Comparison of the Prognostic Outcome between High-Grade Ovarian Sertoli-Leydig Cell Tumors (SLCTs) and Low-Grade SLCTs

The purpose of the current study was to compare prognostic outcomes between patients with high-grade ovarian Sertoli-Leydig cell tumors (SLCTs) and those with other low-grade SLCTs. We retrospectively reviewed medical records for 24 patients pathologically diagnosed with SLCTs between 2006 to 2019 at two institutions. The patients were grouped according to pathological grade: SLCT was classified as grade 1, well differentiated; grade 2, intermediated differentiated; or grade 3, poorly differentiated (Meyer’s classification). Statistical analysis was performed to compare survival outcomes according to pathological grade. The median patient age was 42.5 years (range 16–75). Eighteen patients (75%) were International Federation of Gynecology and Obstetrics stage I, and none were diagnosed in stage IV. Nine patients (37.5%) were grade 3, and 15 patients (63.5%) were grades 1–2. When comparing clinical baseline characteristics of the grade 1–2 group with those of the grade 3 group, only serum CA125 level at diagnosis was significantly higher in the grade 3 group (38.34 vs. 382.29, p=0.002). Five patients experienced recurrence of grade 3 disease, while no recurrence was reported in grade 1–2 disease. Four of the five recurrent patients died. In result, grade 3 ovarian SLCT showed significantly poorer prognosis than grade 1–2 disease (overall survival, hazard ratio=14.25, 95% confidence interval= 1.881–108.0; log-rank p=0.010). Our findings were consistent with the concept that patients with stage I/grade 1–2 tumors have a good prognosis without adjuvant chemotherapy. Since grade 3 ovarian SLCT appears to be relatively more fatal than grade 1 or 2, patients with grade 3 SLCT might require more aggressive surgical intervention and post-treatment surveillance.

A Single-Center, Retrospective Study of Bevacizumab-Containing Neoadjuvant Chemotherapy followed by Interval Debulking Surgery for Ovarian Cancer

PURPOSE: We evaluated whether adding bevacizumab to current platinum-based chemotherapy could improve clinical outcomes without affecting safety.MATERIALS AND METHODS: We retrospectively reviewed medical records of patients with pathologically confirmed ovarian cancer who received neoadjuvant chemotherapy (NAC) at Yonsei Cancer Hospital. We divided the patients into groups based on the use of bevacizumab for NAC (CP group: carboplatin+paclitaxel vs. BCP group: bevacizumab+carboplatin+paclitaxel) and compared patient characteristics, responses to NAC, and surgical and survival outcomes between the two groups. Overall, 88 patients in the CP group and 16 patients in the BCP group received NAC. The primary endpoint was survival outcomes. Complete resection rate after interval debulking surgery (IDS), cancer antigen 125 (CA-125) normalization after NAC, and chemotherapy response score were secondary endpoints.RESULTS: After NAC treatment, all patients underwent IDS. There were no significant differences in adverse events during NAC or postoperative complications between the two groups (p=0.293 and p=0.485, respectively). There were also no significant differences in CA-125 normalization after NAC (42.0% vs. 43.8%, p=0.899) or complete resection rate after IDS (47.7% vs. 56.3%, p=0.530). However, although the BCP group did not show longer overall survival (OS) (log-rank p=0.854), they had significantly longer progression-free survival (PFS) than the CP group (log-rank p=0.048).CONCLUSION: Bevacizumab-containing NAC might be safe and provide longer PFS than chemotherapy alone in patients with advanced ovarian cancer. However, further study is necessary to investigate the impact of bevacizumab-containing NAC on OS.

How to use immune checkpoint inhibitor in ovarian cancer? / 부인종양

No abstract available.

Herpes Zoster DNA Vaccines with IL-7 and IL-33 Molecular Adjuvants Elicit Protective T Cell Immunity

Herpes zoster (HZ), or shingles, is caused by the reactivation of latent varicella-zoster virus (VZV) from the sensory ganglia when VZV-specific T-cell immunity is decreased because of aging or immunosuppression. In the present study, we developed HZ DNA vaccine candidates encoding VZV proteins and cytokine adjuvants, such as IL-7 and IL-33. We immunized C57BL/6 mice with DNA plasmids encoding VZV glycoprotein E (gE), immediate early (IE) 63, or IE62 proteins and found that robust VZV protein-specific T-cell responses were elicited by HZ DNA vaccination. Co-administration of DNA plasmids encoding IL-7 or IL-33 in HZ DNA vaccination significantly enhanced the magnitude of VZV protein-specific T-cell responses. Protective immunity elicited by HZ DNA vaccination was proven by challenge experiments with a surrogate virus, vaccinia virus expressing gE (VV-gE). A single dose of HZ DNA vaccine strongly boosted gE-specific T-cell responses in mice with a history of previous infection by VV-gE. Thus, HZ DNA vaccines with IL-7 and IL-33 adjuvants strongly elicit protective immunity.

Treatment of Failed Arthrodesis of First Metatarsophalangeal Joint with Tensor Fascia Lata Interposition Arthroplasty: A Case Report / 대한족부족관절학회지

Surgical treatments for arthritis in the first metatarsophalangeal joint include arthrodesis, interposition arthroplasty using silicone or meniscus cartilage, and rarely arthroplasty. Although arthrodesis was performed successfully, pain can persist if the angle of fusion was inappropriate. Interposition arthroplasty can be tried for the treatment of persisting pain after the arthrodesis. Interposition arthroplasty using tensor fascia lata is known that has low risk of adhesions and easy to harvest. Compared to autologous grafts, grafting rates is high and low risk of rejection additionally. Herein, we report a successfully managed arthritis with severe pain with interposition arthroplasty using tensor fascia lata after a failed metatarsophalangeal joint arthrodesis.

The Effect of Weightbearing after Distal Reverse Oblique Osteotomy for Bunionette Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the radiological and clinical effects of early eightbearing after distal reverse oblique osteotomy of bunionette. MATERIALS AND METHODS: Between 2009 and 2015, 52 patients who underwent surgical treatment at our hospital for bunionette deformity with a minimum follow up of one year were included in the study. Postoperatively, foot cast was applied and full weightbearing was permitted in 28 patients. And short leg splint was applied with only partial weightbearing using crutches allowed in 24 patients. Clinical scores were evaluated. Radiologically, the 4th~5th intermetatarsal angle (IMA), and 5th metatarsophalangeal angle (MPA) were analyzed preoperatively and at the final follow up visit. RESULTS: The visual analogue scale and American Orthopaedic Foot and Ankle Society scores improved in the partial weightbearing group and full weightbearing group, but without significant differences. The average 4th~5th IMA and average 5th MPA correction also did not showed significant differences between the partial weightbearing group and full weightbearing group. Moreover, the full weightbearing group did not encourage non-union rate compared with the partial weightbearing group. CONCLUSION: Effective bone union may be achieved through early weightbearing, resulting in better clinical outcomes. It is considered that early weightbearing did not have any effect on the changes of IMA and bone union.

Endosalpingiosis in Postmenopausal Elderly Women

In gynecology, endosalpingiosis is a benign condition in which the fallopian tube-like epithelium is found outside the fallopian tube. The thirty-four point five percent of endosalpingiosis cases have concurrent endometriosis and 40% of the endosalpingiosis group are in postmenopausal states. In contrast with endometriosis, there are no significant links between infertility, chronic pelvic pain and endosalpingiosis. The symptoms of endosalpingiosis are not yet settled. Endosalpingiosis is almost always an incidental finding; it is commonly found through microscopic examinations, and is then confirmed by pathologists for excision and biopsy. Therefore, the clinical differential diagnosis of an intramural mass is more important for clinicians when discussing further surgery with the patients. We report case of woman who has endosalpingiosis and is presented with vaginal bleeding. We first suspect the disease during physical examination. Under the impression of pelvic mass, laboratory tests and radiological images of contrast enhanced chest computer tomography are taken. Images show multisepted cystic masses in left adnexa. To rule out the pelvic mass, we executed exploratory laparotomy. Pathologic results show endosalpingiosis near the ovary section. But the endosalpingiosis, is not generally considered a pathology, and thus, no treatment is necessary.

Sclerosing Stromal Tumor in an Elderly Postmenopausal Woman

Sclerosing stromal tumor (SST) of the ovary is a rare tumor derived from the sex cord stroma. This tumor was first described by Chalvaridjian and Scully in 1973. SST of the ovary is prevalence of 1.5% to 6% of ovarian stromal tumors. Patients are most commonly diagnosed in their 20s and 30s. There have been reports of SST postmenopausal women aged 65-, 67-, and 71 in the Republic of Korea; however, no report of this disease has been reported in women older than 80. In this study, we would like to report an 80-year-old postmenopausal woman who did not previously complain of any symptoms, and was finally diagnosed with SST. She was involved in a traffic accident, and huge pelvic mass was found during the evaluation of intra-abdominal hemorrhage. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed ; a final pathologic diagnosis reported SST.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Perimenopausal Women

OBJECTIVES: To evaluate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) of perimenopausal women at a university hospital along with their menstrual characters. METHODS: A questionnaire survey regarding premenstrual symptoms was carried out in 100 perimenopausal women (43 to 53, years). The pattern of menstruation and, the intensity of dysmenorrhea were assessed; and further, the symptoms were classified according to their number, intensity, and persistence. The PMS criteria of American College of Obstetrics and Gynecology (ACOG) and PMDD criteria by American Psychiatric Association (APA) were evaluated. RESULTS: The approximate prevalence of PMS criteria was 95% and that of PMDD criteria was 23%. The most dominant symptoms were 'breast tenderness', 'abdominal bloating', 'and headache'. PMDD was significantly associated with the severity of dysmenorrhea (P = 0.020). There was no significant relation with age, height, weight, body mass index and the cycle of menstruation. CONCLUSION: Most women experience PMS and PMDD, which and have a significant impact on the activity of perimenopause women. However in most women that do not know well about PMS and PMDD. We should educate and inform women of PMS and PMDD, thus helping them increase their quality of life.

Expression of Ezrin in Vagina Cells of Postmenopausal Rats after Dietary Administration of Omega-3 Fatty Acid Formula

OBJECTIVES: To see the effect of dietary administration of omega 3-fatty acid formula on the vaginal cells of postmenopausal rats. METHODS: Three-week-old female Wistar/ST rats were raised after one week of adjustment period. The rats were then divided into three groups, for three different kinds of diet; general diet, 1% omega-3 fatty acid diet, and 2% omega-3 fatty acid diet. After eight weeks of having assigned diet, after the oophorectomy, with the same diet previously they had Immunohistochemistry, Immunofluorescence, and Western Blot about ezrin, merlin were done. RESULTS: In immunohistochemistry, estrogen injection group revealed thicker and well differentiated features. In Immunofluorescence, Omega-3 fatty acid composition in diet did not effect expression of ezrin and merlin in rat vagina in estrogen injection group, their vaginal epithelium showed full layers (from basal to apical layer). In Western Blot analysis, Omega-3 fatty acid composition in diet did not affect expression of ezrin and merlin in rat vagina estrogen presented significant impact on expression of ezrin and merlin. CONCLUSION: Although omega-3 fatty acid composition changed in diet, vaginal epithelial morphology unchanged. Estrogen did effect on vagina cell, but omega-3 fatty acid did not effect on ezrin and merlin in vagina.

Immunohistochemical detection of the 1, 25-dihydroxy vitamin D receptor in the human vagina

Vitamin D plays a critical role in the regulation of growth and differentiation of squamous epithelium. The pleiotropic effects of 1, 25-dihydroxyvitamin D3. [1, 25 [OH]2 D3], include proliferative, pro-apoptotic, and pro-differentiation effects on numerous cell types. Although 1, 25-dihydroxyvitamin D3 is involved in the regulation and differentiation of epithelium, there is no data in the aspect of the distribution of 1, 25-[OH] 2 D3. receptor [VDR], estrogen receptor-beta [ER-beta] and ezrin, and how it changes according to the menstrual phases and serum vitamin D level in the human vagina. To detect of the 1, 25-dihydroxyvitamin D3. receptor [VDR], estrogen receptor-beta [ER-beta], and ezrin in human vagina. This cross-sectional study enrolled 15 premenopausal women who had hysterectomies. Vaginal tissues were obtained from vaginal vaults of hysterectomized uterus and processed for immunohistochemical analysis. We recorded the localization, distribution, and expression of VDR, ER-beta, and ezrin in the vaginal epithelium. VDR was detected in all layers of vaginal epithelium regardless of the menstrual cycle stage and serum 25-hydroxyvitamin D levels. In this study, we have characterized the presence and distribution of VDR, ER-beta, and ezrin in human vaginal epithelium, including menstrual cycle-related and vitamin D-related expression. However, the VDR-related mechanisms underlying vaginal epithelial proliferation and differentiation remain to be elucidated

Gynecologic complication of chronic graft-versus-host disease: Vaginal obstruction

Allogenic peripheral blood stem cell transplantation (Allo-PBSCT) is being used to treat hematological malignancies with increasing frequency. Graft-versus-host disease (GvHD) is a complex complication of PBSCT. A 43-year-old woman came to the gynecology clinic for amenorrhea. She had been diagnosed with acute myeloid leukemia 2 years earlier and treated with induction and consolidation chemotherapy. After developing complete remission, she underwent Allo-PBSCT. When she started chemotherapy, her menstrual cycle completely disappeared. Fourteen months after menopausal hormone replacement therapy, it was discovered that her upper vaginal canal was completely obstructed. The lower vagina had an atrophic appearance. We report a rare case of partial vaginal obstruction as a complication of chronic GvHD and review the literature. We expect that this case report provides an opportunity to remind clinician of the gynecologic complications of GvHD.

Expression of Vitamin D Receptor by Pulse Consumption in the Uterus of Menopausal Mouse Model / 대한폐경학회지

OBJECTIVES: Phytoestrogen-containing pulse supplements have beneficial effects on postmenopausal symptoms, but how such effects are achieved is unclear. This study investigates the effects of pulse consumption on the menopausal changes in ovariectomized rats. METHODS: Female Sprague-Dawley rats were either sham operated (Sham; n = 3) or surgically ovariectomized (n = 13). The Sham group was fed the regular AIN-93M diet. Ovariectomized group was divided into 3 sub-groups and fed AIN-93M containing soybean (n = 5), mung bean (n = 3), or cowpea (n = 5) for 10 weeks. At the end of the experiment, all rats were sacrificed, and the uterus was harvested, rinsed, and weighed. Expressions of vitamin D receptor (VDR), estrogen receptor (ER) beta, and ezrin in uterus were evaluated by immunohistochemistry. RESULTS: VDR was highly expressed in the uterus of rat, irrespective of ovariectomized state. VDR was more definitely expressed in the uterus of ovariectomized groups than the sham-operated group. There were no significant differences in expression of ER beta. However the expression of ezrin was highly expressed in the cowpea group compared to sham group (P = 0.044). CONCLUSION: This study suggested that legumes diet may concern menopausal changes via VDR and ezrin. The result may partly explain the beneficial effects of VDR on menopausal symptoms. Further study is necessary to study the detailed mechanisms of VDR and ezrin on the menopausal changes in the uterus.

Hormone Therapy in Postmenopausal Women According to the Correlation of Changes in Bone Mineral Density / 대한폐경학회지

OBJECTIVES: We investigated the relationship between bone mineral density (BMD) and hormone therapy (HT) and its duration in postmenopausal women. METHODS: We performed a retrospective study on 291 postmenopausal women who had their BMD and follow-up BMD measured in a university hospital. We analyzed BMD, HT types and HT duration according to clinical characteristics. RESULTS: The mean age of the study subjects was 53.7 +/- 5.9 years. HT types and HT duration were not statistically related to improvement in BMD (P = 0.956, 0.483). But osteoporosis in patients with hormone therapy improves bone mineral density showed statistical significance (P = 0.001). CONCLUSION: HT types and HT duration did not have any effect on bone mineral density, but further prospective multicenter studies regarding HT should be considered for osteoporosis.

Lichen Sclerosus in a Post-Menopausal Woman: A Case Report / 대한폐경학회지

Lichen sclerosus (LS) refers to a benign, chronic, progressive dermatologic condition that primarily causes anogenital lesions in middle aged women. But LS has been identifi ed in patients of all ages including those in the fi rst years of life. The risk of squamous cell carcinoma of the vulva is 4% to 5% in women with LS, and has been reported to be as high as 7% in some reviews. We recently encountered a case of LS in a post-menopausal woman without hormone therapy. To remind clinicians of the neglected issue of LS, we report a case of LS with literature review.

Ovarian Rete Cyst in a Post-menopausal Woman: A Case Report / 대한폐경학회지

The term rete ovarian cyst has been used mostly in animal pathology. Cysts of the ovarian hilus have been reported in experimental animals, but have not received attention in human beings. In the literature review, most women with these cysts were postmenopausal and the cysts were not malignancy. But, there have been some reports of hormonal imbalance associated with these cysts. This article reports the clinicopatholgical findings of a case of ovarian rete cyst in postmenopausal woman with some literature review.

Routine Application of the Korean FRAX Model in Women: a Single-center Study

OBJECTIVES: The objective of this study was to assess the efficacy of the Korean fracture-risk assessment tool (FRAX) model for routine application in women who had a general check-up for bone mineral density (BMD). METHODS: This retrospective study was conducted at a university hospital and comprised 343 patients, whose BMD and clinical risk factors were assessed for FRAX calculation. The 10-year probabilities of hip and major osteoporotic fractures were compared with the result of the FRAX(R) tool (http://www.shef.ac.uk/FRAX, web version 3.5) applied to Korean models developed at the World Health Organization Collaborating Center with or without femoral neck bone mineral density. RESULTS: The T-score gradually decreased with increasing age. Additionally, the 10-year probability of a major osteoporotic fracture increased with age. However, the probability of hip fracture showed no correlation with age if BMD was not included in the estimation. CONCLUSION: Previous report on patients whose probability of a proximal femoral fracture were calculated using Korean FRAX models produced a higher score than our data because our data involved a general population. A larger general population is needed to confirm the Korean FRAX model. However, our data provide information for physicians to assess the Korean FRAX model in the general female population.

Routine Application of the Korean FRAX Model in Women: a Single-center Study

OBJECTIVES: The objective of this study was to assess the efficacy of the Korean fracture-risk assessment tool (FRAX) model for routine application in women who had a general check-up for bone mineral density (BMD). METHODS: This retrospective study was conducted at a university hospital and comprised 343 patients, whose BMD and clinical risk factors were assessed for FRAX calculation. The 10-year probabilities of hip and major osteoporotic fractures were compared with the result of the FRAX(R) tool (http://www.shef.ac.uk/FRAX, web version 3.5) applied to Korean models developed at the World Health Organization Collaborating Center with or without femoral neck bone mineral density. RESULTS: The T-score gradually decreased with increasing age. Additionally, the 10-year probability of a major osteoporotic fracture increased with age. However, the probability of hip fracture showed no correlation with age if BMD was not included in the estimation. CONCLUSION: Previous report on patients whose probability of a proximal femoral fracture were calculated using Korean FRAX models produced a higher score than our data because our data involved a general population. A larger general population is needed to confirm the Korean FRAX model. However, our data provide information for physicians to assess the Korean FRAX model in the general female population.

Cervical Endometriosis in a Post-menopausal Woman: A Case Report / 대한폐경학회지

Cervical endometriosis is defined as the presence of endometrial glands and stroma at the cervix. This is rare and sometimes asymptomatic. Most of these are diagnosed by incidental findings within histopathology. As the presence of cytological features do not guarantee the presence of cervical endometriosis, it is difficult to diagnose this disorder prior to surgery. We recently encountered a case of cervical endometriosis in a post-menopausal woman who was not receiving hormone therapy. As a reminder to clinicians about this neglected issue, we report a case of cervical endometriosis with a literature review.

Prevalence of Human Papilloma Virus Infection in Perimenopausal Women in Bucheon Province / 대한폐경학회지

OBJECTIVES: To investigate the prevalence of human papillomavirus (HPV) infection in Bucheon province. METHODS: Two hundred eighty Korean women (average age 41.9, range 21~90 years) were enrolled, who received a regular thinprep pap test and an HPV deoxyribonucleic acid (DNA) chip test simultaneously at Soonchunhyang University Hospital, Bucheon, from February 2011 to March 2011. RESULTS: The overall prevalence of HPV infection was 33.9% (95/280). The prevalence of HPV infection in postmenopausal women (24.3%) was significantly lower than that of premenopausal women (37.1%, P = 0.049). CONCLUSION: Although the prevalence of HPV infection in postmenopausal women was lower than that of premenopausal women, HPV infection is more critical in postmenopausal women as HPV infection in postmenopausal women is more likely to induce cervical cancer than in premenopausal women.