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

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

Ovarian Cancer during Pregnancy: Clinical and Pregnancy Outcome

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

Fertility preservation in patients with early epithelial ovarian cancer / 부인종양

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

Clinicopathologic study of ovarian granulosa cell tumors / 대한산부인과학회지

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

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

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

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

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

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

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

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

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

Clinicopathologic characteristics of malignant germ cell tumors of ovary / 대한산부인과학회지

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

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

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

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

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

Clinico-pathologic features in endometrial carcinoma by the histologic type / 부인종양

OBJECTIVE: The aim of this study was to correlate histologic type with the clinico-pathologic features of endometrial carcinoma. METHODS: A retrospective review was performed of 158 patients with endometrial cancer who had treated surgically at Cheil General Hospital between Jan. 2000 and Dec. 2003. Histologic findings after operation were divided two groups (endometrioid group vs. non-endometrioid group) then compared to each other groups. Clinico-pathologic factors were reviewed, compared and statistically analyzed. RESULTS: Endometrioid group was 112 cases (70.9%) and non-endometrioid group was 46 cases (29.1%). Non-endometrioid group was mucinous; 5 (3.2%), UPSC; 6 (3.8%), clear Cell; 2 (1.3%), mixed; 32 (20.3%), adenosquamous; 1 (0.6%). Non-endometrioid group showed older (p=0.0003) and higher proportion of menopausal women (p=0.0017) than Group 1. But menopause mean age were not diffent between two group. Abnormality in Pap smear and thickness of endometrium (TVS) were not diffent between two group. Non-endometrioid group were significantly associated with higher grade (p=0.0000), deeper myometrial invasion (p=0.0030), larger tumor size (p=0.0006), Lympho-vascular invasion (p=0.0486) and higher recurrence rate (p=0.0369) CONCLUSION: This study revealed non-endometrioid group was significantly associated with older age, menopause status, advanced pathologic features at surgical staging, and high recurrence rate.

Clinical Efficacy of HPV DNA Chip test in Human papillomavirus detection of Uterine Cervix / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the efficacy of HPV DNA chip method for detection and genotyping of various human papillomavirus in the patients with intraepithelial lesions of uterine cervix. METHODS: The study subjects included two hundred patients with abnormal Pap smear from July 2004 to October 2004. After confirmed the pathological status of the cervix with colposcopic biopsy or conization, we evaluated for HPV infection and genotyping with the commercially available Hybrid-Capture II assay (HC-II) and HPV DNA chip. Then we compared the concordance rate between the two methods for the detection of HPV and analysed the HPV genotypes. RESULTS: We compared the results in HPV DNA chip with those in HC-II. In result, the concordance rate between the two methods for the detection of HPV was 85.5% (171 of 200 cases). In 111 patients confirmed the presence of lesions higher than flat condyloma in cervix by pathologc examination, sensitivities of HC-II and HPV DNA chip in detecting HPV were 91.0% and 88.3%, respectively. In HPV DNA chip, HPV-16 was the most frequent type (14.7%) in all patients, the next frequent types were HPV-58 (14.1%) and HPV-18 (9.2%). CONCLUSION: We confirmed that HPV DNA chip method was as sensitive and effective method for detecting HPV in cervical lesions as HC-II. And that it would provide useful clinical information on genotyping and multiple infections of HPV.

Genotyping of Human Papillomavirus Detected with the HPV DNA Chip in Cervical Cancer / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the efficacy of DNA chip method for detection and genotyping of various human papillomavirus in the patients with invasive cervical cancer in Korea. METHODS: The study subjects included 38 cases of cervical cancer for HPV detection and genotyping, and the commercially available DNA chip was used. Retrospectively cervical specimens of thirty eight patients with pathologically confirmed invasive cancer of the uterine cervix were tested for HPV typing performed by DNA chip method in Samsung Cheil Hospital from September 1999 to October 2000. RESULTS: Among 38 cervical carcinomas, histological examination revealed that 34 (89.5%) cases were squamous cell carcinoma, three (7.9%) were adenocarcinoma and one (2.6%) was small cell carcinoma. In carcinoma patients thirty two cases (84.2%) of invasive carcinoma were positive for at least one type of high risk HPV. Only two woman (5.3%) among the healthy group had HPV positive. We compared the results in HPV DNA chip with those in sequencing. The concordance rate between the two methods for the detection of HPV was 95.7% (67 of 70 cases). CONCLUSION: We confirmed that DNA chip method was a simple, convenient, and effective method for detecting HPV in cervical carcinoma and health women.

A Clinical Study of 25 Cases of Uterine Papillary Serous Carcinoma / 대한산부인과학회지

OBJECTIVE: Uterine papillary serous carcinoma (UPSC) has been recognized as an aggressive tumor characterized by deep myometrial invasion and reported high recurrence and low survival rates. METHODS: We retrospectively investigated the clinicopathologic findings and analyzed the survival rate and prognostic factors in 25 patients with UPSC who were surgically staged at the oncology department between January 1994 and December 2003. RESULTS: The mean age of the cases was 55.8 (range: 45-69) years. The most frequent presenting symptom was abnormal uterine bleeding (88%). According to FIGO staging, seven of the cases were stage I, six of the cases were stage II, eleven of the cases were stage III, and one case was stage IV. Mean follow up period is 42.7 months (range: 9-123 months). Overall survival rate was 80 percent. The recurrence was seen in 5 patients (25%). CONCLUSION: Univariate analysis showed that invasion of uterine serosa, ovarian and tubal metastasis, and positive peritoneal washing cytology were significantly associated with prediction of prognosis. In multivariate analysis, tubal metastasis was an independent prognostic factor for overall survival.

Neoadjuvant chemotherapy in stage IB2 cervical cancer / 부인종양

OBJECTIVE: This retrospective study was purposed to evaluate the effects (clinico-pathologic findings and treatment outcomes) of neoadjuvant chemotherapy in management of cervical carcinoma stage IB2 (tumor diameter>4 cm) METHODS: 22 surgically treated patients due to cervical cancer IB2 between January 1993 and December 2001 were abstracted. They were divided into two groups; the one group (neoadjuvant chemotherapy group) was treated with preoperative neoadjuvant chemotherapy [taxol-cisplatin or bleomycin, vincristin, mitomycin and cisplatin (BOMP), 2-3 cycles] and the other group was treated by primary radical hysterectomy. Clinico-pathologic factors were reviewed and statistically analyzed and compared. RESULTS: There was no significant difference in age, tumor size, and histopathologic type between two groups (p>0.05). After surgery, lymph node, lymphovascular space invasion (LVSI), parametrial invasion, margin involvement, and recurrence rate had no significant difference between two groups (p>0.05). But in neoadjuvant chemotherapy group, postoperative adjuvant chemotherapy or radiation therapy was significantly less needed (p=0.0073). CONCLUSION: The needs of postoperative adjuvant treatment (chemotherapy or radiation therapy) in neoadjuvant chemotherapy group were less than in non-neoadjuvant chemotherapy group, even though there was no difference in clinico-pathologic factors and prognosis between two groups.

Study of Factors that Influence Sentinel Lymph Node Identification and Detection Rate in Cervical Cancer of Uterus / 대한산부인과학회지

OBJECTIVE: The purpose of this prospective study was to determine the feasibility of sentinel lymph node (SN) identification and to evaluate the factors that influence the sentinel node detection rate in patients with cervical cancer of the uterus. METHODS: Forty three patients underwent intracervical injection of 1% isosulfan blue dye at the time of planned radical hysterectomy and lymphadenectomy between January 2003 and July 2003. With visual detection of blue nodes, SNs were identified and separately removed. And then all patients underwent complete pelvic lymph nodes dissection and/or para-aortic lymph nodes dissection. If frozen sections of the lymph nodes were negative, radical hysterectomy was performed. Tumor characteristics, surgical findings, specific locations of SN and final pathologic results were recorded and correlated with final pathologic results. RESULTS: The mean age of patients was 49.3 years (30-78). SNs were identified in 23 of 43 (53%) patients. About 48.7% of SNs were found in the external iliac region, 31.7% in the obturator region, 17.0% in the internal iliac region and 2.4% in the common iliac region. Metastatic nodes were detected in 11 of 43 (26%) patients. Among 23 patients whose SNs were detected, 5 patients had metastatic nodes while among 20 patients whose SNs were not detected, 8 patients had metastatic nodes. No false negative SN results were obtained. Successful SN detection was more likely performed in patients with preoperative conization (P=0.0156). However, age, stage, histologic type, operation type, and neoadjuvant chemotherapy did not show any significant differences in SN detection rate. CONCLUSION: The identification of the SN with isosulfan blue dye is feasible and safe. SN detection rate was high in patients with preoperative conization. But low detection rate should be further investigated.

Carcinoma in situ of the uterine cervix in pregnancy / 부인종양

OBJECTIVE: The purpose of this study was to determine whether carcinoma in situ (CIS) of the uterine cervix in pregnancy alters in the postpartum period and to evaluate the factors associated with this alteration. METHODS: In this retrospective study, we found 30 pregnant women with CIS of the uterine cervix between 1999 and 2003. All women had the diagnosis of CIS made on cervical biopsy performed during pregnancy at Samsung Cheil Hospital. All pathologic reports of initial cytology and biopsy were reviewed and compared to the same evaluations postpartum. Postpartum alteration of CIS was analyzed with respect to the mode of delivery, gravidity and parity. RESULTS: The incidence of CIS in pregnancy was 0.6 per 1000 pregnancies (30/44,807) in this study. The mean age was 31.2 years (20-40), the mean gravidity was 2.7 (1-6) and the mean parity was 0.3 (0-2). The prenatal cytology that initiated the referral to our colposcopy center was commonly discordant with the histologic diagnosis of CIS. Five (16.7%) had cytology of ASCUS, 3 (10.0%) had LSIL, and 22 (73.3%) had HSIL. The overall postpartum persistence and regression rates of CIS were 73.3% and 26.7% respectively. No lesion progressed to invasive carcinoma. There was no statistically difference in regression or persistence rates according to the delivery mode, gravidity and parity. CONCLUSION: According to the result of this study, postpartum persistence rate of CIS was high but progression rate was low. The mode of delivery, gravidity and parity did not influence the regression or persistence rates of CIS in pregnancy.

Mucinous Borderline tumor associated with Mature Cystic Teratoma of Ovary / 부인종양

OBJECTIVE: To evaluate the clinicopathological characteristics of mucinous borderline tumor associated with mature cystic teratoma and the origin of its cell type. METHODS: Five patients who were diagnosed as mucinous borderline tumor associated with mature cystic teratoma and treated in Samsung Cheil Hospital from January 1996 to September 2004 were analyzed. In addition MEDLINE, other data bases in English as well as in Korean revealed two more cases. We analyzed the result with patient's characteristics, preoperative symptoms, mass sizes, serum CA-125, operative procedure, stages, recurrence and survival period. Histological slides of the specimens were analysed for expression of cytokeratin (CK)-7 and cytokeratin (CK)-20 by immunohistochemical staining to know the origin of the cell. RESULTS: The mean age was 45 years (25-61 years). Preoperative symptoms were palpable abdominal mass, abdominal pain and urinary frequency. The mean level of CA-125 was 46.05 U/mL and the mean tumor size was 16.75 cm (8.8-22.0 cm). Post surgical FIGO staging was; stage Ia in 6 cases, stage Ic in 1 case. Four cases were CK7(-)/CK20(+), reflecting gastrointestinal origin, and also showed pattern of pseudomyxoma peritoneii. Mean survival period was 32.7 months (6-67 months) without evidence of recurrence, except one case. CONCLUSION: Our findings suggest that mucinous borderline tumor associated with mature cystic teratoma, is diagnosed at relatively young age and early stage, associated with good prognosis.

A clinical study of 15 cases of primary carcinoma of the fallopian tube / 부인종양

OBJECTIVE: The aim of the study is to determine the clinical characteristics and management of primary fallopian tube malignancies together with the results there unto that had been diagnosed and treated in Samsung Cheil Hospital oncology department retrospectively. METHODS: The fifteen cases of fallopian tube malignancies, of a total of 3495 gynecologic malignancies (0.043%) that has been diagnosed in or referred to our hospital between January 1993 and December 2004 were evaluated retrospectively. We investigate the clinicopathologic findings and analyze the survival period for 15 patients with primary fallpian tube malignancies who were surgically operated. RESULTS: The mean age of patients is 53.47 years. Most frequent application symptoms of the cases are pelvic mass (46.7%) and abnormal uterine bleeding (40%). The staging laparotomy was done in 12 patients. According to FIGO staging, seven of the cases are stage I, six of the cases are stage III, and one of the cases is borderline malignancy. Adjuvant chemotherapy was applied 13 cases and adjuvant radiotherapy was applied one case. Mean follow up period of the cases is 27.8 months. CONCLUSION: Primary fallopian tube malignancies are very rare malignancies. Diagnosis can be made generally peri or postoperatively. More extensive clinical research must be performed in order to have definite etiologic diagnostic management modalities and prognostic markers.