Clinical Efficacy of HPV DNA Chip test in Human papillomavirus detection of Uterine Cervix / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the efficacy of HPV DNA chip method for detection and genotyping of various human papillomavirus in the patients with intraepithelial lesions of uterine cervix. METHODS: The study subjects included two hundred patients with abnormal Pap smear from July 2004 to October 2004. After confirmed the pathological status of the cervix with colposcopic biopsy or conization, we evaluated for HPV infection and genotyping with the commercially available Hybrid-Capture II assay (HC-II) and HPV DNA chip. Then we compared the concordance rate between the two methods for the detection of HPV and analysed the HPV genotypes. RESULTS: We compared the results in HPV DNA chip with those in HC-II. In result, the concordance rate between the two methods for the detection of HPV was 85.5% (171 of 200 cases). In 111 patients confirmed the presence of lesions higher than flat condyloma in cervix by pathologc examination, sensitivities of HC-II and HPV DNA chip in detecting HPV were 91.0% and 88.3%, respectively. In HPV DNA chip, HPV-16 was the most frequent type (14.7%) in all patients, the next frequent types were HPV-58 (14.1%) and HPV-18 (9.2%). CONCLUSION: We confirmed that HPV DNA chip method was as sensitive and effective method for detecting HPV in cervical lesions as HC-II. And that it would provide useful clinical information on genotyping and multiple infections of HPV.

Genotyping of Human Papillomavirus Detected with the HPV DNA Chip in Cervical Cancer / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the efficacy of DNA chip method for detection and genotyping of various human papillomavirus in the patients with invasive cervical cancer in Korea. METHODS: The study subjects included 38 cases of cervical cancer for HPV detection and genotyping, and the commercially available DNA chip was used. Retrospectively cervical specimens of thirty eight patients with pathologically confirmed invasive cancer of the uterine cervix were tested for HPV typing performed by DNA chip method in Samsung Cheil Hospital from September 1999 to October 2000. RESULTS: Among 38 cervical carcinomas, histological examination revealed that 34 (89.5%) cases were squamous cell carcinoma, three (7.9%) were adenocarcinoma and one (2.6%) was small cell carcinoma. In carcinoma patients thirty two cases (84.2%) of invasive carcinoma were positive for at least one type of high risk HPV. Only two woman (5.3%) among the healthy group had HPV positive. We compared the results in HPV DNA chip with those in sequencing. The concordance rate between the two methods for the detection of HPV was 95.7% (67 of 70 cases). CONCLUSION: We confirmed that DNA chip method was a simple, convenient, and effective method for detecting HPV in cervical carcinoma and health women.

Neoadjuvant chemotherapy in stage IB2 cervical cancer / 부인종양

OBJECTIVE: This retrospective study was purposed to evaluate the effects (clinico-pathologic findings and treatment outcomes) of neoadjuvant chemotherapy in management of cervical carcinoma stage IB2 (tumor diameter>4 cm) METHODS: 22 surgically treated patients due to cervical cancer IB2 between January 1993 and December 2001 were abstracted. They were divided into two groups; the one group (neoadjuvant chemotherapy group) was treated with preoperative neoadjuvant chemotherapy [taxol-cisplatin or bleomycin, vincristin, mitomycin and cisplatin (BOMP), 2-3 cycles] and the other group was treated by primary radical hysterectomy. Clinico-pathologic factors were reviewed and statistically analyzed and compared. RESULTS: There was no significant difference in age, tumor size, and histopathologic type between two groups (p>0.05). After surgery, lymph node, lymphovascular space invasion (LVSI), parametrial invasion, margin involvement, and recurrence rate had no significant difference between two groups (p>0.05). But in neoadjuvant chemotherapy group, postoperative adjuvant chemotherapy or radiation therapy was significantly less needed (p=0.0073). CONCLUSION: The needs of postoperative adjuvant treatment (chemotherapy or radiation therapy) in neoadjuvant chemotherapy group were less than in non-neoadjuvant chemotherapy group, even though there was no difference in clinico-pathologic factors and prognosis between two groups.

Clinico-pathologic features in endometrial carcinoma by the histologic type / 부인종양

OBJECTIVE: The aim of this study was to correlate histologic type with the clinico-pathologic features of endometrial carcinoma. METHODS: A retrospective review was performed of 158 patients with endometrial cancer who had treated surgically at Cheil General Hospital between Jan. 2000 and Dec. 2003. Histologic findings after operation were divided two groups (endometrioid group vs. non-endometrioid group) then compared to each other groups. Clinico-pathologic factors were reviewed, compared and statistically analyzed. RESULTS: Endometrioid group was 112 cases (70.9%) and non-endometrioid group was 46 cases (29.1%). Non-endometrioid group was mucinous; 5 (3.2%), UPSC; 6 (3.8%), clear Cell; 2 (1.3%), mixed; 32 (20.3%), adenosquamous; 1 (0.6%). Non-endometrioid group showed older (p=0.0003) and higher proportion of menopausal women (p=0.0017) than Group 1. But menopause mean age were not diffent between two group. Abnormality in Pap smear and thickness of endometrium (TVS) were not diffent between two group. Non-endometrioid group were significantly associated with higher grade (p=0.0000), deeper myometrial invasion (p=0.0030), larger tumor size (p=0.0006), Lympho-vascular invasion (p=0.0486) and higher recurrence rate (p=0.0369) CONCLUSION: This study revealed non-endometrioid group was significantly associated with older age, menopause status, advanced pathologic features at surgical staging, and high recurrence rate.

Carcinoma in situ of the uterine cervix in pregnancy / 부인종양

OBJECTIVE: The purpose of this study was to determine whether carcinoma in situ (CIS) of the uterine cervix in pregnancy alters in the postpartum period and to evaluate the factors associated with this alteration. METHODS: In this retrospective study, we found 30 pregnant women with CIS of the uterine cervix between 1999 and 2003. All women had the diagnosis of CIS made on cervical biopsy performed during pregnancy at Samsung Cheil Hospital. All pathologic reports of initial cytology and biopsy were reviewed and compared to the same evaluations postpartum. Postpartum alteration of CIS was analyzed with respect to the mode of delivery, gravidity and parity. RESULTS: The incidence of CIS in pregnancy was 0.6 per 1000 pregnancies (30/44,807) in this study. The mean age was 31.2 years (20-40), the mean gravidity was 2.7 (1-6) and the mean parity was 0.3 (0-2). The prenatal cytology that initiated the referral to our colposcopy center was commonly discordant with the histologic diagnosis of CIS. Five (16.7%) had cytology of ASCUS, 3 (10.0%) had LSIL, and 22 (73.3%) had HSIL. The overall postpartum persistence and regression rates of CIS were 73.3% and 26.7% respectively. No lesion progressed to invasive carcinoma. There was no statistically difference in regression or persistence rates according to the delivery mode, gravidity and parity. CONCLUSION: According to the result of this study, postpartum persistence rate of CIS was high but progression rate was low. The mode of delivery, gravidity and parity did not influence the regression or persistence rates of CIS in pregnancy.

Study of Factors that Influence Sentinel Lymph Node Identification and Detection Rate in Cervical Cancer of Uterus / 대한산부인과학회지

OBJECTIVE: The purpose of this prospective study was to determine the feasibility of sentinel lymph node (SN) identification and to evaluate the factors that influence the sentinel node detection rate in patients with cervical cancer of the uterus. METHODS: Forty three patients underwent intracervical injection of 1% isosulfan blue dye at the time of planned radical hysterectomy and lymphadenectomy between January 2003 and July 2003. With visual detection of blue nodes, SNs were identified and separately removed. And then all patients underwent complete pelvic lymph nodes dissection and/or para-aortic lymph nodes dissection. If frozen sections of the lymph nodes were negative, radical hysterectomy was performed. Tumor characteristics, surgical findings, specific locations of SN and final pathologic results were recorded and correlated with final pathologic results. RESULTS: The mean age of patients was 49.3 years (30-78). SNs were identified in 23 of 43 (53%) patients. About 48.7% of SNs were found in the external iliac region, 31.7% in the obturator region, 17.0% in the internal iliac region and 2.4% in the common iliac region. Metastatic nodes were detected in 11 of 43 (26%) patients. Among 23 patients whose SNs were detected, 5 patients had metastatic nodes while among 20 patients whose SNs were not detected, 8 patients had metastatic nodes. No false negative SN results were obtained. Successful SN detection was more likely performed in patients with preoperative conization (P=0.0156). However, age, stage, histologic type, operation type, and neoadjuvant chemotherapy did not show any significant differences in SN detection rate. CONCLUSION: The identification of the SN with isosulfan blue dye is feasible and safe. SN detection rate was high in patients with preoperative conization. But low detection rate should be further investigated.

A Clinical Report of Pregnancy Induced Hypertension according to the Severity / 대한주산의학회잡지

The aim of present study was to establish the baseline data for pregnancy induced hypertension (PIH). From November 2000 through October 2001, a total of 212 women diagnosed as PIH and delivered at Samsung Cheil Hospital were included in this study. We reviewed the obstetric and neonatal records, then analyzed the incidence, maternal complications, and neonatal outcomes according to the severity of PIH. The incidence of PIH was 2.6% (mild and severe form was 59% and 41%, respectively). In maternal age, parity, number of fetus (singletone or multiple pregnancy), and gestational diabetus, there was no significant different incidence between mild and severe form of PIH. But, the women with severe PIH delivered more frequently at 21~28 and 33~36 gestational weeks than in mild form (p<0.05). Among fetuses with intrauterine growth restriction (IUGR), a group with birth weight below the population 5 percentile was more frequent in severe than in mild form of PIH (p0.05). As to maternal, fetal and neonatal complications of PIH, maternal anemia, preterm labor, and IUGR were more frequently founded in severe form of PIH than in mild. We could not found significant different frequency in other complication (disseminated intravascular coagulation, abruptio placenta, pulmonary edema, low apgar score, meconium stained, respiratory distress syndrome, and intracranial hemorrhage) between mild and severe form of PIH.

A Case of Marked Hydroureter, Misdiagnosed as a Hydrosalpinx by Ultrasound / 대한산부인과학회잡지

The retroperitoneal space of the posterior abdomen and the pelvic retroperitoneum contain the major neural, vascular and lymphatic supply to the pelvic viscera, the urinary system and colorectal system. A pain or mass in the pelvis may arise primarily from the reproductive organs, but it may just as easily arise from the retroperitoneal space, include the urinary tract and the gastrointestinal tract. Therefore, the gynecologic surgeon should be aware of the various conditions associated with retroperitoneal mass and the correct management of these disorders. Hydroureter may misdiagnose as a pelvic mass or retroperitoneal mass. The cause of hydroureter is mainly secondary obstruction such as malignancy, idiopathic retroperitoneal fibrosis and pelvic disease but primary obstructive megaureter should be considered. This report describes a case of marked hydroureter, misdiagnosed as a hydrosalpinx by ultrasound.

A Case of Marked Hydroureter, Misdiagnosed as a Hydrosalpinx by Ultrasound / 대한산부인과학회잡지

The retroperitoneal space of the posterior abdomen and the pelvic retroperitoneum contain the major neural, vascular and lymphatic supply to the pelvic viscera, the urinary system and colorectal system. A pain or mass in the pelvis may arise primarily from the reproductive organs, but it may just as easily arise from the retroperitoneal space, include the urinary tract and the gastrointestinal tract. Therefore, the gynecologic surgeon should be aware of the various conditions associated with retroperitoneal mass and the correct management of these disorders. Hydroureter may misdiagnose as a pelvic mass or retroperitoneal mass. The cause of hydroureter is mainly secondary obstruction such as malignancy, idiopathic retroperitoneal fibrosis and pelvic disease but primary obstructive megaureter should be considered. This report describes a case of marked hydroureter, misdiagnosed as a hydrosalpinx by ultrasound.

Surgical Management of Adnexal Masses in Pregnancy: Laparoscopy Versus Laparotomy / 대한산부인과학회잡지

OBJECTIVE: To determine the feasibility, safety, advantages and limitations of laparoscopic management of adnexal masses in pregnancy by comparing with laparotomy. METHODS: Between Jan 2001 to Jan 2003, 36 laparoscopic procedures and 15 laparotomy procedures were performed in 51 patients with adnexal masses in pregnancy. Operation time, hospital stay, pathologic findings, complications and pregnancy outcome were analyzed in these patients. RESULTS: Most common pathologic finding was mature cystic teratoma (45%) and malignancy of adnexal tumors were 3 cases (5.9%). There were no differences in size of adnexal tumor, operation time, hemoglobin level change after operation, gestational age at delivery, birth weight, Apgar score, preterm delivery and fetal anomaly between the two groups. Hospital stays was shorter and gestational age at operation was earlier in laparoscopy than explolaparotomy. CONCLUSION: Laparoscopic management of adnexal masses in pregnancy is safe and effective procedure.

Maternal Serum Levels of VCAM-1, ICAM-1 and E-selectin in Preeclampsia

Endothelial dysfunction is thought to be a central pathogenic feature in preeclampsia on the basis of elevated adhesion molecules. The aim of the present study was to compare the levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1) and E-selectin (sE-selectin) in sera of normal and preeclamptic pregnancies. We studied the serum levels of sVCAM-1, sICAM-1 and sE-selectin in normal pregnant women (n=63), mild preeclampsia (n=33) and severe preeclampsia (n=82). Concentrations of soluble adhesion molecules were determined with enzyme-linked immunoassay (ELISA). Serum concentrations of sVCAM-1 were significantly higher in both mild (p=0.004) and severe preeclampsia (p=0.000) than normal pregnancy. There were also significant differences in sVCAM-1 levels between mild and severe preeclampsia (p=0.002). sICAM-1 levels of severe preeclampsia were statistically different from those of normal pregnancy (p=0.038). Levels of sE-selectin were elevated in both mild (p=0.011) and severe preeclampsia (p=0.000) compared to normal pregnancy, but no statistical difference between the mild and severe preeclampsia (p=0.345). These results suggest that all three soluble adhesion molecules are increased in severe preeclampsia, and sVCAM-1 among them may be useful in predicting the severity of preeclampsia.

A Case of Perineal Endometriosis at the Site of Episiotomy Scar / 대한산부인과학회잡지

Endometriosis generally occurs in the pelvis, particularly in the broad ligament, round ligament, ovaries, fallopian tubes or uterosacral ligament. However, many unusual sites have been described, including the umbilicus, cesarean section scars, hernia sacs, appendix, vagina, vulva, omentum and perineum. We experienced a case of perineal endometriosis diagnosed according to cyclic perineal pain associated with menstration and report it with brief review of literature.