A rare case of gastric-type mucinous adenocarcinoma in a woman with Peutz-Jeghers syndrome

Adenocarcinoma of the cervix is less common than squamous cell carcinoma. Minimal deviation adenocarcinoma (adenoma malignum) is considered an extremely well-differentiated variant of GAS. An association exists between GAS and Peutz-Jeghers syndrome, which is a rare autosomal dominant disorder characterized by mucocutaneous pigmentation and multiple hamartomatous polyps in the gastrointestinal tracts. The incidence of GAS in patients with Peutz-Jeghers syndrome is estimated to be 11–17%. We present a rare case of adenoma malignum, diagnosed using colposcopic biopsy in a woman with Peutz-Jeghers syndrome, which was histopathologically confirmed to be GAS after surgery.

Currarino syndrome in an adult woman

Currarino syndrome is a hereditary disease characterized by the triad of sacral agenesis, anorectal malformation, and presacral mass. Most patients are diagnosed in childhood, and this condition rarely manifests in adulthood. In women, gynecological malformations associated with Currarino syndrome have been reported, such as bicornuate uterus, rectovaginal fistula, and septate uterus. We present a rare case of a 29-year-old woman with a suspected pelvic mass who was diagnosed with Currarino syndrome.

Survival outcomes and toxicity of intraoperative intraperitoneal chemotherapy in advanced epithelial ovarian cancer

OBJECTIVE: To assess the effect of single-dose cisplatin intraperitoneally administered during cytoreductive surgery in advanced epithelial ovarian cancer. METHODS: Data from patients who underwent surgical management followed by intravenous (IV) chemotherapy for stage III epithelial ovarian cancer from 2003 to 2012 were retrospectively reviewed. Subjects were divided into intraperitoneal (IP) and no-intraperitoneal (NIP) groups according to the administration of IP cisplatin 100 mg during the staging surgery. Clinical results such as survival outcomes and chemotherapeutic toxicity were compared between the two groups. RESULTS: Thirty-seven patients in the IP group and 26 in the NIP group were identified. There were no significant differences between the two groups in basic characteristics such as age, histology, and surgical procedures. After the surgery with or without IP chemotherapy, there was no difference in the rate of either hematologic or gastrointestinal toxicity or in the rate of incompletion of following IV chemotherapy. Tumor recurrence occurred in 67.6% (25 patients) of IP group and 57.7% (15 patients) of NIP group (P=0.423) during the mean follow-up period of 37 months. The 3-year disease free-survival rate was 39.9% in the IP group and 35.8% in the NIP group, and the relative risk of recurrence was 0.864 (95% confidence interval, 0.447-1.673; P=0.665) in the IP group as compared with the NIP group. CONCLUSION: IP chemotherapy with single-dose cisplatin during cytoreductive surgery is safe and feasible with little chemotherapeutic toxicity in advanced epithelial ovarian cancer, but no distinct improvement in survival could be demonstrated in the present study.

Comparison of laparoscopy and laparotomy for the management of early-stage ovarian cancer: surgical and oncological outcomes / 부인종양

OBJECTIVE: To investigate the surgical and oncological outcomes of laparoscopic surgery compared with laparotomy for the treatment of early-stage ovarian cancer. METHODS: Data from patients who underwent surgical management for early-stage ovarian cancer between 2006 and 2012 were retrospectively reviewed. All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of a total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal cytology. RESULTS: Seventy-seven patients who underwent laparoscopic surgery (24 patients) or laparotomy (53 patients) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The mean operation time was shorter and the estimated blood loss was lower in the laparoscopy group than in the laparotomy group, though the differences were not statistically significant (193 min vs. 224 min, p=0.127; 698 mL vs. 973 mL, p=0.127). There were no differences in the intraoperative or postoperative complications. During a mean follow-up period of 31 months, tumor recurrence occurred in 4 patients: 2 (8.3%) in the laparoscopy group and 2 (3.8%) in the laparotomy group. The mean disease-free survival was 59 months after laparoscopy and 66 months after laparotomy (p=0.367). CONCLUSION: Laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage ovarian cancer with comparable results to laparotomy in terms of the surgical outcomes and oncological safety.

Clinical experience in ovarian squamous cell carcinoma arising from mature cystic teratoma: A rare entity

OBJECTIVE: We sought to investigate the clinicopathologic features of ovarian squamous cell carcinomas arising from mature cystic teratomas (MCT) and to report our clinical experience and lessons learned. METHODS: From January 1993 to November 2012, a total of 6,260 women with ovarian MCT were surgically treated at Cheil General Hospital and Women's Healthcare Center. Among them, the cases with malignant transformation to squamous cell carcinoma were included in this analysis. Patient demographic characteristics, surgical findings, and prognosis were evaluated retrospectively. RESULTS: Of the 6,260 ovarian MCT patients, four (0.06%) had ovarian squamous cell carcinoma arising from MCT. The mean patient age was 43 years (range, 35-51 years), and the mean tumor size was 12 cm (range, 9-16 cm), with two patients in the International Federation of Gynecology and Obstetrics stage I and the other two in stage III. Upon preoperative imaging, all cases were expected to be benign ovarian tumors, but the preoperative squamous cell carcinoma antigen level was elevated from 1.5 ng/mL in stage Ia to 11.3 ng/mL in stage IIIc, suggesting malignancy, while the CA-125 level was normal in two of the three patients who received the test. Optimal debulking surgery was performed and adjuvant chemotherapy was used in all patients, but death from the recurrence of disease occurred in one patient, whose overall survival was 10 months. CONCLUSION: Ovarian squamous cell carcinoma arising from MCT is extremely rare, and it is rarely diagnosed preoperatively on imaging workups. Measuring the squamous cell carcinoma antigen level might be a useful diagnostic clue, and it might also be predictive of the tumor stage. An adequate staging surgery should be included in the standard treatment, but multicenter studies are needed to confirm this.

Endometrial Stromal Sarcomas: a clinico-pathological analysis of 27 patients

To evaluate clinico-pathological features and prognostic valuses of Endometrial stromal sarcomas [ESS] through comparison of the two grade groups [low- and high-grade disease]. We retrospectively analyzed the medical records of 27 patients who were diagnosed with ESS at a single institute between March 1988 and November 2009. Our retrospective chart review was approved by our local institutional Review Board [IRB]. The median age of the patients was 44.0 years, the median follow-up period was 101.0 months and the 10-year survival rate was 74.2%. The median uterine weight was 215.0 gm. Twenty-three [70.4%] and four patients [29.6%] had low- and high-grade disease, respectively. As primary treatment, twenty-four [70.4%] and three patients [11.1%] underwent type I hysterectomy and type III hysterectomy, respectively. Total six cases were recurred and two cases of the six-recurred patients were distant metastasis [lung] and four cases were died of the disease. Univariate analysis revealed that the histologic grade and the uterine tumor weight were significantly related with longer disease-free survival [p=0.025 and 0.043 respectively]. ESSs with high-grade or larger tumor size have to be carefully and sufficiently managed, because of its rarity and aggressive behavior. To determine the proper adjuvant treatment of ESS with high risks, further clinical data should be collected and studied

Laparoscopic management of endometrial cancer according to body mass index; a Korean Outcome Research & Analysis in Gynecologic Cancers (KORAGCs) Study / 대한산부인과내시경학회지

OBJECTIVE: To compare clinicopathologic characteristics and surgical outcomes of laparoscopic surgery in women with endometrial cancer according to body mass index (BMI). METHODS: From June 2009 to October 2010, prospective observational study without randomization of 159 patients treated by laparoscopic surgery from 10 hospitals nationwide. RESULTS: Patients were divided according to the WHO guidelines for Asia-Pacific populations and the distributions of BMI were as follows: 3 patients (1.9%) in underweight (BMI or = 30.0 kg/m2). Age, history of previous surgery, surgery extend, and history of previous surgery were not different between non-obese patients (BMI or = 25.0 kg/m2). Co-morbidities were more common in obese patients but marginally significant (23.5% vs. 37.7%, p=0.072). Four patients (2.5%) were converted to abdominal surgery because of severe adhesion. Regarding to surgical outcomes, operation time was significantly longer in obese patients (199 min vs. 235 min, p=0.013) but blood loss, lymph node yield, hospital stay, Foley removal, transfusion rate and peri-operative complication were not statistically significant. Regarding to pathologic results, there were no difference in terms of lymphovasucular space invasion, tumor grade, histologic type, lymph node metastasis and FIGO stage. CONCLUSION: Clinicopathologic characteristics and surgical outcomes does not seem to be significantly influenced by BMI except operation time. So the laparoscopic approach can be the alternative method for obese patients.

The safety of conization in the management of adenocarcinoma in situ of the uterine cervix / 부인종양

OBJECTIVE: To evaluate the occurrence of residual or recurrent disease after conization for adenocarcinoma in situ (AIS) of the uterine cervix. METHODS: Medical records of 99 patients with a histologically diagnosis of AIS of the uterine cervix by conization between 1991 and 2008 were reviewed retrospectively. RESULTS: Seventy eight of 99 patients (78.8%) had negative and 18 (18.2%) had positive resection margins of the conization specimen, and 3 (3.0%) had unknown margin status. Of the 78 patients with negative margins, 45 underwent subsequent hysterectomy and residual AIS were present in 4.4% (2/45) of patients. Ten of the 18 patients with positive margins received subsequent hysterectomy and 3 patients (30%) had residual AIS. Twenty-eight patients had conservative treatment and during the median follow-up time of 23.5 months (range, 7 to 124 months), only one patient (3.6%) had recurrent AIS and was treated with a simple hysterectomy. Eight patients became pregnant after conization, 4 of them delivered healthy babies, one had a spontaneous abortion and 3 were ongoing pregnancies. CONCLUSION: Patients with positive resection margins after conization for AIS of the uterine cervix are significantly more likely to have residual disease. However, negative resection margin carries a lower risk for residual AIS, therefore conservative management with careful surveillance seems to be feasible in women who wish to preserve their fertility.

Ovarian Cancer during Pregnancy: Clinical and Pregnancy Outcome

The aim of this study is to evaluate the clinical feature and pregnancy outcome in patients with ovarian cancer diagnosed during pregnancy. We retrospectively analyzed the medical records of 27 patients diagnosed with ovarian cancer during pregnancy at Cheil General Hospital & Women's Healthcare Center from January 1996 to December 2006. Mean age of the patients was 29.1 yr (range 23-40), and a mean follow-up period was 57 months (range 7-112 months). Of 27 patients, 15 (55.5%) had borderline malignancies, 7 (25.9%) had epithelial malignancies and 5 (18.6%) had germ cell tumors. A total of 26 patients received a conservative surgery preserving pregnancy. The mean time for surgical intervention during pregnancy was 20 weeks of gestational age. Of the 27 patients, 26 had full term delivery of a healthy baby without any congenital malformation. Only one patient with epithelial ovarian cancer had a relapse at 19 months after the first conservative operation with adjuvant chemotherapy. There were few data for managing patients with ovarian cancer diagnosed during pregnancy. This study results could help establish a guideline for management of ovarian malignancy complicating pregnancy.

Comparison of surgical approach to staging operation for endometrial cancer including pelvic and paraaortic lymphadenectomy / 대한산부인과학회지

OBJECTIVE: To compare laparoscopic surgery with laparotomy in comprehensive surgical staging of endometrial cancer. METHODS: We retrospectively analyzed the medical records of 272 patients with endometrial adenocarcinoma treated by staging operation including pelvic and paraaortic lymphadenectomy between January, 1996 and December, 2007. RESULTS: There was no significant difference between the two groups in terms of age, body mass index, or histologic type, but in the laparotomy group, grade and surgical stage were significantly higher. All the patients, 182 in the laparotomy and 90 in the laparoscopy group, had lymphadenectomy, and the mean number of pelvic and paraaortic lymph nodes (LNs) obtained were 33.1+/-13.2 and 16.1+/-11.6 in the laparoscopy group, and 32.5+/-14.5 and 19.0+/-12.7 in the laparotomy group, respectively; these differences were not statistically significant. In the laparoscopy group, the operating time and postoperative hospital length of stay were shorter than in the laparotomy group, as were the pre- and post-operative hemoglobin changes. There were no significant differences between the two groups in terms of intra- or post-operative complications, but positive lymph nodal metastasis and conducting of postoperative adjuvant therapy were highter in the laparotomy group. The operative technique did not influence overall or disease-free survival after adjusting for several confounding factors. CONCLUSION: Laparoscopic-assisted surgical staging for endometrial cancer required a shorter operating time, shorter postoperative hospital stay, and lower blood loss compared to traditional laparotomy staging, and can be a good therapeutic option for staging operation including lymphadenectomy of endometrial cancer.

The clinical approach for endometrial biopsies with atypical endometrial hyperplasia for further management / 대한산부인과학회지

OBJECTIVE: To evaluate the proper approach in women diagnosed with atypical endometrial hyperplasia (AEH) by endometrial biopsy. METHODS: We retrospectively analyzed the medical records of 108 patients who underwent hysterectomies for AEH diagnosed by endometrial biopsy from 2000 to 2007. The results of the endometrial biopsies were graded on an ordinal scale and were compared with pathologic features obtained at the hysterectomy. RESULTS: AEH was initially diagnosed by dilatation and curettage (87 cases) or endometrial biopsy with a Z-sampler (17 cases). The remaining four cases were diagnosed by hysteroscopic polypectomy. In patients preoperatively diagnosed with AEH by biopsy, hysterectomy specimens revealed a rate of simple or complex endometrial hyperplasia without atypia of 33.3% with AEH and normal endometrium found in 52.8 and 3.7% of specimens, respectively. The incidence of endometrial carcinoma was considerably high (11/108, 10.2%). All cases were confined to the endometrium and two of those were located at the adenomyosis without myometrial invasion. All patients with endometrial carcinoma displayed coexisting atypical complex hyperplasia following hysterectomy. CONCLUSION: Biopsy specimens showing AEH, particularly atypical complex hyperplasia, are associated with an increased risk of coexisting endometrial carcinoma. When considering management strategies for women with a biopsy diagnosis of AEH, clinicians should take into account the considerable rate of concurrent endometrial cancer and the discrepancy with pathologic diagnosis.

Fertility preservation in patients with early epithelial ovarian cancer / 부인종양

OBJECTIVE: To assess the role of fertility preservation in the treatment of patients with early epithelial ovarian cancer (EOC). METHODS: We retrospectively analyzed the medical records of 21 patients with early EOC from January 1995 to December 2006. All eligible patients with a strong desire to preserve fertility were younger than 35 years and underwent fertility-sparing surgery with or without adjuvant chemotherapy. RESULTS: Twenty-one eligible patients with a median age of 26.7 years (range, 20 to 33 years) were identified, and the mean follow-up period was 43 months (range, 5 to 86 months). Only one patient with stage IC recurred 34 months after the first operation. A total of five patients were able to become pregnant at least once after the first fertility preserving treatment, with or without adjuvant chemotherapy. All five patients succeeded in full-term vaginal delivery with healthy infants. No patients died of their disease. CONCLUSION: Fertility preserving treatment in patients with early EOC can be considered as a proper treatment strategy in patients with early EOC, who have the strong desire for fertility preservation.

Clinicopathologic study of ovarian granulosa cell tumors / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the clinicopathologic characteristics of granulosa cell tumor of the ovary (OGCT). METHODS: We retrospectively reviewed the medical records of 27 patients with OGCT at our hospitals from January 1995 to December 2003. RESULTS: The mean age was 48.3 years (24~70) and mean follow up period was 56.7 months (12~102). The most common symptom was vaginal bleeding (n=11, 40.7%). The tumors were ranging from 3 cm to 21 cm in diameter (mean: 9.9). Post-surgical FIGO stage was stage I in 20 (74.1%), stage II in 6 (22.2%), and stage III in 1 (3.7%). Endoemetrial samples were available in 21 patients and the results were endometrial carcinoma in 1 and endometrial hyperplasias in 5. Staging operation was performed in 17, unilateral salpingo-oophorectomy in 6, total hysterectomy and bilateral salpingo-oophorectomy in 2, and fertility sparing operation in 2. Postoperative chemotherapy was administered in 13 patients (48.2%). Two patients had recurred and recurrence rate was 7.4% (2/27). Two recurred patients finally died of the disease at 42 months and 103 months after first operation respectively. During follow-up period, 2 patients had 3 pregnancies and all of them delivered at term. CONCLUSION: These results shows that most OGCT is detected in early stage and have relatively excellent survival. However, because OGCT is a slow-growing tumor and has a late recurrence, long time follow-up is required.

The effect of lymph-vascular space invasion on clinicopathologic features in patients with endometrial cance / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the effect of lymph-vascular space invasion (LVSI) on clinicopathologic features and outcomes in patients with endometrial cancer. METHODS: All women who were surgically treated for endometrial cancer at the Cheil General Hospital & Women's Healthcare Center between January 2000 and December 2003 were eligible. One hundred-forty one patients underwent retrospective review of medical record. Pathologic findings of LVSI were reviewed and divided in LVSI-positive group and LVSI-negative. Statistical analysis was performed by dBSTAT-4. RESULTS: Fifty-five patients (39%) were LVSI-positive and eighty-six patients (61%) were LVSI-negative. LVSI-positive patients were statistically older than LVSI-negative. LVSI-positive patients had more abnormal cytology, poorer differentiation, larger tumor size (diameter>2 cm), more myometrial invasion. more pelvic nodal metastasis, more paraaortic nodal metastasis, and more advanced stage. There was no difference between the two groups in the percentage of patients with gravidity, parity, histologic types (endometrioid vs nonendometrioid). CONCLUSION: LVSI-positive patients with endometrial cancer are generally older, consistent with more abnormal cytology, poorer differentiation, larger tumor size, more myometrial invasion, more lymph-node metastasis, and more advanced-stage disease. So, LVSI should be a consideration in appropriate treatment in endometrial cancer.

Outcomes of Controlled Ovarian Hyperstimulation/In Vitro Fertilization for Infertile Patients with Borderline Ovarian Tumor after Conservative Treatment

To evaluate the outcomes of controlled ovarian hyperstimulation (COH)-in vitro fertilization (IVF) such as clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) for infertile patients with borderline ovarian tumor (BOT) after conservative treatment, 10 IVF cycles in five patients from January 1999 to July 2005 were analyzed. At the time of diagnosis with BOT, the mean age of patients was 30.0 yr (range, 22-40). For 8 cycles out of 10 attempted IVF cycles, except for 2 cancellation cycles, the mean number of oocytes retrieved was 5.6 (range, 2-16) with a mean fertilization rate of 74.4%. The CPR, IR, and LBR were 50.0% (4/8 cycles), 31.6% (6/19) and 50.0% (4/8 cycles) respectively. The mean follow-up period after COH-IVF initiation was 29.6 (range, 14-61) months. A gynecological oncologist followed all patients every 3 months during the first year and every 6 months thereafter. There was no recurrence during the follow-up period. Our results suggest that COH-IVF may be acceptable for infertile patients with BOT, especially in patients with early-stage BOT after conservative treatment.

The clinicopathologic significance of glandular cell abnormality on preoperative abnormal PAP smears in endometrial carcinoma / 부인종양

OBJECTIVE: The aim of this study was to evaluate the correlation between the results of preoperative PAP smears and known poor prognostic factors in patients with endometrial carcinoma. METHODS: Between Jan. 2000 and Dec. 2003, preoperative evaluation of PAP smears were done in 111 patients with endometrial carcinoma who underwent surgical staging. Pathologic parameters of permanent specimens were evaluated and correlated with the results of PAP smears. chi-square-test was used for statistical analysis and p-values <0.05 was considered as statistically significant result. RESULTS: The mean age of patients was 49 years with range between 24 and 75 years old. The results of preoperative PAP smears were normal in 70 patients (57.7%), atypical glandular cells of undetermined significance (AGUS) in 22 patients (22.5%), adenocarcnoma in 19 patients (19.8%) on preoperative PAP smears. Statistically significant associations were found between preoperative PAP smears and poor histologic grade (p=0.000), depth of myometrial invasion (p=0.000), lymph-vascular space invasion (p=0.003), cervical involvement (p=0.004), adnexal involvement (p=0.024), positive peritoneal cytology (p=0.042). However, old age, poor histologic type, higher surgical staging, pelvic nodes metastasis and para-aortic lymph node metastases were not statistically significant. CONCLUSION: This study revealed glandular cell abnormalities on preoperative PAP smears in patients with endometrial carcinoma were significantly associated with poor histologic grade, deep myometrial invasion, lympho-vascular invasion, cervical involvement, adnexal involvement, positive peritoneal cytology. Therefore, the results of preoperative PAP smears could be considered as an important part of the preoperative evaluation in patients with endometrial carcinoma.

Detection of Sentinel Lymph Nodes in patients with Early Stage Cervical Cancer

The purpose of this study was to determine the feasibility of identifying the sentinel lymph nodes (SNs) as well as to evaluate factors that might influence the SN detection rate in patients with cervical cancer of the uterus. Eighty nine patients underwent intracervical injection of 1% isosulfan blue dye at the time of planned radical hysterectomy and lymphadenectomy between January 2003 and December 2003. With the visual detection of lymph nodes that stained blue, SNs were identified and removed separately. Then all patients underwent complete pelvic lymph node dissection and/or para-aortic lymph node dissection. SNs were identified in 51 of 89 (57.3%) patients. The most common site for SN detection was the external iliac area. Metastatic nodes were detected in 21 of 89 (23.5%) patients. One false negative SN was obtained. Successful SN detection was more likely in patients younger than 50 yr (p=0.02) and with a history of preoperative conization (p=0.05). However, stage, histological type, surgical procedure and neoadjuvant chemotherapy showed no significant difference for SN detection rate. Therefore, the identification of SNs with isosulfan blue dye is feasible and safe. The SN detection rate was high in patients younger than 50 yr or with a history of preoperative conization.

Clinicopathologic characteristics of malignant germ cell tumors of ovary / 대한산부인과학회지

OBJECTIVES: The aim of this study was to evaluate the clinicopathologic characteristics of malignant germ cell tumors of ovary. METHODS: Thirty five patients who were dignosed as malignant germ cell tumors of ovary and treated in Cheil General Hospital from January 1995 to December 2003, were retrospectively analyzed. The age, chief complaints, histologic type, tumor marker, FIGO stage, maximal tumor diameter, management, survival and future pregnancy outcome were reviewed. RESULTS: The mean age was 23.4 years (8-34) and 2 patients were premenarche. The mean follow-up period was 59.6 months (16-118). Palpable lower abdominal mass and pain were the most frequent symptoms. Preoperative CA125 were checked in 32 patients and elevated in 23 patients . The tumors were ranging from 7cm to 27cm in diameter (mean : 16.6). The site of tumors was right-sided in 17(48.6%), left-sided in 15(42.9%), and bilateral in 3(8.6%) which were dysgerminomas only. Post-surgical FIGO stage was stage I in 28 cases (80.0%), stage II in 4 cases (11.4%), and stage III in 3 cases (8.6%). Histologically, immature teratomas were found most frequently (n=14, 40.0%), followed by dysgerminoma (n=10, 28.6%), endodermal sinus tumor (n=9, 25.7%), and mixed form (n=2, 5.7%). Unilateral salpingo-oophorectomy was performed in 9, cystectomy in 4, and staging operation in 22, which included 16 patients of fertility sparing operation. Postoperative chemotherapy was administered in 30 and most were BEP except one TIP. Two patients had recurred, who were stage Ic and IIIb EST at diagnosis and expired at 59 and 16 months after first operation. Recurrence rate was 5.7% and 5-year survival rate was 94.7%. During follow-up period, 8 patients were pregnant and the results were 4 normal deliveries at term, 1 missed abortion, 1 therapeutic abortion due to acne medication, 1 H-mole and 1 current pregnant state at 20 weeks without problem. CONCLUSION: These results shows that most malignant germ cell tumors of ovary is detected in early stage and have relatively excellent survival with conservative operation and combination chemotherapy.

Comparison of prognosis of FIGO stage IB 1 adenocarcinoma and squamous cell carcinoma who were treated primarily by surgery / 부인종양

OBJECTIVE: The objective of this study was to compare clinical and pathologic variables and prognosis of FIGO stage IB 1 adenocarcinoma and squamous cell carcinoma of uterine cervix who were treated primarily by surgery. METHODS: From May 1982 to October 2000, 2,209 patients with invasive cancer of the uterine cervix were diagnosed and treated at Cheil Hospital. A retrospective review was performed of 533 patients with stage IB1 squamous cell carcinoma (group A) and 84 with adenocarcinoma (group B) of cervix who treated primarily by type 3 hysterectomy and pelvic and paraaortic lymphadenectomy. RESULTS: Age, endometrial extension, lymph node metastasis and postoperative adjuvant therapy were not different between two group. There were more the lymphovascular space invasion in group A (136 patients, 25.5%) than group B (9 patients, 10.7%) (p<0.0046). 5 year survival were 95.0% vs 93.8% for group A and group B (p=0.75). Using univariate analysis, pelvic node metastasis, paraaortic metastasis, postoperative adjuvant therapy were significant for survival. Multivariate analysis of 5 year survival revealed independent prognostic factor as postoperative adjuvant therapy. CONCLUSION: Prognosis of FIGO stage IB1 cervical cancer patients who were treated by primarily by type 3 hysterectomy and pelvic and paraaortic lymphadenectomy between adenocarcinoma and squamous cell carcinoma was found to be same.

The Results of Postoperative Radiotherapy for Early Stage Endometrial Carcinoma / 대한방사선종양학회지

PURPOSE: To determine treatment policy for early stage endometrial carcinoma, we analyzed the results of postoperative radiotherapy. MATERIALS AND METHODS: From Oct. 1994 to Aug. 2002, 42 patients with FIGO stage I endometrial carcinoma received postoperative radiotherapy. All patients received curative surgery and pelvic lymph node dissection was done in 26 patients. Based on the FIGO staging system, 3 were at stage IA, 21 were at stage IB and 18 were at stage IC. Histologically, there were 14 grade 1, 16 grade 2, and 12 grade 3. Nineteen patients received intracavitary brachytherapy and 23 patients did whole pelvic radiotherapy. The median period of follow-up was 41 months (22 to 100 months). RESULTS: Five-year overall survival, disease-free survival, local control, and regional control rates of all patients were 86.0%, 87.9%, 100%, and 97.5%, respectively. All failures were distant metastases in 5 patients and two patients had simultaneous regional recurrences. There was no intrapelvic failure in patients who received intracavitary radiotherapy. Grade 3 chronic complications were found in 1 patient (4.3%), who received whole pelvic radiotherapy. CONCLUSION: We achieved high rates of loco-regional control and survival by curative surgery and postoperative radiotherapy. However, we need to select the type of radiotherapy based on the risk factors for recurrence to reduce the treatment-related complication.