Smooth muscle tumors are very common tumors in the uterus and related adjacent structures but occur rarely in the retroperitoneum. Traditionally, most retroperitoneal smooth muscle tumor are believed to be malignant. But well-differentiated smooth muscle tumors with lack of atypia, necrosis, and significant mitotic activity appear to have a benign behaviors. Laparotomy revealed a huge solid tumor in the retroperitoneal space, about 50 cm in diameter, and histologically diagnosed as a smooth muscle tumor of uncertain malignant potential (STUMP). We report a case of primary retroperitoneal smooth muscle tumor with a brief review of literatures.
Laparotomy ; Muscle, Smooth* ; Necrosis ; Ovarian Neoplasms* ; Retroperitoneal Space ; Smooth Muscle Tumor* ; Uterus

OBJECTIVE: To evaluate the clinical characteristics and the outcome of the management for gestational trophoblastic disease (GTD) patients diagnosed at our hospital and to report the current situation of GTD in Korea. METHODS: Between January, 1991, and December, 2000, One hundred and eleven women were diagnosed as GTD and managed in our hospital. Patients were classified according to clinical diagnosis and their medical records were investigated. RESULTS: Cases of benign, malignant nonmetastatic, malignant metastatic low risk and malignant metastatic high risk GTDs were 62, 36, 2 and 11 respectively. The mean age (year), gravidity and parity (number) of GTD patients were 33.3+/-9.9 (range: 19-54), 3.2+/-3.0 (range: 0-16) and 1.7+/-1.8 (range: 0-7) overall. About 75% of GTD patients were women in their 20s and 30s, and 85% occurred in patients with parity of 3 or less. The most common prior gestational event was abortion (37.1%) for molar pregnancy and molar pregnancy (61.2%) for persistent gestational trophoblastic tumor (PGTT). The progression rate of molar pregnancies to PGTT was 38.0%. MTX (16.3%) was mainly used as a single agent, and EMACO (28.6%) or MAC (22.4%) were primarily used for multidrug chemotherapy for the treatment of PGTT. In the treatment of PGTT, overall remission rate was 95.9% (n=47/49). CONCLUSION: The trends for GTD in Korea revealed significant changes, not only a decrease in the incidence of GTD, but also an improvement in the outcome of the management. There is a necessity of further community-based surveys for GTD.
Diagnosis ; Drug Therapy ; Female ; Gestational Trophoblastic Disease* ; Gravidity ; Humans ; Hydatidiform Mole ; Incidence ; Korea ; Medical Records ; Parity ; Pregnancy ; Trophoblastic Neoplasms

OBJECTIVE: This study was performed to evaluate the efficacy of paclitaxel based combination chemotherapy by response rate and survival time in the treatment of recurrent endometrial cancer. METHODS: From May 1995 to February 2004, 27 out of 301 cases of endometrial cancer treated at the Asan Medical Center in Seoul were recurrent. We identified 11 patients treated with paclitaxel based combination chemotherapy and 7 patents treated with other combination chemotherapy, and then retrospectively estimated the survival times from the chemotherapy after recurrence to the death or last visit. RESULTS: The non-paclitaxel based combination chemotherapy group showed partial response in 1 case (14.3%) and disease progression in 4 (57.1%). In contrast, the paclitaxel group showed 7 cases (63.6%) of partial response. The median survival time for total study patients was 18.0 months, 22.0 months for paclitaxel group and 15.0 months for the non-paclitaxel group, the difference being statistically significant (p=0.047). Side effect of chemotherapy such as leukopenia, neutropenia and thrombocytopenia showed no difference between the two groups. CONCLUSION: Paclitaxel-based combination chemotherapy may be the first-line chemotherapeutic agent in recurrent endometrial cancer patients if it's more effective than other combination chemotherapy in prolonging survival times.
Chungcheongnam-do ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination* ; Endometrial Neoplasms* ; Female ; Humans ; Leukopenia ; Neutropenia ; Paclitaxel* ; Recurrence ; Retrospective Studies ; Seoul ; Thrombocytopenia

OBJECTIVE: The purpose of this retrospective study is to identify and to discuss the clinical relevance of prognostic factors and survival rate in patients with epithelial ovarian cancer treated with combination chemotherapy. METHODS: A total of 98 histologically verified patients with epithelial ovarian cancer who were treated at Dong-A Medical Center between 1997 and 2002 were used for analysis. The 30 patients having borderline tumor were excluded. Kaplan-Meier survival curves were computed and tested statistically by the log rank test. A multivariable Cox proportional hazard model was applied to access the prognostic significance of the different covariates. RESULTS: The median age of the patients with epithelial ovarian cancer was 46.6 years and FIGO stage distribution was 38.2% for stage I, 5.9% for stage II, 44.1% for stage III, 11.8% for stage IV. The histopathologic type distribution were serous type (45.6%), mucinous type (36.8%), endometriod type (8.8%), clear cell type (7.4%), mixed type (1.4%). Residual tumor volume size of less than 1 cm or 1 cm was identified in 50 patients (73.5%) and more than 1 cm in 18 patients (26.5%) after primary cytoreductive surgery. The overall 5-year survival rate was 55.7%. According to univariate analysis, FIGO stage (p<0.0001), residual volume (p<0.0001), ascitic fluid volume (p=0.0001), menopause (p=0.0021), CA125 (p=0.0058), tumor size (p=0.0099), age (p=0.0113) were significant prognostic factors affecting survival. However, multivariate analysis in this study demonstrated that FIGO stage (p=0.011), residual tumor volume (p=0.026), ascitic fluid volume (p=0.031) were found to be the most significant independent prognostic factors. CONCLUSION: In this retrospective study, the overall 5-year survival rate of patients with epithelial ovarian cancer treated with combination chemotherapy was 55.7% and 5-year survival rate of stage I/II was 95.8%, stage III 28.4%, stage IV 0%. The overall survival of stage I/II were 90 months, stage III 39 months, stage IV 17 months. In multiple analysis, FIGO stage, residual volume, ascitic fluid volume were identified as three most significant independent prognostic factors.
Ascitic Fluid ; Drug Therapy, Combination* ; Female ; Humans ; Kaplan-Meier Estimate ; Menopause ; Mucins ; Multivariate Analysis ; Neoplasm, Residual ; Ovarian Neoplasms* ; Proportional Hazards Models ; Residual Volume ; Retrospective Studies ; Survival Rate

OBJECTIVE: The aim of this investigation was to analyze the association between a single nucleotide polymorphism (SNP) in L-myc gene (T3109G) and ovarian cancer risk or prognosis in Korean women. METHODS: The blood samples of 98 ovarian cancer patients and 332 non-cancer control subjects who managed at Seoul National University Hospital from 1999 to 2002 were collected. Polymorphism in L-myc (T3109G) was determined using TaqMan method. Allele frequency and genotype distribution in the ovarian cancer group were compared with those of the control group to determine whether this polymorphism elevates the susceptibility of Korean women to ovarian cancer. The relationship between this SNP and cancer invasiveness or prognosis were also evaluated by collating clinicopathologic data of those in the cancer group, such as surgical stage, stromal invasion, histologic type, and survival. RESULTS: In the ovarian cancer group, the allele frequency of G was 51.0%, in the control group 48.5%, showing no significant difference (p=0.569). Similarly the genotypes with TG or GG showed no increased risk for ovarian cancer susceptibility compared with TT genotype. A subgroup analysis of the clinicopathologic parameters in cancer group also showed no significant difference suggesting the lack of an association between SNP of the L-myc and ovarian cancer invasiveness and survival. CONCLUSION: This study shows that Korean women with specific polymorphism in L-myc are neither more susceptible to develop ovarian cancer nor more vulnerable for cancer progression.
Female ; Gene Frequency ; Genes, myc ; Genotype ; Humans ; Ovarian Neoplasms* ; Polymorphism, Single Nucleotide* ; Prognosis* ; Seoul

OBJECTIVE: The overexpression of p16(INK4A) is induced by human papillomavirus (HPV) and associated with the carcinogenesis of cervical epithelia. So, immunostaining of p16(INK4A) may be useful biomarker in detecting CIN of cervix uteri in abnormal cervical lesions. The potential of p16(INK4A) as a biomarker for Atypical squamous cells of undetermined significance (ASCUS) examined in liquid-based specimens. METHODS: We collected samples 30 cases of ASCUS in Thinprep(TM) smears between March 2003 and August 2003. 23 control Thinprep(TM) cases were included; 10 negative for intraepithelial lesions, 13 cervical squamous intraepithelial lesions. p16(INK4A) immunochemial staining was performed on 53samples. At the same time, we tested another cervical swabs of patients by the Hybrid Capture II(TM) test. The cut off value was scored positive if it contained above 5 abnormal cells with nuclear and cytoplasmic immunostaining. RESULTS: The results of p16(INK4A) immunochemial staining comparing with one of HC II(TM) showed negative results with low kappa coefficient of 0.034. The sensitivity of p16(INK4A) immunochemial staining were 30.8% and the specificity were 82.4% respectively (p<0.01). p16(INK4A) is a useful marker for the detection of the cervical intraepithelial neoplasia but is not ASCUS. CONCLUSION: Immunostaining of p16(INK4A) is not useful triage test in detecting abnormal lesion of ASCUS in liquid-based specimens.
Carcinogenesis ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Cyclin-Dependent Kinase Inhibitor p16* ; Cytoplasm ; Female ; Humans ; Sensitivity and Specificity ; Triage

OBJECTIVE: To identify resection margin status and HPV DNA test as predictive factors for residual lesion in the management of CIN3 with cervical conization. METHODS: A retrospective study was conducted on 96 patients with CIN3 who had been performed cervical conization (LEEP or CKC) between January 1999 and December 2003 at Soonchunhyang university Chunan hospital. Secondary conization or hysterectomy were performed in case of positive margin on cone specimen or negative margin with other hysterectomy indication. Resection margin status and pre conization HPV DNA test were compared with residual lesion on subsequent cone or hysterectomy specimen. RESULTS: Among 96 cases, 24 cases (15.6%) showed positive resection margin on cone specimen. Of 24 cases with positive resection margin, 2 cases were followed up without treatment, 2 cases were treated with secondary conization and 20 cases were treated with hysterectomy. Of 72 cases with negative resection margin, hysterectomy was performed due to other indication in 16 cases. Persistence of residual lesion in the secondary conization and hysterectomy specimens was significantly correlated with high risk HPV infection and positive resection margin status (p<0.05). CONCLUSION: Conization is good treatment modality of the management of CIN3. HPV DNA test and resection margin status are good predictor of residual lesion after cervical conization for the management of CIN 3. Therefore, when HPV positive and resection margin positive, secondary treatment is mandatory.
Chungcheongnam-do ; Conization* ; Human Papillomavirus DNA Tests* ; Humans ; Hysterectomy ; Retrospective Studies

OBJECTIVE: The aim of this study was to determine the correlation between SCC Ag and the prognosis in cervical cancer patients following concurrent chemoradiotherapy (CCRT). METHODS: The charts of 116 patients following concurrent chemoradiotherapy among 330 patients diagnosed to cervical cancer at Yonsei University Medical Center from Jan. 1998 to June 2003 were reviewed retrospectively. Clinical characteristics (age, parity, body mass index), stage, lesion size, cell type, squamous cell subtype, initial SCC Ag (<1.5 and >or=1.5), posttreatment SCC Ag (<1.5 and >or=1.5) was evaluated with overall survival. Distribution of SCC Ag level before CCRT in relation to FIGO stage and failure pattern in SCC positive patients before CCRT were reviewed. Overall survival was estimated according to respectively, subgroups of initial SCC Ag, SCC Ag after 2nd CCRT and posttreatment SCC Ag. Chi square test and Kaplan Meier test were used for statistical analysis (P<0.05). RESULTS: Overall survival was significantly correlated with only stage (P=0.0014). Two patients (15.4%) among 13 patients with recurrence had SCC Ag<1.5. Subgroups (1.5 Academic Medical Centers ; Cell Size ; Chemoradiotherapy* ; Female ; Humans ; Kaplan-Meier Estimate ; Parity ; Prognosis* ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*

OBJECTIVE: To evaluate the expression level, localization and distribution of 14-3-3sigma and zeta proteins in human ovarian epithelial carcinoma cells. METHODS: Epithelial carcinoma, benign epithelial tumor and normal ovarian tissues were evaluated by immunohistochemistry. For this study, mucinous adenoma (n=10), serous adenoma (n=10), mucinous adenocarcinoma (n=10) and serous adenocarcinoma (n=10) of ovary and normal ovarian tissue (n=10) were analyzed. Goat anti 14-3-3sigma polyclonal antibody and rabbit anti-14-3-3zeta polyclonal antibody were used as primary antibodies. RESULTS: The 14-3-3sigma protein expression in the glandular epithelium was not statistically different among normal ovary, cystadenoma and cystadenocarcinoma. The 14-3-3zeta protein expression in the glandular epithelium was significantly higher for cystadenocarcinoma than for cystadenoma and normal ovary. The 14-3-3sigma and zeta proteins were immunohistochemically demonstrated in the nuclei and more preferably in the cytoplasm of adenocarcinoma epithelial cells. CONCLUSION: The expression of 14-3-3zeta protein increased significantly in ovarian adenocarcinoma compared with adenoma and normal ovary. It is suggested that 14-3-3zeta protein expression may play an important role in abnormal growth of ovarian epithelial tumor cell.
14-3-3 Proteins ; Adenocarcinoma ; Adenocarcinoma, Mucinous ; Adenoma ; Antibodies ; Cystadenocarcinoma ; Cystadenoma ; Cytoplasm ; Epithelial Cells ; Epithelium ; Female ; Goats ; Humans ; Immunohistochemistry ; Mucins ; Ovarian Neoplasms* ; Ovary

OBJECTIVE: The most important biologic characters of malignant tumor are invasion and metastasis, and extracellular matrix is first barrier in metastatic process. Therefore, proteases are linked to the malignant phenotype of different solid tumor. METHODS: In this study, the expression of the matrix metalloproteinase (MMP)-2 and MMP-9 and of the serine protease urokinase-type plasminogen activator (uPA) and its inhibitor plasminogen activator inhibitor type 1 (PAI-1) in the ovarian epithelial tumors was investigated. Immunohistochemical expression of MMP-2, MMP-9, uPA, and PAI-1 were analyzed in formalin fixed tumor tissues of 20 benign cystadenomas, 20 low malignant potential (LMP) tumors, and 20 malignant ovarian cancer, including 10 FIGO stage I cancer and 10 stage III cancer. In the same tissue extracts, DNA levels of MMP-2, MMP-9, uPA, and PAI-1 were determined by PCR. RESULTS: The immunohistochemical expression and DNA level of MMP-2, MMP-9, uPA, and PAI-1 were low in benign ovarian tumors but significantly increased LMP tumors and malignant ovarian cancers. The highest values of all of the proteolytic enzymes were detected in stage III ovarian cancers with omentum metastases. There are significant correlations between expression of uPA and MMP. CONCLUSION: These results suggest that high expression of MMP-2, MMP-9, and uPA is associated with activity of tumor invasion and metastasis, and expressions of MMP-2 and MMP-9 are correlated with uPA activity.
Cystadenoma ; DNA ; Extracellular Matrix ; Female ; Formaldehyde ; Neoplasm Metastasis ; Omentum ; Ovarian Neoplasms ; Ovary* ; Peptide Hydrolases ; Phenotype ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Polymerase Chain Reaction ; Serine Proteases ; Tissue Extracts ; Urokinase-Type Plasminogen Activator*