenic trauma or surgery. These splenic implants may be located anywhere in the abdominal cavity. These implants may misinterpreted as endometriosis or malignancy. We present a case of multiple pelvic splenic implants after a splenectomy.

Intravenous Leiomyomatosis extending to Right Atrium: A case report / 대한흉부외과학회지

Intravenous leiomyomatosis is a rare neoplasm characterized by intravenous growth of histologically benign smooth muscle cell tumor. We report a case of intravenous leiomyomatosis with right atrial extension in a 19-year-old woman. Various surgical techniques and approaches have been previously reported. In this case, the tumor was removed with a single-stage approach via laparotomy without cardiopulmonary bypass.

Intravenous Leiomyomatosis with Cardiac Extension: 1 Case

Intravenous leiomyomatosis (IVL) is a rare neoplasm that is characterized by a histologically benigh-looking smooth muscle cell tumor growing within the uterine and the extrauterine venous system. We report here on patient had a uterine and extrauterine leiomyoma that extended into the right atrium through the inferior vena cava. A 19-year old female patient was suffering from dyspnea, swelling of the lower extremity, abdominal pain and abdominal distension. She had total abdominal hysterectomy performed at a private clinic due to uterine leiomyoma 4 months previously. 4 months after the first operation, we again completely excised the recurred intraperitoneal tumor mass. At 6 months after the re-operation, the tumor mass recurred intraperitoneally. A preoperative abdominal CT scan and an echocardiogram revealed multiple tumor masses that were located intraperitoneally and they extended to the right atrium. We performed intraperitoneal tumor excision and removal of the intravenous tumor mass via the right iliac vein by the one-stage approach. At present, the patient has shown a clinically favorable outcome except for local recurrence of tumor mass in the pelvic cavity. The cure of this complex disease emphasizes the need for a planned systemic approach by a multidisciplinary surgical team. We present here an unusual case of intravenous leiomyomatosis that originated from the uterus and it extended to the inferior vena cava and right atrium.

The effectiveness of Lysophosphatic acid (LPA) as a biological marker in gynecologic cancer patients / 대한산부인과학회잡지

OBJECTIVE: LPAs are suggested as useful biological markers in early detection of ovarian carcinoma and other gynecological malignancies except breast and hematologic malignancy. We assessed the possible diagnostic role of serum LPA level in cervical, ovarian and the uterine corpus in Korean women. METHODS: The patients were enrolled in Hanyang University Hospital, Department of OB/GYN from Jan. 1999 to Jun. 2001. There were 19 ovarian carcinomas including 2 metastatic carcinomas, and 1 primary peritoneal carcinoma, 10 cervical carcinomas, 6 uterine carcinomas, 15 benign tumor as the study group and 5 healthy nulliparous women as the control group. Plasma was obtained following the centrifuge of whole blood, LPA was extracted from the plasma and the level was assessed by tandem mass spectrometry in multiple reaction mode. The quantity was measured by ratio of level of LPA and standard material, C14:0 LPA, in chromatogram compared with standard. The level of LPA were compared among control group, benign disease and gynecological malignancies, and also with conventional tumor markers. The statistical significance was analyzed by unpaired student-T test and McNemar test. RESULTS: The mean level of LPA and standard deviation were 7.1698 nmol/mL, 1.70 in malignancies, 4.5357 nmol/mL, 1.10 in benign disease and 5.2812 nmol/mL, 0.88 in healthy control. The level of LPA was significantly higher than in benign and control groups (p0.05). But, in cervical cancer, LPA level is more sensitive than CEA (p=0.039). CONCLUSION: The levels of LPA in cervical cancer, uterine cancer, ovarian carcinoma were significantly higher than in benign disease. Thus LPA is considered as an useful tumor marker in diagnosis and follow-up after treatment, especially in recurrent cervical carcinoma and uterine carcinoma which have no sensitive tumor markers. But further study with large number of casesfor a long period is required for clinical application in the future.

Clinical Efficacy of Levonorgestrel-Releasing Intrauterine System (Mirena(R)) for Abnormal Uterine Bleeding / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to study the clinical efficacy of Levonorgestrel-releasing intrauterine system (Mirena(R)) for patients who have abnormal uterine bleeding before menopause or sustaining vaginal spotting during postmenopaual hormone replacement therapy. METHODS: Between June, 2001 and June, 2003, forty six premenopausal women with abnormal uterine bleeding such as menorrhagia and intermenstrual bleeding who did not prefer surgical treatment (Group 1) and twenty four postmenopausal patients with vaginal spotting (Group 2) were included in this study. The various parameters such as uterine bleeding, dysmenorrhea, volume changes of myoma or adenomyosis, and endometrial thickness were evaluated by transvaginal ultrasound examination before and after Levonorgestrel- releasing intrauterine system usage. RESULTS: A significant reduction in abnormal bleeding (26.3 vs 11.0) (p<0.0001) and dysmenorrhea (11.6 vs 6.1) (p<0.0001) were noticed. However, there was no significant change in volume of uterine myoma (40.0 vs 11.3) (p=0.282) and adenomyosis (103.0 vs 95.83) (p=0.266) before and after Mirena(R) insertion in Group 1. Vaginal spotting during hormone replacement therapy disappeared completely in 18/24. Also there was a significant reduction in endometrial thickness (6.3 vs 4.9) (p<0.0001) after Mirena(R) insertion in both group 1 and group 2. CONCLUSION: Levonorgestrel-releasing intrauterine system insertion was acceptable and convenient therapeutic modality for abnormal uterine bleeding of premenopausal abnormal uterine bleeding and vaginal spotting during the postmenopausal hormone replacement therapy.

A Case of Heterotopic Pregnancy after in Vitro Fertilization and Embryo Transfer / 대한주산의학회잡지

Heterotopic pregnancy is a rare event, occurring less than 1 : 30,000 pregnancies in natural conception cycles. With assisted reproduction techniques, however, this incidence increase to between 1 : 100 and 1 : 500. It is known to present with a variety of symptoms and signs after leading to a delay in establishing the correct diagnosis. Delay in diagnosing and surgery can jeopardize both maternal well-being and survival of the intrauterine fetus. Prompt diagnosis and appropriate surgery contribute to the favorable outcome for the mother and surviving infant. We experienced a case of heterotopic pregnancy after in vitro fertilization and embryo transfer, which carried the intrauterine pregnancy to term delivery following rupture of the tubal pregnancy, with hypovolemic shock. So we report this case with review of literatures.

Analysis of Expression of p63 in Cervical Neoplasia Comparing with Other Immunohistochemical Markers

BACKGROUND: The reproducibility in grading a cervical intraepithelial neoplasia (CIN) are not perfect. The aim of this study was to assess the value of the immunohistochemical expression of p63 and the other biomarkers for grading a CIN (dysplasia and in situ carcinoma), and diagnosing invasive carcinomas. METHODS: Sixty six cervical specimens were immunostained with the monoclonal antibodies against p63, Ki-67, p27Kip1, and p53 to determine the localization. RESULTS: The p63 positive cells are well linked with squamous cell maturation and the degree of dysplasia. In mild dysplasia, the p63 positive cells were localized to the basal and parabasal cells, which gradually extended into the middle and upper layers in moderate and severe dysplasia. p63 expression was strong in immature squamous epithelium and invasive squamous cells, but was constantly absent in an adenocarcinoma. The Ki-67 positive cells were scattered from the parabasal cells to the superficial cells in accordance with the degree of dysplasia. p27Kip1 expression was noted in the intermediate cells in the normal cervix. In CIN, the p27Kip1 positive nuclei tended to extend to the basal cells, but it showed no diagnostic consistency in an invasive carcinoma. p53 expression was also variable. CONCLUSION: p63 is a useful diagnostic adjunct for grading CIN as well as for detecting microinvasion and squamous differentiation in invasive carcinoma. However, immunohistochemical expressions for the p27Kip1 and p53 have no correlation with the grade of CIN and squamous cell carcinoma.

A Study of Ovarian Dysfunction after Chemotherapy in Cancer Survivals / 대한산부인과학회잡지

OBJECTIVE: We analysed the duration of ovarian dysfunction, amenorrhea and pregnancy rate of the patients who underwent the fertility preserving surgery and adjuvant chemotherapy at the reproductive age to identify the contributing factors of ovarian dysfunction and premature menopause. METHODS: We select the 25 patients (<40 years old at diagnosis) among the 270 patients with malignant ovarian tumor who undergone conservative surgery and platinum-based adjuvant chemotherapy between the year 1985 and 2001. All patient was disease free state. Method used for follow up were physical exam, tumor markers and ultrasonography. We analysed age at diagnosis, amenorrheic period, recovery of ovarian function whether hormonal agent was used or not, times of pregnancy, times of successful pregnancy, and times of pregnancy outcome with anomaly. RESULTS: In 25 cases, patients who became pregnant had a shorter period of amenorrhea of 2.55 months compared to 20.47 months of the rest. Total times (Kur) of chemotherapy shows no difference between two groups (6.45 vs 6.33). Average age show no differences between two groups (22.43 years vs 22.9 years), but amenorrheic period increased in proportion to age at treatment and times of chemotheapy, so we can guess that ovarian dysfunction is more serious with higher age at diagnosis and many times of chemotherapy. In the group who had been pregnant, successful outcome were 7 of 9 total times of pregnancy (abortion rate was 22%), and no baby had gross anomaly. CONCLUSION: So we can guess that ovarian dysfunction is more serious with higher age at diagnosis and more times of chemotherapy.