The sentinel lymph node is defined as the first node of a regional lymphatic basin that receives the lymphatic drainage from a tumor, thus representing an elective site of lymph node metastasis. According to the sentinel lymph node hypothesis, histologically negative sentinel lymph nodes can guarantee the histological negativity of the remaining regional lymph nodes. These assumptions suggest that the sentinel node can be a suitable marker of regional lymph node status. Thus sentinel node biopsy may be a reasonable alternative to unnecessary pelvic lymph nodes dissection and a suitable method for limited control of early stage cervical cancer. To improve the sentinel node detection in surgical procedures, we investigated lymphatic mapping of sentinel lymph nodes with isosulfan blue dye (lymphazur 1%) and technetium-99m colloid albumin. We have made it a rule to inject 5 ml of isosulfan blue dye in the peritumoral area of cervix. It is reported that isosulfan blue dye has been safe and easily used in the detection of sentinel lymph node in melanoma, breast cancer and vulvar cancer. We experienced a case of anaphylactic reactions to isosulfan blue dye in cervical cancer patient, so we report it with a brief review of literature.
Anaphylaxis* ; Biopsy ; Breast Neoplasms ; Cervix Uteri ; Colloids ; Drainage ; Female ; Humans ; Lymph Nodes ; Melanoma ; Neoplasm Metastasis ; Uterine Cervical Neoplasms* ; Vulvar Neoplasms

OBJECTIVE: The aim of this study was to obtain information on the prognosis and treatment of the low grade endometrial stromal sarcoma. PATIENTS AND METHODS: Three patients with low grade endometrial stromal sarcoma treated in kangnam St. Mary's hospital between 1993 and 2002 were evaluated. The clinical stage, management and outcome were analyzed. RESULTS: Those patients with low grade endometrial stromal sarcoma had a long overall survival in the presence of receiving hormonal therapy after initial surgery. Two are alive with disease-free status, one has shown a partial response to hormonal treatment. CONCLUSION: Surgery is the primary treatment for low grade endometrial stromal sarcoma. High dose hormonal replacement as adjuvant therapy will be associated with a lengthened overall survival in patients with low grade endometrial stromal sarcoma.
Humans ; Prognosis ; Sarcoma, Endometrial Stromal*

OBJECTIVE: The purpose of this study is to evaluate the clinical effect of V-Y advancement flap after vulvectomy in patients with vulvar cancer. Local and systemic morbidity, the degree of satisfaction after operation, length of hospital stay were evaluated. PATIENTS AND METHODS: From March 2001 to september 2002, five patients with invasive vulvar cancer were eligible for this study. All the patients underwent radical vulvectomy with groin lymph nodes dissection. All of them were reconstructed by the same surgeon using ischial fasciocutaneous V-Y flaps based on perforators from the inferior border of the gluteous maximus muscle. RESULTS: Flap survival was 100%. There were no major complication including wound infection, wound disruption, urinary tract infection, and seroma in the femoral triangle. Functional outcome was excellent in all patients. CONCLUSION: The V-Y advancement flap provides a straight-forward and simple safe reliable method as a common approach in radical vulvectomy.
Groin ; Humans ; Length of Stay ; Lymph Nodes ; Seroma ; Urinary Tract Infections ; Vulvar Neoplasms* ; Wound Infection ; Wounds and Injuries

No abstract available.
Cesarean Section* ; Fascia* ; Female ; Pregnancy

The purpose of this study was to investigate the feasibility of sentinel node frozen biopsy to minimize the extensive pelvic lymph nodes dissection in early stage cervical cancer patients on the basis that the risk of skip metastasis to the paraaortic area is negligible. Twenty-six patients with early stage cervical cancer were enrolled in this study. Technetium-99m colloid albumin (Tc(99m)) was injected intradermally around the tumor for allowing preoperative lymphoscintigraphy and intraoperative hand-held gama probe detection of seninel nodes. For visual detection, isosulfan blue dye was injected into the peritumoral sites before peritoneal opening. Postoperative morbidity and negative predictive value were the endpoints of this study. The 26 patients, ranging in age from 32 to 71 yr, underwent intraoperative sentinel nodes mapping. All the patients underwent complete pelvic lymph nodes dissection including para-aortic nodes. There was one case with positive non-sentinel nodes despite the negative sentinel node by frozen biopsy (negative predictive value, 95.2%). This new technique of sentinel node mapping is safe and simple to perform. Further clinical trials using the combination of Tc(99m) and isosulfan blue dye are warranted and this technique will make a true advance for less aggressive management of patients with early stage cervical cancer.
Adult ; Aged ; Female ; Humans ; *Lymph Node Excision ; Lymph Nodes/pathology/radionuclide imaging/*surgery ; Middle Aged ; Pelvic Neoplasms/*pathology/radionuclide imaging/surgery ; Pelvis ; Predictive Value of Tests ; Rosaniline Dyes/metabolism ; Sensitivity and Specificity ; *Sentinel Lymph Node Biopsy ; Technetium Tc 99m Aggregated Albumin/diagnostic use ; Uterine Cervical Neoplasms/*pathology/radionuclide imaging/surgery

Mucocele arised at the vermiform appendix is uncommon, either benign or malignancy and their clinical presentation is not specific. The preoperative diagnosis is rare,1 and their diagnosis is an incidental event. Mucocele seems to be developed due to chronic obstruction of the lumen of the appendix. Higa and Cowerkers2 classified 73 cases of "mucocele" into three clinicopathologic entities; focal or diffuse mucosal hyperplasia, mucinous cystadenoma, mucinous cystadenocarcinoma. Appendiceal mucoceles are rare lesions of the appendix, characterized by a gross enlargement of the appendix from accumulation of mucoid substance within the lumen. It is encountered in only 0.1-0.4% of all appendectomies with a female predominance and an average age at the time of diagnosis over 50 years. A case of appendiceal mucocle found during total hysterectomy is presented with a brief review of the literatures.
Appendectomy ; Appendix ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Diagnosis ; Female ; Humans ; Hyperplasia ; Hysterectomy* ; Mucocele*

Malignant melanoma may show a predisposition for vulvar skin. Although 37% of all melanomas in women affect the vulva, the skin in this area accounts for only 12% of the total surface area of body. Malignant melanoma of the vulva presented as polypoid tumours in 35% of patients. The most common sites of disease were the clitoral area and the labia majora, which accounted for more than 60% of all lesions. Only 15% of tumours were located primarily in hair-bearing areas. Two women who were diagnosed vulvar melanoma in Uijongbu St. Mary's Hospital were evaluated. We reviewed their medical records. One woman underwent the radical vulvectomy with bilateral inguinal and femoral lymph node dissection, and the other underwent wide local excision with both inguinal lymph nodes dissection. We experienced 2 cases of vulvar melanoma, so we report it with a brief review of literature.
Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Medical Records ; Melanoma* ; Skin ; Vulva

Isosulfan blue dye can be used to mark the sentinel lymph node during various surgeries. The dye was known to have minimal side effects, but recently a few cases of an anaphylactic reaction were reported in melanoma and breast surgery. We experienced an anaphylactic reaction during peritumoral injection of this dye in a patient with cervical cancer. Immediately after dye injection, the patient showed an anaphylactic reaction with cardiovascular collapse and oxygen desaturation. We resuscitated the patient and she recovered without complications.
Anaphylaxis* ; Breast ; Humans ; Lymph Nodes ; Melanoma ; Oxygen ; Uterine Cervical Neoplasms

OBJECTIVE: The aim of this study is to evaluate the clinicopathologic characteristics of tuberculous peritontitis from calcinomatosis peritonei. METHODS: From July 1994 to May 2002, fifteen women who were diagnosed tuberculous peritonitis in Kangnam St. Mary's Hospital were analyzed. We reviewed their medical records. RESULTS: A total of 15 patients eventually diagnosed by pathological or bacteriological method were reveiwed. Five patients were taken explorative lapartomy and biopsy. Eight patiets were taken laparoscopy and biopsy. One patient shows M. tubcerculous only cutured in ascites. One patient with cervical lyhphadenopathy shows chronic granuloma on cervical lymph node. CONCLUSION: Tuberculous peritonitis needs differential diagnosis with ovarian cancer because of its vague symptoms as ascites, abdominal pain and fever. Since there is no specific and sensitive method, at present, an explorative laparotomy or pelviscopic surgery can be alternatives for differetial diagnosis between tuberculous peritonitis and ovarian cancer.
Abdominal Pain ; Ascites ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Female ; Fever ; Granuloma ; Humans ; Laparoscopy ; Laparotomy ; Lymph Nodes ; Medical Records ; Ovarian Neoplasms ; Peritonitis, Tuberculous*

OBJECTIVE: The purpose of this study is to evaluate the validity of sentinel lymph node detection and the possibility of clinical application in treatment of vulvar cancer patients. PATIENTS AND METHODS: From March 2001 to January 2002, four patients with vulvar cancer were eligible for this study. All the patients were preoperative technetium-99 m colloid albumin and intraoperative isosulfan blue dye injection intradermally at the junction of tumor mass and normal skin. Superficial lymphatic channels and groin lymph node dissections were made to detect sentinel lymph node and then complete inguinofemoral lymph nodes dissection was performed. All the sentinel lymph nodes were sent to pathologic department for frozen biopsy. RESULTS: Ten sentinel lymph nodes were identified in one-hundred and ten groin lymph nodes. All the ten sentinel lymph nodes showed benign. There was no case that non-sentinel lymph nodes were positive in the presence of negative sentinel lymph nodes by frozen biopsy (negative predictive value was 100%). CONCLUSION: Sentinel lymph nodes detection by combination use of technetium-99 m colloid albumin and isosulfan blue dye injection was simple and accurate in our preliminary study. To reduce postoperative morbidity, lymphedema and to minimize extensive inguinofemoral lymph nodes dissection, sentinel lymph node frozen biopsy may be a reasonable alternatives and a suitable method for limited control of vulvar cancer. This preliminary study showed the possibility of clinical application of sentinel lymph node detection in vulvar cancer surgery.
Biopsy ; Colloids ; Groin ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Lymphedema ; Skin ; Vulvar Neoplasms*