The effect of body mass index on survival in advanced epithelial ovarian cancer.

Controversy remains regarding the effect of obesity on the survival of patients with ovarian cancer in Asia. This study examined the impact of obesity on the survival outcomes in advanced epithelial ovarian cancer (EOC) using Asian body mass index (BMI) criteria. The medical records of patients undergoing surgery for advanced (stage III and IV) EOC were reviewed. Statistical analyses included ANOVA, chi-square test, Kaplan-Meier survival and Cox regression analysis. Among all 236 patients, there were no differences in overall survival according to BMI except in underweight patients. In a multivariate Cox analysis, surgical optimality and underweight status were independent and significant prognostic factors for survival (HR, 2.302; 95% CI, 1.326-3.995; P=0.003 and HR, 8.622; 95% CI, 1.871-39.737; P = 0.006, respectively). In the subgroup of serous histology and optimal surgery, overweight and obese I patients showed better survival than normal weight patients (P = 0.012). We found that underweight BMI and surgical optimality are independent risk factors for the survival of patients with advanced ovarian cancer. High BMI groups (overweight, obese I and II) are not associated with the survival of advanced EOC patient. However, in the subgroup of EOC patients with serous histology and after optimal operation, overweight and obese I group patients show better survival than the normal weight group patients.

Detection of microRNA as novel biomarkers of epithelial ovarian cancer from the serum of ovarian cancer patients.

OBJECTIVE: MicroRNA (miRNA) is an abundant class of small noncoding RNAs that act as gene regulators. Recent studies have suggested that miRNA deregulation is associated with the initiation and progression of human cancer. However, information about cancer-related miRNA is mostly limited to tissue miRNA. The aim of this study was to find specific profiles of serum-derived miRNAs of ovarian cancer based on a comparative study using a miRNA microarray of serum, tissue, and ascites. METHODS: From 2 ovarian cancer patients and a healthy control, total RNA was isolated from their serum, tissue, and ascites, respectively, and analyzed by a microarray. Under the comparative study of each miRNA microarray, we sorted out several miRNAs showing a consistent regulation tendency throughout all 3 specimens and the greatest range of alteration in serum as potential biomarkers. The availability of biomarkers was confirmed by qRT-PCR of 18 patients and 12 controls. RESULTS: Out of 2222 kinds of total miRNAs that were identified in the microarray analysis, 95 miRNAs were down-regulated and 88 miRNAs were up-regulated, in the serum, tissue, and ascites of cancer patients. Among the miRNAs that showed a consistent regulation tendency through all specimens and showed more than a 2-fold difference in serum, 5 miRNAs (miR-132, miR-26a, let-7b, miR-145, and miR-143) were determined as the 5 most markedly down-regulated miRNAs in the serum from ovarian cancer patients with respect to those of controls. Four miRNAs (miR-132, miR-26a, let-7b, and miR-145) out of 5 selected miRNAs were significantly underexpressed in the serum of ovarian cancer patients in qRT-PCR. CONCLUSIONS: Serum miR-132, miR-26a, let-7b, and miR-145 could be considered as potential candidates as novel biomarkers in serous ovarian cancer. Also, serum miRNAs is a promising and useful tool for discriminating between controls and patients with serous ovarian cancer.

The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity.

OBJECTIVE: To analyse factors associated with endocervical cone margin involvement and suggest appropriate cone depth for the conization procedure. DESIGN: Retrospective cohort study. SETTING: Gynecological oncology center. POPULATION: One thousand two hundred and twenty women undergoing conization for cervical intraepithelial neoplasia (CIN) II or III or stage IA1 microinvasive cervical carcinoma. METHODS: The following factors were analysed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic curve analyses were used to determine the best cut-off points to define appropriate cone depth. MAIN OUTCOME MEASURES: Cone depth to avoid endecervical margin involvement. RESULTS: Ninety-one women had endocervical margin involvement (7.5%). This was positively associated with disease severity and age and inversely related to cone depth. In women under 50 years of age, the cut-off value was achieved at 1.8 cm cone depth, with high sensitivity and relatively low specificity [area under the curve (AUC) 0.64, sensitivity 0.86, specificity 0.27, p= 0.005]. For a subset of CIN II patients aged ≤50 years, the cut-off value was 1.2 cm (AUC 0.75, sensitivity 0.90, specificity 0.47, p= 0.008). In women <40 years of age, the cut-off value was 1.8 cm (AUC 0.60, sensitivity 0.88, specificity 0.25, p= 0.036). In a subset of CIN II, the cut-off value was 0.9 cm (AUC 0.87, sensitivity 0.83, specificity 0.69, p= 0.002). CONCLUSIONS: Age, disease severity and cone depth are predictive factors for endocervical margin involvement. In women of reproductive age, the appropriate cone depth to avoid endocervical margin involvement can be changed depending on age and disease severity.

The relationship between fat depot-specific preadipocyte differentiation and metabolic syndrome in obese women.

OBJECTIVE: Obesity is strongly associated with metabolic syndrome, but not all obese individuals display a clustering of metabolic risk factors. Recent studies have shown that in vitro subcutaneous (SC)-preadipocyte differentiation is negatively associated with obesity. These results suggest that impaired adipogenesis is an important factor linking obesity to metabolic disorders. We examined whether in vitro preadipocyte differentiation is associated with metabolic syndrome, independent of obesity. DESIGN/PATIENTS/MEASUREMENTS: Paired adipose tissue samples were obtained from the 13 nonobese women and the 65 obese women. The CD34(+)/CD31(-) cells were isolated from the stromal-vascular fraction of both SC and omental (OM) fat depots by immune magnetic separation, and the subset was cultured with a differentiation cocktail. Then, we analysed the relationship between the degree of preadipocyte differentiation and metabolic factors. RESULTS: Obese women without metabolic syndrome (n = 37) had significantly higher SC-preadipocyte differentiation than equally obese women with metabolic syndrome (n = 28); however, OM-preadipocyte differentiation was similar in both groups. SC-preadipocyte differentiation was strongly correlated with triglycerides, HDL cholesterol, homoeostasis model assessment of insulin resistance and OM-adipocyte size. However, OM-preadipocyte differentiation was not correlated with any of these parameters. CONCLUSIONS: This study identified that SC-preadipocyte differentiation is associated with metabolic syndrome independent of obesity, whereas OM-preadipocyte differentiation is not. These findings suggest that, in the setting of obesity, an enhanced adipogenic capacity of SC depots could be protective for metabolic syndrome. Our data underscores an interaction between adipose tissue homoeostasis and metabolic disorder.

Transvaginal single-port natural orifice transluminal endoscopic surgery for benign uterine adnexal pathologies.

Transvaginal natural orifice transluminal endoscopic surgery (NOTES) with pneumoperitoneum has been used in cholecystectomies, appendectomies, and nephrectomies, but transvaginal NOTES using a single port in gynecologic procedures has not been described despite gynecologist familiarity with the vaginal approach. We performed transvaginal single-port NOTES in 10 women with benign uterine adnexal disease: oophorectomy in 3 patients, salpingostomy and salpingectomy in 2 each, and ovarian cystectomy, paratubal cystectomy, and ovarian wedge resection in 1 each. The patients were discharged at 1 or 2 days postoperatively, and were satisfied, with minimal pain, no abdominal scar, and no complications at 2-month follow-up. We conclude that transvaginal single-port NOTES to treat benign uterine adnexal disease is a feasible and attractive option.

Candidates for tumor markers of cervical cancer discovered by proteomic analysis.

Cervical cancer is the second most common gynecological cancer among Korean women. While nationwide screening program has developed, the pathogenesis of cervical cancer is unknown. The aim of this study was to compare the protein expression profiles between cervical squamous carcinomas and normal cervical tissues in order to identify proteins that are related to the cancer. Three cervical cancer tissue samples and three normal cervical tissue samples were obtained and protein expression was compared and was identified in the samples with the use of matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS). A total of 20 proteins that showed up-regulated expression in the cervical cancer tissue samples were selected and identified. Seven proteins were matched to allograft inflammatory factor 1 (AIF-1), actine-like protein 2 (ALP2), brain type fatty acid-binding protein (B-FABP), NCK adaptor protein 1 (NCK-1), islet cell autoantigen 1 (ICA69), cationic trypsinogen (PRSS1), and cyclin-dependent kinase 4 (CDK4), but the remaining 13 proteins were unidentifiable. After confirmation by RT-PCR, Western blotting and immunohistochemistry, we found that B-FABP, NCK-1, and CDK4 were related to the pathogenesis of cervical cancer. These proteins are suggested as candidates of new pathological tumor markers for cervical cancer.

Relationship between serum estradiol and follicle-stimulating hormone levels and urodynamic results in women with stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The purpose of the current study was to determine the relationship between the serum estradiol (E2) and follicle-stimulating hormone (FSH) levels and the urodynamic study results in women with stress urinary incontinence (SUI). METHODS: Eighty women were selected among patients who underwent urodynamic testing for SUI. Basic demographic features were evaluated and laboratory tests were performed. Multiple linear regression analyses were performed among the serum E2 and FSH levels and urodynamic results. RESULTS: E2 had a negative correlation with the Q-tip test in post-menopause. FSH had positive correlations with the post-void residual volume in the uroflowmetry and the voiding and flow times in the pressure-flow study in all of the patients and a negative correlation with the peak flow rate in the pressure-flow study in pre-menopause. CONCLUSIONS: E2 and FSH were associated with urodynamic parameters in female patients with SUI.

Vaginal cuff closure: a comparison between the vaginal route and laparoscopic suture in patients undergoing total laparoscopic hysterectomy.

BACKGROUND: To compare the vaginal route and laparoscopic suture for vaginal cuff closure (VCC) in patients undergoing a total laparoscopic hysterectomy (TLH). METHODS: A total of 471 women who required hysterectomy were allocated to two groups. 261 women had TLH via VCC by the vaginal route and 210 women had TLH via VCC by laparoscopic suture. All TLHs were performed by the same laparoscopic surgeon. RESULTS: The cuff-related complications included vaginal disruption (3.4%), dehiscence (1.27%), vaginal vault bleeding (1.91%), vaginal spotting (19.32%), granulation (1.27%), cuff infection (1.49%), and yellowish vaginal discharge (6.16%). No difference in vaginal cuff complications was found between the laparoscopic and vaginal approach. The median operation time was significantly shorter for the laparoscopic suture (76.74 min, range 40-220; 95% CI 74.84-83.45) than the vaginal route for VCC (85.77 min, range 45-290; 95% CI 86.87-95.36) after hysterectomy (p < 0.001). CONCLUSION: For VCC with TLH, laparoscopic suture was a safe and less time-consuming procedure. The cuff-related complications were similar in the two groups.

Primary hepatoid adenocarcinoma of the endometrium with a high alphafetoprotein level.

Primary hepatoid adenocarcinoma of the endometrium is a rare tumour that is similar to hepatocellular carcinoma histologically. Here, a patient with primary hepatoid carcinoma of the endometrium with a high alphafetoprotein (AFP) level (90,508 ng/mL) is presented in a 75-year-old woman. The pelvic computed tomography and magnetic resonance imaging suggested a submucosal leiomyoma with degeneration or endometrial hyperplasia. However, the endometrial biopsy revealed a primary hepatoid carcinoma of the endometrium. The patient underwent a staging laparotomy including a total abdominal hysterectomy, bilateral salpingo-oophorectomy and lymph node sampling with pelvic cytology. The AFP level can be highly elevated in hepatoid carcinoma of the endometrium.

Age at menarche in a Korean population: secular trends and influencing factors.

This study was designed to identify the secular trend in the age at menarche and to investigate the possible factors that influence the age at menarche using representative Korean data from the 2005 Korean National Health and Nutrition Survey. Three thousand five hundred sixty-two women born between 1920 and 1985 were enrolled to identify secular trends in the age at menarche and 620 girls born between 1986 and 1995 were recruited to evaluate the factors influencing the age at onset of menarche. Mean age at menarche decreased from 16.90 +/- 1.25 years for women born between 1920 and 1925 to 13.79 +/- 1.37 years for those born between 1980 and 1985, indicating a downward trend of 0.68 years per decade (95% CI, 0.64-0.71) in age at menarche. Mean age at menarche of girls born between 1986 and 1995 was 13.10 +/- 0.06 years as estimated by the Kaplan-Meier method. Among girls born between 1986 and 1995, menarcheal girls had a larger waist circumference, a higher body mass index (BMI), and lower maternal menarcheal age and maternal age at birth than premenarcheal girls. The energy and nutrient intake of protein, sugar, fiber, ash, phosphate, natrium, thiamine, riboflavin, and niacin were greater for menarcheal girls than for premenarcheal girls. These data indicate a decreasing secular trend of age at menarche in a Korean population born between 1920 and 1995. Furthermore, maternal menarcheal age, BMI, maternal age at birth, and nutrition are important variables that appear to influence age at menarche in Korean girls.

Years from menopause-to-surgery is a major factor in the post-operative subjective outcome for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The purpose of the current study was to determine the main factors associated with post-operative subjective outcome in post-menopausal patients with pelvic organ prolapse. METHODS: Ninety-four women were selected among patients who underwent surgery for grade 3 or 4 prolapse. The outcome was evaluated by the Patient Global Impression of Improvement (PGI-I) scale. Multivariate ordinal regression analysis was performed. RESULTS: The number of patients with improvement (1 or 2 on the PGI-I scale) was 88 (93.7%). Age and years from menopause-to-surgery were negatively (beta = -0.16, P = 0.01) and positively (beta = 0.14, P = 0.01) associated with the PGI-I scale. The aging effect was lost after adjusting for prolapse grade. CONCLUSION: The greater the number of years from menopause-to-pelvic organ prolapse surgery, the less satisfied were the patients. The association between older patients and greater satisfaction appears to be a confounding effect of prolapse grade.

Prenatally detected congenital perineal mass using 3D ultrasound which was diagnosed as lipoblastoma combined with anorectal malformation: case report.

We report a case of prenatally diagnosed congenital perineal mass which was combined with anorectal malformation. The mass was successfully treated with posterior sagittal anorectoplasty postnatally. On ultrasound examination at a gestational age of 23 weeks the fetal perineal mass were found on the right side. Any other defects were not visible on ultrasonography during whole gestation. Amniocentesis was performed to evaluate the fetal karyotyping and acetylcholinesterase which were also normal. As the fetus grew up, the mass size was slowly increased more and more. At birth, a female neonate had a perineal mass on the right side as expected. During operation, the anal sphincteric displacement was found near the mass and reconstructed through posterior sagittal incision. This is the first reported case of prenatally diagnosed congenital perineal mass, after birth which was diagnosed as lipoblastoma and even combined with anorectal malformation. This case shows that it can be of clinical importance to be aware of this rare fetal perineal mass in prenatal diagnosis and counseling.

Primary small cell carcinoma of the endometrium: report of a case with immunochemical studies.

BACKGROUND: Small cell carcinoma (SCC) is a well-known tumor that occurs predominantly in the lung. These tumors may also occur in the female genital tract, where it occurs most commonly in the cervix. Primary SCC of the endometrium is extremely rare. We report a case of an endometrial tumor that was a combination of an SCC and endometrioid adenocarcinoma with squamous components and that penetrated half of the thickness of the uterine wall. CASE: A 59-year-old, postmenopausal woman suffering from postmenopausal bleeding presented for care. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node dissection, followed by concurrent chemoradiotherapy. Immunohistochemical studies showed neuroendocrine differentiation with positive CD 56, chromogranin and synaptophysin markers. CONCLUSION: Immunohistochemical analyses are helpful in diagnosing and differentiating primary SCC of the endometrium from benign and malignant diseases of the endometrium.

Classification and management of cervical ectopic pregnancies: experience at a single institution.

OBJECTIVE: To classify cervical ectopic pregnancies including previous cesarean section scar pregnancies and to describe the management of cervical ectopic pregnancies. STUDY DESIGN: This was a retrospective analysis of all cervical ectopic pregnancies, including previous cesarean scar pregnancies, diagnosed at the Korea University Guro Hospital, Seoul, Korea, between January 1997 and October 2009 using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. The pregnancies were categorized into three groups and subclassified into five types on the basis of transvaginal ultrasound and history of a previous cesarean delivery. The management of cervical pregnancies included medical treatment such as systemic methotrexate (single dose or multiple doses) or intraamniotic methotrexate and surgical treatment such as dilation and curettage (D&C), laparoscopic exploration and hysterectomy. RESULTS: Forty cervical ectopic pregnancies including previous cesarean section scar pregnancies were diagnosed. Cesarean section scar-related pregnancy (intramural type and nonintramural type) and cesarean section scar-unrelated pregnancy accounted for 10, 12 and 18 cases, respectively. D&C was performed in 21 patients and was successful in all cases except one. The success rate of medical treatment was 61.5% (8/13). Nine patients (22.5%) required a blood transfusion, and a total hysterectomy was performed in five patients (12.5%). CONCLUSION: Cervical ectopic pregnancies were classified, including previous cesarean scar pregnancies, into five types based on the findings of transvaginal ultrasound and history of a previous cesarean delivery.

Relationship between the serum CA-125 level and bone mineral density in healthy pre- and post-menopausal women.

BACKGROUND: Osteoporosis and tumour-associated antigen (TAA) levels are associated with inflammatory processes, but little remains known about TAA levels and bone mineral density (BMD). AIMS: We determined whether or not high-normal TAA levels are associated with a lower BMD in healthy women. METHODS: A total of 3769 healthy women were enrolled from the health screening programme over 5 years. Each participant had undergone a basic health examination. Serum carbohydrate antigen (CA)-125, CA-19-9, carcinoembryonic antigen (CEA) and alpha-fetoprotein levels were evaluated as tumour markers. The correlations between serum TAA levels and BMD were analysed. RESULTS: Carbohydrate antigen 125 and CEA levels were positively associated with a higher BMD in the pre-menopause. In the post-menopause, the CA-125 level was positively associated with BMD. In the pre-menopause, CA-125 (r = 0.102; P < 0.001) and CEA levels (r = 0.134; P < 0.001) had a significant correlation with BMD. In the post-menopause, CA-125 was negatively associated with alkaline phosphatase (r = -0.298; P < 0.001). CONCLUSIONS: There was a significant positive association between CA-125 and BMD in healthy women. Additional basic and clinical studies on the relationship between CA-125 and bone are needed.

An unusual presentation of a severely calcified parasitic leiomyoma in a postmenopausal woman.

We report the case of a calcified parasitic leiomyoma in a 51-year-old postmenopausal woman with lower abdominal discomfort. She had no history of surgery. Workup confirmed a calcified leiomyoma. On laparoscopy, the mass was separate from the uterus and adhered to the bowel and bladder. Histopathological examination confirmed a calcified leiomyoma. A calcified parasitic leiomyoma in a postmenopausal woman is rare. Most prior cases were in persons with a history of a laparoscopic myomectomy. The diagnosis can be made by radiological findings. Laparoscopic excision is the treatment of choice in such cases.

Borderline-like mucinous tumor arising in mature cystic teratoma of the ovary associated with pseudomyxoma peritonei.

SUMMARY: Pseudomyxoma peritonei (PMP) is now considered to originate from appendiceal mucinous neoplasms in almost all cases. However, a mucinous neoplasm arising in a mature cystic teratoma is rarely responsible for PMP. We herein report 2 cases of PMP associated with borderline mucinous tumors arising in mature cystic teratoma. Both ovarian borderline mucinous tumors were morphologically and immunohistochemically similar to the secondary tumors from appendiceal origin, and PMP was histologically similar to peritoneal adenomucinosis.

Current hormone therapy associated with atypical squamous cells of undetermined significance in postmenopausal women.

OBJECTIVE: This study evaluated the relationship between hormone therapy (HT) and squamous cytologic abnormalities of the cervix in postmenopausal Korean women. METHODS: Two hundred sixty-eight cases of atypical squamous cells of undetermined significance (ASCUS), or more severe cervical lesions, and 4728 negative controls were included in this study. Hormone therapy status was analyzed as functions of 2 categories (current user and noncurrent user) and 3 categories (never user, past user, and current user). RESULTS: With HT users categorized as current HT users and noncurrent users, HT use had a significant relationship with abnormal cervical squamous cells (chi2, P = 0.018). When the noncurrent users were more categorized into never users and past users, the relationship did not exist. There was a greater risk of cellular abnormality among current HT users than never users (odds ratio, 1.805; 95% confidence interval, 1.042-3.127; P = 0.035); the risk was no greater among past users than the never users. The risk was limited to ASCUS and not related to more advanced lesions. CONCLUSIONS: In postmenopausal women, current HT use might have an effect on initial abnormal changes of the cervical squamous cells, such as ASCUS; however, the effect is extinguished with respect to more advanced lesions.

Multiple vaginal mullerian cysts: a case report and review of literature.

Vaginal wall cysts occur rarely and can cause a variety of symptoms. A 33-year-old woman presented with a 2-week history of vaginal bulging and pelvic pressure. Pelvic examination revealed a protruding cystic mass on the anterior vaginal wall and two small cysts located in the left upper vaginal wall. The pelvic magnetic resonance imaging (MRI) revealed a non-septated homogenous vaginal cyst that was differentiated from the urethral diverticulum. MRI is useful for localizing and differentiating vaginal cysts. However, physical examination is important for the detection and characterization of small cysts.

Magnetic resonance imaging for assessment of deep endometrial invasion for patients with endometrial carcinoma.

AIMS: To evaluate the value of magnetic resonance imaging (MRI) for the detection of deep myometrial invasion. METHODS: The patient group consisted of 53 women with endometrial cancer who underwent preoperative workup, including MRI, and surgical staging between August 1999 and August 2008 at Korea University Medical Center, Seoul, South Korea. The pathological data from surgical staging were compared with the preoperative MRI results. RESULTS: The mean age of the patients was 51 years and most patients had endometrioid cancer. On pathological evaluation of the myometrium, 20.8% had a deep myometrial invasion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting deep myometrial invasion were 50.0%, 89.7%, 79.2%, 63.6% and 83.3%, respectively. Evaluation of MRI findings and tumour grades by preoperative biopsy had a sensitivity and specificity of 88.9% and 87.5%, respectively, with a kappa of 0.764. CONCLUSION: In patients with endometrial cancer, MRI is limited in its ability to detect deep myometrial invasion. The combination of MRI findings and tumour histology or grade can be helpful in determining if lymphadenectomy is necessary.