Ascites following radical hysterectomy with retroperitoneal lymphadenectomy for invasive cervical cancer has been reported previously. Most of these reports described chylous ascites. The chylous ascitic fluid is milky; further, chylous ascites leads to nutritional problems. Authors present the case of a patient who developed serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy. The amount of ascites was approximately 18,000 ml over 52 days. The patient had no nutritional problems or complications. Although the etiology could not be determined, Authors surmise that the ascites may have been due to massive drainage from injured lymphatic channels below the cisterna chyli. Authors could not found any literatures which described massive serous ascites following surgery in gynecologic malignancy and reports this case with review of literatures.
Adenocarcinoma ; Ascites ; Ascitic Fluid ; Chylous Ascites ; Drainage ; Humans ; Hysterectomy ; Lymph Node Excision ; Thoracic Duct ; Uterine Cervical Neoplasms

Endometrial stromal sarcoma (ESS) that arises from extrauterine endometriosis is a rare form of malignancy. We report the case of a 37-year-old ESS patient with extrauterine endometriosis who was treated with ifosfamide/cisplatin chemotherapy. A woman presented with epigastric pain and abdominal distension. Computed tomography imaging revealed a profuse amount of ascites, including a 12.4x12.3 cm sized posterior cul-de-sac mass composed of solid and cystic components. Cytoreductive surgery was performed to remove the mass and the histopathologic findings indicated ESS associated with extrauterine endometriosis. Six cycles of combination chemotherapy [ifosfamide (5 g/m(2)) with mesna (1 g/m(2)) and cisplatin (50 mg/m(2)) (IP)] were administered. After a six-month of disease-free interval, recurrent ESS developed in the pelvic cavity and in both lung fields. Megace medication decreased tumor marker CA-125 for six weeks. However, the patient expired sixteen months after the cytoreductive surgery. ESS associated with extrauterine endometriosis showed response to IP chemotherapy and megace.
Adult ; Ascites ; Cisplatin ; Drug Therapy, Combination ; Endometriosis ; Female ; Humans ; Lung ; Megestrol Acetate ; Mesna ; Sarcoma, Endometrial Stromal

Malignant fibrous histiocytoma (MFH) is the most frequent malignant soft tissue tumor in adults. A primary MFH occurs most commonly in the extremities and the trunk, but rarely in the pelvic cavity. We report a case of malignant fibrous histiocytoma of the unknown origin in the pelvic cavity with a review of the literature. The neoplasm occurred in the pelvic cavity of 53-year-old female who complained of enlarging nontender mass in the lower abdomen. The final diagnosis was based on the pathological report of the surgical specimen.
Abdomen ; Adult ; Extremities ; Female ; Histiocytoma, Malignant Fibrous ; Humans ; Middle Aged ; Pelvic Neoplasms

OBJECTIVE: To identify clinical prognostic factor improving survival of recurrent epithelial ovarian cancer (EOC) patients treated with secondary cytoreductive surgery (SCS). METHODS: The indications of SCS were as follows; 1) complete response (CR) after primary cytoreductive surgery and adjuvant chemotherapy, 2) disease-free survival (DFS) (> or =6 months). Clinical data of 17 patients including age, DFS, peritoneal seeding identified during SCS, the number of recurrent tumors (> or =1 cm), serum CA-125 levels and maximal diameter of residual tumor after SCS were reviewed retrospectively between January 1990 and March 2007. Survival analyses were performed using Kaplan-Meier method with log-rank test and univariate Cox's regression analysis. RESULTS: Mean age of them was 51.7 years. No peritoneal seeding identified during SCS was a prognostic factor improving progression-free survival after SCS (PFS-SCS) (30 vs. 6 months, p<.01 hazard ratio 0.099, 95% confidence interval 0.011-0.929, p=.043). Furthermore, serum CA-125 level (< or =37 U/ml) after SCS was a significant prognostic factors improving overall survival (51 vs. 19 months, p=.033; hazard ratio 0.212, 95% confidence interval 0.045-0.983, p=.045). CONCLUSION: Serum CA-125 levels with normal value after SCS and no peritoneal seeding may be associated with the improvement of survival in recurrent epithelial ovarian cancer patients treated with SCS.
Chemotherapy, Adjuvant ; Disease-Free Survival ; Humans ; Neoplasm, Residual ; Neoplasms, Glandular and Epithelial ; Ovarian Neoplasms ; Reference Values ; Retrospective Studies ; Seeds

OBJECTIVE: Paclitaxel is one of the most effective antineoplastic drugs. HPV-related cervical lesions have only managed with invasive procedure. Topical drug administration with temperature sensitive copolymer gels are useful approaches to clinical situation. In this study, we evaluated the activity of multiblock copolymers of PEG/PLA (poly(L-lactic acid)/polyethylene glycol) gels with paclitaxel (PTX) formulation administered by topical treatment to mice bearing human cervical cancer cell lines (HeLa). METHODS: We have synthesized gels of PEG/PLLA (poly(L-lactic acid)/polyethylene glycol) multiblock copolymers containing Paclitaxel which have temperature-sensitivecharacteristics. This Paclitaxel-containg copolymers has the sol-gel-sol transition temperature at body temperature. The efficacy of PTX in PEG/PLA mutiblock copolymer micelle were conducted in HeLa-tumor bearing Balb/c Nu/Nu athymic mice at an equivalent paclitaxel dose of 10 mg/kg with 48 hr interval. The inhibition of tumor growth was evaluated after 8 days of treatment. Tumors were harvested at day 10 and stained with hematoxylin and eosine to measure tumor. RESULTS: PTX-containing PEG/PLA mutiblock copolymer significantly decreased tumor growth at day 8, as measured by tumor size; ie, PEG/PLA mutiblock copolymer only goup ; 1.43+/-0.26 m versus intraperitoneal treatment of Paclitaxel : 0.75+/-0.07 mm and topical treatment of PTX-containing PEG/PLA copolymer containing Paclitaxel : 0.28 mm (Min; 0.1 mm-Maxu0.8 mm). CONCLUSION: This demonstration that PTX-containing PEG/PLA mutiblock copolymer have a useful topical drug deliversy system carrying temperature sensitive characetersitics in HPV-related cervical lesions.
Administration, Topical ; Animals ; Antineoplastic Agents ; Body Temperature ; Cell Line ; Eosine Yellowish-(YS) ; Gels ; Hematoxylin ; Humans ; Lifting ; Mice ; Mice, Nude ; Models, Animal ; Paclitaxel ; Polymers ; Transition Temperature ; Ursidae ; Uterine Cervical Neoplasms

OBJECTIVE: Homeostasis of the extracellular matrix (ECM) is maintained by the action of a specific system of proteolytic enzymes known as matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP). The MMP/TIMP system regulates the composition and turnover of ECM to control the site and extent of connective tissue remodeling. In pathologic conditions, MMP play a key role in degradation of basement membrane and extracellular matrix, and is responsible for cancer invasion, progression and metastasis. The aim of this study is to evaluate the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. METHODS: Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 were assessed by immunohistochemistry in a total of 55 endometrial cancers and were analyzed by the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. RESULTS: Expression rates of MMP-2,-9, TIMP-1, and TIMP-2 were 71.7%, 54.9%, 41.2%, and 76.5% respectively. Expression of MMP-2 was correlated with the group of positive lymph node metastasis in endometrial cancer (p=0.04). Specially, coexpression of MMP-2 and TIMP-2 was significantly more frequent in the group of positive lymph node metastasis (p<0.01) and the group of positive peritoneal CONCLUSION: The expressions of MMP and TIMP were not a significant difference in survival analysis, but this study was recognized that the coexpression MMP-2 and TIMP-2 is correlated with lymph node metastasis and positive peritoneal cytology.
Basement Membrane ; Connective Tissue ; Endometrial Neoplasms ; Extracellular Matrix ; Female ; Homeostasis ; Immunohistochemistry ; Lymph Nodes ; Matrix Metalloproteinases ; Metalloproteases ; Neoplasm Metastasis ; Peptide Hydrolases ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2

OBJECTIVE: Hibiscus protocatechuic acid (PCA) is a food-derived polyphenol antioxidants used as a food additive and a traditional herbal medicine. In this study, PCA was to determine its effect on cell proliferation and cell cycle progression in primary cultured human uterine leiomyoma cells. METHODS: The effect of PCA on cell proliferation and cell cycle progression was examined in the primary cultured human uterine leiomyoma cells. MTT reduction assay was carried out to determine the viability of uterine leiomyoma cells. Cell cycle analysis for Hibiscus protocatechuic acid treated leiomyoma cells was done by FACS analysis. DNA fragmentation assay was performed to determine fragmentation rate by PCA in leiomyoma cells. Western blot analysis was done using anti pRB, anti-p21(cip1/waf1), anti-p53, anti-p27(kip1), anti-cyclinE, anti CDK2 antibodies to detect the presence and expression of these proteins in PCA treated myoma cells. RESULTS: PCA induced growth inhibition in a dose dependent manner, treatment with 5 mmol/L PCA blocked 80% cell growth. FACS results showed that there was increased the percentage of cells in sub G1. DNA fragmentation assay by ELISA was done to find the rate of apoptosis. Apoptosis took place but in a dose dependent manner. From Western blot analysis it revealed PCA induced the expression of p21(cip1/waf1) and p27(kip1) increasingly and was not mediated by p53. Caspase-7 pathway was activated and dephosphorylation of pRB took place. CONCLUSION: In Conclusions, PCA, a polyphenol antioxidant, inhibited cell proliferation and induced cell cycle arrest at sub G1 phase by enhancing the production of p21cip1/waf1 and p27kip1. These results indicate that PCA will be a promising agent for use in chemopreventive or therapeutics against human uterine leiomyoma.
Antibodies ; Antioxidants ; Apoptosis ; Blotting, Western ; Caspase 7 ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Proliferation ; DNA Fragmentation ; Enzyme-Linked Immunosorbent Assay ; Food Additives ; G1 Phase ; Herbal Medicine ; Hibiscus ; Humans ; Hydroxybenzoates ; Hypogonadism ; Leiomyoma ; Mitochondrial Diseases ; Myoma ; Ophthalmoplegia ; Passive Cutaneous Anaphylaxis ; Proteins ; Uterus

OBJECTIVE: The conventional Papanicolaou smear seems to be more accurate for detecting a high-grade squamous intraepithelial lesion (HSIL) than a low-grade squamous intraepithelial lesion (LSIL). The purpose of this study was to investigate false-negative results of conventional Pap smear cytology in women with cervical conization. METHODS: This study was performed in Gynecologic Oncology Clinic of the Department of Obstetrics and Gynecology at Dankook University Medical Center from July 1, 1994 to December 31, 2004. 260 women from age 22 to 75 years had undergone conventional Papanicolaou cervical cytologic test and cervical conization. Conization was performed using ncold-knife cone' method or nlarge electrosurgical excision procedure (LEEP) cone' method. The cervical cytology were studied in comparison with histology of conization specimens. RESULTS: Of the 260 histologic diagnoses, there were 41 (15.8%) diagnoses of chronic cervicitis, 8 (3.1%) of CIN 1, 18 (6.9%) of CIN 2, 150 (57.7%) of CIN 3, 38 (14.6%) of SCC, 2 (0.8%) of AIS, 1 (0.4%) of ACC, and 2 (0.8%) of ASC. Pap cytology showed sensitivity of 97.9-98.2%, specificity of 4.9-6.7%, and false-negative rate of 1.8-2.2% according to the variables. CONCLUSION: Significantly false-negative rate of Pap cytology in women with conization was very low. And so, conventional Pap cytology is still clinically efficient for screening high-grade cervical lesions with adequate sampling technique.
Academic Medical Centers ; Conization ; Female ; Gynecology ; Humans ; Mass Screening ; Obstetrics ; Sensitivity and Specificity ; Uterine Cervicitis ; Vaginal Smears

OBJECTIVE: Vascular endothelial growth factor (VEGF) increases angiogenesis. It is known that one of angiogenetic factors, angiopoietin-1 (Ang-1) stabilizes maturity of normal vessels and angiopoietin-2 (Ang-2) antagonizes the action of angiopoietin-1 by binding Tie-2 that is their receptor. Recently those factors are known to be involved in carcinogenesis. The aim was to investigate the mRNA expression of those factors in epithelial ovarian cancer including normal ovary and ovarian cyst and to evaluate their role in ovarian carcinogenesis. METHODS: The tissue samples of 16 ovarian cyst, and 29 epithelial ovarian cancer patients who were diagnosed at Ewha Woman's University MokDong Hospital from 1997 to 2003, and 18 normal ovary subjects who had hysterectomy and salpingoophorectomy due to uterine myoma and confirmed as normal controls, were obtained. The mRNA expressions of Angiopoietin-1, Angiopoietin-2, Tie-2 and Vascular endothelial growth factor were measured by Quantitative Competitive polymerase chain reaction (PCR). Their expressions were analyzed with ANOVA test and Spearman correlation test. RESULTS: The expressions of Ang-1 mRNA were higher in normal ovary than those of ovarian cyst and ovarian cancer (p<0.05). The expressions of Tie-2 mRNA were higher in ovarian cyst than those of normal ovary and ovarian cancer (p<0.05). The expressions of VEGF mRNA were higher in ovarian cancer than those of normal ovary and ovarian cyst (p<0.05). The expression of Ang-2 mRNA in ovarian cancer was related with the expression of VEGF and Tie-2 mRNA. CONCLUSION: The lower expression of Ang-1 mRNA and higher expression of VEGF mRNA might be a role in ovarian carcinogenesis. The expression of Ang-1, Tie-2 and VEGF might be related to ovarian carcinogenesis, together. However, this study is based on limited number of cases and short-term period of follow up, further prospective studies on a larger population should be done.
Angiopoietin-1* ; Angiopoietin-2* ; Carcinogenesis ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Leiomyoma ; Ovarian Cysts* ; Ovarian Neoplasms* ; Ovary* ; Polymerase Chain Reaction ; RNA, Messenger* ; Vascular Endothelial Growth Factor A*

OBJECTIVE: To determine pathologic variables associated with overall survival and disease free survival of patients with endometrial cancer. METHODS: Survival of 81 endometrial cancer patients treated with primary surgery between January 1997 and December 2003 at our center was compared about various histopathologic variables. All patients underwent complete surgical staging including pelvic +/- paraaortic lymph node dissection. Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model using likelihood-ratio statistics based on the conditional parameter estimate (Conditional). RESULTS: With regard to disease free survival, univariate analysis revealed no significant differences in subgroups according to age category, grade and adjuvant radiotherapy. However, significant differences in disease free survival were found between stage I+II and stage III, and between endometrioid type and the others type. Among these significant subgroups, the Cox-proportional hazards model showed that stage was the only independent prognostic factor. There were no significant differences in the overall survival of patients in subgroups according to age category and adjuvant radiotherapy. But, significant differences in overall survival were found in subgroups according to stage, histology and grade. Multivariate analysis revealed that stage was the only independent significant adverse prognostic effect. CONCLUSION: Our results showed that only stage was an independent prognostic factor of disease free survival and overall survival in endometrial cancer patients.
Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Humans ; Lymph Node Excision ; Multivariate Analysis ; Proportional Hazards Models ; Radiotherapy, Adjuvant