A clear cell cystadenofibroma of the ovary / 대한산부인과학회지

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

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

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

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

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

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

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

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

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

A case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma / 대한산부인과학회지

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.

A case of successful laparoscopic surgical staging in patient of Sertoli-Leydig cell tumor / 대한산부인과학회지

Sertoli-Leydig cell tumors are rare sex cord-stromal tumors. These tumors account for less than 0.5% of all ovarian tumors. Because these tumors appear predominantly in young women (between the age of 30 and 40) and are bilateral in less than 1% of cases, conservative removal of the tumor and adjacent fallopian tube is justifiable. Recently, we experienced a case of successful laparoscopic surgical staging in patient of Sertoli-Leydig cell tumor which was previously incompletely evaluated in local OBGY clinic. There are no solid data to suggest that usefulness and risk of laparoscopic surgical staging and adjuvant therapy with stage I disease of these tumors until now. So we present it with a brief review of literature.

Analysis of HLA-G expression in preeclampsia and intrauterine growth restriction / 대한산부인과학회지

OBJECTIVE: To determine whether soluble HLA-G protein levels in plasma and/or HLA-G protein in placental tissues differ between women with gestational complications (preeclampsia and/or intrauterine growth restriction, IUGR) and women with normal pregnancies. METHODS: A sandwich enzyme-linked immunosorbent assay was used to investigate the HLA-G expression level in 11 cases of preeclampsia, 8 cases of preeclampsia with IUGR, 18 cases of IUGR, and 10 normal control subjects. RESULTS: Plasma HLA-G levels were decreased significantly in the preeclampsia group (median, 0.072 microgram/mL), the preeclampsia with IUGR group (median, 0.086 microgram/mL), and the IUGR group (median, 0.081 microgram/mL), in comparison with normal pregnant women (median, 0.360 microgram/mL) (P=0.002, P=0.049, and P=0.003, respectively). Also, Placental HLA-G levels were decreased significantly in the preeclampsia group (median, 0.016 microgram/mg), the preeclampsia with IUGR group (median, 0.015 microgram/mg), and the IUGR group (median, 0.021 microgram/mg), in comparison with normal pregnant women (median, 0.091 microgram/mg) (P<0.001, P=0.002, and P=0.001, respectively). There was a significant correlation between plasma and placental HLA-G levels (r=0.807, P<0.001). CONCLUSION: Our results indicate that the attenuated expression of placental HLA-G and reduced release of this protein into the maternal circulation in gestational complications, such as preeclampsia and IUGR may alter the maternal-fetal immune relationship, and thus could be at play in the pathophysiology of these diseases. This suggests that assessment of levels of HLA-G proteins may be useful in predicting development of preeclampsia and IUGR.

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

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

Synergistic apoptotic effect of Taxol on oral squamous cell carcinoma by cyclosporin A

Clinical Analysis of Placental Abruption / 대한주산의학회잡지

OBJECTIVE: Placental abruption is one of the obstetric hemorrhage diseases that needs emergent treatment. But there is no predictable tool for placental abruption at present, we clinically analyzed its incidence, etiological factors, signs and symptom and neonatal outcome for reducing complications of this disease. METHODS: The data presented here were based on 80 cases of placental abruption among 20,483 deliveries during 13 years of period from January, 1991 to December, 2003. RESULTS: The incidence of placental abruption was 0.4%. Most of cases (97.5%) occurred over 28 weeks of gestational age. The incidence of unknown etiological factor was 67.5% and pregnancy-induced hypertension was related in 22.5% of cases. The most common signs and symptom was vaginal bleeding (46.3%). Lower abdominal pain (33.8%), fetal distress (10%), premature labor (5%) were also noted. The half of the patients was diagnosed before delivery and the mode of delivery was cesarean section in 93.8%. The survival rate of newborns in severe degree group (14.3%) of placental abruption was lower than that of mild degree group (94.1%) or moderate degree group (84.6%). Additionally, Apgar scores at 1min and 5min of newborns in severe degree group (1.3+/-2.4/1.3+/-3.0) were significantly lower than that of mild degree group (5.9+/-2.5/7.5+/-2.2) or moderate degree group (5.5+/-2.7/7+/-2.8) (p<0.01). There was no maternal death in our study. CONCLUSION: Because the etiological factor of this disease was uncertain in two thirds of cases, comprehension of etiological factor such as pregnancy-induced hypertension and signs and symptom is emphasized. Bleeding and uteroplacental insufficiency caused by placental abruption affect fetal jeopardy in severe cases. Accurate diagnosis and adequate treatment including management of premature baby should be conducted in suspicious case of placental abruption for prevention of progression of this disease.

A case of primary tubal cancer evaluated with laparoscopy / 대한산부인과학회지

Malignant neoplasm of the fallopian tube is the rarest of the gynecologic cancers. Vaginal bleeding, vaginal discharge, and pelvic pain are the most common symptoms. Because of these non-specific symptoms, the diagnosis of this least common neoplasm is rarely made before laparotomy. The tumor is typically unilateral and has histologic subtypes, endometrioid and serous adenocarcinoma being the most common subtypes. Surgery, clearly the mainstay of treatment, is also the first approach to diagnosis. The procedure of choice is total abdominal hysterectomy with bilateral salpingo-oopho-rectomy. We had experienced one patient with primary tubal cancer, successfully evaluated with laparoscopy. And then we intend to report the case of the above patient and have a brief discussion about that.

The length of active labor in women with vaginal birth after cesarean section compared with nulliparas and multiparas / 대한산부인과학회지

OBJECTIVE: Despite the general information of vaginal birth after cesarean section (VBAC), little is known about the duration of active labor in women attempting VBAC. The aim of this study was to compare the time length of active labor in women attempting VBAC compared with nulliparas or multiparas, and then, provide further insight for better management of labor. METHODS: From January 1999 to December 2003, a total of 444 patients with VBAC were entered into the study. Women with two or more history of caesarean section or previous vaginal delivery were all excluded from the study. Time length of active labor in these patients was compared with 335 nulliparas and 218 multiparas consecutively visiting our unit for delivery in 2003. RESULTS: For patients with VBAC, the duration of active and second phase were 184.8+/-115.7, and 25.1+/-15.2 minutes, which was significantly shorter than nulliparas (p<0.05), but longer than multiparas (p<0.05). To eliminate confounding factors affecting the duration, 374 women without use of vacuum, oxytocin, or epidural anesthesia were selected for analysis. Consistently, the time length of active and second phase in women with VBAC was significantly shorter than in nulliparas, but longer than in multiparas (p<0.001) except for active phase compared with nulliparas (p=0.295). CONCLUSION: With regard to the time length of active labor, women attempting VBAC were in the intermediate group when compared with nulliparas or multiparas. Understanding of this unique time interval in women attempting VBAC may help in allowing an appropriate management for labor process.