Detection of Recurrence by 18F-FDG PET in Patients with Endometrial Cancer Showing No Evidence of Disease

This study assessed the feasibility of F-18-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) in the post-therapy surveillance for patients with endometrial cancer showing no evidence of disease (NED). From April 1997 to June 2007, 127 patients with endometrial cancer showing NED were performed 18F-FDG PET scan. The feasibility of 18F-FDG PET for the early detection of recurrence in patients with endometrial cancer was evaluated retrospectively. Of the 127 patients, 32 patients showed positive lesions on 18F-FDG PET scan. Nineteen (19/127 cases, 15%) of them were confirmed to have a recurrence clinically or histologically. The sensitivity, specificity and positive and negative predictive value of 18F-FDG PET for detecting recurrences in patients with endometrial cancer were 100%, 88%, 59% and 100%, respectively. In conclusion, 18F-FDG PET may be a useful method for the post-therapy surveillance in patients with endometrial cancer.

Clinicopathologic characteristics and prognostic factors of primary peritoneal carcinoma / 대한산부인과학회지

OBJECTIVE: The objective of this study was to examine the clinicopathologic characteristics and prognostic factors of primary peritoneal carcinoma (PPC). METHODS: Clinicopathologic variables were obtained by examining the medical records of patients with PPC who were diagnosed and treated at our institute, between January 1996 and December 2005. To find prognostic factors, the association of clinicopathologic variables with survival was evaluated by univariate and multivariate analysis. RESULTS: All patients had advanced-stage tumors. Residual tumor was smaller than 1 cm in 12 patients and was equal or larger than 1 cm in nine patients. The response rate to adjuvant chemotherapy was 47.6%. The median progression-free survival was eight months (range 1~95) and the median overall survival was 14 months (range 1~99). In univariate analysis, stage, the response to adjuvant chemotherapy, and neoadjuvant chemotherapy were associated with survival. However, in multivariate analysis, no variables were associated with survival. CONCLUSION: In spite of aggressive treatments, patients with PPC had poor prognosis. No prognostic factors were identified in this study.

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.

Modalities for evaluation of tumor size in cervical cancer / 부인종양

No abstract available.

A case of multiple primary malignancy involving the endometrial cancer / 부인종양

The incidence of multiple primary malignancy is extremely rare although the prevalence rate is increasing recently. There are several reasons of increment of multiple primary malignancy. First, the advances in the treatment and the diagnostic modality of malignancy have led to increased survival rate. So many of the patients who survived the first cancer could live long enough to develop additional primary cancers. Second, the long term effects of chemotherapy and radiation therapy have been proved oncogenic. Third, increasing age, environmental carcinogen, some kinds of viral infection, and genetic predisposition have potentials for multiple carcinogenesis. Most of multiple primary cancer is double primary, however triple primary cancer is rare. We experienced a case of triple primary cancer involving endometrium, colon, and stomach. We report this case with a review of literatures.

Outcome of cervical cancer in extremely elderly patients receiving radiation therapy / 부인종양

OBJECTIVE: The aim of this study was to evaluate the tolerance and outcome of elderly cervical cancer patients who were treated with radiation therapy retrospectively. METHODS: Fourteen patients over 80 years with pathologically proven stage I-IV cervical cancer who were treated with definitive RT between 1993 and 2003 were analyzed. We investigated response rates, recurrence rates, complications, progression free intervals, and current status of subjects. RESULTS: The age of the 14 patients ranged from 80 to 88 (median age: 81). The distribution of clinical stage by FIGO classification were > or =stage IIB (78.6%). The most common histologic type was squamous cell carcinoma. Nine patients (64.3%) underwent definitive radiation therapy. Among the 9 patients who had undergone radiotherapy, 7 patients (77.8%) showed complete response. One patient underwent surgical intervention followed by chemotherapy due to progression of disease despite radiotherapy. Two patients experienced radiation cystitis and 1 patient suffered from radiation colitis, however, other patients did not manifestate significant complications. One patient who underwent palliative chemotherapy due to persistent disease experienced mild marrow suppression and neurologic symptoms temporarily. CONCLUSION: The elderly patients over 80 years with good performance status may tolerate definitive pelvic radiation administered according to conventional fractionation schedules to control cervical cancer. Definitive radiation therapy with or without concurrent chemotherapy should not be excluded as a treatment option even for patients older than 80 years.

A case of alveolar rhabdomyosarcoma of vulva / 부인종양

Rhabdomyosarcoma is a malignant tumor of mesenchymal origin. It is the most common soft tissue sarcoma of childhood and approximately 250 new cases are diagnosed in the U.S. each year. The most common sites for rhabdomyosarcoma are the head and neck (parameningeal, orbit, paryngeal etc.), the extremities, and the genitourinary tract. Histologically, it can be classified into embryonal, alveolar, pleomorphic, and undifferentiated. Alveolar subtype accounts for approximately 25%. Alveolar rhabdomyosarcoma is very rare and its prognosis is very poor. Especially, cases that reported from vulva are extremely rare, and informations regarding treatment and prognosis are not standardized. We present a case of a girl with alveolar rhabdomyosarcoma of vulva with a review of a literature.

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.

Two Cases of Sertoli-Leydig Cell Tumor of Ovary / 대한산부인과학회잡지

The Sertoli-Leydig cell tumor is a rare sex cord stromal tumor of the ovary. It is the most common type of all virillizing ovarian tumors, accounting for less than 0.5% of all primary ovarian neoplasm. Recently, we experienced two cases of intermediately differentiated Sertoli-Leydig cell tumor with amenorrhea and so we present it with brief review of literature.

Two Cases of Sertoli-Leydig Cell Tumor of Ovary / 대한산부인과학회잡지

The Sertoli-Leydig cell tumor is a rare sex cord stromal tumor of the ovary. It is the most common type of all virillizing ovarian tumors, accounting for less than 0.5% of all primary ovarian neoplasm. Recently, we experienced two cases of intermediately differentiated Sertoli-Leydig cell tumor with amenorrhea and so we present it with brief review of literature.

Primary Ovarian Non-gestational Choriocarcinoma in a Young Women A Case Report / 대한산부인과학회잡지

Primay ovarian choriocarcinoma is very rare disease. Especially, non-gestational choriocarcinoma of ovary has worse prognosis than gestational tumor. Here, we report a non-gestational pure ovarian choriocarcinoma in 11 years old woman with the review of literature.

A Case of Sarcomatoid squamous cell carcinoma of the Uterine Cervix / 대한산부인과학회잡지

Primary cervical carcinosarcoma is very rare malignancy with fewer than 50 documented cases in the literature, which is a histologic variant of cervical cancer. In addition, sarcomatoid squamous cell carcinoma has been described in only 4 prior cases. We experienced a case of 42 year-old female with sarcomatoid squamous cell carcinoma of the uterine cervix. We report this case with a brief review of literatures.

Study of the Disease Free Intervals of the Patients with No Evidence of Disease by FDG-PET after Treatment and the Feasibility of FDG-PET as Follow up method / 대한산부인과학회잡지

OBJECTIVE: This study was aimed to investigate the disease free interval and feasibility of FDG-PET for following up the patients with no evidence of cervical cancer after primary treatment. METHODS: From May, 1998 to February, 2003, 406 patients with no evidence of cervical cancer by FDG-PET were investigated retrospectively. They underwent primary treatment and FDG-PET between 3 to 16 months after treatment. All of them were monitored closely after FDG-PET scanning. RESULTS: Of the 406 patients with no evidence of cervical cancer by FDG-PET after treatment, recurrence was detected in 17 patients. The recurrence sites were lymph nodes (7), lung (6), liver (1), central lesion (1) and others (2). The Mean disease free interval (DFI) in patients with No evidence of disease (NED) was 27 months, DFI with recurrence was 35 months, and the mean DFI in all patients were 28 months (p=0.051). FIGO stage, initial tumor size, status of lymph node metastasis and cell type had no effect on the recurrence rate of NED patients by FDG-PET. Our study also shows high false positive rate and low sensitivity in the conventional imaging and tumor marker. CONCLUSION: The FDG-PET is proved to be a useful imaging study for following up cervical cancer patients after primary treatment. If there is no evidence of disease by the first FDG-PET after primary treatment, we can expect the average disease free interval to be about 28 months. And it is suggested that the patients should undergo the FDG-PET every one or two years to detect possible early recurrence.

A Clinical Study of Pregnancy and Delivery in Women Aged 40 Years and Older / 대한산부인과학회잡지

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 40 years and older. METHODS: From January 1999 to June 2001, 7882 deliveries were in Gacheon Medical School. Among them we compared 95 cases of pregnant women aged 40 years and older with 94 cases of those aged under 40 years as a control group. RESULTS: The parity was higher in women aged older than 40 years compared to control group. Number of prenatal special studies was higher in women aged older than 40 years (n=82) compared to control group (n=14). In modes of delivery and indications for c/sec, there were no difference in two groups. There were no difference in prenatal complications between two groups. But, number of cases related to placenta previa, myoma and anemia were increased in women aged older than 40 years. In postpartum complications, uterine atony and hysterectomy, postpartum bleeding and placenta accreta were higher in women aged older than 40 years compared to control group. CONCLUSION: For pregnant women aged 40 years and older, a careful approach and appropriate management will be necessary for good pregnant outcome.

Aortic Compression to Control Massive Postpartum Hemorrhage / 대한산부인과학회잡지

Traditionally postpartum hemorrhage is a bleeding more than 500 ml that occurs immediately after the placenta is delivered. It remains one of the most common causes of maternal mortality. Morbid adhesion of the placenta is emerging as a major cause of massive postpartum hemorrhage unresponsive to medical therapy. We experienced three cases of major postpartum hemorrhage over 5,000 ml, developed from anterior placenta previa totalis with adhesion of placenta. The hemorrhage had been controlled successfully by compressing abdominal aorta intermittently with the operator's hand during Cesarean hysterectomy. In immediate life- threatening postpartum hemorrhage this simple and safe technique can be used in slowing the bleeding while stabilizing the patient and preparing for definitive treatment.

Development of an Evaluation Baseline Module for Clinical Clerkship: Gachon Medical School Experience / 한국의학교육

PURPOSE: The aims of this paper are to develop a student evaluation format as a part of core clinical clerkship (student internship) program at Gachon Medical School, and to identify its impeding factors in implementation. METHODS: Both rating scale of Likert type and check list for student's clerkship assessment were designed; the rating scale format was developed into two parts, namely attendance and the clinical competence demonstrated during the clerkship in which 3 domains of knowledge, skills and attitude were included in balance; the professional competence was made of 9 items, each being designed to accommodate 3 degrees by learner's performance. The clinical instructors in charge were requested to sit a short feedback session on the evaluation results with students who were signed at the end. Nursing staff was also asked to participate in evaluation of the student attitude in a limited area. RESULTS: Despite the full acceptance of the evaluation approach theoretically, its practical implementation was not successful because of difficulties related to adjustment of their department-based scoring system to the comprehensive assessment, or unfamiliarity with face-to-face feedback system. CONCLUSION: The authors assume that this Likert type of the rating scale is a simple, more comprehensive and strong tool to meet the learning objectives, and easy to enhance the feedback effect. It is, however, advised that the formative reporting system is crucial to transform the traditional evaluation approach into the pass/fail format so that unnecessary conversion risk is eliminated.

Prenatally Diagnosed Anterior Abdominal Wall Defects / 대한산부인과학회잡지

OBJECTIVE: Anterior abdominal wall defects are classified into three basic types: omphalocele, gastroschisis and bodystalk anomaly. Its incidence and prognosis are different according to each type of anomaly. We aimed at investigating its demographic characteristics and risk factors. METHODS: From Jan. 1996 to Jun. 2002, 20 cases of anterior abdominal wall defects were diagnosed by prenatal ultrasonography and all ultrasonographic findings and delivery records were reviewed. RESULTS: We had experienced 13 cases of omphalocele, 5 cases of gastroschisis and 2 cases of bodystalk anomaly. Mean maternal age was 29.9 (+/-5.5) years in omphalocele, 25.6 ( +/- 1.7) in gastroschiss, 32 ( +/- 4.2) in bodystalk anomaly. The median gestational weeks at the time of diagnosis was 17.6 for omphalocele, 20 for gastroschisis, 14.5 for bodystalk anomaly. Live born cases were 3 in omphalocele, 1 in gastroschisis and none in bodystalk anomaly. Of the 13 cases of chromosomal analyses, there was one case of trisomy 18 in omphalocele. Multiple anomalies were found in all bodystalk anomalies including kyphoscoliosis, facial defect, central nervous system defects. 54% of associated anomalies were found in omphalocele and no associated anomaly in gastroschisis. CONCLUSION: Omphaloceles were most frequently detected in abdominal wall defects and the gastroschisises were the next. Our results suggested that the pathogenesis of anterior abdominal wall defect might be different one another, but we could not find out definite risk factors for the individual type of defect.

Cytologic Features of Signet Ring Cell Carcinoma of the Uterine Cervix: A Report of Two Cases / 대한세포병리학회지

Signet ring cell carcinoma is a rare type of mucinous adenocarcinoma of the uterine cervix. To the best of our knowledge, there is no report on cytologic findings of primary signet ring cell carcinoma of the uterine cervix in the literature. Recently, we experienced two cases of signet ring cell carcinoma of the uterine cervix. The finding of characteristic signet ring cells on cervicovaginal smear led to the diagnosis of signet ring cell carcinoma. However, primary signet ring cell carcinoma could not be cytologically distinguished from more common metastatic tumor. Therefore, diagnosis rests upon the recognition of signet ring cells and the absence of signet ring cell carcinoma elsewhere.

Four Cases of Primary Serous Papillary Carcinoma of Peritoneum / 대한산부인과학회잡지

Primary serous papillary carcinoma of peritoneum (PSCP) is a tumor of the peritoneum, distinct from malignant mesothelioma, but similar in many ways to primary epithelial ovarian carcinoma (EOC). It seems to be histologically identical to EOC and is differentiated from EOC based on the extent of gross ovarian involvement and microscopic invasion of the cortex. Currently, PSCP is evaluated, staged and treated in the same fashion as EOC, with the Gynecologic Oncology Group trials for the treatment of EOC now open to patients with PSCP. Therefore it is managed surgically in the same way as EOC with shared goal of optimal cytoreduction. Although the preponderance of evidence supports the benefit of maximal cytoreductive efforts for EOC, only limited data are available for debulking in PSCP. Here we report four cases of PSCP with a short literature, in who excisions of all visible implants were performed and residual lesions were measured up to less than 2 cm.