Human papillomavirus genotyping for predicting disease progression in women with biopsy-negative or cervical intraepithelial neoplasia grade 1 of low-grade intraepithelial lesion cytology.

OBJECTIVE: Our study used human papillomavirus (HPV) genotyping to assess the disease occurrence probability in women with a low-grade squamous intraepithelial lesion (LSIL) without histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+). METHODS: This study investigated CIN2+ incidence in 1986 women from January 2005 to August 2016, including 1123 with LSIL who were histology-proven negative and 863 with LSIL who were histology-proven CIN1. Baseline high-risk HPV (HR-HPV) status was determined using the hybrid capture II assay (HC2), and HR-HPV genotype was determined using the HPV DNA chip test (HDC). RESULTS: Among 1986 women, the HC2 yielded positive results in 1529 (77.0%), while the HDC identified 1624 (81.8%). Thus, the overall HDC and HC2 agreement was 93.2%. Overall, 169 (8.5%) patients developed CIN2+. The 5-year cumulative CIN2+ incidence rates for HPV-16, HPV-18, HPV-31, and HPV-33 were 11.8%, 9.9%, 16.3%, and 16.1%, respectively. Multivariate analysis revealed that HPV-16 (HR 1.637, 95% CI 1.064 to 2.520, p=0.025), HPV-31 (HR 1.845, 95% CI 1.051 to 3.238, p=0.033), and HPV-33 (HR 2.272, 95% CI 1.235 to 4.183, p=0.008) were significantly associated with CIN2+ development. CONCLUSION: Among women with LSIL, those who test positive for HPV-16, HPV-31, or HPV-33 may require more rigorous follow-up because of a higher CIN2+ risk.

Is human papillomavirus genotype important in predicting disease progression in women with biopsy-proven negative or CIN1 of atypical squamous cell of undetermined significance (ASC-US) cytology?

OBJECTIVES: Our aim was to estimate the risk of disease incidence in women with atypical squamous cell of undetermined significance (ASC-US) without histology-proven cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by human papillomavirus (HPV) genotype. METHODS: Between January 2002 and September 2010, incidence of CIN2+ in 2880 women including 2172 with ASC-US and histology-proven negative and 708 with ASC-US with histology-proven CIN1 was investigated. Baseline HR-HPV status was determined by the hybrid capture II assay (HC2) and HR-HPV genotype by the HPV DNA chip test (HDC). Cumulative incidence and hazard ratios were estimated to explore differences between index data and associations with CIN2+. RESULTS: Of the 2880 women, the HC2 was positive in 1509 women (52.4%) and the HDC was positive in 1563 women (54.3%). The overall agreement between the HDC and HC2 was 97.4%. One hundred ninety (6.6%) patients developed CIN2+. The 5-year cumulative incidence rate of CIN2+ in HPV-16, HPV-31, HPV-52, and HPV-58 were 16.7%, 15.1%, 12.6%, and 12.9%, respectively. On multivariate analysis, being positive in HPV-16 (hazards ratio [HR]=2.431; 95% CI, 1.789-3.332; P<0.01), HPV-31 (HR=2.335; 95% CI, 1.373-3.971; P<0.01), HPV-52 (HR=1.592; 95% CI, 1.031-2.458; P=0.03), and HPV-58 (HR=1.650; 95% CI, 1.132-2.407; P<0.01) were significantly associated with developing CIN2+ compared to being negative for that type. CONCLUSIONS: Among women with ASC-US, HPV-16, HPV-31, HPV-52, or HPV-58 positive women may need intensified follow-up as they have the highest risk of becoming CIN2+.

Human U87 glioblastoma cells with stemness features display enhanced sensitivity to natural killer cell cytotoxicity through altered expression of NKG2D ligand.

BACKGROUND: Glioblastoma (GBM) is one of the most lethal tumors with a poor prognosis. Its inevitable recurrence is frequently explained by the presence of cancer stem cells. We aimed to show that human GBM cells with stemness features are more sensitive to natural killer (NK) cells than GBM cells without stemness characteristics. METHODS: Natural killer cell cytotoxicity was measured using flow cytometry in neurosphere-forming U87 GBM cells cultured with neurobasal media (NBE condition) and compared with that in serum-cultured U87 GBM cells (serum condition). Cytotoxicity was examined after addition of blocking NKG2D monoclonal antibodies. The expression profile of NK ligands of NK cells were investigated by reverse transcription polymerase chain reaction and western blot analysis in the U87 GBM cells in both conditions. RESULTS: NBE U87 cells showed higher cytotoxicity to NK cells than serum U87 cells did (55 vs 35% at an effector to target cell ratio of 5:1). The increased cytotoxicity was diminished in NBE U87 cells by a larger gap than in serum U87 cells by adding NKG2D blocking antibodies. Of the NKG2D ligands, the expression of ULBP1 and ULBP3 was relatively increased in NBE U87 cells compared to serum U87 cells. CONCLUSIONS: U87 GBM cells with stemness features demonstrate increased cytotoxicity to NK cells in association with altered NKG2D ligand expression of NK cell activating receptor. Applying immune modulation to GBM treatment may be a promising adjuvant therapy in patients with intractable GBM.

Development and Validation of the Korean Version of Hand-Foot Skin Reaction and Quality of Life Questionnaire (HF-QoL-K).

Given the growing number of cancer patients and the resulting increase in the administration of chemotherapeutic agents, convenient and effective methods for measuring the symptoms and quality of life associated with the hand-foot syndrome (HFS) are needed. Therefore, the aim of this study was to develop and validate the Korean version of the hand-foot skin reaction and quality of life questionnaire (HF-QoL-K), comprising a 20-item symptom domain and an 18-item daily activity domain. After we developed the HF-QoL-K, 209 Korean patients with gynecologic cancer who were undergoing chemotherapeutic agents relating the HFS were asked to fill in the questionnaire. The content validity, internal consistency reliability, and test-retest reliability were evaluated. The internal validity index, Cronbach's alpha coefficient, and intra-class correlation coefficient of the HF-QoL-K were 0.90, 0.958, and 0.825 (95% confidence interval [CI], 0.774-0.865), respectively. The scatter plot (Pearson correlation coefficient, 0.826) and the Bland-Altman plot for test-retest reliability were also acceptable. The HF-QoL-K instrument is a valid and reliable questionnaire for the measurement of the symptoms and quality of life in Korean cancer patients suffering HFS.

Review of ovarian tumors in children and adolescents: radiologic-pathologic correlation.

The incidence, histologic distribution, and clinical manifestations of ovarian tumors in the pediatric population are distinct from those in adults. Although ovarian neoplasms in childhood and adolescence are rare, the diagnosis should be considered in young girls with abdominal pain and a palpable mass. Differential diagnosis in children and adolescents with ovarian tumors should be conducted on the basis of unique clinical manifestations, elevated serum tumor marker levels, and distinctive imaging findings. Although the clinical manifestations are nonspecific and may overlap, they may assist in diagnosis of some types of ovarian tumors. Children who present with a palpable mass or symptoms of precocious puberty have a high likelihood of malignancy. Many ovarian tumors are associated with abnormal hormonal activity and/or abnormal sexual development. Elevated levels of serum tumor markers, including α-fetoprotein, the beta subunit of human chorionic gonadotropin, and CA-125, raise concern for ovarian malignancies. However, negative tumor markers do not exclude the possibility of malignancy. Identification of imaging features at ultrasonography, computed tomography, and magnetic resonance imaging can help differentiate benign from malignant ovarian tumors and, in turn, plays a crucial role in determining treatment options. At imaging, malignant ovarian tumors usually appear predominantly solid or heterogeneous and are larger than benign tumors. Because surgery is the primary treatment for ovarian tumors, ovarian salvage with fertility preservation and use of a minimally invasive surgical technique are important in children and adolescents.

Uterine artery pseudoaneurysm manifesting as delayed postpartum hemorrhage after precipitous delivery: three case reports.

Precipitous delivery may lead to serious maternal and neonatal complications. Uterine artery pseudoaneurysm (UAP) is one of the causes of delayed postpartum hemorrhage. Here we describe 3 cases of UAP manifesting as delayed postpartum hemorrhage after precipitous delivery. The duration of the second stage of labor in cases 1, 2, and 3 was 15, 15, and 60 min, respectively. Excessive vaginal bleeding occurred 10, 9, and 31 days after delivery, respectively. Ultrasonogram and pelvic angiography revealed the UAP in each case and uterine artery embolization was performed. UAP may be a complication of precipitous delivery.

Enhancing the accuracy of preoperative and intraoperative evaluation of malignant ovarian germ cell tumors with a focus on fertility preservation in young women.

OBJECTIVE: To analyze and improve the accuracy of preoperative assessment and intraoperative frozen-section analysis (FSA) for malignant ovarian germ cell tumors (MOGCTs), especially in the context of fertility preservation. METHODS: A retrospective review of 48 women aged under 40 years, diagnosed with MOGCTs, and treated at Chonnam National University Hospital between July and December 2022 was conducted. The results of preoperative magnetic resonance imaging (MRI), measurement of serum tumor markers (α-fetoprotein [AFP], ß-human chorionic gonadotropin, lactate dehydrogenase [LDH], cancer antigen [CA] 125, CA 19-9, CA 72-4, carcinoembryonic antigen), and intraoperative FSA were compared with the final pathology diagnosis. RESULTS: MRI demonstrated a sensitivity of 95.5%, whereas FSA showed a sensitivity of 72.9% for all MOGCTs. Sensitivities varied according to the subtype, but were consistently higher in MRI (100% for dysgerminoma, 88.9% for immature teratoma, 100% for endodermal sinus tumor, 100% for others). However, there were differences in FSA according to subtype (100% for dysgerminoma, 50.0% for immature teratoma, 100% for endodermal sinus tumor, 25.0% for others). Serum tumor markers also provided diagnostic insights, particularly LDH for dysgerminoma (82.4%) and AFP for immature teratoma (75.0%) and endodermal sinus tumor (100%). CONCLUSION: Preoperative MRI and serum tumor marker measurement may be effective in guiding fertility-sparing surgical decisions. MRI could outperform FSA in terms of accuracy, especially for immature teratoma.

Development of immature ovarian teratoma after mature teratoma in a girl with familial ovarian teratoma: A case report.

BACKGROUND: Immature ovarian teratoma is a rare and aggressive neoplasm that affects young women. This report is the first to describe the development of immature teratoma after ovarian cystectomy for mature teratoma of the ovary in an adolescent female with a family history of ovarian teratoma. CASE SUMMARY: A 16-year-old girl who had undergone bilateral ovarian cystectomy for mature teratomas 3 years ago showed bilateral adnexal tumors during her regular ultrasonography follow-up every 6 months. She received laparoscopic bilateral ovarian cystectomy, and final histopathology showed grade-1 immature teratoma of the left ovary and mature teratoma of the right ovary. Laparoscopic left salpingo-oophorectomy and staging procedures were performed again. Her mother, maternal aunt, and maternal grandmother had also received surgeries for mature ovarian teratomas. CONCLUSION: It is important to have guidance on management of patient and family members with familial ovarian teratomas.

Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)?

OBJECTIVES: This study was conducted to determine whether vaccination with the quadrivalent human papillomavirus (HPV) vaccine after loop electrosurgical excision procedure (LEEP) for high-grade cervical intraepithelial neoplasia (CIN2-3) is effective in preventing recurrence of CIN2-3. METHODS: Between August 2007 and July 2010, 737 patients aged 20-45 years who were diagnosed with CIN2-3 were treated by LEEP and followed. Three hundred and sixty patients were vaccinated with the quadrivalent HPV vaccine after LEEP (vaccination group), and 377 patients were followed without vaccination (non-vaccination group). The vaccination group received the first dose at 1 week after LEEP and the remaining two doses two and six months later. Post-LEEP follow-up was performed at 3, 6, 9, 12, 18, and 24 months during the first 2 years and yearly thereafter. RESULTS: Irrespective of causal HPV type, 36 (4.9%) patients developed recurrence. In the vaccination group (360 patients), 9 patients (2.5%) developed recurrence, whereas 27 patients (7.2%) in the non-vaccination group (377 patients) developed recurrence. In patients infected with HPV of 16 and/or 18 type, 5 patients (2.5%) in the vaccination group (197 patients) and 18 patients (8.5%) in the non-vaccination group (211 patients) developed recurrent disease related to vaccine HPV types (HPV 16 or 18 types) after LEEP (P<0.01). Multivariate analysis showed that no vaccination after LEEP was an independent risk factor for recurrent CIN2-3 (HR=2.840; 95% confidence interval, 1.335-6.042; P<0.01). CONCLUSIONS: Vaccination with the quadrivalent HPV vaccine after treatment may be considered in preventing recurrence of CIN2-3.

Prediction of persistent gestational trophobalstic neoplasia: the role of hCG level and ratio in 2 weeks after evacuation of complete mole.

OBJECTIVE: The aim of this study was to determine whether or not the serum human chorionic gonadotropin (hCG) level and ratio during 2 weeks after evacuation is predictive of persistent gestational trophoblastic neoplasia (GTN) in patients with complete molar pregnancies. METHODS: Between January 2000 and June 2010, a total of 467 patients with complete molar pregnancies were diagnosed. Seventeen patients, who had prophylactic chemotherapy and in whom insufficient data were available, were excluded. A receiver operating characteristic curve was used to determine the most useful predictive factor for persistent GTN and multivariate logistic regression was used for analyses. RESULTS: Persistent GTN was diagnosed in 109 of the 450 patients (24.2%) on the basis of the 2000 FIGO criteria. The optimal cut-off point for hCG 1 and 2 weeks after evacuation was 6400 mIU/mL (sensitivity, 54.1%; specificity, 65.1%) and 2400 mIU/mL (sensitivity, 64.2%; specificity, 78.3%), respectively. The optimal cut-off point for the ratio of pre-evacuation hCG to hCG 2 weeks after evacuation was 30 (sensitivity, 63.3%; specificity, 86.5%). Based on multivariate analysis, this ratio<30 was an independent predictive factor for persistent GTN (odds ratio=6.885; 95% confidence interval, 4.006-11.832; P<0.001). CONCLUSIONS: The decline ratio in hCG level 2 weeks after evacuation in patients with complete molar pregnancies is the most reliable predictor of persistent GTN. Our analysis may allow clinicians to stratify risk in patients with complete molar pregnancies and to provide more accurate counseling based on the hCG levels obtained 2 weeks after evacuation.

Anatomic and functional outcomes with the prolift procedure in elderly women with advanced pelvic organ prolapse who desire uterine preservation.

STUDY OBJECTIVE: To assess the clinical outcomes of total mesh repair with the Prolift technique as treatment of advanced pelvic organ prolapse in elderly patients who desire uterine preservation. DESIGN: Case control series study (Canadian Task Force classification II-2). SETTING: Medical school-affiliated hospital. PATIENTS: Sixty-eight patients over the age of 70 years with advanced pelvic organ prolapse, Pelvic Organ Prolapse Quantification stage III (n = 59) or IV (n = 9), underwent a total Prolift procedure and were followed up for a minimum of 2 years. INTERVENTIONS: Transvaginal pelvic floor repairs were performed with a total Prolift system. The concurrent pelvic surgery included midurethral sling operation with a TVT-O, if indicated. The assessment included intraoperative and postoperative complications, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores. MEASUREMENTS AND MAIN RESULTS: Objective and subjective data were available for 68 patients. The anatomic success rate was 97.1% after 2 years. Complications included bladder perforation in 1 patient (1.5%), de novo stress urinary incontinence in 20 patients (29.4%), dyspareunia in 4 patients (22.2%), and vaginal erosion in 1 patient (1.5%). The Pelvic Organ Prolapse Quantification stages, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores all improved significantly after surgery. CONCLUSIONS: The total Prolift procedure is an alternative surgical option that uses a minimally invasive transvaginal approach to surgically treat elderly patients with advanced pelvic organ prolapse.

HPV-18 is a poor prognostic factor, unlike the HPV viral load, in patients with stage IB-IIA cervical cancer undergoing radical hysterectomy.

OBJECTIVES: This study was conducted to determine the prognostic significance of the human papillomavirus (HPV) genotype using the HPV DNA chip (HDC) test and the HPV viral load by the hybrid capture II assay (HC2) in FIGO stage IB-IIA cervical cancer undergoing radical hysterectomy. METHODS: Between January 2001 and December 2005, 204 consecutive patients who underwent radical hysterectomy with pelvic lymphadenectomy for International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA cervical cancer were retrospectively reviewed. The Cox proportional hazard models adjusted for covariates were used for analyses and a receiver operating characteristic (ROC) curve was used to determine the HPV viral load in predicting disease progression. RESULTS: Of the 204 cases, the HDC was positive in 195 (95.6%) and the HC2 was positive in 192 (94.1%). The 5-year progression-free survival (PFS) was 78.4%. On multivariate analysis, HPV-18 positivity was an independent prognostic factor predictive for disease progression. The risk of recurrence was higher for HPV-18 positivity (hazard ratio=2.664; 95% confidence interval [CI], 1.437-4.938; P=0.003). The 5-year PFS rate for patients who were HPV-18-negative was 83.8%, which was higher than the 5-year PFS for patients who were HPV-18-positive (54.1%; P<0.001). The area under the ROC curve for the HPV viral load was 0.550 (P=0.314; 95% CI, 0.455-0.644). CONCLUSIONS: The HPV-18 genotype is a reliable prognostic factor of early-stage cervical cancer; however, the HPV viral load may not be helpful in predicting disease prognosis.

Value of serum CA125 levels in patients with high-risk, early stage epithelial ovarian cancer.

OBJECTIVES: The aim of this study was to ascertain whether serum CA125 level is predictive of disease progression in patients with high-risk, early stage (stage IA/B grade 3, stage IC any grade, stage I clear cell, or stage II) epithelial ovarian cancer who have achieved a complete response to chemotherapy. METHODS: Between January 1998 and April 2004, we reviewed the records of 95 patients with high-risk, early stage epithelial ovarian cancer who had elevated CA125 levels at the time of diagnosis and were complete responders after 6 cycles of adjuvant paclitaxel/carboplatin chemotherapy. A receiver operating characteristic curve was used to determine the most useful CA125 level in predicting disease progression and Cox proportional hazards models adjusted for covariates were used for analyses. RESULTS: The 5-year progression-free survival (PFS) was 70.5%. The optimal cutoff point of CA125 after completing adjuvant chemotherapy to predict disease progression was 12 U/mL (sensitivity, 71.4%; specificity, 82.1%). On multivariate analysis, CA125 level>12 U/mL after completing adjuvant chemotherapy was an independent prognostic factor predictive for disease progression. The risk of recurrence was higher for CA125 level>12 U/mL (hazards ratio=10.567; P<0.001). The 5-year PFS rate for patients with CA125 level< or =12 U/mL was 83.3%, which was higher than a PFS of 37.5% for CA125>12 U/mL (P<0.001). CONCLUSIONS: CA125 level after 6 cycles of adjuvant chemotherapy is a strong independent prognostic factor for high-risk, early stage epithelial ovarian cancer after achieving a complete response.

Weekly methotrexate (50mg/m(2)) without dose escalation as a primary regimen for low-risk gestational trophoblastic neoplasia.

OBJECTIVES: The aim of this study was to compare the efficacy and toxicity of an 8-day methotrexate-folinic acid regimen and a weekly methotrexate regimen (50mg/m(2) without dose escalation) for low-risk gestational trophoblastic neoplasia (GTN) according to the revised FIGO 2000 scoring system in a single institution. METHODS: Between January 1997 and June 2007, 107 patients with low-risk GTN were treated with an 8-day methotrexate-folinic acid regimen (MTX-FA group; n=59) or a weekly methotrexate regimen (50mg/m(2) without dose escalation) (MTX group; n=48). The primary remission rate, change of chemotherapy because of drug resistance or toxicity, and relapse rate were compared. RESULTS: All 107 patients with low-risk GTN were cured. The primary remission rates were 69.5% and 70.8% for the MTX-FA and MTX groups, respectively (P>0.99). The commonly reported toxic effects in the MTX-FA and MTX groups, respectively, were as follows: hepatotoxicity (31/59 and 9/48), neutropenia (7/59 and 4/48), stomatitis (3/59 and 2/48), alopecia (2/59 and 2/48), and thrombocytopenia (2/59 and 0/48). Drug toxicity necessitating changes in chemotherapy were reported to be 13.6% (8/59) in the MTX-FA group and 2.1% (1/48) in the MTX group (P<0.05). The overall duration of treatment was 8.6 weeks in the MTX-FA group and 6.4 weeks in the MTX group (P<0.001). CONCLUSIONS: The weekly methotrexate regimen was as effective as the 8-day methotrexate-folinic acid regimen for low-risk GTN. The weekly methotrexate regimen was less toxic, better tolerated, and more convenient for patients compared to the 8-day methotrexate-folinic acid regimen.

Significance of human papillomavirus genotyping with high-grade cervical intraepithelial neoplasia treated by a loop electrosurgical excision procedure.

OBJECTIVE: This study was conducted to determine whether the human papillomavirus (HPV) genotype by the HPV DNA chip test (HDC) is predictive of residual or recurrent high-grade cervical intraepithelial neoplasia (CIN) 2-3 following a loop electrosurgical excision procedure (LEEP). STUDY DESIGN: Between January 2001-February 2007, 672 patients with CIN2-3 were treated by a LEEP and followed up with cytology, the hybrid capture II assay, and the HDC. RESULTS: A total of 37 (5.5%) patients developed a recurrence, and those who developed a recurrence tested positive for the same high-risk (HR) HPV genotype before and after the LEEP. The same HR-HPV genotype by the HDC during the follow-up had a sensitivity and negative predictive value of 100% for detecting residual/recurrent disease. Persistent HPV-16 and HPV-18 were significantly associated with recurrent CIN2-3 (P < .05). CONCLUSION: Persistent infection with the same HR-HPV genotype, especially HPV-16 and HPV-18, should be considered a risk factor for developing residual/recurrent CIN2-3.

Human papillomavirus L1 capsid protein and human papillomavirus type 16 as prognostic markers in cervical intraepithelial neoplasia 1.

INTRODUCTION: The aim of the study was to determine whether human papillomavirus (HPV) L1 capsid protein and the HPV genotype can predict the disease course as prognostic markers for cervical intraepithelial neoplasia 1 (CIN1). METHODS: Immunohistochemical staining was performed for HPV L1 capsid protein in 101 women who had been confirmed to have CIN1 by histologic examination and HPV high-risk infection by HPV genotyping. The disease course was analyzed by follow-up histologic examination according to the HPV L1 capsid protein and HPV genotype over a minimum of 12 months. RESULTS: The CIN1 regressed spontaneously in 60.4% of the women; most cases of regression occurred within 1 year (90.9% of regression cases). The HPV L1 capsid protein-positive patients had a spontaneous regression rate of 72.7% (48/66) and a rate of persistent disease or progression to higher grade disease of 27.3% (18/66). The HPV L1 capsid protein-negative women had a regression rate of 37.1% (13/35) and a rate of persistent disease or progression of 62.9% (22/35; P < 0.001). The HPV-16-infected patients had a regression rate of 38.6% (17/44) and a rate of persistent disease or progression of 61.4% (27/44), whereas the non-HPV-16-infected patients had a regression rate of 77.2% (44/57) and a rate of persistent disease or progression of 22.8% (13/57; P < 0.001). CONCLUSIONS: The HPV L1 protein expression is closely related to spontaneous disease regression, but HPV-16 infection is related to persistent disease or progression to high-grade lesions in patients with CIN1.

Serum hCG level and rising world health organization score at second-line chemotherapy (pulse dactinomycin): poor prognostic factors for methotrexate-failed low-risk gestational trophoblastic neoplasia.

INTRODUCTION: The aim of this study was to determine the factors associated with failure in patients receiving pulse dactinomycin as second-line chemotherapy for low-risk gestational trophoblastic neoplasia (GTN) according to the revised International Federation of Obstetrics and Gynecology 2000 scoring system at a single institution. METHODS: Between January 1997 and June 2007, 37 patients with methotrexate-failed low-risk GTN were treated with pulse dactinomycin (1.25 mg/m intravenously every 2 weeks). All patients had low-risk GTN based on the revised International Federation of Obstetrics and Gynecology 2000 scoring system at the time of second-line chemotherapy. A logistic regression model was used to analyze the relationship between covariates and treatment failure. RESULTS: There were 28 (75.7%) patients who achieved primary remission with pulse dactinomycin. All 9 treatment failures achieved complete remission after receiving subsequent chemotherapy; 1 patient also underwent hysterectomy. Patients successfully treated with pulse dactinomycin required a median of 4.0 cycles (range, 2-7) to achieve a complete response. The risk of failure with pulse dactinomycin was higher for serum hCG levels 10 or higher when initiating pulse dactinomycin (odds ratio, 8.91; 95% confidence interval, 1.08-73.53) and a rising World Health Organization score of 2 or higher after first-line chemotherapy (odds ratio, 12.59; 95% confidence interval, 1.60-99.25). With respect to the previous methotrexate regimen and cause of failed methotrexate chemotherapy, there were no differences between those who were successfully treated and those who failed pulse dactinomycin. CONCLUSIONS: Serum hCG level and a rising World Health Organization score at the time of initiating pulse dactinomycin are important prognostic factors in patients with methotrexate-failed low-risk GTN receiving pulse actinomycin as second-line chemotherapy.

Lymphadenectomy for low-risk endometrial cancer based on preoperative and intraoperative assessments.

INTRODUCTION: The aim of this study was to ascertain whether lymphadenectomy is necessary when endometrial cancer is considered low risk based on preoperative and intraoperative assessments. METHODS: Between 2000 and 2004, a total of 122 patients with low-risk endometrial cancer who underwent preoperative endometrial sampling and magnetic resonance imaging (MRI) were treated surgically. All 122 patients were considered eligible for the study if they fulfilled the following criteria: (a) grade 1 or 2 endometrioid corpus cancer by endometrial sampling, (b) no lymphadenopathy by MRI, (c) myometrial invasion of 50% or less by MRI, and (d) no intraoperative evidence of macroscopic extrauterine spread. We divided the 122 patients into 2 groups (the total abdominal hysterectomy and bilateral salpingo-oophorectomy [TH/bilateral salpingo-oophorectomy] with lymphadenectomy [THND group, n = 64] and the TH/bilateral salpingo-oophorectomy without lymphadenectomy [TH group, n = 58]). RESULTS: The concordance rate between preoperative and postoperative grades was 92.6% (113/122, kappa = 0.805). Evaluation of the depth of myometrial invasion with MRI had an accuracy of 95.1% (116/122) for ruling out deep myometrial invasion. In the THND group, the operative time, the hospital stay, the estimated blood loss during surgery, and the incidence of perioperative complications were significantly higher than those in the TH group. The 5-year progression-free survival rates were similar (96.9% in the THND group and 98.3% in the TH group). CONCLUSIONS: The present findings suggest that MRI and office endometrial sampling may accurately categorize patients into low- or high-risk groups. Lymphadenectomy should be limited to patients with high-risk endometrial cancer.

Comparison of the hybrid capture II assay with the human papillomavirus DNA chip test for the detection of high-grade cervical lesions.

Cervical intraepithelial neoplasia (CIN) 2 is used as the threshold for treatment decisions. This study was conducted to evaluate the clinical efficacy of the Hybrid Capture II assay (HC2) and the human papillomavirus (HPV) DNA chip test (HDC) for detecting HPV in high-grade cervical lesions CIN2 or greater, including adenocarcinoma (CIN2+). Seven hundred forty-one women with abnormal cervical cytology were evaluated with the HC2, the HDC, and histological assessment of the cervix. The overall agreement of the 2 HPV tests was 88.8% (kappa value, 0.61). Of 615 high-risk HPV-positive specimens by the HC2, 571 (92.8%) were HDC-positive. Both tests were performed similarly on CIN2+ samples; the sensitivities of the HC2 and HDC as predictors of CIN2+ were 93.4 and 92.6%, respectively. In 83 cases of discrepancies between the HC2 and HDC, genotyping of 39 HC2-negative/HDC-positive cases revealed 13 HPV-53, 8 HPV-58, 7 HPV-16, 6 HPV-18, 2 HPV-68, 1 HPV-31, 1 HPV-45, and 1 HPV-66. In 515 patients with CIN2+, HPV-16 (45.0%) was the most common type; the next most common types were HPV-58 (20.8%), HPV-18 (16.1%), HPV-31 (6.6%), and HPV-33 (6.6%). Human papillomavirus types 16, 58, and 18 were more likely associated with CIN2+ (P < 0.05). In conclusion, the HDC is a reliable diagnostic tool for the detection of CIN2+. In addition, the HDC provides useful information regarding viral genotypes.

Three isolated, large retroperitoneal leiomyomas.

Leiomyomas are very rare as retroperitoneal neoplasms. The pathogenesis of retroperitoneal leiomyomas remains obscure. A 42-year-old multiparous woman presented with a large abdominopelvic mass. At surgery, the uterus was displaced laterally to the right and the right kidney was displaced medially by three isolated large retroperitoneal masses. A total abdominal hysterectomy and complete excision of the retroperitoneal masses was performed. The histopathologic findings of the resected three tumors revealed leiomyomas without evidence of malignancy and the remaining surgical specimens were normal. This is the first case of three isolated large retroperitoneal leiomyomas without a uterine leiomyoma. The distribution of retroperitoneal leiomyomas in our case suggests that these may be of primary multifocal origin, rather than metastatic or parasitic.