Significant progress has been made in the molecular diagnosis of cancer. It provides personalized medicine, including cancer diagnosis, prognosis, targeted therapy, and risk detection. These advances allow physicians to identify patients at risk for cancer before it develops and offer them an opportunity to prevent its development. Mutations in breast cancer susceptibility genes 1 and 2 (BRCA1 and 2) are one of the most well-known cancer-related gene mutations since actor Angelina Jolie shared her experience with genetic mutations and risk-reducing surgery in the media. In Korea, tests for germline BRCA1/2 mutations have been covered by insurance since May 2012 and the number of women of BRCA1/2 mutations has continued to increase over the past decade. Most carriers of BRCA1/2 mutations consider risk-reducing salpingo-oophorectomy (RRSO) resulting in early menopause and want to know the lifetime risks and benefits of RRSO. However, despite the increasing number of carriers of BRCA1/2 mutations, the counseling and management of patients requiring RRSO varies among physicians. This article provides basic knowledge on RRSO to help physicians comprehensively assess its risks and benefits and manage at-risk women.

The hem-o-lock is useful tools for the laparoscopic surgeon. We herein describe a simplified technique for suturing and knotting technique using hem-o-loc. After enucleation of the myoma, uterine parenchymal defect was closed laparoscopically using a 1-0 vicryl suture on a needle, also prepared with a hem-o-lock. Before suturing, the vicryl is tied up with hem-o-loc on the tail of continuous suture that is start point of suture site. Once the suture is passed, a hem-o-loc is used to cinch it down on the suture site and secure the knot tightly. All sutures can be completed with just one suture, continuously. We experienced no major surgical complication.
Myoma ; Needles ; Polyglactin 910 ; Sutures

OBJECTIVE: Galectin-3, a member of the beta-galactoside-binding proteins, is an intracellular and extracellular lectin that interacts with intracellular glycoproteins, cell surface molecules and extracellular matrix proteins. Galectin-3 is expressed widely in epithelial and immune cells and the level of expression varies in many cancer cells relative to the normal tissues from which they arise. We investigated whether the expression of galectin-3 is associated with the progression of cervical neoplasia. METHODS: The galectin-3 expression was evaluated by immunohistochemistry in 90 formalin-fixed paraffin-embedded cervical tissues: 10 normal cervical specimens, 20 low-grade squamous intraepithelial lesions (LSILs), 20 high-grade squamous intraepithelial lesions (HSILs), and 40 invasive squamous cell carcinomas (ISCCs). RESULTS: The immunohistochemical staining showed that the expression of galectin-3 was strong in all normal cervical squamous epithelia. Staining gradually decreased in accordance with the histopathologic grades from an LSIL to an HSIL and an ISCC (P<0.001). In particular, the expression of galectin-3 was significantly decreased in HSILs (P=0.001) and this down-regulation was more pronounced in ISCCs than normal tissues (P<0.001). CONCLUSION: These data constitute the first observation that the expression of galectin-3 is down-regulated in cervical cancer tissues and suggest the decreased expression of this galactoside-binding lectin is associated with the progression of cervical neoplasia.
Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; Down-Regulation ; Extracellular Matrix Proteins ; Galectin 3* ; Immunohistochemistry ; Membrane Glycoproteins ; Uterine Cervical Neoplasms

OBJECTIVE: To compare laparoscopic surgery with conventional abdominal surgery in patients with early stage endometrial cancer. METHODS: A retrospective review of 63 patients with early stage endometrial cancer managed between March 2003 and May 2005. Two groups were defined whether they had been treated by laparoscopy (case group: n=26) or by laparotomy (control group: n=37). We compared age, body mass index (BMI), hemoglobin change, operation time, number of pelvic lymph nodes, hospital stay, case with adjuvant treatment and recurrence between two groups. RESULTS: There was no statistical difference in characteristics (age, BMI, nulliparity, previous abdominal surgery, FIGO stage, histologic grade). between case and control group. In addition, there was no statistical difference in operation data and outcomes between two groups. Hemoglobin changes were 1.1 g/dL (case group) vs 1.7 g/dL (control group) (p=0.072). Operation time was 131 min vs. 115 min. The numbers of lymph nodes obtained were 8.7 vs 7.7 (right) 9.2 vs. 7.6 (left). Hospital stays were 8.4 vs. 9.2 days. Adjuvant treatment cases were 7 vs. 15. Recurrent case was one in each group. Two patients initially evaluated by laparoscopy were converted to laparotomy due to bleeding and adhesion. CONCLUSION: Laparoscopic surgery for treatment of early endometrial cancer is a safe and effective alternative to laparotomy . However, long-term survival and risk of recurrence have yet to be determined.
Body Mass Index ; Endometrial Neoplasms* ; Female ; Hemorrhage ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal* ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Nodes ; Parity ; Recurrence ; Retrospective Studies

OBJECTIVE: To analyze the clinical characteristics of Korean pediatric, adolescent and premarital women who visited the Adolescent Gynecology Clinic at Samsung Medical Center. METHODS: A retrospective study was performed on the 2070 women visiting the Adolescent Gynecology Clinic at Samsung Medical Center from Feb. 1995 to Sep. 2003. The patients were divided into 3 groups according to patients' age; group I (~9 years, 258 patients), group II (10-20 years, 911 patients), group III (21-30 years, 901 patients). Clinical characteristics were analyzed by chart review and compared among three groups. RESULTS: The mean patient age was 18.4 +/- 6.9 years (mean SD) and the mean age at menarche was 13.4 +/- 1.5 years. The most common disease entity and disorder according to age groups were infectious disease and vaginitis in group I, menstruation associated problems and abnormal uterine bleeding (AUB) in group II, and menstruation associated problems and amenorrhea in group III. Among gynecologic problems, AUB was cited as the most common problem for the patients visiting the Adolescent Gynecology Clinic (425 cases, 20.5%), followed by amenorrhea (393 patients, 19.0%). 51.0% of primary amenorrhea had a congenital defects. Among the patients with pelvic tumor (293 patients), 85.3% was due to ovarian tumor, and 166 patients (66.4%) with ovarian tumor underwent operation. The most common pathologic diagnosis for ovarian tumor was endometrioma (60 cases, 36.1%). In primary dysmenorrhea (214 patients, 76.2% of total dysmenorrhea), treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) resulted in symptomatic improvement in 82.6% of the patients. The most common infectious disease was vaginitis and the most commonly isolated organisms varied according to age group (group I, II: E. coli, group III: Candida albicans). CONCLUSION: The most common gynecologic problem in korean pediatric, adolescent and premarital women is menstruation related disorders, presenting in 58.8% of patients visiting the Adolescent Gynecology Clinic.
Adolescent* ; Amenorrhea ; Candida ; Communicable Diseases ; Congenital Abnormalities ; Diagnosis ; Dysmenorrhea ; Endometriosis ; Female ; Gynecology* ; Humans ; Menarche ; Menstruation ; Retrospective Studies ; Uterine Hemorrhage ; Vaginitis

OBJECTIVE: This study was conducted to compare the perioperative outcomes in patients with symptomatic uterine myoma who underwent laparoscopic (LM) or laparoscopically assisted myomectomy (LAM). METHODS: A total of 207 patients with myoma underwent LM or LAM in Samsung Medical Center between October 2006 and March 2010. Of them, 121 patients with LM and 50 with LAM met the inclusion criteria and were compared for the perioperative outcomes. RESULTS: The operation time was significantly shorter in the LAM group than in the LM group (111 min versus 139 min; p<.001, respectively). Estimated blood loss was significantly higher in the LAM group (p<.001). Intraoperative, early postoperative complications, hospitalization days and postoperative analgesics use were similar between the 2 study groups. CONCLUSION: LM and LAM is comparable in the perioperative outcomes in patients with symptomatic uterine myoma.
Analgesics ; Female ; Hospitalization ; Humans ; Laparoscopy ; Lipopolysaccharides ; Myoma ; Postoperative Complications

OBJECTIVE: This study was to determine the expression of Toll-like receptor 4 (TLR-4) in ovarian serous adenocarcinoma tissues. METHODS: TLR-4 expression was evaluated at the RNA level by real-time quantitative RT-PCR, in 24 fresh frozen ovarian serous adenocarcinoma tissues and 9 normal ovarian tissues. TLR-4 expression was also evaluated by immunohistochemistry (IHC) in each three ovarian carcinoma tissues and normal ovarian tissues. RESULTS: Positive immunoreactivity for TLR-4 was observed in the normal ovarian tissues but not in the ovarian carcinoma tissues. The staining was localized in the cytoplasm as well as on the cell surface. Real-time quantitative RT-PCR revealed that TLR-4 expression was significantly lower in tumors than in normal ovarian tissues (p=0.0003). There were no significant correlations between clinical parameters and the expression level of TLR-4 mRNA in ovarian serous adenocarcinomas. However, tumors without LN metastasis (p=0.068) and lower grade (p=0.075) showed trends of higher TLR-4 mRNA expression. CONCLUSION: TLR-4 expression was significantly lower in ovarian serous adenocarcinoma tissues than in normal ovarian tissues, and further studies on TLR-4 signaling pathway in ovarian carcinoma are needed.
Adenocarcinoma ; Cytoplasm ; Immunohistochemistry ; Neoplasm Metastasis ; Ovarian Neoplasms* ; RNA ; RNA, Messenger ; Toll-Like Receptor 4

Aortic aneurysms are extremely uncommon in women under age 40 and are rarely encountered by obstetricians. Various physiologic changes of pregnancy appear to make pregnancy a risky situation of rupture of an aortic aneurysm and pregnancy is discouraged in women with an aortic aneurysm. Development of pregnancy induced hypertension in women with an aortic aneurysm is a profound problem and their treatment is not established. We report a case of emergent cesarean delivery followed by aortic aneurysm replacement surgery in a patient with thoracic aortic aneurysm which was accompanied by pregnancy induced hypertension.
Aortic Aneurysm ; Aortic Aneurysm, Thoracic* ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Pregnancy ; Rupture ; Transplants*

OBJECTIVE: Tissue inhibitors of metalloproteinases (TIMPs) play a key role in maintaining homeostasis of the extracellular matrix (ECM) by controlling matrix metalloproteinases (MMPs). In addition to their role in regulating MMPs, TIMPs have also been shown to have pluripotential effects on cell growth, apoptosis and differentiation. The aim of this study was to examine TIMP-2 level in serous ovarian tumor tissues and to understand further the role of TIMP-2 protein in ovarian tumorigenesis. METHODS: Expression of TIMP-2 was assessed by immunohistochemistry in a total of 57 ovarian specimens including five normal ovaries, 12 benign serous cystadenomas, 20 serous borderline tumors and 20 serous carcinomas. RESULTS: The present study found that TIMP-2 immunostaining was significantly more frequent in serous carcinomas, mainly in tumor epithelium, compared with cells of the other tissues studied. CONCLUSION: TIMP-2 in serous ovarian carcinoma may function to favor tumor growth in serous ovarian tumorigenesis. Additional research is now needed to elucidate further the role of TIMP-2 in the biological behavior of ovarian serous tumors.
Apoptosis ; Carcinogenesis ; Cystadenoma, Serous ; Epithelium ; Extracellular Matrix ; Female ; Homeostasis ; Immunohistochemistry ; Matrix Metalloproteinases ; Metalloproteases ; Ovarian Neoplasms ; Ovary ; Tissue Inhibitor of Metalloproteinase-2

OBJECTIVE: The aim of this study was to investigate the association of phosphorylated AKT (pAKT) expression and radiation resistance in cervical cancer. METHODS: A retrospective review was made of the records of 25 women who received primary radiation therapy due to locally advanced cervical cancer (LACC) with FIGO stage IIB-IVA. Nine patients regarded as radiation resistant developed local recurrences with a median progression free interval of 10 months. Sixteen patients did not show local recurrences, and were regarded as a radiation sensitive group. Using pretreatment paraffin-embedded tissues, we evaluated pAKT expression by immunohistochemistry. RESULTS: A significant association was found between the level of pAKT expression and local recurrence. Immunohistochemical staining for pAKT was significantly more frequent in the radiation resistant than in the radiation sensitive group (p=0.007). The mean progression free survival (PFS) was 84 months for patients with pAKT negative staining (17 cases) and 44 months for patients with pAKT positive expression (8 cases)(p=0.015). CONCLUSION: These results suggest that signaling from PI3K/pAKT can lead to radiation resistance in LACC.
Disease-Free Survival ; Female ; Humans ; Immunohistochemistry ; Negative Staining ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*