Modalities for evaluation of tumor size in cervical cancer / 부인종양

No abstract available.

Accelerated Hyperfractionated Radiotherapy for Locally Advanced Uterine Cervix Cancers / 대한방사선종양학회지

PURPOSE: To assess the efficacy of the use of accelerated hyperfractionated radiotherapy (AHRT) for locally advanced uterine cervix cancers. MATERIALS AND METHODS: Between May 2000 and September 2002, 179 patients were identified with FIGO stage IIB, IIIB, and IVA cancers. Of the 179 patients, 45 patients were treated with AHRT (AHRT group) and 134 patients were treated with conventional radiotherapy (CRT group), respectively. Patients undergoing the AHRT regimen received a dose of 30 Gy in 20 fractions (1.5 Gyx2 fractions/day) to the whole pelvis. Subsequently, with a midline block, we administered a parametrial boost with a dose of 20 Gy using 2 Gy fractions. Patients also received two courses of low-dose-rate brachytherapy, up to a total dose of 85~90 Gy to point A. In the CRT group of patients, the total dose to point A was 85~90 Gy. The overall treatment duration was a median of 37 and 66 days for patients that received AHRT and CRT, respectively. Statistical analysis was calculated by use of the Kaplan-Meier method, the log-rank test, and Chi-squared test. RESULTS: For patients that received cisplatin-based concurrent chemotherapy and radiotherapy, the local control rate at 5 years was 100% and 79.2% for the AHRT and CRT group of patients, respectively (p=0.028). The 5-year survival rate for patients with a stage IIB bulky tumor was 82.6% and 62.1% for the AHRT group and CRT group, respectively (p=0.040). There was no statistically significant difference for severe late toxicity between the two groups (p=0.561). CONCLUSION: In this study, we observed that treatment with AHRT with concurrent chemotherapy allows a significant advantage of local control and survival for locally advanced uterine cervix cancers.

A case of primary leiomyosarcoma of the mesentery with hepatic metastasis / 부인종양

Primary tumors of the mesentery are uncommon, and primary leiomyosarcoma of the mesentery is especially rare, and thus an accurate preoperative diagnosis is difficult. We experienced a case of 32-year female with primary leiomyosarcoma of the mesentery. We report this case with a brief review of the literature.

Two cases of synchronous squamous cell carcinoma and adenocarcinoma of the uterine cervix / 부인종양

Cervical cancer is the most common malignancy of the female genital tract in Korea. The most common histologic type of cervical cancer is squamous cell carcinoma. The simultaneous occurrence of histologically distinct squamous cell carcinoma of the cervix and invasive adenocarcinoma of the cervix is extremely unusual. We have experienced two cases of synchronous squamous cell carcinoma and adenocarcinoma of the uterine cervix. We report these cases with a brief review of the literature.

The Aberrant Expression of FHIT Transcripts in Uterine Cervical Cancer using Laser-capture Microdissection / 대한산부인과학회지

OBJECTIVE: This study was performed to determine the exact pattern of FHIT expression of the cervical carcinoma cell per se by microdissection and to investigate the clinical significance of the FHIT alteration in cervical cancer. METHODS: RT-PCR for FHIT transcript was performed in 18 cervical cancer tissues. Microdissection was performed using laser capture microdissection device and RNA was extracted by RT-nested PCR. PCR products were compared with known aberrant FHIT transcripts. Immunohistochemical analysis was performed to evaluate correlation between the altered expression of FHIT protein and clinical parameters. RESULTS: Six different size of aberrant FHIT transcripts were observed in cervical cancer tissues. Six of 18 (33.3%) cervical cancer sections exhibited full-length normal FHIT transcript only. Aberrant FHIT transcripts with normal one were observed in 9 (50%) and only aberrant transcripts in 3 (16.7%) frozen sections. Five normal cervical tissues expressed only a normal FHIT transcript. The sequences of the 6 different sizes of aberrant FHIT transcripts showed (1) deletion of exons 4-8, (2) deletion of exons 4-7, (3) deletion of exons 5-8, (4) deletion of exons 5-7, (5) deletion of exons 5-7 and insertion of intronic sequences, 153 bp, (6) deletion of exons 5-7 and insertion of intronic sequences, 84 bp. Microdissection of paired cervical tumor and normal stroma showed expression of aberrant FHIT transcripts only in tumor tissues. CONCLUSION: Aberrant FHIT expression was observed frequently in cervical carcinoma and they were observed mainly in cervical cancer cells by microdissection, but not in normal stromal cells. However, absence of FHIT expression did not correlate with clinical prognostic factors in cervical carcinoma.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

A Case of Persistent Endometrial Cancer with Metastasis to Bone / 대한산부인과학회잡지

In endometrial cancer, the risk of metastasis to bone seems to be rare. We describe the clinicopathologic features of a rare case of endometrial endometrioid adenocarcinoma presenting as a metastasis to the ischium in a 37-year-old premenopausal woman. The patient had treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy and bilateral pelvic lymphadenectomy followed by radiotherapy. Three months later, Pelvic bone metastasis was detected and palliative radiotherapy was performed. After a follow-up of 1 year, she underwent palliative right hindquater amputation and T-colostomy. Postoperative follow-up of the case has no evidence of disease 6 months after operation.

A Case of Adenoid Basal Carcinoma of the Uterine Cervix / 대한산부인과학회잡지

Adenoid basal carcinoma of the uterine cervix is rare tumors that have often been regarded as a single entity. 14 cases with adenoid basal carcinoma of the uterine cervix have been reported in the literature. We experienced a case of 36-year female with adenoid basal carcinoma of the uterine cervix. We report this case with a brief review of the literature.

A Case of Colonic Metastasis of Recurrent Cervical Cancer / 대한산부인과학회잡지

It is estimated that approximately 35% of patients with invasive cervical cancer will have recurrent or persistent disease following therapy. The common metastatic sites of recurrent cervical cancer included the lung, liver and vertebra, however, colon metastases from cervical cancer were extremely rare. Recently we experienced a case of colonic metastasis in a patient with cervical cancer who had been treated with radiation and chemotherapy. We present this case with a brief review of literature.

A case of mixed germ cell tumor of the ovary / 대한산부인과학회잡지

Malignant germ cell tumors of the ovary are rare gynecologic tumors usually affecting younger women. Recently, we experienced a case of 11-year old female with mixed germ cell tumor of ovary which was composed of yolk sac tumor and immature teratoma with high serum levels of alpha-fetoprotein (AFP) and human chorionic gonadoprotein (hCG). We report this case with brief review of concerned literature.

Clinicopathologic Characteristics of 42 Cases of Krukenberg Tumor of the Ovary / 대한산부인과학회잡지

OBJECTIVES: This study is to investigate clinicopathologic characteristics, survival and prognostic factors in patients with Krukenberg tumor of the ovary. MATERIAL & METHODS: From Jan. 1991 to Dec. 2000, 42 patients with Krukenberg tumor of the ovary were investigated with clinical profiles, such as age, stage, primary sites, clinical symptoms, and survival, retrospectively. RESULTS: A mean age of 42 patients was 44.8 years (range 27-77). Stomach was the most frequent primary site (30/42, 71.4%), followed by colon (7/42, 16.7%) and gallbladder (1/42, 2.4%). In 38 patients, primary sites diagnosed before or after 1 month of diagnosis of Krukenberg tumor of ovary (36/38 cases, 94.7%). The most common feature of patients with Krukenberg tumor of ovary was bilateral abdominal mass. 5-year survival rate of patients with Krukenberg tumor of ovary was 8.94% (95% CI=3.33-14.55) and median survival time was 11 months. Age, bilaterality of tumor, time of diagnosis, presence of ascites and the primary site did not affect the survival. The patients who received post-operative adjuvant chemotherapy had better 3-year survival than those who did not (17.28% vs 10% p=0.03). CONCLUSION: Krukenberg tumor of the ovary is an aggressive tumor with poor prognosis. Post-operative adjuvant chemotherapy may increase the survival of patients with Krukenberg tumor of the ovary. Further prospective studies for the role of surgery and chemotherapy are needed.

Clinicopathologic Characteristics of 42 Cases of Krukenberg Tumor of the Ovary / 대한산부인과학회잡지

OBJECTIVES: This study is to investigate clinicopathologic characteristics, survival and prognostic factors in patients with Krukenberg tumor of the ovary. MATERIAL & METHODS: From Jan. 1991 to Dec. 2000, 42 patients with Krukenberg tumor of the ovary were investigated with clinical profiles, such as age, stage, primary sites, clinical symptoms, and survival, retrospectively. RESULTS: A mean age of 42 patients was 44.8 years (range 27-77). Stomach was the most frequent primary site (30/42, 71.4%), followed by colon (7/42, 16.7%) and gallbladder (1/42, 2.4%). In 38 patients, primary sites diagnosed before or after 1 month of diagnosis of Krukenberg tumor of ovary (36/38 cases, 94.7%). The most common feature of patients with Krukenberg tumor of ovary was bilateral abdominal mass. 5-year survival rate of patients with Krukenberg tumor of ovary was 8.94% (95% CI=3.33-14.55) and median survival time was 11 months. Age, bilaterality of tumor, time of diagnosis, presence of ascites and the primary site did not affect the survival. The patients who received post-operative adjuvant chemotherapy had better 3-year survival than those who did not (17.28% vs 10% p=0.03). CONCLUSION: Krukenberg tumor of the ovary is an aggressive tumor with poor prognosis. Post-operative adjuvant chemotherapy may increase the survival of patients with Krukenberg tumor of the ovary. Further prospective studies for the role of surgery and chemotherapy are needed.

Paclitaxel-Cisplatin regimen as First-Line Chemotherapy after Cytoreductive Surgery in Patients with Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: The purpose of this retrospective study is to assess the efficacy and toxicity of paclitaxel/cisplatin as first-line chemotherapy after cytoreductive surgery in patients with epithelial ovarian cancer. MATERIAL & METHODS: From November 1999 to April 2001, 31 patients with histologically-proven epithelial ovarian cancer not previously treated with chemotherapy entered the study. FIGO stage IA or IB and grade 1 or 2 tumors were excluded. A comprehensive staging was performed during initial laparotomy. Paclitaxel was administered at a dose of 135 mg/m2, intravenously with cisplatin (75 mg/m2) every 3 weeks for 6 planned cycles, with prophylactic oral dexamethasone regimen (20 mg b.i.d.). The response of patients was evaluated with tumor markers and CT before and after chemotherapy. Responses and toxicities were defined according to the Gynecologic Oncology Group (GOG) criteria. RESULTS: The overall response rates were 73% (16/22) in patients with residual disease after cytoreductive surgery (complete response, 64%; partial response, 9%). The median survival was 18 months. Grade 3/4 neutropenia and neuropathy (grade 2) were observed in 16 (52%), 12 (39%) patients, respectively. CONCLUSION: The combination of paclitaxel and cisplatin is a well tolerated regimen with significant activity in the treatment of epithelial ovarian carcinoma after surgery.

Paclitaxel-Cisplatin regimen as First-Line Chemotherapy after Cytoreductive Surgery in Patients with Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: The purpose of this retrospective study is to assess the efficacy and toxicity of paclitaxel/cisplatin as first-line chemotherapy after cytoreductive surgery in patients with epithelial ovarian cancer. MATERIAL & METHODS: From November 1999 to April 2001, 31 patients with histologically-proven epithelial ovarian cancer not previously treated with chemotherapy entered the study. FIGO stage IA or IB and grade 1 or 2 tumors were excluded. A comprehensive staging was performed during initial laparotomy. Paclitaxel was administered at a dose of 135 mg/m2, intravenously with cisplatin (75 mg/m2) every 3 weeks for 6 planned cycles, with prophylactic oral dexamethasone regimen (20 mg b.i.d.). The response of patients was evaluated with tumor markers and CT before and after chemotherapy. Responses and toxicities were defined according to the Gynecologic Oncology Group (GOG) criteria. RESULTS: The overall response rates were 73% (16/22) in patients with residual disease after cytoreductive surgery (complete response, 64%; partial response, 9%). The median survival was 18 months. Grade 3/4 neutropenia and neuropathy (grade 2) were observed in 16 (52%), 12 (39%) patients, respectively. CONCLUSION: The combination of paclitaxel and cisplatin is a well tolerated regimen with significant activity in the treatment of epithelial ovarian carcinoma after surgery.

The Application of Doppler Ultrasound in the Assessment of Fetal Weight / 대한산부인과학회잡지

OBJECTIVE: The objective of this study was to determine the relationship between the fetal doppler flow velocimetry and birth weight in low risk pregnancy population. METHODS: From December 1995 to May 1996, We prospectively performed doppler study in 254 uncomplicated, term pregnant women, who visited Pohang Hospital, Dongguk University. Using pulsed color doppler, we measured umbilical artery RI, middle cerebral artery RI and middle cerebral-umbilical artery RI ratio within one week before delivery. RESULTS: The result was that low birth weight group (below 2500gm) had very significant lationship with umbilical artery RI(P<0.01), middle cerebral artery RI(P<0.05) and middle cerebral-umbilical artery RI ratio(P<0.05), but there was no significant relationship in these blood flow indices between normal birth weight group (2501gm- 3999gm) and macrosomia group (above 4000gm). CONCLUSIONS: We concluded that application of doppler ultrasonopaphy in the assessment of fetal weight is somewhat helpful for identification of low birth weight, not for macrosomia.

Sertoli Cell Adenomas in Complete Testicular Feminization Syndrome / 대한산부인과학회잡지

Testicular feminization is an uncommon genetic disorder with considerably familial predisposition and results in total feminization due to end-organ unresponsiveness to androgens. It is characterized by the presence of testes in phenotypically female with adequate breast development, normal extemal genitalia, absence of mullerian structures, and meager or absence of body hair. These patients characteristically have male karyotype(XY) and negative sex chromatin and are at increased risk of undergoing malignant transformation of the undescended gonad. In recent times, the malignant potential of the dysgenetic gonads in the intersex patients with a Y chromosome has been stressed by many authors, but few reports of an association between testicular feminization syndrome and benign tumors such as Sertoli cell adenomas. In the present study, postoperative pathology revealed that the gonads were Sertoli cell adenomas. The main features of clinical presentation and histological studies are briefly discussed with a review of the literature.

Two Cases of Mayer-Rokitansky-Kster-Hauser Syndrome Managed by McIndoe Operation / 대한산부인과학회잡지

Mayer-Rokitansky-Kster-Hauser Syndrome is characterized by the absence of the vagina and uterus, the presence of apparently normal tubes and ovaries, feminine appeara-nce, normal female secondary sexual characteristics, a normal 46,XX karyotype, and a fem-inine psychosexual orientation. Various methods of surgical treatment have been introduced, but the ideal method is still not found. The two cases reviewed in this paper were all treated with McIndoe operation using full thickness skin graft. Both women were satisfied with vaginal depth and excellent result was achieved. We report two vaginoplasties in patients of Mayer-Rokitansky-Kster-Hauser Syndr- ome including a brief review of literature.

A Clinical Study of Multiple Primary Malignancies in Patients Treated for Cervical Carcinoma / 대한산부인과학회잡지

BACKGROUND: Knowledge about the degree of risk and location of multiple primary cancers can facilitate the targeting of screening and surveillance practices on follow-up after treatment of cervical cancer. PURPOSE: The retrospective study was performed to evaluate the characteristics of multiple primary malignancies in patients treated for cervical carcinoma. METHOD: From data base file of gynecologic cancer patients between 1976 and 1995, total 20 patients were found to have cervical cancer and another primary malignancy. Their medical records and pathologic slides were reviewed. Follow-up information was obtained from medical records or by telephone. RESULT: There were 8 synchronous and 12 metachronous multiple primary cancers (MPC) among 20 patients. Their mean age was 51 years (range 23 ~ 68 years). The distribution of FIGO stage of the patients with cervical cancer was classified into stage I, 6 patients; stage II, 9 ; and stage III, 5. All patients showed squamous cell type histology of cervical cancer. Eight(40 %) of 20 patients developed second cancer in uterus : 6 malignant mixed Mllerian tumors(MMMT), one endometrial stromal sarcoma, and one endometrial adenocarcinoma. Seven of 8 synchronous type MPC patients are alive (median follow-up, 27 months). In contrast, only one out of 12 metachronous type MPC patients is alive(median follow-up, 114 months). The occurrence of eight malignancies including 6 MMMT, one bladder cancer, and one rectal cancer might be related with previous radiation therapy for cervical cancer. CONCLUSION: These results suggest that routine screening and surveillance work-up might not be necessary in most of patients with cervical cancer. However, the patients with cervical cancer undergoing radiation treatment have to be followed carefully with the consideration of possibility for developing second cancer in the field of irradiation.