A Case of Recurrent Aggressive Angiomyxoma of the Vulva / 대한산부인과학회지

Aggressive angiomyxoma (AAM) is an extremely uncommon neoplasm of the female genitalia. This tumor arises from soft tissue of the perineum, and affects predominantly young women. Although surgical excision with wide tumor-free margins may be necessary to obtain a complete cure, some of patients experience local recurrences because of the infiltrative nature of this tumor. We experienced a case of recurrent huge AAM on the right vulva in 29-year-old woman and reported it with a brief review of literature.

Expression of E-cadherin and Catenin (alpha-, beta-catenin) in Endometrial Cancer and Atypical Complex Endometrial Hyperplasia / 대한산부인과학회지

OBJECTIVE: To evaluate the correlation of the expression of E-cadherin, alpha-catenin, beta-catenin and the clinicopathological features in endometrial cancer (EC) and atypical complex endometrial hyperplasia (ACEH). METHODS: Immunohistochemical (IHC) staining of E-cadherin, alpha-catenin, beta-catenin was performed in tissues of 6 ACEHs, 44 endometrioid ECs. We analyzed the correlation of the expression of IHC staining with the prognostic factors according to tumor stage of ACEH and EC, histopathologic grade, and myometrial invasion. RESULTS: According to tumor stage, reduced E-cadherin expression and abnormal alpha-catenin expression were observed more frequently in advanced stage (reduced E-cadherin: ACEH 0%, stage I-II 47.2%, stage III-IV 62.5%, p=0.050; abnormal alpha-catenin: ACEH 0%, stage I-II 27.8%, stage III-IV 62.5%, p=0.035). All of the IHC staining showed no correlation with the depth of myometrial invasion but showed correlation with presence of myometrial invasion (reduced E-cadherin: invasion(-) 14.3%, invasion(+) 66.7%, p =0.001; abnormal alpha-catenin: invasion(-) 7.1%, invasion (+) 46.0%, p=0.010; abnormal beta-catenin: invasion(-) 7.1%, invasion(+) 63.0%, p=0.000). According to histological differentiation only abnormal beta-catenin expression shows relationship with histopathologic grade (grade 1:23.1%, grade 2:60%, grade 3:62.5%, p=0.039). CONCLUSION: Expression of E-cadherin and alpha-catenin showed significantly more reduced expression in EC than in ACEH, and more reduced expression in advanced stage, myometrial invasion and high histopathologic grade. And alpha-catenin showed more frequent abnormal expression in advanced stage, myometrial invasion and beta-catenin showed more frequent in myometrial invasion, high histopathologic grade significantly. These results suggests that the expression of E-cadherin and alpha-catenin, beta-catenin in EC and ACEH could be related to prognosis of the tumor.

Labor Induction at Term with Different Regimens of Misoprostol / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the efficacy and the safety of two different dose regimens of intravaginal misoprostol for labor induction. METHODS: Sixty-seven consenting women with maternal or fetal indication for labor and no prior cesarean delivery were randomly assigned to receive either vaginal misoprostol 100 microgram or 50 microgram every 4 hours with maximum 6 doses. Uterine contraction, abnormal fetal heart rate pattern, mean time from induction to vaginal delivery, apgar score, and meconium staining were compaired. RESULTS: In two groups, dermographic characteristics and the average number of doses of misoprostol used were simliar. The group who were administered 100 ug misprostol showed shorter average time interval from induction to delivery. Both groups showed similiar result in terms of tachysystole, abnormal fetal heart rate tracing, meconium passage, fetal weight, low 1-min and 5-min Apgar scores, and admission to the neonatal intensive care unit. CONCLUSION: The optimal misoprostol dose to induce labor in term pregnant women has not been established. We also could not find any difference between two groups (100 microgram or 50 microgram every 4 hours) in time interval from induction to delivery and neonatal outcomes.

A Case of Wernicke's Encephalopathy due to Hyperemesis gravidarum / 대한산부인과학회잡지

Hyperemesis gravidarum is a complication defined as nausea and vomiting during early pregnancy. Wernickes encephalopathy is an illness of acute onset characterized by mental disturbance, paralysis of eye movements, and ataxia of gait cause by thiamine deficiency. We recently experienced a case of Wernickes encephalopalhy due to hyperemesis gravidarum, which is treated by administration of thiamine even though outcome of serious healthy problem to both mother and fetus, and reported it with a brief review of the literature.

Role of annexin-I in cervical cancer cell proliferation / 대한산부인과학회잡지

OBJECTIVES: To investigate the role of annexin-I in human cervical cancer, we evaluated the expression of annexin-I and the relation with the proliferation of cancer cells. Methods: By immunohistochemical analysis and the western blotting of annexin-I , we investigated the extent and distribution of the expression of annexin-I in cervical cancer tissues. After treating the human cancer cell lines ( SiHa and HeLa cell lines ) with tamoxifen, estradiol, and retinoic acid for 5 days to make the cells proliferate and antiproliferate, we measured the proliferation simultaneously with 3-(4,5- dimethyl thiazol- 2-yl)-2,5-diphenyl-tetr -azolium bromide (MTT) colorimetric assay and the expression level of annexin-I with flowcytometry. RESULTS: In the immunohistochemical stains, a granular staining pattern involving the entire cytoplasm was more heavily observed in malignant lesions than in normals. In the western blotting, the antibodies against 35-kDa annexin-I appeared to react more strongly with the lysates of cancer tissues than normal and benign tissues. In SiHa and HeLa cell lines with tamoxifen and beta- estradiol treatment, increased expressions of annexin-I were noted with correlated increased proliferation of cells, and with the treatments of all trans retinoic acid, decreased expressions of annexin-I were noted with correlated decreased proliferation of cells. CONCLUSIONS: The results suggest that the expression of annexin-I might correlate with cervical cancer than normal and the proliferation of cancer cells.

A Case of Primary Malignant Lymphoma of the Ovary / 대한산부인과학회잡지

A 41-year-old woman was operated under the impression of ovarian malignancy. The ovarian mass was diagnosed as a non-Hodgkin's lymphoma, diffuse large cell type of B lineage pathologically. Because regional lymph nodes and bone marrow were not involved and Ga67 whole body bone scan was normal, we suspected that ovary was a primary site of lymphoma. After six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, prednisone) chemotherapy, complete remission status was maintained for 16 months. We report a case of primary ovarian lymphoma with a review of literatures.

Diagnostic Accuracy of Cytology, Colposcopically Directed Biopsy and Conization and Predictive Factors for Residual Tumor after Conization in Patients with Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. METHODS: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. RESULTS: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. CONCLUSION: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.

Comparison of the Clinical Outcomes Between Cisplatin-Chemoradiotherapy and Radiotherapy Alone in Patient with Cervical Cancer / 대한부인종양콜포스코피학회잡지

We compared the therapeutic effects of concomitant chemoradiotherapy (CRT) using cisplatin to single radiotherapy (RT) in uterine cervical cancer. 34 cases of non-operable uterine cervical cancer were reviewed retrospectively from Mar, 1993 to May, 1996 in St. Mary' s Hospital. The patients were randomly selected to compare the effects of both methods. 22 patients were included in CRT group and 12 patients in RT group. The results were as follows: 1. The decrease of tumor size was not significant (2.17 cm in CRT and 1.95 cm in RT) (p=0.61), but the number of responders of CRT group was larger than that of RT group significantly (p0.05) 3. The overall survival rate showed no difference between two groups (p>0.05). The disease-free survivals for 38 months were 17.02% in CRT and 11.36% in RT, but it was not significant (p>0.05). In conclusion, concomitant chemoradiotherapy showed better rate of response, but size of tumor decrease and tumor markers showed no difference. CRT might improve the overall survival and disease-free survival, although it was not significant in this study. The clinical significance of CRT remains to be determined in large randomized clinical trial.