The significance of Human Papillomavirus viral load by using hybrid capture II assay in diagnosis of CIN II or above in women with PAP smear showing only ASCUS/LSIL / 대한산부인과학회지

OBJECTIVE: To determine the clinical significance of high risk Human papillomavirus (HPV) DNA viral load measured by hybrid capture (HC) II assay in diagnosis of CIN II or above in women with cervical smear showing only Atypical squamous cells of undetermined significance (ASCUS)/Low-grade squamous intraepithelial lesion (LSIL). METHODS: This study was performed from September 2003 to September 2004 and included 111 patients with ASCUS/LSIL on PAP smear. All of them underwent high risk HPV DNA tests by HC II assay and colposcopy directed cervical biopsies. The histologic results were classified as low grade lesion (normal, CIN I) and high grade lesion (CIN II, III, and invasive cancer). The viral load was transformed into their logarithm (Log10RLU/PC ratio), and categorized as following four groups; negative HPV DNA (Log10RLU/PC or =2.0). We evaluated the relationships of the detection rate and viral load of high risk HPV DNA with histologic severity of cervical lesions. RESULTS: The rate of CIN II or above in 111 patients with ASCUS/LSIL was 25.2%. The detection rate of high risk HPV DNA using HC II assay was 96.4% in high grade lesion, and 66.3% in low grade lesion of histologic test. There was strong correlation between CIN II or above and positivity for HPV DNA when this group was compared with women with only CIN I or normal cervix (OR:13.7, 95% CI:1.7-106.4). The higher the viral load of HPV DNA infection observed, the higher the probability of being associated with stage of CIN (correlation coefficient:0.279). The frequency of high viral load observed in high grade lesion (89.3%) was significantly higher than low grade lesion (33.7%)(OR:16.3, 95% CI:4.5-58.9). When the cutoff of positivity was changed from 1.0RLU/PC ratio to 100.0RLU/PC ratio (Log10 RLU/PC ratio=2.0), the sensitivity for the prediction of high grade lesion was slightly decreased (96.4->89.3%), but pronounced gain in specificity (33.7->66.3%), and reduction in false positive rate (66.3->33.7%). CONCLUSION: The viral load of high risk HPV DNA measured by HC II assay was significantly associated with the severity of histology, and useful in diagnosis of CIN II or above in women referred because of ASCUS/LSIL on PAP smear.

Clinical Study of Ectopic Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this article is to assist in early diagnosis and treatment of ectopic pregnancy. METHODS: We analyzed clinical statistics of 401 patients, who visited Masan Samsung Hospital from January 1, 1998 to December 31, 2002, received treatment under diagnosis of ectopic pregnancy, and were comfirmed by histopathologic examination. RESULTS: During the index period, the occurrence rate of ectopic pregnancy was 1:16.5, with peak age of occurrence between 30 to 34 year-old (34.4%). Previous history of artificial abortion was noted in 76.1%, previous cesarean delivery in 17%, previous pelvic inflammatory disease in 15.7% and history of previous ectopic pregancy in 9.5%. Concerned to clinical manifestations, lower abdominal pain was reported in 93.3%, amenorrhea in 86.5%, and vaginal bleeding in 69.3%. Onset of clinical manifestation was 6-8 weeks from the last menstrual period in 39.7%, being the most common. As the implantation site, fallopian tube was affected in 95.3%, ovary in 3%, and cervix of the uterus in 1%. Total amount of intraperitoneal hemorrhage was less then 500 mL in 45.6%. As an operative treatment, salpingectomy of the affected side was conducted in 76.8%. Average lengths of hospital stay for laparoscopy versus laparotomy were 3.4 and 5.2 days, respectively. CONCLUSION: Ectopic pregnancy, as a common emergent disorders, requires continuous attention for women in reproductive age. With the aid of various diagnostic modalities, early diagnosis and treatment can reduce mortality and morbidity rates, and enhance future fetility.

The Vaginal Hysterectomy for the Woman with Uterine Enlargement / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the relationship between uterine size and surgical outcomes in women undergoing total vaginal hysterectomy. METHODS: We reviewed the medical records of the 170 patients who underwent total vaginal hysterectomy from February 2001 to November 2003. These patients were stratified into two groups; Group I, patients with uterine weight of between 300 gm to 1000 gm; Group II, patients with uterine weight of 300 gm) is not an absolute contraindication to vaginal hysterectomy.

Struma Ovarii Asssociated with Pseudo-Meigs' Syndrome and Elevated Serum CA 125 / 대한산부인과학회잡지

Meigs' syndrome is defined as serous ascites and hydrothorax in association with a benign ovarian fibroma, thecoma, granulosa cell tumor; the ascites and hydrothorax must resolve fully after removal of the tumor. Pseudo-Meigs' syndrome refers to the same clinical features associated with other ovarian or gynaecological tumors. Although struma ovarii is associated with ascites in up to one third of cases it has only rarely been reported to cause Pseudo-Meigs' syndrome. We have experienced a case of Pseudo-Meigs' syndrome with an elevated CA 125 resulting from struma ovarii with a brief review of the concerned literatures.

A Case of Adenocarcinoma in Situ of the Fallopian Tube / 대한산부인과학회잡지

Primary carcinoma of the fallopian tube is the rarest cancer of the female genital tract with an incidence of 1% all gynecologic tumors Moreover, adenocarcinoma in situ of fallopian tube accounts for approximately 1% of primary fallopian tube cancer. Ovarian cancer and primary carcinoma of the fallopian tube are similar in many aspects. Both carcinomas show an increase incidence among nulliparous women, are often of serous papillay histology, and they have not only a poor pronosis with stage and residual tumor size as important prognostic factors, but also respond to paclitaxel-based treatment. Nevertheless, presenting symptoms are variable and nonspecific, so pre-operative diagnosis of fallopian tube carcinoma is seldom made. We have experiened a case of primary adenocarcinoma in situ of fallopian tube and reported with brief review of literature.

A Clinical, Pathologic and Prognostic Features of Adnexal Masses Operated on during Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate retrospective data concerning patients with adnexal masses that were managed surgically during pregnancy and their effect on fetal outcome. METHODS: Data were reviewed concerning pregnant women who required surgery at our hospital from January 1991 to December 2000 for an adnexal mass. RESULTS: In the recent 10 years at our hospital a total of 47 pregnant women aged 27.9+/-3.6 years were diagnosed with adnexal masses that required surgery. The masses were removed at 12.3+/-3.7 weeks of gestation and maximum diameter was 8.4+/-2.3 cm. The pathologic features of the 47 lesions were as follows : 17 mature cystic teratomas, 14 epithelial origins (12 serous cystadenoma, 2 mucinous cystadenoma), 9 functional cysts, 4 endometriotic cysts, 2 paraovarian cysts, 1 malignant neoplasm. Of the 41 patients for whom the outcome of pregnancy was available, 2 (4.2%) gave preterm birth before 37 weeks, while 4 (8.5%) experienced spontaneous abortion. There were not any perinatal death for the 43 infants. CONCLUSION: Although our studies are smaller for confirmation, so larger studies are required, but our results suggest that an adnexal mass may be associated with an adverse fetal outcome. Surgical intervention at<22 weeks of gestation might not have been related to the adverse fetal outcomes.