OBJECTIVE: To explore the appropriate treatment of malignant germ cell tumor (MGCT) in the female genital system, and to analyze the factors influencing both therapeutic response and survival outcome. METHODS: A cohort of 230-Chinese women diagnosed with MGCT of the genital system was retrospectively reviewed and prospectively followed. The demographic and pathological features, extent of disease and surgery, treatment efficiency, recurrence and survival were analyzed. RESULTS: MGCTs from different genital origins shared a similar therapeutic strategy and response, except that all eight vaginal cases were infantile yolk sac tumors. The patients' cure rate following the initial treatment, 5-year overall survival and disease-free survival (DFS) were 85.02%, 95.00%, and 86.00%, respectively. Although more extensive excision could enhance the remission rate; it did not improve the patients' survival. Instead, the level of the medical institution, extent of surgery and disease were independent prognostic factors for relapse (p<0.05). Approximately 20% of patients had recurrent or refractory disease, more than half of whom were in remission following secondary cytoreductive surgery with salvage chemotherapy. CONCLUSION: Fertility-sparing surgery with or without standardized PEB/PVB (cisplatin, etoposide/vincristine, and bleomycin) chemotherapy is applicable for female MGCTs of different origins. Comprehensive staging is not required; nor is excessive debulking suggested. Appropriate cytoreduction by surgery and antineoplastic medicine at an experienced medical institution can bring about an excellent prognosis for these patients.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Female ; Genital Neoplasms, Female/diagnosis/mortality/pathology/*therapy ; Humans ; Infant ; Middle Aged ; Neoplasms, Germ Cell and Embryonal/diagnosis/mortality/pathology/*therapy ; Prognosis ; Recurrence ; Survival Analysis ; Young Adult

OBJECTIVE: Although radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) are the global standards for adjuvant therapy treatment in cervical cancer, many Japanese institutions choose chemotherapy (CT) because of the low frequency of irreversible adverse events. In this study, we aimed to clarify the trends of adjuvant therapy for intermediate/high-risk cervical cancer after radical surgery in Japan. METHODS: A questionnaire survey was conducted by the Japanese Gynecologic Oncology Group to 186 authorized institutions active in the treatment of gynecologic cancer. RESULTS: Responses were obtained from 129 facilities. Adjuvant RT/CCRT and intensity-modulated RT were performed in 98 (76%) and 23 (18%) institutions, respectively. On the other hand, CT was chosen as an alternative in 93 institutions (72%). The most common regimen of CT, which was used in 66 institutions (51%), was a combination of cisplatin/carboplatin with paclitaxel. CT was considered an appropriate alternative option to RT/CCRT in patients with risk factors such as bulky tumors, lymph node metastasis, lymphovascular invasion, parametrial invasion, and stromal invasion. The risk of severe adverse events was considered to be lower for CT than for RT/CCRT in 109 institutions (84%). CONCLUSION: This survey revealed a variety of policies regarding adjuvant therapy among institutions. A clinical study to assess the efficacy or non-inferiority of adjuvant CT is warranted.
Chemoradiotherapy, Adjuvant ; Combined Modality Therapy ; Female ; Humans ; Japan/epidemiology ; Middle Aged ; Neoplasm Recurrence, Local/prevention & control ; *Practice Patterns, Physicians'/statistics & numerical data ; Risk Assessment ; Risk Factors ; Surveys and Questionnaires ; Uterine Cervical Neoplasms/radiotherapy/*therapy

Unclassified type occupies about 5 to 10 percent of all ovarian sex cord stromal tumors. Diagnosis is very difficult and subjective because tumors show insufficient differentiation to ovarian or testicular line or display insufficient findings to diagnose as a gynandroblastoma in spite of divergent differentiation. To our knowledge sixty-two cases have been reported in the pathology literatures as yet. The behavior of this group of tumors has not been adequately studied but is similar to granulose cell tumors or Sertoli-Leydig cell tumors. We present a case of unclassified sex cord-stromal tumor which has been experienced in our hospital with brief review of the literature.
Diagnosis ; Female ; Ovary ; Pathology ; Sertoli-Leydig Cell Tumor ; Sex Cord-Gonadal Stromal Tumors*

Uterine tumor resembling ovarian sex cord tumors (UTROSCTs) are uncommon neoplasms that histologically resemble ovarian sex cord tumor. Over 50 cases have been reported up to recently. Clement and Scully reported 14 cases of UTROSCT, which they devided into two groups by clinicopathological features. Group I tumors are endometrial stromal sarcomas with partially sex-cord like elements (less than 40% of total tumor volume). On the other hand, group II tumors are mostly or entirely composed of sex-cord like elements. We have experienced a very rare case of type II UTROSCT at the uterine fundus in a 52-year-old woman and report it with a brief review of the literatures.
Female ; Hand ; Humans ; Middle Aged ; Sarcoma, Endometrial Stromal

Ovarian carcinoma is usually asymptomatic in early stage and over 70% of it initially diagnose advanced stage due to diffuse intraabdominal disease. Presenting symptoms and signs often relate to the degree of intraabdominal spread. The most common presenting symptoms and sign include abdominal pain, distension and palpable pelvic mass. The enlarged finding of isolated, distant lymph node without intraabdominal symptom and sign is vary rare. We experienced a patient who initially diagnosed enlarged axillary lymph node from ovarian carcinoma. We report this case with a brief review of literature.
Abdominal Pain ; Humans ; Lymph Nodes*

OBJECTIVE: The purpose of this study is to compare the expression rate of cyclooxygenase-2 (COX-2), p53 in endometrial hyperplasia, endometrial cancer and normal endometrium and to correlate COX-2 with the clinicopathological factors and p53 in endometrial cancer. METHODS: Immunohistochemical stain of COX-2, p53 was performed on samples from a series of 19 cases of normal proliferative endometrium, 20 cases of complex endometrial hyperplasia and 19 cases of endometrial cancer. And then we analyzed the expression of COX-2 correlated the findings with clinicopathological factors and p53. Expression of COX-2 was scored according to the proportion of positive-staining cells: negative, no staining; 1+, <10%; 2+, 10-50%; 3+, >50. For p53 overexpression, when there were at least 10% of tumor cells stained, it was considered as positive. RESULTS: Overexpression of COX-2 (> or =2+) was seen in 5 (26.3%) of the endometrial cancers, 6 (30%) of the complex endometrial hyperplasia, and 4 (21.1%) of the normal endometria. The expression rates of COX-2 in endometrial cancer, hyperplasia and normal endometrium were not different statistically significant (p=0.93). COX-2 was not correlated with clinicopathological factors but correlated with p53 significantly (p=0.021). CONCLUSION: In this study, the immunohistochemical analysis showed no difference statistically in COX-2 expression between endometrial cancer and hyperplasia compared to normal endometria. COX-2 was significantly correlated with p53. This finding may represent that tumor suppressor p53 upregulates COX-2 expression.
Cyclooxygenase 2* ; Endometrial Hyperplasia* ; Endometrial Neoplasms* ; Endometrium* ; Female ; Hyperplasia

OBJECTIVE: To evaluation of the effect of pelvic or paraaortic lymphadenectomy on survival rates in the management of clinical stage I endometrial cancer METHODS: A retrospective analysis was performed on a total 303 clinical stage I endometrial cancer patients from 1989 to 2004 at Asan Medical Center. Two hundred-sixty-three (86.8%) underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic or paraaortic lymphadenectomy, while forty (13.2%) underwent a total hysterectomy and bilateral salpingo-oophorectomy only. Characteristics of patients and 5-year survival rate of each patients group were analyzed. RESULTS: Seventeen (6.5%) showed lymph node metastases and overall 5-year survival rate of clinical stage I endometrial cancer was 96.9%. The 5-year and 10-year survival rate of a group with lymphadenectomy were 96.4% and 86.6%, and those of a group without lymphadenectomy were 100% and 75.2%, respectively (p=0.48). The 5-year survival rate of a group with positive lymph nodes was 73.3%, that of a group with negative lymph nodes was 97.7% (p<0.05). CONCLUSION: The complete staging operation including lymphadenectomy did not improve the survival rates in a group with lymphadenectomy significantly. But the debates regarding the necessarity of lymphadenectomy in clinical stage I endometrial cancer still remains and a large randomized prospective study is needed.
Chungcheongnam-do ; Endometrial Neoplasms* ; Female ; Humans ; Hysterectomy ; Lymph Node Excision* ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Survival Rate*

OBJECTIVE: To evaluate the therapeutic value of conization using right-angled triangular shape loop cone biopsy excisor in patients with CIN 3 who want preserve the uterus. METHODS: A retrospective review of 64 patients was performed who underwent therapeutic conization for CIN 3 by using right-angled triangular shape loop cone biopsy excisor from January 2000 to August 2005. RESULTS: The mean duration of 64 follow-up patients who had conization for therapeutic purpose was 21.5 months (range 10-68). Their mean age was 41.1 years old and mean parity was 1.7. Two of 64 patients had CIN 3 on exocervix margin. During the followed up period, only one person (1/64) had relapse of CIN 3, hence, a simple hysterectomy was done. CONCLUSION: Right-angled triangular shape loop cone biopsy excisor is more effective than U-shaped loop with low rate of margin positive and recurrent rate in conservative treatment in CIN 3 patients who want to preserve uterus or fertility.
Biopsy ; Cervical Intraepithelial Neoplasia* ; Conization* ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Parity ; Recurrence ; Retrospective Studies ; Uterus

OBJECTIVE: The aim of this study was to evaluate the tolerance and outcome of elderly cervical cancer patients who were treated with radiation therapy retrospectively. METHODS: Fourteen patients over 80 years with pathologically proven stage I-IV cervical cancer who were treated with definitive RT between 1993 and 2003 were analyzed. We investigated response rates, recurrence rates, complications, progression free intervals, and current status of subjects. RESULTS: The age of the 14 patients ranged from 80 to 88 (median age: 81). The distribution of clinical stage by FIGO classification were > or =stage IIB (78.6%). The most common histologic type was squamous cell carcinoma. Nine patients (64.3%) underwent definitive radiation therapy. Among the 9 patients who had undergone radiotherapy, 7 patients (77.8%) showed complete response. One patient underwent surgical intervention followed by chemotherapy due to progression of disease despite radiotherapy. Two patients experienced radiation cystitis and 1 patient suffered from radiation colitis, however, other patients did not manifestate significant complications. One patient who underwent palliative chemotherapy due to persistent disease experienced mild marrow suppression and neurologic symptoms temporarily. CONCLUSION: The elderly patients over 80 years with good performance status may tolerate definitive pelvic radiation administered according to conventional fractionation schedules to control cervical cancer. Definitive radiation therapy with or without concurrent chemotherapy should not be excluded as a treatment option even for patients older than 80 years.
Aged* ; Appointments and Schedules ; Bone Marrow ; Carcinoma, Squamous Cell ; Classification ; Colitis ; Cystitis ; Drug Therapy ; Humans ; Neurologic Manifestations ; Radiotherapy ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*

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.
Adenocarcinoma* ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms