A Case of Leiomyoma of the Vagina / 대한산부인과학회잡지

The leiomyoma of the uterus is most common benign genital tumor in women of reproductive age but occurs in the vagina rarely and may be confused with a variety of vaginal tumors. A preoperative diagnosis is seldom made. Recently we experienced a case of vaginal leiomyoma arising in the anterior vagina wall and concomitant uterine leiomyoma, so we report this case with a brief review of literature.

Expression of MAGE 3 Gene Products in Uterine Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The human MAGE 3 gene encodes tumor specific antigens that are recognized by autologue cytotoxic T lymphocytes (CTL). The MAGE 3 gene is expressed not only in melanoma but in the other malignant tumors as well. There is, however, little information on the expression of the gene in uterine cervical carcinomas. The author thus studied the expression of the MAGE 3 gene products in uterine cervical carcinoma and discuss the possibility of specific immunologic diagnosis using MAGE 3 gene products. METHODS: The expression of MAGE 3 gene product in 17 normal tissues of the cervix, 32 cervical intraepithelial neoplasia (8 CIN I, 10 CIN II, 14 CIS), and 43 invasive cervical carcinomas was studied by immunohistochemistry using anti-MAGE 3 mAb 57B in paraffin sections RESULTS: No expression of MAGE 3 gene product was detected in normal cervical tissues and in cervical intraepithelial neoplasias. The expression of MAGE 3 gene product was detected in 30.2% (13/43) of invasive cervical carcinomas. The MAGE 3 gene product was stained as a cytoplasmic protein in cancer cells. No statistically significant differences were observed between MAGE 3 gene product expression status and clinicopathologic parameters. CONCLUSIONS: The MAGE 3 gene products was expressed in invasive cervical carcinoma tissues.

Dectection of Ureaplasma urealyticum in Invasive Cervical Cancer Tissue / 대한산부인과학회잡지

OBJECTIVE: Mycoplasmas have been implicated in many diseases including cervicitis, urethritis, salpingitis, endometritis... and functioning as cofactors catalyzing the HIV disease state. The oncogenic potentiality of mycoplasma was only recently realized when they were shown causing chromosomal changes and in vitro cell transformations through gradual progressive chromsomal loss and translocation. Few study has been reported the prevalence of mycoplasma infection in human cancers and suggested that there was a connection between these organisms and human cancers. The objective of this study was to determine the relationship between Ureaplasma urealyticum infection and cervical cancer. METHODS: The detection frequency of Ureaplasma urealyticum in 52 invasive cervical cancer tissues and 17 normal cervical tissues was studied using PCR. RESULTS: U. urealyticum DNA was detected in 8 out of 52(15.4%) invasive cervical cancer tissues and 1 out of 17(5.9%) normal cervical tissues. No statistic significance was observed between the detection frequency of Ureaplasma urealyticum and clinicopathologic parameters. The prevalence of Ureaplasma urealyticum in invasive cervical tissues was 15.4% and this rate was higher than 5.9% in normal cervical tissues but there was no statistic significance. CONCLUSIONS: With respect to clinicopathologic parameters of cervical cancer, there was no significant relation between U. urealyticum infection and cervical cancer. There is, however, few study and case on cervical cancer internally and externally. It is considered that more studies on the subject with much cases should be made.

A Clinicopathologic Study of 31 Cases with Ovarian Malignant Germ Cell Tumors / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to review the clinicopathologic features, recurrent rate, survival rate and controversable issues in the treatment of the ovarian malignant germ cell tumors. PATIENTS AND METHODS: From August, 1991 to November, 1998 thirty-one patients with malignant germ cell tumors of the ovary treated in the department of obstetrics and gynecology, Kosin University Medical college, were eligible and assessable. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow up were reviewed retrospectively. RESULTS: The patients with malignant germ cell tumor constituted 6.37% of all ovarian malignancies during this period. Histologic subtypes were 8 dysgerminoma(25.8%), 7 endodermal sinus tumor(22.6%), 10 immature teratoma(32.3%), 3 mixed germ cell tumor(9.7%), 3 choriocarcinoma(9.7%). The age of the patients ranged from 10 to 40 years (mean +/-S.D.; 24.26 +/- 7.51). The most common symptom was abdominal pain(38.7%). Most had stageI(18 cases, 58.0%) or stageIII(5 cases, 16.2%) diseases. All patients underwent surgery as the initial treatment, and nine patients received more than one operation. Postoperative adjuvant chemotherapeutic regimens were VAC, VBP, EP, BEP, EMA, and EMA CO. The mean follow up duration was 26.0(+/- S.D.; +/- 20.3) months. The 2-year and 5-year survival rate were 91.97%(+/- S.E.; +/- 0.05) and 86.86%(+/- S.E.; +/- 0.07).

Long term effects on oral progestogen (medroxyprogesterone acetate) on the bone mineral densities and the level of serum lipid metabolism during estrogen replacement therapy in postmenopausal women

BACKGROUND: In postmenopausal women, progestogen should be added to protect the endometrium from hyperplasia or carcinoma induced by the unopposed estrogen. However, the effects of progestogen on bone mineral densities and serum lipodproteins have not been precisely evaluated in Korean postmenopausal women. METHODS: To evaluate the effects of progestogen on bane mineral densities and serum lipoprotein in estrogen rephcement therapy, we canducted a 2-year trial of long conjugated equine estrogen(conjugated estrogen 0.625mg/day) with or without cyclic progestogen(MPA 5mg/day for 12 days) in 120 postmenopausal women. In all subjects, bone mineral density was measured in lumbar vertebra(L2-L4) and femur neck using dual energy X-ray absorptiometry(DEXA) and serum lipoprotein was measured from the beginning of the treatment, 12 manths, and 24 manths later, respectively. RESULTS: BMD of femur neck in both groups increased but not significantly compared to basal level at 12 months and/or 24 months of treatment. As for BMD of lumbar spine, it increased significantly in both groups. Both groups showed a significant decrease in the levels LDL cholesterol, but there was no statistical significance in serum triglycerids. Conjugated estrogen plus MPA group in constrast to conjugated estrogen only group showed a significant decrease in total cholesterol levels. CONCLUSIONS: These results suggest that the addition of MPA of the daily of 5mg for 12 days cyclically in estrogen replacement treatment appear to be effective in postmenopausal women with protection on bone mineral density and maintenance of long-term favorable effects on serum lipoprotein.

Expression of bcl-2 and p53 Protein in Invasive Cervical Cancer / 대한부인종양콜포스코피학회잡지

Recently, the bcl-2 and p53 protein have been recognized as important factors that is contributed to programmed cell death. The objective of this study was to evaluate the prognostic significance of bcl-2 and p53 protein expression in uterine cervical carcinoma. The expression of bcl-2 and p53 in 59 cases of uterine cervical carcinoma (stage IB to IIB) were surgically treated from January 1993 to June 1994. The expression of bcl-2 and p53 was examined by immunohistochemical method using formalin fixed paraffin embedded tissue specimens. The 48 cases were squamous cell carcinoma and 11 cases were adenocarcinoma. The results were as follows: 1. The expression rate of bcl-2 protein was 28.8%(17/59) and there was no significant correlaltion between the expression of bcl-2 protein and the clinicopathologic parameters (histologic type, grade, FIGO stage, cervical invasion depth, lymph node metastasis, parametrial invasion, tumor size, neoadjuvant chemotherapy response, recurrence, survival). 2. The expression rate of p53 protein was 32.2%(19/59) and there was no significant correlation between expression of p53 protein and the clinicopathologic parameters. 3. There was significant correlation between and expression of bcl-2 and p53 protein (P 0.05). In conclusion, bcl-2 and p53 protein are thought to be possible factors in the carcinogenesis of uterine cervical carcinoma and correlate with progression of it. But further study will be required to clarify the role of bcl-2 and p53 in carcinogenesis of the uterine cervix.

Taxol as Salvage Therapy in Patients with Recurrent Ovarian Carcinoma After First Line Chemotherapy / 대한부인종양콜포스코피학회잡지

As salvage therapy for recurrent ovarian cancer, Taxol has been tried alone or combined with cisplatin, or carboplatin. Paclitaxel (Taxol) is an antineoplastic agent; isoloated from the back of the western yew which acts as an antimicrotubule agent. In our study, 28 patients were eligible and assessable, Taxol was administered at a dose of 175 mg/m2, infused over 3hr every 21 days. A total of 161 courses of Taxol were infused, and the median treatmemt cycle was 6.25 cycles (1 to 16 cycles). The overall response rate was 21.4%, but we found higher response rate in sensitive group to platinum combined therapy than resistant. The median survival duration was 10.2 months and the median duration of follow up was 25.0 months. The worst severe toxicity was grade 4 leukopenia and expirement with sepsis. 39% of patients experienced myalgia and 25% experienced nausea, vomiting and diarrhea. Other adverse effects were not important or considerable. Taxol has been shown to be the most useful agent in patients with advanced ovarian cancer who had shown sensitivity with platinum previously, and Taxol has yielded low response rate in platinum-resistant patients. Further more study is repuired about Taxol itself, its optimal dose, combinding use with other antitumor agent, and as first line therapy in the treatment of advanced ovarian carcinoma.

Taxol as Salvage Therapy in Patients with Recurrent Ovarian Carcinoma After First Line Chemotherapy / 대한부인종양콜포스코피학회잡지

As salvage therapy for recurrent ovarian cancer, Taxol has been tried alone or combined with cisplatin, or carboplatin. Paclitaxel (Taxol) is an antineoplastic agent; isoloated from the back of the western yew which acts as an antimicrotubule agent. In our study, 28 patients were eligible and assessable, Taxol was administered at a dose of 175 mg/m2, infused over 3hr every 21 days. A total of 161 courses of Taxol were infused, and the median treatmemt cycle was 6.25 cycles (1 to 16 cycles). The overall response rate was 21.4%, but we found higher response rate in sensitive group to platinum combined therapy than resistant. The median survival duration was 10.2 months and the median duration of follow up was 25.0 months. The worst severe toxicity was grade 4 leukopenia and expirement with sepsis. 39% of patients experienced myalgia and 25% experienced nausea, vomiting and diarrhea. Other adverse effects were not important or considerable. Taxol has been shown to be the most useful agent in patients with advanced ovarian cancer who had shown sensitivity with platinum previously, and Taxol has yielded low response rate in platinum-resistant patients. Further more study is repuired about Taxol itself, its optimal dose, combinding use with other antitumor agent, and as first line therapy in the treatment of advanced ovarian carcinoma.

Comparison study of interferon-a combined chemotherapy versus chemotherapy only in patients with invasive uterine cervical cancer / 대한부인종양콜포스코피학회잡지

This study is to evaluate therapeutic effects between interferon-a combined chemotherapy and chemotherapy(5-fluorouracil, cisplatin) only in invasive uterine cervical cancer. The study included 35 cases of interferon-a combined chemotherapy group and 50 cases of chemotherapy(5-FU, cisplatin) only group. Then we analyzed the therapeutic effects with respect to size of tumor, number of lymphocyte subsets and NK activity, and SCC Ag(squamous cell carcinoma antigen) level in peripheral blood. (continue)

Long-term Impacts of Oral Progestogen ( Medroxyprogestogen Acetate ) on the Levels of Serum Lipid and Lipoprotein durign Estrogen Replacement Therapy in Postmenopausal Women / 대한산부인과학회잡지

Estrogen replacemetn therapy is known to reduce the incidence of cardio-ascular disease in postmenopausal women, and its beneficial effect is thought to be mediated in part by favorable changes in serum lipoprotien levels. However, the long-term effects on serum lipoproein levels of estrogen in low doses currently used have not been precisely evaluated in Korea. In postmenopausal women with uterus, progestogen should be added to protect the endometrium from the hyperplasia or carcinoma induced by unopposed estrogen. However, progestogens may adversely influence the beneficial effects of oral estrogen. To evaluate the impacts of progestogen on the lipid and lipoprotein levels during estrogen replacement therapy, we conducted the 1-year trial of conjugated equine estrogen(Premarine, 0.625mg/day) with or without cyclic prgoestogen(medroxy-progesterone acetate: MPA, 10mg/day for 12 days) in 120 postmenopausal women. Serum total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol levels in fasting state were measured in all subjects before treatment and at 12 months during treatment. The value of post-treatment levels were compared with that of baseline levels. In patients who received either premarine only or premarine plus MPA, serum HDL cholesterol levels increased significantly. While premarine plus MPA group showed a smaller increase in HDL cholesterol than premarine only group. And premarine plus MPA group showed a significant decrease in LDL cholesterol, total cholesterol, and triglyceride. While premarine only group showed a significant decrease in LDL cholesterol, but no statistical significance in total cholesterol and triglyceride levels. These results suggest that the addition of MPA at the daily dose of 10mg for 12 days cyclically in estrogen repalcement treatmetn appears to lessen the change to lipid and lipoprotein levels induced by unopposed estrogen, therefore maintain the longterm favorable effects on serum lipoprotein levels in postmenopausal women.

A Clinical Study of 16 Cases of Uterine Sarcomas / 대한산부인과학회잡지

Sarcoma of the uterus is very rare malignant tumor arising from the muscle or connective tissue, and there are only a few cases reported in Korea. We have experienced 16 cases of uterine sarcomas for 10 years from 1986 to 1995. The results are as follows: 1. The incidence of uterine sarcomas in uterine leiomyomas was estimated to 0.69%. 2. The pathologic types were 5 cases(31.3%) of leiomyosarcoma, 3 cases(18.8%) of endometrial stromal sarcoma, 6 cases(37.5%) of malignant mixed Mllerian tumor 2 cases(12.5%) of rhabdomyosarcoma in order. 3. The mean age was 46.4 years. 4. Seven(58.7%) were stage I, 2(16.7%) were stage III, and 3(25.6%) were stage IV. 4. The chief complaints on admission were abdominal mass(50%), abnormal bleeding(25%), and pelvic or abdominal pain(25%). 5. The estimated median survival was 43 months, and there was no correlation between survival and number of mitotic figure per 10 high power fields, stages, or radiation therapy.

c-erb B2 and p53 Overexpression in Presence of Human Papilloma Virus Type 16/18 Infection in Carcinomas of the Uterine Cervix: Genesis and Clinicopathologic Analysis / 대한산부인과학회잡지

The 43 cases of the primary uterine cervical carcinoma were analyzed for HPV type 16/18 infection and also analyzed for overexpression of p53 and c-erb B2 oncoprotein to evaluate theirs oncogenic and clinicopathologic relationships. HPV type 16/18 infection was examined by polymerase chain reaction(PCR) and the overexpression of p53 and c-erb B2 protein by using immunohistochemical method. The results were as follow: 1. The HPV infection rate in primary uterine cervical carcinomas was 83.7% respectively.The standard clinicopathologic characteristics(age, histologic type, koilocytosis, mitosis, clinical stage, tumor size, cervical invasion depth, lymph node metastasis, parametrial invasion) were nat significantly correlated with HPV type 16/18 infectivity. 2. The overexpression rate of p53 protein was 72.1% and there was no Significant correlation between expression of p53 protein and the Clinicopathologic characteristics. 3. The overexpression of c-erb B2 oncoprotein was 44.2% and there was no significant correlation between the overexpression of c-erb B2 oncoprotein and the clinicopathologic characteristics. 4. There was no significant correlation between HPV type 16/18 infection and overexpression of p53 and c-erb B2 oncoprotein.

Expression of CD44 Splice Variants(v4/5 and v6), alpha-Smooth Muscle Actin, and nm23 Proteins in IB-IIB Uterine Cervical Cancer

We examined the expressions of CD44 splice variants (v4/5, v6), alpha-smooth muscle actin, nm23 to evaluate their roles as prognostic factors in 70 cases of uterine cervical carcinoma (stage IB to IIB) who were surgically treated from January 1989 to June 1990 with a clinical follow-up of a minimum of 5 years. The expression was examined by an immunohistochemical method using archival formalin fixed paraffin embedded tissue. In the 70 cases, 61 cases were squamous cell carcinoma and 9 cases were adenocarcinoma. CD44v4/5, CD44v6, alpha-smooth muscle actin, and nm23 were detected in 41.4%, 70%, 100%, and 74.3% of tumor samples, respectively. CD44 splice variants and nm23 showed membrane and cytoplasmic staining of tumor cells, respectively. The expression of alpha-smooth muscle actin showed cytoplasmic staining confined to stromal cells and was classified into three grades by the extent in stromal cells: with less than 10% of stromal cells; 32.9%, 10-50% of stromal cells; 40.0%, more than 50%; 27.1%. These expressions were not correlated with histologic types, lymph node involvement, recurrence, and grades of tumor infiltrating lymphocyte (TIL). But CD44v4/5 had significantly inverse correlation with TIL (p=0.049). The expression of CD44v4/5 was significantly correlated with that of CD44v6 (p=0.05), and that of alpha-smooth muscle actin was inversely correlated with that of nm23 (p=0.049). In conclusion, in FIGO IB-IIB uterine cervical carcinoma CD44 variants, nm23, and SMA show high prevalence, however, with little prognostic significance assessed by recurrence and lymph node metastasis.

A Case of Absence of One Tube and a Corresponding Ovary / 대한산부인과학회잡지

Absence of one tube and a corresponding ovary is very rare anomaly.We reported a case of absence of one tube and a corresponding ovary and reviewthe literature briefly.

Prognostic Significance of Proliferating Cell Nuclear Antigen in Epithelial Ovarian Cancer / 대한산부인과학회잡지

No abstract available.

The Effects of Hormon Replacement Therapy on Serum Osteocalcin, Serum Calcium, Serum Alkaline Phosphatase, and Urine Calcium of Postmenopausal Women / 대한산부인과학회잡지

No abstract available.

Diagnostic Conization of the Cerivx / 대한부인종양콜포스코피학회잡지

To evaluate the effectiveness of conization in the diagnosis of cervical cancer, the histopathologic finding of 464 consecutive cases were analized with respect to the cytology, punch biopsy and hysterectomy. Cold knife conization was performed under direct visualization(naked eye conization) from January, 1987 to Octorber 1994 at department of Obstetrics and Gynecology, Kosin Medical Center. The results were summerized as follows : 1. The rate of agreement and underdiagnosis of between pap smear and naked eye conization were 43.7% and 47%. 2. The rate of agreement and underdiagnosis of between punch biopsy and naked eye conization were 64.5% and 21.8% 3. Subsequent hysterectomy was done on the 382 case and their incidence of residual disease rate was 44.2%(169 cases). Their incidence of residual lesion was increased with severity of the carcinomatous change. 4. The rate of complication undergoing conization was 8.4%(39 cases).

10 Year's Expreience on Gestational Trophoblastic Disease / 대한부인종양콜포스코피학회잡지

For the clinical analysis and evaluation on the patients with gestational trophoblastic disease(GTD), a study was done retrospectively on 114 patients with GTD(60 in Hydatidiform mole, 10 in invasive mole, 44 in choriocarcinoma) treated from Jan. 1, 1985 to Dec. 31, 1994 at the Department of Obstetrics and Gynecology, Kosin Medical College, Pusan, Korea. We obtained the following results ; The incidence of GTD was 1 per 73 deliveries in H. mole, 1 per 437 deliveries in invasive mole, and 1 per 99 deliveries in choriocarcinoma. The most prevalent age was 21-40 groups. Abnormal vaginal bleeding was a main symptom and sign. 30.6% of H. mole was managed by dilatation and curettage. 90.0% of invasive mole and 51.4% of choriocarcinoma were managed by surgical treatment and chemotherapy. The overall remissinon rate of choriocarcinoma was 71.4%(100.0% in stage I, 66.7% in stage II, 54.5% in stage III, 50.0% in stage IV).

Follow up Study of Second Look Laparotomy in Ovarian Cancer patients / 대한부인종양콜포스코피학회잡지

A study was to evaluate the efficacy and clinical utility of second look operation in the managements of malignant ovarian tumor at the Department of Obstetrics and Gynecology, Kosin medical colleage from January 1986 to September 1993. Of 220 patients diagnosed as ovarian cancer, 48 patients who had underwent primariy laparotomy were performed second look operation. Thirty-seven patients were found to have no evidence of disease. The result revealed that negative second look operation rate was noted 96.3% at stage I, 66.6% at stage II, 50.0% at stage III, and 42.9% at stage IV and total negative second look operation rate was 77.1%. The 2 year survival rate for stage I, II, III, IV were 85.2%, 66.6%, 50.0% and 42.9% respectively. The survival rate of negative second look operation was 86.5%, that of positive second look operation was 18.1%. In conclusion, second look operation in early stage ovarian cancer need to be justified.

The Clinical Effect of Recombinant Human Granulocyte-Colony Stimulating Factor to the Leukopenia During Chemotherapy in the Patients with Gynecologic Malignancies / 대한부인종양콜포스코피학회잡지

An increase in the dose of chemotherapy enhances the response of many experimental and clinical cancers, but the extent of chemotherapy dose escalation and repeated use is often limited by myelosuppression. The side effects of chemotherapy including bleeding and infection due to myelosuppression have resulted in delayed therapy and a reduction in the therapeutic dose, therefore it is necessary to overcome myelosuppression especially leukopenia in patients with gynecologic malignancies who recieved chemotherapy. This study is undertaken to investigate the clinical effects of rhG-CSF(recombinant human Granulocyte-colony stimulating factor) in 29 patients with gynecologic malignancy who recieved chemotherapy. It was given at a dose of 100 microgram bid/day subcutaneously until significantly increase of leukocyte count in leukopenic patient. The results showed, the rhG-CSF has significantly increased the number and function of leukocyte. The use of rhG-CSF was effective and useful to treat chemotherapy induced leukopenia and to accelerate the recovery from this complications.