Non-Hodgkin's lymphoma presented as a malignancy of the uterine cervix is exceedingly rare disease and accounts for approximately only 0.12-0.6% of extranodal lymphomas. There is no consensus on the management and prognosis of the disease because of its extreme rarity. Previously, treatment of this disease has been radiation therapy, surgery or chemotherapy either alone or in combination. We present the case of a 45-year-old woman diagnosed with diffuse, large B-cell non-Hodgkin's lymphoma of the uterine cervix. We administered neoadjuvant chemotherapy according to CHOP protocol (cyclophosphamide, adriamycin, vincristine, and prednisone) followed by hysterectomy and bilateral salpingo-oophorectomy. The patient is alive 20 months after the initial diagnosis. We report the case with a brief review of literature.
B-Lymphocytes ; Cervix Uteri* ; Consensus ; Diagnosis ; Doxorubicin ; Drug Therapy* ; Female ; Humans ; Hysterectomy ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Middle Aged ; Prognosis ; Rare Diseases ; Vincristine

Aggressive angiomyxoma is a rare, locally infiltrative soft tissue tumor that usually arises in the vulvoperitoneal region of young female. Frequent relapses are common. Clinicians should consider the diagnosis of aggressive angiomyxoma when a patient presents with an atypical vulvoperineal mass, because an incorrect diagnosis may lead to repeated surgical procedures. Treatment is wide surgical excision. Medical management with a GnRH agonist and radiation therapy with total dose of 60 Gy may be helpful adjuvant treatment in recurrent aggressive angiomyxoma. We experienced a case of recurrent aggressive angiomyxoma and report it with a brief review of literatures.
Adolescent* ; Diagnosis ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Myxoma* ; Recurrence ; Vulva*

The Brenner tumors of the ovary are uncommon and constitute 1.5-2.5% of all ovarian neoplasms. And their malignant counterparts are rare. Although the first malignant Brenner tumor was described by Von Numers in 1945, only a few malignant Brenner tumors have been reported. The definition and its biologic behavior, and the optimal treatment has not been established. We present a patient who had total abdominal hysterectomy with unilateral salpingooophorectomy due to adenomyosis. The resected ovary had only follicular cysts and the remained ovary was grossly normal . Malignant Brenner tumor developed at the remained ovary 15 years after operation. Operation and adjuvant chemotherapy was applied and patient is alive without evidence of disease. We have experienced a case of malignant Brenner tumor developed at the remained ovary after contralateral oophorectomy with a brief review of literature.
Adenomyosis ; Brenner Tumor* ; Chemotherapy, Adjuvant ; Female ; Follicular Cyst ; Humans ; Hysterectomy ; Ovarian Neoplasms ; Ovariectomy* ; Ovary*

Total abdominal hysterectomy was considered an inadequate treatment method for invasive cervical cancer. Usually the procedure was inadvertently performed on patients who were thought preoperatively to have benign conditions. Survival for patients with gross disease remaining after inappropriate hysterectomy is poor. So, early cancer detection and proper management with precise pretreatment staging is necessary to avoid inadequate hysterectomy, especially in cases of gross residual disease. Cervical cancer typically recurs at the vaginal vault or in the pelvis; however it can recur distantly in the abdomen or lung. Although recurrences have been reported at laparoscopic trocar sites, it is unusual to have recurrence in the abdominal wall after laparotomy. A case of isolated metastasis to the abdominal wall after treatment of unexpected invasive cervical cancer found at total hysterectomy is presented with a brief review of the literature.
Abdomen ; Abdominal Wall* ; Humans ; Hysterectomy* ; Laparotomy ; Lung ; Neoplasm Metastasis* ; Pelvis ; Recurrence ; Surgical Instruments ; Uterine Cervical Neoplasms*

OBJECTIVE: This study was to investigate the status of hypermethylation and loss of heterozygosity (LOH) in chromosome 3p tumor-suppressor gene for cervical carcinoma. METHODS: We examined the promoter methylation status of the chromosome 3p gene, fragile histidine triad (FHIT), in 37 samples of cervical squamous cell carcinoma and corresponding noncancerous tissues using a methylation-specific polymerase chain reaction. We also analyzed the 37 paired samples for LOH at two loci on chromosome 3p. RESULTS: Promoter hypermethylation in FHIT was detected in 24% of tumors, whereas no hypermethylation was detected in the corresponding noncancerous tissues. LOH in the regions of FHIT was observed in 10% of informative cases. There were no correlations between LOH and promoter hypermethylation for the gene. FHIT hypermethylation was associated with small tumors and, when adjusted for tumor size, correlated significantly with more frequent lymph node metastasis. CONCLUSION: Promoter hypermethylation and LOH of FHIT gene may play a role in cervical carcinogenesis. In addition, hypermethylation of FHIT may be associated with the status (aggressiveness) of cervical carcinoma.
Carcinogenesis ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Histidine ; Loss of Heterozygosity* ; Lymph Nodes ; Methylation ; Neoplasm Metastasis ; Polymerase Chain Reaction

OBJECTIVE: Telomerase is an RNA-dependent DNA polymerase that synthesizes TTAGGG telomeric DNA. It has been detected in a variety of human malignancies, suggesting that it's activity may play a role in the tumorigenic process. Also, maintenance of telomerase activity is associated with increased resistance to apoptosis. Caspase-3 activation has been found to be essential components of the apoptotic pathway. METHODS: To determine whether telomerase is involved in carcinogenesis of uterine cervix and to analyze the relationship between telomerase RNA and caspase-3 expression according to cervical cancer stage, we performed in situ hybridization for telomerase RNA and immunohistochemistry for caspase-3. The materials were 10 normal cervical tissues, 12 low grade intraepithelial lesions (LSIL), 20 high grade intraepithelial lesions (HSIL), 17 microinvasive carcinomas, 19 invasive carcinomas. RESULTS: Telomerase RNA was weakly expressed in a few basal cells of normal squamous epithelium in uterine cervix. But, high expression rate was noted in squamous intraepithelial lesions and invasive carcinoma groups. Expression of telomerase RNA was demonstrated 5 (41.6%) of LSIL, 7 (35.0%) of HSIL, 6 (35.2%) of microinvasive carcinoma, and 11 (57.8%) of invasive carcinoma. Expression of caspase-3 was demonstrated 0% of LSIL, 13 (65.0%) of HSIL, 13 (76.4%) of microinvasive carcinoma, and 7 (36.8%) of invasive carcinoma. Relationship between telomerase RNA and caspase-3 expression according to stage was not seen. Telomerase RNA and caspase-3 expression showed weakly inverse correlation in invasive carcinoma group. Telomerase RNA and caspase-3 expression was not correlated with clinico-pathologic factors, including stage, tumor differentiation, invasion depth, and lymph node metastasis (p>0.05). But, weak correlation between telomerase RNA expression and tumor size was noted (p=0.05). CONCLUSION: These data indicate telomerase might be involved in carcinogenesis of uterine cervix. Distinct relationship between telomerase RNA and caspase-3 was not seen according to stage. Expression of telomerase RNA and caspase-3 had no correlation with clinico-pathologic factors.
Apoptosis ; Carcinogenesis ; Caspase 3* ; Cervix Uteri ; DNA ; Epithelium ; Female ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Lymph Nodes ; Neoplasm Metastasis ; RNA* ; RNA-Directed DNA Polymerase ; Telomerase* ; Uterine Cervical Neoplasms

OBJECTIVE: The aim of this study was to evaluate the prognostic significance of primary tumor volume and uterine corpus invasion assessed by MRI in stage II uterine cervical cancer patients treated by concurrent chemotherapy and radiotherapy. METHODS: Fifty-two patients diagnosed with stage II cervical carcinoma were entered into the study. The tumor volume was calculated by the equation (Volume=widthXlengthXheightXpi/6) as an ellipsoid approximation. Univariate and multivariate analyses were performed to identify the prognostic factors for overall survival (OS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). RESUITS: The 5-year OS, DFS, PC, and DMFS rates were 65.8%, 59.3%, 72.6%, and 79.9%, respectively. The average volume of primary cervical tumor on MRI was 29.5 ml (5-109) and volume was not correlated with stage (p=0.180). Corpus invasion was exhibited in 50.0% and 93.8% of patients with small tumor volume (<30 ml) and large tumor volume (> or =30 ml), respectively; and strongly correlated with tumor volume (p<0.001). By univariate analyses, larger clinical tumor diameter (p=0.031), positive pelvic lymph node (p=0.033), uterine corpus invasion (p=0.045), and larger tumor volume (p=0.003) showed a statistically significantly relation to worse survival. In multivariate analyses, dividing patients according to whether the tumor volume was more or less than 30 ml predicted OS (p=0.048) and uterine corpus invasion also predicted DFS (p=0.042). CONCLUSION: Tumor volume and uterine corpus invasion determined by pre-treatment MRI examinations were significant prognostic factors for patients with invasive cervical carcinoma treated with concurrent chemotherapy and radiotherapy.
Disease-Free Survival ; Drug Therapy ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Radiotherapy ; Tumor Burden* ; Uterine Cervical Neoplasms*

OBJECTIVE: We investigated whether microarray-based gene expression profiling of primary tumor biopsy material could be used to predict lymph node (LN) metastasis in patients with uterine squamous cell carcinoma by comparing this approach with magnetic resonance imaging. METHODS: Forty three primary cervical cancer samples (16 with LN metastasis and 27 without LN metastasis) from radical hysterectomy with pelvic LN dissection were obtained, RNA was isolated, and oligonucleotide gene chips (Macrogen, Seoul, Korea) were hybridized. The samples were randomly divided into training (31 samples) and test (12 samples) sets. A prediction model for LN metastasis from the training set was developed by support vector machine methods using a 10-fold cross-validation and it was tested for its prediction accuracy by applying it to the test set. We evaluated pelvic LN status by MRI with newly designed criteria in these patients and compared the accuracy of MRI with microarray. In addition, we created a new approach by a combination of both. RESULTS: The "LN prediction model" derived from the signature of 156 distinctive genes had a prediction accuracy of 83% when applied to the independent test set. MRI showed an accuracy (69%) for the prediction of LN metastasis. The combination model with MRI findings and microarray improved prediction accuracy over MRI alone but the improvement was not statistically significant (74% and 69%, respectively; p=0.688). CONCLUSION: Current data show that the prediction of LN metastasis can be allowed by DNA microarray of the primary tumor biopsy, alone or in combination with MRI.
Biopsy ; Carcinoma, Squamous Cell* ; Gene Expression Profiling ; Humans ; Hysterectomy ; Lymph Nodes* ; Magnetic Resonance Imaging* ; Neoplasm Metastasis* ; Oligonucleotide Array Sequence Analysis ; RNA ; Seoul ; Support Vector Machine ; Uterine Cervical Neoplasms

OBJECTIVE: This study was undertaken to evaluate the therapeutic results and complications after concurrent chemoradiation therapy and to investigate the prognostic factors for cervical cancer with para-aortic lymph node involvement. METHODS: From May 1999 to August 2005, thirty eight patients with cervical cancer, treated by combined platinum base chemotherapy and extended field radiation therapy in Gachon University Gil medical center. All patients were diagnosed as paraaortic lymphnode involvement with imaging studies. The radiation dose of external beam was 34.2-64.4 Gy to whole pelvis and 32.4-59.4 Gy to paraaortic area. Cisplatin based chemotherapy was done simultaneously. We evaluated the prognostic factors such as stage, tumor size, inguinal and supraclavicular lymphnode status, and radiation doses. RESULTS: Median follow-up period is 34 months (7-85 months). The 3 year overall and disease free survival rates were 63.6% and 56.4%, respectively. There was no case of recurrence after 3 years of treatment. In 2 patients, the treatment was not completed because of Grade III or IV gastroenteral complications; abdominal pain and diarrhea. Grade III or IV hematologic complications were occurred in fifteen patients, but all patients were recovered without serious complications. We could not find any significant prognostic factors in this study. CONCLUSION: Concurrent chemoradiation therapy for cervical cancer with paraaortic lymph node involvement is well tolerable and effective treatment.
Abdominal Pain ; Cisplatin ; Diarrhea ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Pelvis ; Platinum ; Recurrence ; Uterine Cervical Neoplasms*

OBJECTIVE: The aim of this study was to evaluate the correlation between the results of preoperative PAP smears and known poor prognostic factors in patients with endometrial carcinoma. METHODS: Between Jan. 2000 and Dec. 2003, preoperative evaluation of PAP smears were done in 111 patients with endometrial carcinoma who underwent surgical staging. Pathologic parameters of permanent specimens were evaluated and correlated with the results of PAP smears. chi-square-test was used for statistical analysis and p-values <0.05 was considered as statistically significant result. RESULTS: The mean age of patients was 49 years with range between 24 and 75 years old. The results of preoperative PAP smears were normal in 70 patients (57.7%), atypical glandular cells of undetermined significance (AGUS) in 22 patients (22.5%), adenocarcnoma in 19 patients (19.8%) on preoperative PAP smears. Statistically significant associations were found between preoperative PAP smears and poor histologic grade (p=0.000), depth of myometrial invasion (p=0.000), lymph-vascular space invasion (p=0.003), cervical involvement (p=0.004), adnexal involvement (p=0.024), positive peritoneal cytology (p=0.042). However, old age, poor histologic type, higher surgical staging, pelvic nodes metastasis and para-aortic lymph node metastases were not statistically significant. CONCLUSION: This study revealed glandular cell abnormalities on preoperative PAP smears in patients with endometrial carcinoma were significantly associated with poor histologic grade, deep myometrial invasion, lympho-vascular invasion, cervical involvement, adnexal involvement, positive peritoneal cytology. Therefore, the results of preoperative PAP smears could be considered as an important part of the preoperative evaluation in patients with endometrial carcinoma.
Aged ; Endometrial Neoplasms* ; Female ; Humans ; Lymph Nodes ; Neoplasm Metastasis