Comparison of diagnostic accuracy between endometrial curettage and aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean Gynecologic Oncology Group study / 부인종양

Objective@#To compare the diagnostic accuracy of dilatation and curettage (D&C) versus endometrial aspiration biopsy in follow-up evaluation of patients treated with progestin for endometrial hyperplasia (EH) Methods: A prospective multicenter study was conducted from 2015 to 2018. Patients with EH were treated with progestin, one of the following three treatment regimens: oral medroxyprogesterone acetate (MPA) 10 mg/day for 14 days per cycle, continuous MPA 10 mg/day or the levonorgestrel-releasing intrauterine system (LNG-IUS). At 3 or 6 months of treatment, endometrial tissues were obtained via 2 methods in each patient: aspiration biopsy, followed by D&C. The primary outcome was the consistency of the histologic results between the 2 methods. The secondary outcome was the regression rate at 6 months of treatment. @*Results@#The study population comprised 65 patients (55 with non-atypical hyperplasia, 10 with atypical hyperplasia). During the follow-up, a comparison of the pathologic results from aspiration biopsy and D&C was carried out for the 65 cases. Thirty-eight cases were diagnosed as EH by D&C. Among these, only 24 were diagnosed with EH from aspiration biopsy, for a diagnostic concordance of 63.2% (ĸ=0.59). Forty-four patients were followed up at 6 months, and the regression rate was 31.8% (14/44). Responses were obtained for 41.7% (5/12) of the cyclic MPA group, 58.3% (7/12) of the continuous MPA group and 10% (2/20) of the LNG-IUS group. @*Conclusion@#As a follow-up evaluation of patients treated with progestin for EH, aspiration biopsy is less accurate than D&C and might not be a reliable method.

Comparison of diagnostic accuracy between endometrial curettage and aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean Gynecologic Oncology Group study / 부인종양

Objective@#To compare the diagnostic accuracy of dilatation and curettage (D&C) versus endometrial aspiration biopsy in follow-up evaluation of patients treated with progestin for endometrial hyperplasia (EH) Methods: A prospective multicenter study was conducted from 2015 to 2018. Patients with EH were treated with progestin, one of the following three treatment regimens: oral medroxyprogesterone acetate (MPA) 10 mg/day for 14 days per cycle, continuous MPA 10 mg/day or the levonorgestrel-releasing intrauterine system (LNG-IUS). At 3 or 6 months of treatment, endometrial tissues were obtained via 2 methods in each patient: aspiration biopsy, followed by D&C. The primary outcome was the consistency of the histologic results between the 2 methods. The secondary outcome was the regression rate at 6 months of treatment. @*Results@#The study population comprised 65 patients (55 with non-atypical hyperplasia, 10 with atypical hyperplasia). During the follow-up, a comparison of the pathologic results from aspiration biopsy and D&C was carried out for the 65 cases. Thirty-eight cases were diagnosed as EH by D&C. Among these, only 24 were diagnosed with EH from aspiration biopsy, for a diagnostic concordance of 63.2% (ĸ=0.59). Forty-four patients were followed up at 6 months, and the regression rate was 31.8% (14/44). Responses were obtained for 41.7% (5/12) of the cyclic MPA group, 58.3% (7/12) of the continuous MPA group and 10% (2/20) of the LNG-IUS group. @*Conclusion@#As a follow-up evaluation of patients treated with progestin for EH, aspiration biopsy is less accurate than D&C and might not be a reliable method.

Clinical factors that affect diagnostic discrepancy between colposcopically directed biopsies and loop electrosurgical excision procedure conization of the uterine cervix

OBJECTIVE: This study aimed to determine the factors affecting pathologic discrepancy and final diagnosis between colposcopic biopsy and pathology by loop electrosurgical excision procedure (LEEP). METHODS: Between 2004 and 2016, 1,200 patients who underwent LEEP were enrolled for this study. 667 underwent cervical cytology, human papillomavirus (HPV) test, colposcopic biopsy, and LEEP. We analyzed patient's age, menopausal status, number of delivery, abortion times, cervical cytology, number of punch biopsies, HPV type, LEEP, and interval between colposcopic biopsy and LEEP. RESULTS: Logistic regression analysis of the final diagnosis showed that age 30–39 years and other high HPV group types were associated with cancer diagnosis, whereas atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL), and HPV type 16 affected the diagnosis of cervical intraepithelial neoplasia (CIN) 2. The overall concordance rate of histopathology between punch biopsy and LEEP was 43.3%. The rates of detecting a more severe lesion by LEEP than those by biopsy were 23.1%. The rates of a less severe lesion detected by LEEP than those by biopsy were 33.6%. Factors related with biopsy underestimation were as follows: < 1 vaginal delivery, HSIL, number of punch biopsies and HPV type. Punch biopsy number is a unique factor of biopsy overestimation. CONCLUSION: Patients with ASC-H, HSIL, and HPV type 16 may undergo conization immediately without colposcopic biopsy. We suggest that colposcopically directed 3 to 5 punch biopsies may be used to determine the need for conization.

Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement / 부인종양

Clinical practice guidelines for gynecologic cancers have been developed by many organizations. Although these guidelines have much in common in terms of the practice of standard of care for uterine corpus cancer, practice guidelines that reflect the characteristics of patients and healthcare and insurance systems are needed for each country. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to produce the third edition of the guidelines as an advanced form based on evidence-based medicine, considering up-to-date clinical trials and abundant qualified Korean data. These guidelines cover screening, surgery, adjuvant treatment, and advanced and recurrent disease with respect to endometrial carcinoma and uterine sarcoma. The committee members and many gynecologic oncologists derived key questions from the discussion, and a number of relevant scientific literatures were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, together with other details. The objective of these practice guidelines is to establish standard policies on issues in clinical areas related to the management of uterine corpus cancer based on the findings in published papers to date and the consensus of experts as a KSGO Consensus Statement.

Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to compare the results of postoperative adjuvant radiotherapy (RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma. MATERIALS AND METHODS: We analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma who were treated with postoperative adjuvant RT or concurrent CRT between March 1999 and July 2013. Thirty-two patients who received postoperative RT alone were matched with those who received postoperative CRT (n=32) in accordance to age, stage, and tumor histology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRT arms were evaluated and compared. RESULTS: The 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. There was no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms (p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factor for relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade 3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alone arm (6.2% vs. 31.2%, p=0.010). CONCLUSION: Adjuvant pelvic concurrent chemoradioherapy did not show superior results in overall survival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.

Aging

Aging is initiated based on genetic and environmental factors that operate from the time of birth of organisms. Aging induces physiological phenomena such as reduction of cell counts, deterioration of tissue proteins, tissue atrophy, a decrease of the metabolic rate, reduction of body fluids, and calcium metabolism abnormalities, with final progression onto pathological aging. Despite the efforts from many researchers, the progression and the mechanisms of aging are not clearly understood yet. Therefore, the authors would like to introduce several theories which have gained attentions among the published theories up to date; genetic program theory, wear-and-tear theory, telomere theory, endocrine theory, DNA damage hypothesis, error catastrophe theory, the rate of living theory, mitochondrial theory, and free radical theory. Although there have been many studies that have tried to prevent aging and prolong life, here we introduce a couple of theories which have been proven more or less; food, exercise, and diet restriction.

Prevalence and Seroprevalence of Low-Risk Human Papillomavirus in Korean Women

Little is known about the prevalence and seroprevalence of low-risk human papillomavirus (HPV) and the risk factors for HPV infection in Korean women. We determined the prevalence of low-risk HPV among 902 women aged 20-59 yr and the seroprevalence of low-risk HPV subtypes 6 and 11 among 1,094 women aged 9-59 yr in the general population. Genital low-risk HPV DNA was assessed by liquid hybridization and polymerase chain reaction. Antibody titers against HPV 6 and 11 were measured by a multiplexed competitive luminex technique. The prevalence of genital low-risk HPV was 4.9%. It reached its highest peak of 10.3% at 20-29 yr of age and a second peak of 3.2% at 50-59 yr of age. The seroprevalence of HPV 6 or 11 was 9.4%. It reached its highest peak of 12.7% at 25-29 yr of age and a second peak of 12.3% at 50-59 yr of age. In multivariable analysis, the number of lifetime sexual partners and past history of sexually transmitted diseases were associated with the seroprevalence but not prevalence of HPV. It is suggested that younger women should receive prophylactic HPV vaccination before they become sexually active and exposed to HPV in their 20s. This study provides baseline data for developing HPV vaccination programs and monitoring vaccine efficacy in Korea.

Treatment outcome in patients with vulvar cancer: comparison of concurrent radiotherapy to postoperative radiotherapy

PURPOSE: To evaluate outcome and morbidity in patients with vulvar cancer treated with radiotherapy, concurrent chemoradiotherapy or postoperative radiotherapy. MATERIALS AND METHODS: The records of 24 patients treated with radiotherapy for vulvar cancer between July 1993 and September 2009 were retrospectively reviewed. All patients received once daily 1.8-4 Gy fractions external beam radiotherapy to median 51.2 Gy (range, 19.8 to 81.6 Gy) on pelvis and inguinal nodes. Seven patients were treated with primary concurrent chemoradiotherapy, one patient was treated with primary radiotherapy alone, four patients received palliative radiotherapy, and twelve patients were treated with postoperative radiotherapy. RESULTS: Twenty patients were eligible for response evaluation. Response rate was 55% (11/20). The 5-year disease free survival was 42.2% and 5-year overall survival was 46.2%, respectively. Fifty percent (12/24) experienced with acute skin complications of grade III or more during radiotherapy. Late complications were found in 8 patients. 50% (6/12) of patients treated with lymph node dissection experienced severe late complications. One patient died of sepsis from lymphedema. However, only 16.6% (2/12) of patients treated with primary radiotherapy developed late complications. CONCLUSION: Outcome of patients with vulvar cancer treated with radiotherapy showed relatively good local control and low recurrence. Severe late toxicities remained higher in patients treated with both node dissection and radiotherapy.

Rate of Isolation and Trends of Antimicrobial Resistance of Multidrug Resistant Pseudomonas Aeruginosa from Otorrhea in Chronic Suppurative Otitis Media

OBJECTIVES: To assess the rate of isolation of Pseudomonas aeruginosa (PA) and multidrug-resistant PA (MDR-PA) from patients with chronic suppurative otitis media (CSOM) otorrhea and the annual trend of antibiotic-resistance. METHODS: Otorrhea samples were collected aseptically from 1,598 CSOM patients. The rate of bacterial isolation and the results of antibiotic susceptibility testing were evaluated retrospectively. RESULTS: The PA isolation rate from CSOM otorrhea was 24.4%. Of the 398 isolated strains tested for their susceptibilities to 10 antibiotics, 395 strains showed definitive results. Of these, 183 (46.3%) were susceptible to whole antibiotics and 212 (53.7%) was resistant to more than 1 antibiotics, with the frequency of antibiotics-resistance increasing significantly over time. Although strains susceptible to all antibiotics decreased over time, the rate of isolation of MDR-PA did not change significantly. Resistance to aminoglycosides and quinolones was higher than to other antibiotics and significantly increased over time, whereas resistance to other antibiotics showed no trend. CONCLUSION: MDR-PA, assessed using five individual antibiotics and six antibiotic-classes, showed no tendency to increase or decrease over time. This may have been due to increased concern about antibiotic-resistant bacterial strains, leading to improved infection control within hospitals and healthcare centers.

A clear cell cystadenofibroma of the ovary / 대한산부인과학회지

Most clear cell tumors of the ovaries are carcinomas; benign and borderline clear cell tumors are uncommon. We describe here a 52-year-old postmenopausal woman with an ovarian clear cell cystadenofibroma that was misdiagnosed before surgery as a borderline malignant cystic mass of the ovary. The ovarian mass had cystic and solid components. Histological examination revealed widely spaced simple glands embedded in a dense fibrous stroma. The glands were lined with one to two layers of hobnail cells, flattened cells, or cells with abundant clear cytoplasm. The patient successfully underwent a left oophoro-salpingectomy.

Dexamethasone effects on survival, differentiation, and proliferation of peritoneal (or B-1 cells) and splenic B cells / 대한산부인과학회지

OBJECTIVE: Although the characteristic feature and function of peritoneal B (B-1) cells are very different from splenic B (B-2) cells, peritoneal B cell study is not known well. The aim of this study is to investigate the effects of dexamethasone on peritoneal (or B-1 cells) and splenic B cells (or B-2 cells). METHODS: The synthetic corticosteroid, dexamethasome, was injected to BALBc mice intraperitoneally or subcutaneously at 4-5 pm for 7 days. Expression level of B cell surface marker analyzed by flow cytometry. The purified peritoneal B cell and splenic B cells were obtained and cell survival rate was analysed by flow cytometry. Isolated B cells were cultured in medium with different concentration of dexamaethasone. During the culture of these cells, immunoglobulin secreted into the culture supernatants was evaluated by enzyme-linked immunosorbent assay. Entering of S phase was measured by proliferative assay. RESULTS: Subcutaneous injection of high dose of Dexamethasone for 7 days did not affect cell surface markers of peritoneal and splenic B cells. However, all cell surface markers of peritoneal B cell after the treatment of dexamethasone are reduced by daily intraperitoneal injection of dexamethasone for 2 days. The survival rate of peritoneal and splenic B cell decrease with increasing concentration of dexamethasone. Proliferation of peritoneal B cells was less affected by dexamethasone than that of splenic B cells (p<0.05). CONCLUSIONS: Dexamethasone induced apoptosis in both peritoneal and splenic B cells. Proliferation and differentiation of splenic B cells were affected by dexamethasone, but peritoneal B cells are less sensitive to dexamethasone.

Severe preeclampsia at 16 weeks' gestation associated with a partial hydatidiform mole and bilateral theca-lutein cysts / 대한산부인과학회지

We present an unusual case in which a patient was diagnosed with the preeclampsia associated with a partial hydatidiform mole and bilateral theca-lutein cysts. The patient newly developed proteinuric hypertension at 16 weeks' gestation. Ultrasound findings showed small multiple cystic spaces in the placenta and a live singleton fetus. Triploid 69, XXX was confirmed at karyotype analysis. Intrauterine fetal death was found at 18 weeks' gestation and termination of pregnancy was performed, and a partial hydatidiform mole was confirmed at pathologic examination. Torsion of bilateral theca-lutein cysts was developed at postpartum one week. Detorsion and aspiration of the bilateral theca-lutein cysts were performed under the laparoscopy.

The correlation of clusterin binding affinity to chemotherapeutic agents with chemoresistance in ovarian cancer cells / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to determine the mechanism of action of clusterin?known as a chemo-resistance protein?by analyzing its binding with chemotherapeutic agents and elucidating its relation with drug resistance. METHODS: Chemotherapeutic agents were diluted with coating buffer and coated onto 96 well plates. We then had these agents cross-react with purified clusterin and wash the wells to remove residual clusterin. We quantified the amount of clusterin with optical density (OD) measured by binding peroxidase-conjugated secondary antibody associated with mouse monoclonal clusterin antibody. To determine if anticancer drug-clusterin binding is related to chemotherapeutic agent resistance, we compared survival rates in the SKOV-3 cell line, which rarely secretes clusterin. We compared a group of SKOV-3 cells treated with a chemotherapeutic agent and a group treated with both the agent and clusterin, by means of XTT. RESULTS: In binding tests using ELISA OD, ratios of paclitaxel, cisplatin, carboplatin, topotecan, Adriamycin, etoposide, and 5-fluoruracil (5-FU) were 2.34, 2.40, 0.52, 2.44, 1.602, 1.14, and 1.13, respectively. Topotecan, cisplatin, and paclitaxel showed relatively higher binding. In addition, when these drugs were treated with clusterin in SKOV-3 cells, anticancer resistance increased (P<0.05). CONCLUSIONS: The anticancer drug resistance endowed by clusterin is considered to be related to its binding with chemotherapeutic agents.

Expression of Toll-like Receptors 2 and 4 and Immunoglobulins in Children wih Recurrent Otitis Media with Effusion

BACKGROUND: Toll-like receptors (TLRs) detect microbial infection and can directly induce innate host defense responses, which are thought to play critical roles in protecting the tubotympanum from infection. However, little is known about the relationship between TLRs, which are related to innate immunity, and immunoglobulins, which are related to adaptive immunity, in recurrent otitis media with effusion (OME). We therefore investigated the expression of TLR2 and TLR4 and immunoglobulin in children with OME. METHODS: The study population consisted of 72 children with OME, 31 with more than 4 episodes in 12 months or more than 3 episodes in 6 months (otitis-prone group), and 41 with fewer than 3 episodes in 12 months (non-otitis prone group). The expression in middle ear effusion of TLR2 and TLR4 mRNA, as determined by Real time- -polymerase chain reaction (RT-PCR), and the concentrations of IgG, IgA, and IgM, as determined by Enzyme-linked immunosorbent assay(ELISA), were compared between the two groups. RESULTS: Expression of TLR2 and TLR4 mRNA was lower in the otitis prone than in the non-otitis prone group, but the difference was not statistically significant (p>0.05). Between group differences in the concentrations of IgG, IgA and IgM in effusion fluid were not significant (p>0.05), and there were no correlations between immunoglobulin concentration and the expression of TLR2 and TLR4. CONCLUSION: Although there was a trend toward lower expression of TLR2 and TLR4 in the otitis-prone group, the differences, and those in immunoglobulin concentration, did not differ significantly between the otitis-prone and non-prone groups.

Surgical repair of recurrent cervical cancer at a skin incision site with using a Gore-Tex(R) Patch: A case report / 대한산부인과학회지

Recurrence of cervical cancer at a skin incision site is uncommon. We met a patient who received an incomplete operation for cervical cancer and she was transferred to our hospital. When she underwent the first operation she was misdiagnosed as having a benign uterine mass and she received an abdominal total hysterectomy. But the postoperative pathologic finding was cervical cancer. Therefore she was then referred for postoperative cisplatin-5FU concurrent chemo-radiotherapy. Five months after the concurrent chemo-radiotherapy, one solitary metastatic mass was found in the abdominal scar. We performed wide excision. The fascia defect at the excision site was so wide we could not perform the primary closure. Therefore, we used a polytetrafluoroethylene (Gore-Tex(R)) patch as a fascia substitute and we reconstructed the abdominal wall with a fasciocutaneous flap. Then she received cisplatin concurrent chemo-radiation therapy.

Leiomyosarcoma of the vagina: a case report and review from the literature / 부인종양

Leiomyosarcomas comprise fewer than 2% of all malignant vaginal neoplasms. Due to their rarity, treatment for vaginal leiomyosarcomas have not been determined. We describe a 66 year old woman with vaginal leiomyosarcoma, which presented as a large palpable mass with vaginal spotting. Complete surgical excision was accomplished and after surgery, she underwent radiation therapy. Tumor recurrence was not detected for the last 5 years and now her general condition is very good. This is a rare case of leiomyosarcoma arising in vagina and we report the results of successful treatment.

Leiomyosarcoma of the vagina: a case report and review from the literature / 부인종양

Leiomyosarcomas comprise fewer than 2% of all malignant vaginal neoplasms. Due to their rarity, treatment for vaginal leiomyosarcomas have not been determined. We describe a 66 year old woman with vaginal leiomyosarcoma, which presented as a large palpable mass with vaginal spotting. Complete surgical excision was accomplished and after surgery, she underwent radiation therapy. Tumor recurrence was not detected for the last 5 years and now her general condition is very good. This is a rare case of leiomyosarcoma arising in vagina and we report the results of successful treatment.

Squamous Metaplasia and BCL-6 in Pediatric Adenoid Accompanied by Otitis Media with Effusion

PURPOSE: Deterioration of local immunity in the adenoids may make them vulnerable to infection by microorganisms, resulting in otitis media with effusion. To determine the factors associated with this condition, we evaluated adenoid size, mucosal barrier, squamous changes of ciliated epithelium, IgA secretion, and BCL-6 expression in adenoids. MATERIALS AND METHODS: Seventeen children diagnosed with otitis media with effusion (OME group) and 20 children without any history of OME (control group) were enrolled. Their adenoids were sized by lateral view X-ray and stained with hematoxylin and eosin to detect squamous metaplasia. The adenoids were also stained with cytokeratin to evaluate mucosal barriers, and with anti- IgA antibody and anti- BCL-6 antibody to determine expression of IgA and BCL-6. RESULTS: The OME group showed greater incidence of squamous metaplasia, fewer ciliated cells, and lower expression of BCL-6 (p 0.05). IgA secretion and adenoid size were the same for the OME and the control groups. CONCLUSION: These results suggest that increased squamous metaplasia and lower BCL-6 expression in adenoids may be associated with increased susceptibility to OME.

Prevalence and risk factors of chlamydia trachomatis and neisseria gonorrhea among Korean women / 대한산부인과학회지

OBJECTIVE: Through a large sample group, the prevalence and risk factors of Chlamydia and Gonorrhea infection in low risk Korean women were examined. METHODS: Among patients visited the department of obstetrics and gynecology of the secondary and tertiary hospital between September 2005 to January 2006, 2,410 women older than 18 years were selected as the determination sample recruitment method. In addition to their disease history and parity, the living standard, a vaginal specimen, it was examined by a polymerase chain reaction test method. Statistical analysis was performed with Chi-square and Fisher's test were used. RESULTS: Chlamydia infection was found to be closely associated with age (P=0.0485), the marital status (P=0.0086), smoking (P=0.0148), and drinking (P=0.0077), and additionally, the number of sex partners (P=<0.0001). Gonorrhea infection showed a significant difference according to the past history of venereal diseases (P=0.036), and a higher incidence was shown in the group with the past history of venereal diseases. The incidence of the simultaneous infection of Chlamydia and gonorrhea showed a significantly higher incidence in the cases with the past history of venereal diseases (P=0.0454), and a higher frequency of sexual intercourse (P=0.0306) and a larger number of sex partners (P=0.0009). CONCLUSION: It is thought that the urgent improvement of the lack of knowledge on Chlamydia and the early management considering the fact that the age of sexual contact is decreasing gradually are required, and based on the selected high risk factors, not only treatments in a wide range but also its prevention should be carried out simultaneously.

A case of sarcoma arising in ovarian mature cystic teratoma / 대한산부인과학회지

Benign cystic teratoma is the common ovarian tumor, and the incidence reported about 20%. Between 1 and 2% of mature cystic teratomas undergo malignant trasformation. This occurs most frequently in postmenopausal women, who account for only 10% of mature cystic teratomas. Among the malignant transformations, squamous cell carcinoma is the most common type (over 75%), and adenocarcinoma, undifferentiated carcinoma, malignant melanoma, thyroid adenocarcinoma, and sarcoma have been reported in the literature. Because of its rarity, the clinico-pathologic characteristics are not well established, and there is no consensus on optimal therapy. There is also no consensus regarding the efficacy of postoperative therapy. We experienced a case of sarcoma of the ovary arising in mature cystic teratoma, which is presented with a brief review of literature.