Large cell neuroendocrine carcinoma of the ovary is rare, aggressive neoplasm frequently accompanied with surface epithelial tumor. A 47-year old woman with asymptomatic pelvic mass which showed malignant on frozen biopsy underwent total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, partial omentectomy, appendectomy. Pathologically, size of the pelvic mass was 11 cm in greatest diameter with surface rupture. Histology and immunohistochemical staining revealed that large cell neuroendocrine carcinoma accompanied with malignant brenner tumor and serous adenocarcinoma. Under the diagnosis of Ic ovarian cancer, patient received six cycles of taxol and cisplatin. After a follow-up 2 years, she shows no evidence of disease.
Adenocarcinoma* ; Appendectomy ; Biopsy ; Brenner Tumor* ; Carcinoma, Neuroendocrine* ; Cisplatin ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Node Excision ; Middle Aged ; Ovarian Neoplasms ; Ovary* ; Paclitaxel ; Rupture

The incidence of multiple primary malignancy is extremely rare although the prevalence rate is increasing recently. There are several reasons of increment of multiple primary malignancy. First, the advances in the treatment and the diagnostic modality of malignancy have led to increased survival rate. So many of the patients who survived the first cancer could live long enough to develop additional primary cancers. Second, the long term effects of chemotherapy and radiation therapy have been proved oncogenic. Third, increasing age, environmental carcinogen, some kinds of viral infection, and genetic predisposition have potentials for multiple carcinogenesis. Most of multiple primary cancer is double primary, however triple primary cancer is rare. We experienced a case of triple primary cancer involving endometrium, colon, and stomach. We report this case with a review of literatures.
Carcinogenesis ; Colon ; Drug Therapy ; Endometrial Neoplasms* ; Endometrium ; Female ; Genetic Predisposition to Disease ; Humans ; Incidence ; Prevalence ; Stomach ; Survival Rate

Mucinous tumors account for 10-15% of all epithelial of ovarian tumors, and 40% of them are borderline. Not many factors are known about progression into mucinous carcinoma of borderline ovarian tumors. The incidence of progression into invasive carcinoma is reported about 2.4% for borderline serous tumous, and 1.6% for borderline mucinous ovarian tumors. Mucinous tumors often exhibit a morphologic continuum of beningn, borderline, and invasive, so a pathologist should pay attention when examine the pathologic specimen not to miss carcinoma. This is the case of 54 female patients who developed invasive mucinous ovarian carcinoma 6 months after surgical treatment of borderline mucinous ovarian tumour.
Adenocarcinoma, Mucinous ; Cystadenocarcinoma, Mucinous* ; Female ; Humans ; Incidence ; Mucins* ; Tumor Markers, Biological* ; Biomarkers, Tumor

Ovarian leiomyoma is a rare type of tumor that only takes about 1% of benign ovarian tumor. It mostly does not induce any symptoms and is often found by chance during a surgical operation in abdominal cavity. It is microscopically observed that smooth muscle cells with an identical shape and a small nucleus grow in a bundle or in a storiform configuration, and they need to be distinguished from other tumors of the smooth-muscle origin that can occur in ovary such as fibroma/thecoma and extragastrointestinal stromal tumor. Using immunohistochemistry staining on desmin, smooth muscle actin (SMA), alpha-inhibin, c-kit, etc can help with distinguishing these tumors. Recently, the authors experienced in this hospital a primary ovarian leiomyoma of a 43-year-old female patient and hereby report the case with a review of literatures.
Abdominal Cavity ; Actins ; Adult ; Desmin ; Female ; Humans ; Immunohistochemistry ; Leiomyoma* ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Ovary

OBJECTIVE: As frozen sections play the role of determining the method or scope of operation for ovarian tumors, the present study examined the accuracy, limitations and clinical utility of frozen sections. METHODS: Among 1583 cases of ovarian tumor surgery conducted during the period from January 1999 to September 2005, 372 for which frozen sections were sent to the Department of Pathology were analyzed through comparison between their frozen section diagnosis and final histopathological diagnosis. RESULTS: Among the ovarian tumor cases, the accuracy of frozen section diagnosis was 91.1% and its sensitive to final diagnosis was highest as 96.0% for benign tumors, and 85.7% for malignant tumors, and as low as 62.9% for borderline?tumors (p<0.01). The positive predictive value was 87.1% for malignant tumors, 68.8% for borderline tumors, and 94.6% for benign tumors. Among the 33 cases for which frozen section did not agree with final diagnosis, 15 cases were false positive and 18 cases were false negative. Among them, 14 cases were mucinous tumors (15.4%, 14/91), showing difficulty in diagnosis compared to non-mucinous tumors (6.8%, 19/281) (p=0.018). CONCLUSION: Despite its limitations, frozen section is a very useful method of high accuracy in diagnosing ovarian tumors. Thus, gynecologists and pathologists need to make efforts to understand the limitations and problems of frozen section, which is not highly sensitive to borderline tumors and mucinous tumors, and to make accurate diagnosis.
Diagnosis* ; Frozen Sections* ; Mucins ; Pathology

OBJECTIVE: To compare clinical results of laparoscopic assisted vaginal hysterectomy for uteri weighing 500 g or more with less than 500 g. And we compared clinical results between laparoscopic coagulation of uterine vessel (LH) and conventional LAVH. METHODS: We reviewed medical records of 296 patient who underwent LAVH from February 2004 to May 2006. They were divided into two groups, uteri weighing greater than 500 g and less than 500 g. And each group was divided into two groups, LH and conventional LAVH. Each groups were compared by operative time, hemoglobin change, complication, transfusion and hospital days. RESULTS: Operation time ,hemoglobin change on the 1st postoperative day and transfusion were significant greater in the uteri > or =500 g group than in the <500 g. However, there was no significant difference in hospital days, hemoglobin change on the 4th postoperative day and complication. In the <500 g group, LH group was lower than conventional LAVH group in operative time, hemoglobin change on the 1st and 4th postoperative day. In the > or =500 g group, there was no signicant difference in hospital days, operative time, hemoglobin change on the 1st postoperative day. However, hemoglobin change was smaller in the LH group than conventional LAVH group on the 4th postoperative day. CONCLUSION: This study demonstrates that despite the increased operating time and blood loss, LAVH can be safely performed for large uterus. However, surgeons need to be aware of high risk of blood transfusion. Modification of surgical method can decrease operating time and blood loss in LAVH.
Blood Transfusion ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Medical Records ; Operative Time ; Uterus*

OBJECTIVE: Endometrial carcinoma is the most common gynecological malignant disease in industrialized countries. However, the molecular bases for endometrial tumoriogenesis are not clearly elucidated. Our hypothesis is that there may be some difference in gene expression patterns between normal endometrium and endometrial cancer lesion. In this study, we analyzed the difference of gene expression profile with cDNA microarray. METHODS: Normal endometrial tissues and cancer lesions were gathered from three patient with endometrioid endometrial cancer. cDNA microarray technique (KNU 4.8K chip) was applied to screen the different gene expression profiles. RESULTS: Many genes such as interleukin-1 receptor-associated kinase 1 (IRAK1), bifunctional apoptosis regulator (BFAR), paraneoplastic antigen MA2 (PNMA2), zinc finger protein 257 (ZNF257), ras homolog gene family, member F (in filopodia) (ARHF), cell division cycle 27 (CDC27) were over-expressed in the endometrial cancer tissue. The genes were down-regulated in the endometrial cancer samples included fibronectin 1 (FN1), meiotic checkpoint regulator (MCPR), transforming growth factor beta-stimulated protein TSC-22 (TSC22), programmed cell death 4 (neoplastic transformation inhibitor) (PDCD4), transcript variant 2, matrix metalloproteinase 2 (MMP2), insulin-like growth factor binding protein 4 (IGFBP4), retinoblastoma binding protein 7 (RBBP7), insulin-like growth factor binding protein 3 (IGFBP3), downregulated in ovarian cancer 1 (DOC1). CONCLUSION: The result of this analysis supports the hypothesis that the endometrial cancer tissue has distinct gene expression profile from normal endometium. But, the vaildation of gene expression with RT-PCR and the further study are needed.
Apoptosis ; Cell Cycle ; Cell Death ; Developed Countries ; DNA, Complementary* ; Endometrial Neoplasms* ; Endometrium ; Female ; Fibronectins ; Gene Expression* ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor Binding Protein 4 ; Interleukin-1 Receptor-Associated Kinases ; Matrix Metalloproteinase 2 ; Oligonucleotide Array Sequence Analysis* ; Ovarian Neoplasms ; Retinoblastoma-Binding Protein 7 ; Transcriptome* ; Transforming Growth Factors ; Zinc Fingers

OBJECTIVE: The decision of optimal age for administration of recently approved prophylactic human papillomavirus (HPV) vaccines in the world depend on the basis of the sexual behavior of each countries. The aim of the study was to survey the age-specific sexual behavior including the sexual debut time and sexual experience in the Korean young women to design the tailored HPV vaccination. METHODS: This study was conducted by the Synovate Healthcare in the 6 city of Korea e.g. Seoul, Pusan, Daegu, Incheon, Kwangju and Daejon. By a stratified sampling methods 2,400 women aged 12-29 years old were included. The measures of sexual behavior presented in this report were collected by a Computer-Assisted Self-Interviewing (ACASI), in which the respondent enters her own answers into a computer without telling them to an interviewer. RESULTS: Among women 12-29 years of age, 39 percent of women (934 persons in 2,400 women) and 33 percent of single women (724 persons in 2,190 women) have had vaginal intercourse; 8 percent of women under 19 years old single women (79 persons in 1,045) and 56 percent of single women with 20-29 years old (645 persons in 1,145). Number of sexual partner was 2.8 person and 54 percent of women had more than 2 partners. Age of the first sexual activity (sexual debut) was 21 years old. The age of partner at the sexual debut was 23.2 years old. Sexual experience before 15 years old was only 2%. About the condom, 41% did not use or rarely use. CONCLUSION: Our data demonstrate that the sexual debut time of young Korean women differ from other countries in which the prophylactic HPV vaccine had already used. We conclude that the optimal age for HPV vaccination in Korea would be determined at 15-17 years old by this situation.
Adolescent ; Busan ; Condoms ; Daegu ; Daejeon ; Surveys and Questionnaires ; Delivery of Health Care ; Female ; Gwangju ; Humans ; Incheon ; Korea ; Seoul ; Sexual Behavior* ; Sexual Partners ; Vaccination ; Vaccines ; Young Adult

OBJECTIVE: p16 is cyclin-dependent kinase (CDK) inhibitor which decelerates cell cycle by inactivating CDKs that phosphorylate retinoblastoma protein (pRb). In cervical carcinogenesis, abnormality of p16 gene such as methylation of p16 gene promoter was investigated as an important factor. The aims of our study are to investigate the expression of p16 gene, methylation of p16 gene promoter region, and HPV typing in uterine cervical neoplasia. METHODS: A total of 104 samples (CIN1, 30 CIN2,3 45, invasive cancer, 29) were included. Expression of p16 was analyzed by immunohistochemistry, methylation of p16 gene promoter region was analyzed with methylation specific polymerase chain reaction (MSP) and we examed the result of HPV DNA testing. RESULTS: 1. In high risk HPV and low risk or negative group, p16 gene expression was observed in CIN1 (30% vs 23%), CIN2, 3 (64% vs 58%) and in invasive cancer (80% vs 37%) respectively. In invasive cancer, p16 gene expression of high risk HPV group was statistically higher than that of low risk or negative group. 2. In high risk HPV and low risk or negative group, p16 promoter methylation was observed in CIN1 (23% vs 17%), CIN2, 3 (25% vs 47%) and in invasive cancer (19% vs 87%) respectively. In invasive cancer, p16 promoter methylation of low risk or negative HPV group was statistically higher than that of low risk or negative group. CONCLUSION: p16 gene expression would be marker for CIN and cancer. Methylation of p16 promoter region may be one of the important mechanism for uterine cervical carcinogenesis especially in negative or low risk HPV group. but further studies are needed to reinforce this statement.
Carcinogenesis ; Cell Cycle ; DNA Methylation ; Genes, p16* ; Human Papillomavirus DNA Tests ; Immunohistochemistry ; Methylation* ; Phosphotransferases ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; Retinoblastoma Protein ; Uterine Cervical Neoplasms

OBJECTIVE: A significant number of patients with ovarian cancer are referred to tertiary center after inadequate staging operation. The purpose of this study was to evaluate the impact of pattern of care, including restaging operation or chemotherapy in these patients. METHODS: We conducted a retrospective analysis of patients with epithelial ovarian cancer (n=29) or borderline tumor (n=15) who were inadequately staged elsewhere at the time of initial surgery between April 1996 and March 2006. RESULTS: In the patients with ovarian cancer, restaging operation was performed in 65.5% (19/29), and primary chemotherapy in 24.1% (7/29). Older age and higher parity was noted in the restaged group, however, it was statistically insignificant. In the restaged group, 26.3% (5/19) were upstaged due to residual tumors. Presence of residual tumor was not associated with histologic type and grade of tumor. Six patients (31.6%) without residual tumor escaped adjuvant chemotherapy. During median 50 months follow up, 13.8% (4/29) of patients with ovarian cancer recurred. There was no difference in recurrence rate according to whether a restaging operation was performed. However, residual tumor status was significantly associated with recurrence rate (60% vs 0%). Restaging operation was undergone in 46.7% (7/15) of patients with borderline tumors and there were no recurrence or residual tumor in patients with borderline tumors. CONCLUSION: It is suggested that restaging operation could reveal residual tumors which are important prognostic factor in predicting recurrence. Nonetheless, Restaging operation seems to have no impact on the prognosis of ovarian cancer.
Chemotherapy, Adjuvant ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Neoplasm Staging ; Neoplasm, Residual ; Ovarian Neoplasms* ; Parity ; Prognosis ; Recurrence ; Retrospective Studies ; United Nations