Follow-up of Cervical Intraepithelial Neoplasia after Conization: The Clinical Usefulness of Repeat Conization / 대한산부인과학회지

OBJECTIVE: This study is aimed to analyze the results of follow up after conization and to determine the value of repeat conization for treatment of cervical intraepithelial neoplasia (CIN) III. METHODS: Between March 1998 and February 2002, 241 women were underwent knife conization due to CIN III of the uterine cervix. After knife conization, follow-up visits were scheduled at 2 weeks interval during the first 3 months for cervical inspection only, then at every 3 months for the first year, every 6 months for the second year, and then annually for pelvic examination and Papanicolaou smears. Among 241 patients, 71 women were suspected of residual or recurrent lesions by cytology and colposcopy. Among 71 patients with residual or recurrent lesions, 37 patients received simple hysterectomy and 34 patients received repeat conization. RESULTS: The mean age of the patients was 36.4 years (range 27-64) and mean parity was 2 (range 0-6). The mean follow-up duration was 25.4 months (range 14-51) after conization. The results of repeat conization (n=34) were as follows; no residual lesion in 7 patients, CIN III in 15 patients, and lower grade neoplasia in 12 patients. Two patients were margin positive; 1 patient with CIN III, 1 patient with lower grade neoplasia. The outcomes of simple hysterectomy (n=37) were as follows; no residual lesion in 8 patients, CIN III in 18 patients, and lower grade neoplasia in 11 patients. Resection margin negative rates of repeat conization and simple hysterectomy were 94.1% and 100%, respectively (p>0.05). CONCLUSION: This study suggests that less invasive technique such as repeat conization might be an alternative method instead of hysterectomy in selected patients with recurrent or residual lesions who wish to preserve fertility.

Relationship between CD44v6 Expression and Clinicopathologic Parameters in Endometrial Carcinomas / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the clinical usefulness of CD44v6 in patients with histologically confirmed endometrial cancer. METHODS: Immunohistochemistry was used to determine the expression of CD44v6 in 39 hysterectomy specimens with the diagnosis of endometrial cancer. RESULTS: CD44v6 expression was detected in 8 specimens with no myometrial invasion of endometrial cancer, one specimen with 50% myometrial invasion. There was a significant association between CD44v6 expression and no myometrial invasion of endometrial cancer. There was a statistically significant association between CD44v6 expression and lymph node metastasis, lymphovascular involvement. And all cases of CD44v6 expression were FIGO stage I with histological grade 1 or 2. CD44v6 expression was statistically related with estrogen receptor expression. Although statistical significance was not revealed, it was likely that CD44v6 expression was related with progesterone receptor expression with positive predictive value of 6/9 (66.7%). CONCLUSION: Significant relationships between myometrial invasion, lymph node metastasis, lymphovascular involvement, surgical stage and expression of estrogen receptor and CD44v6 expression suggest that CD44v6 expression could be a good prognostic factor. CD44v6 expression may have potential clinical usefulness if this expression is demonstrated in a further study with prehysterectomy sampling specimens containing endometrial cancer.

Two Cases of Swyer Syndrome in Sisters / 대한산부인과학회잡지

46,XY pure gonadal dysgenesis, also known as Swyer syndrome, is a disorder of sexual differentiation. Its characteristics include a female phenotype without the somatic stigmata of Turner's syndrome, primary amenorrhea, sexual infatilism and bilateral streak gonads. Neoplasia occurs in 20-30% of individuals who have gonadal dysgenesis and Y chromosomal material. Gonadoblastoma and dysgerminoma are the most frequent tumor in phenotypic females with Y chromosome. One case was referred for palpable low abdominal mass. No other somatic abnormalities could be detected. Laparotomy revealed dysgerminoma of left ovary and mesenteric metastasis. In the course of postoperative adjuvant chemotherapy, her elder sister was diagnosed as Swyer syndrome. And karyotype of this patient was 46,XY, too. So right gonadectomy was performed thereafter. The other case visited for primary amenorrhea and delayed development of breast. Physical examination revealed no development of breast, no pubic and axillary hair. External genital organ was normal shaped. Peripheral blood karyotyping was 46,XY. Bilateral gonadectomy was performed and hormone replacement therapy was started. We report two cases of Swyer syndrome and review of literature.

Expression of CD44, p53 and p21 in Uterine Cervical Intraepithelial Neoplasia and Squamous Cell Carcinoma with Respect to HPV Status / 대한산부인과학회잡지

OBJECTIVE: To clarify the possible role of CD44, p53 and p21 in the development or progression of uterine cervical tumors, an immunohistochemical investigation was carried out on 99 cases of cervical intraepithelial neoplasia (CIN) III and stage Ib squamous cell carcinoma. Abnormal expression of CD44, p53 and p21 has been observed in a variety of human tumor, but little is known about its expression during cervical carcinogenesis. METHODS: The author examined the expression pattern of CD44, p53, and p21 in CIN III and invasive carcinoma groups with respect to high risk HPV positivity and tumor invasion. RESULTS: CD44s was expressed in CIN III and invasive carcinoma groups, and the positivities of expression were 75.0% and 52.7%, respectively. The positivities of CD44-v5 and CD44-v6 expression were 81.8%, 63.6% and 43.2%, 36.4%, respectively. The positivities of p53 and p21 expression in CIN III and invasive carcinoma groups were 18.2, 40.0% and 54.5%, 36.4%, respectively. This study revealed that neither CD44s nor CD44v appears to have independent prognostic relevance. No association between p53 immunostaining and p21 expression was found. Expression of CD44 and p21 was independent of the high risk HPV status, but expression of p53 is higher in the high risk HPV negative cases. CONCLUSION: The author demonstrated reduced expression of CD44 and increased expression of p53 with progression from CIN III to invasive squamous cell carcinoma. CD44 may have an important role in early tumorigenesis. Immunohistochemically detected CD44, p53 and p21 appeared to be of no predictive value with regard to clinical outcome.

A Case of Normal Spontaneous Vaginal Delivery in a Woman with Bicornuate Uterus 3 weeks after Expelling the Decidual Cast due to Spurious Labor of Contralateral Horn / 대한산부인과학회잡지

No abstract available.

Two Cases of Presacral Teratomas in Adult / 대한산부인과학회잡지

Teratomas are neoplasm composed of a wide variety of tissues foreign to the organs or anatomic sites in which they arise. They generally arise in gonads but a few cases are described in extragonadal sites, such as sacro-coccygeal region, mediastinum, neck, and retroperitoneum. Most sacrococcygeal teratomas are encountered in infants, particularly in neonates, and a primary sacrococcygeal teratoma is a extremely rare neoplasm in adults. Recently, we experienced two cases of presacral teratomas arising in adult, therefore we present these cases with a brief review of the literatures

Pulmonary Thromboembolism Following Spinal Anesthesia: A case report / 대한마취과학회지

Pulmonary thrombo-embolism in operating room is one of the important cause of morbidity and mortality in patients undergoing femur neck fracture surgery. However, the diagnosis of pulmonary thromboembolism may not be easy because sudden shock can have many different causes (e.g. myocardial infarction, hypovolemia, pneumothorax, non-cardiogenic pulmonary edema, pulmonary thrombo- embolism) and specialized diagnostic tools are not readily available in the operating room. Rapid and accurate diagnosis of pulmonary thromboembolism is very important in outcome of patients. We report a case in which pulmonary thromboembolism under spinal anesthesia occured just before the beginning of operation.