This study was performed to assess the significance of plasma level and histochemical character of carcinoembryonic antigen(CEA) in early diagnosis and prognosis of ovarian tumor. Plasma level of CEA was measured using EIA method and immunohistochemical tissue staining of CEA was done using biotin-strepto avidin complex immunoperoxidase technique. The percentage of patients with positive CEA level(above 2.5 ng/ml) was 23.1%(6/26) in malignant ovarian tumor and 15.6%(12/77) in benign ovarian tumor. Positive tissue staining of CEA was 42.3%(11/26) in malignant ovarian tumor and 19.5%(15/77) in benign ovarian tumor. In histologic typing, positive tissue staining of CEA was 18.1%(2/11) in serous cystadenocarcinoma, 85.7%(6/7) in mucinous cystadenocarcinoma, 37.5%(3/8) in other malignant ovarian tumors, 7.1%(1/15) in serous cystadenoma, 7.1%(1/14) in mucinous cystadenoma and 27.1%(13/48) in other benign ovarian tumors. Among 5 cases of malignant ovarian tumors with positive CEA level, 3 cases(60%) showed positive tissue staining of CEA, whereas among 21 cases of malignant ovarian tumors with negative CEA level, 8 cases (38.1%) showed positive tissue staining of CEA. However, among 11 cases of benign ovarian tumors with positive CEA level, 4 cases(36.4%) showed positive tissue staining of CEA, whereas among 66 cases of benign ovarian tumors with negative CEA level, 11 cases(16.7%) showed positive tissue staining of CEA. In the 3 year follow-up study of 12 cases with malignant ovarian tumor, among 3 cases with positive tissue staining of CEA, 2 cases(66.7%) survived. In 9 cases with negative tissue staining of CEA, 6 cases(66.7%) survived. In conclusion, these results suggest that the measurement of tumor CEA may be of value in the differential diagnosis of malignant and benign ovarian tumor, especially in diagnosing mucinous cystadenocarcinoma. However, due to the small amount of cases available for study, it was difficult to determine the correlation between the prognosis and tissue CEA staining of ovarian tumors.
Avidin ; Carcinoembryonic Antigen* ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis, Differential ; Early Diagnosis ; Follow-Up Studies ; Humans ; Immunoenzyme Techniques ; Plasma* ; Prognosis

c-erbB-2 oncogene is a gene that encodes a growth factor receptor-like molecule with tyrosine kinase activity and has a structure similar to that of the epidermal growth factor receptor. Overexpression of the c-erbB-2 oncoprotein is detected in human adenocarcinoma of the breast, cervix, and salivary gland, in all of which the association between overexpression of the c-erbB-2 and poor prognosis of the disease has been reported. The role of c-erbB-2 oncoprotein in the tumorigenesis of the human ovary has been poorly understood and remains controversial. In order to explore the relationship between c-erbB-2 oncoprotein status and ovarian carcinoma, tissue from 32 patients, each of whom had invasive ovarian carcinoma prior to treatment, 10 patients with benign cyst and 10 control case who underwent hysterectomy due to gynecological disease at Yonsei University Colloge of Medicine were analyzed. We measured c-erbB-2 oncoprotein with an enzyme-linked immunosorbent assay(ELISA) which was a sandwich type. Patients with invasive ovarian cancer were found to have significantly higher median c-erbB-2 oncoprotein expression than patients with either benign ovarian cyst(P<0.05) or control group(P<0.05), respectively. However there was no significant difference in c-erbB-2 oncoprotein status between benign cyst and control group. verexpression of c-erbB-2 oncoprotein was found in 7 of 32(21.9%) epithelial ovarian cancer. In invasive epithelial cancer, no significant difference in c-erbB-2 oncoprotein levels was noted when stratified according to age, menopausal status, histological cell type, tumor size or surgical stage. Our results were consistent with the concept that c-erbB-2 oncoprotein may play an important role in malignant and tumorigenesis in epithelial ovarian cancer.
Adenocarcinoma ; Breast ; Carcinogenesis ; Cervix Uteri ; Female ; Genes, vif ; Humans ; Hysterectomy ; Oncogenes ; Ovarian Neoplasms ; Ovary ; Prognosis ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Salivary Glands

Based on the facts that expression of insulin-like growth factors(IGFs), their receptors, and insulin-like growth factor binding proteins(IGFBPs) have been found in many different types of malignancies including human ovarian cancer and their potent mitogenic effects in vitro, a role for IGFs mediated autocrine loop in oncogenesis and growth regulation of human malignancies was suggested. Since ascites support the biological environment for advanced ovarian cancer, it seemed to be resonable to measure the level of growth factors or cytokines in ascites for understanding precise mechanism of those factors in tumor biology. To investigate their roles and to evaluate prognostic significance in ovarian cancer, the IGFs/IGFBPs system were studied in the ascites, not in sera or cystic fluids, from 22 patients with ovarian cancer, who underwent surgical staging and subsequent cis-platinum based systemic chemotherapyery at the Department of Obstetrics and Gnecology, Hanyang University Hospital from Jan. 1989 through Dec. 1994. Ascites from 7 patients with benign disease were used as the control. IGF-I, II, IGFBP-1, and 3 were measured by immunoradiometric assay. The IGF-I level was significantly higher in ascites with ovarian cancer compared with those of benign disease(63.3-/+11.1 vs 17.9-/+6.2ng/ml, p=0.0098), but the level of IGF-II was not significantly different(70.5-/+13.9 vs 70.8-/+31.5 ng/ml, p=0.2827). IGFBP-1 levels were tend to be lower in ascites of patients with ovarian cancer than that of control(25.2-/+9.5 vs 58.6-/+28.2ng/ml, p=0.0637). However, IGFBP-3 levels had no statistically significant difference between two groups(779.7-/+110.6 vs 674.7-/+175.1ng/ml, p=0.8328). Although growth hormone levels were significantly higher in ascites with metastatic ovarian cancer than those of primary epithelial ovarian cancer, the levels of IGF-I, II, IGFBP-1 and 3 in ascites were not significantly different between two groups. IGF-I levels were correlated with the levels of IGFBP-3 in ascites with ovarian cancer(Y=8.83X-2.0, r=0.745, p=0.0000). High level of IGF-I in ascites of patients with ovarian cancer in this study was suggested that IGF-I had an important role on growth regulation of ovarian cancer. As majority of ascites were obtained from advanced and poorly differentiated ovarian cancer patients, IGF-I in ascites seemed to be related with intraperitoneal metastasis. Further large number of study including data from sera or cystic fluid will be needed to elucidate the role of the IGFs and IGFBPs in ascites of patients with ovarian cancer.
Ascites* ; Biology ; Carcinogenesis ; Cisplatin ; Cytokines ; Growth Hormone ; Humans ; Immunoradiometric Assay ; Insulin-Like Growth Factor Binding Protein 1 ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor Binding Proteins* ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Intercellular Signaling Peptides and Proteins ; Neoplasm Metastasis ; Obstetrics ; Ovarian Neoplasms* ; Somatomedins*

OBJECTIVE: To evaluate the status of cone margins and severity of cervical neoplasia as predictors of residual lesions in the remaining cervices, and provide guideline for further treatment or close follow-up. METHOD: We performed a 3-year retrospective study and reviewed 95 patients who had undergone cervical conization followed by subsequent hysterectomy. RESULT: The prevalence rates of positive cone margins were 33, 50, 44, 71 and 88% respectively in patients with cervical intraepithelial neoplasia(CIN)II, CIN III, cervical cancer stage Ia1, Ia2 and Ib1. The prevalence rates of positive residual lesions in postcone hy-sterectomy specimens were 0, 31, 19, 29 and 59% respectively in patient with CIN II, CIN III, cervical cancer Ia1, Ia2 and Ib1. Residual lesions were significantly more frequently found in patients with positive cone margins(51%) than in those with negative margins(4.8%). Positive predictive values of margin status for the presence of residual lesions were 0, 56, 36, 40 and 67% respectively. Negative predictive values of margin status for the absence of residual lesions were 100, 94, 94, 100 and 100% respectively. CONCLUSIONS: (1) The prevalence of positive cone margin and residual lesion increased with more severe cervical neoplasia. (2) Positive cone margins had significantly higher risks of residual lesion than negative cone margins. (3) Positive cone margin does not invariably indicate the presence of residual lesion. (4) Negative cone margin does not ensure the absence of residual lesion. Subsequent hysterectomy may be reserved for the patient with CIN III or cervix cancer having positive cone margin or invasive lesion, or the patient who is not reliable for continuous follow-up.
Conization* ; Follow-Up Studies ; Humans ; Hysterectomy ; Prevalence ; Retrospective Studies ; Uterine Cervical Neoplasms

OBJECTIVE: The purpose of this study is to evaluate the histologic correlations and the clinical significance among patients with atypical squamous cells of undetermined significance (ASCUS), atypical glandular cells of undetermined significance(AGUS) and benign endometrial cells identified on cervical Pap smear screening. MATERIALS & METHODS: The computerized files of the Department of Pathology at Samsung Cheil Hospital were searched from 1991 to 1997 to evaluate the annual statistics of cytologic diagnoses including normal/benign, ASCUS, AGUS, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion(HSIL) and cancer classified by the Bethesda System(TBS). Cytohistologic correlations on follow-up were separately analysed in ASCUS(190 cases), AGUS(268 cases) and benign endometrial cells(169 cases), respectively. Additionally, post-menopausal squamous atypia(83 cases) were also included in this study. TBS terminology was used in both cytologic and histologic diagnoses. RESULTS: During 7-year period (1991-1997), 447,049 cervicovaginal smears were evaluated. The median rate of abnormal cytology was 4.4%, with 2.1% of ASCUS, 2.06% of squamous intraepithelial lesion(SIL), and 0.08% of AGUS. The median ratio of ASCUS versus SIL was 1.24. Specimen adequacy was evaluated on 47,525 cases, of which categories of "satisfactory for evaluation but limited by" and "unsatisfactory for evaluation" were 28.3% and 0.03%, res-pectively. Follow-up of 190 patients with ASCUS cytology showed 30%(57 cases) with SIL on biopsy; 18%(35cases) with LSIL, 11%(21cases) with HSIL, and 1%(1case) with microinvasive squamous cell carcinoma. On histologic examination, 77%(37/48cases) with ASCUS favoring SIL revealed SIL in contrast to 14%(20/142cases) with ASCUS favoring reactive change, which is statistically significant.(Chi-Square test, P<0.0001). Of 83 cases of post-menopausal squamous atypia(PSA), smears with LSIL showed 34.9%(15/43cases) with LSIL on biopsy. 268 patients with AGUS smears had 25%(67cases) with clinically significant cervical or endometrial lesions on histologic examinations. Among 17.9%(48cases) with cervical lesions, squamous abnormalities were 10.5%(28cases); including 1.5%(4cases) with LSIL and 9.0%(24cases) with HSIL. Glandular lesions in cervix were 7.5%(20cases); 3.0%(8cases) of glandular atypia or dysplasia, 1.9%(5cases of adenocarcinoma in situ, 1.1%(3cases) of microinvasive adenocarcinoma and 1.5%(4cases) of adenocarcinoma. Of 7.1%(19cases) of endometrial lesions, 2.2%(6cases) was endometrial hy-perplasia, 4.1%(11cases) endometrial carcinoma, 0.4%(1case) MMMT and 0.4%(1case) metastatic adenocarcinoma from stomach were verified. The pathologies of 169 cases with benign endometrial cells shed in cervicovaginal smears were confirmed to be endometrial polyp(8.3%), endometrial hyperplasia(4.1%) and endometrial carcinoma(5.9%). CONCLUSION: The results of this study indicates that clinicians should communicate with pathologists for proper management of abnormal cytology. Further evaluation and decision of management should be made based on input from pathologists as well as on clinical setting and professional guidelines.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri ; Diagnosis ; Endometrial Neoplasms ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Pathology ; Stomach

To evaluate the efficacy and diagnostic and prognostic significance of two tumor markers (SCCA, CA 125) in patient with squamous cell carcinoma of uterine cervix, the authors studied 215 patients with squamous cell carcinoma in situ and invasive carcinoma from September 1993 to November 1996. Both tumor markers were measured coincidently in 215 patients preopera-tively and in 70 cases of benign gynecologic disease for control group. Serum SCCA level of 2.5 ng/ml and CA 125 level of 35.0 U/ml were determined as cut-off levels. The results were as follows: 1. The pretreatment positive rate of SCCA in patient group were 35.8 %(77/215) and 5.7 %(4/70) in control group. 2. The mean values and positive rates of SCCA according to clinical stage were 1.44+/-3.59 ng/ml(8.7 %) for stage 0, 3.81+/-10.22 ng/ml(23 %) for stage I, 8.54+/-15.23 ng/ml(51.3 %) for stage II, 35.54+/-38.34 ng/ml(70.0 %) for stage III, 22.49+/-36.06 ng/ml(75.0 %) for stage IV, 40.33+/-58.66 ng/ml(66.7 %) for recurrent cancer, respectively. The mean SCCA value and positive rate were significantly increased stepwise by clinical stage from stage I to stage III (P<0.05). 3. The pretreatment positive rate of CA 125 in patient group were 21.9 %(47/215) and 17.1 %(12/70) in contrl group. 4. In pre-invasive and invasive groups, the mean value and positive rate of SCCA were 1.44+/-3.59 ng/ml(8.7 %), 9.05+/-25.26 ng/ml(43.2 %), respectively, and it was statistically significant between two groups (P<0.05). The mean values and positive rate of CA 125 were 24.36+/-16.14 U/ml(10.9 %), 35.15+/-59.52 U/ml(24.9 %), respectively, it was not statistically significant (P>0.05). 5. The result of preoperative serum levels of SCCA can be characterized by 35.8 % sensitivity, 94.3 % specificity, 95.1 % positive predictive value, 32.4 % negative predictive value, 49.5 % diagnostic efficiency, and with 21.9 %, 82.8 %, 79.7 %, 25.7 %, 36.8 % respectively for CA 125. Between these two tumor markers, the result of SCCA was more valuable than the other in sensitivity, positive predictive value, negative predictive value and diagnostic efficiency. The results indicate that measurement of SCCA and/or CA 125, have little efficacy in the early detection of squamous cell carcinoma considering it's low rate of positivity in preinvasive and early stage of invasive squamous cell carcinoma. However, in patients with advanced stage invasive carcinoma, measurement of serum SCCA is useful in prediction of prognosis and in early detection of recurrence, and concomitant measurements of SCCA and CA 125 may be more useful in determining prognosis, therapeutic response, and early detection of recurrence than measurement of SCCA alone.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Genital Diseases, Female ; Humans ; Prognosis ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor*

Massive ovarian deema is a tate conditian. It is a benign enlargement of the ovary caused by accumulation of fluid, which is thought to result from intermittent partial toraion of the ovarian pedicle. Histologically, the ovaries were characterized by diffuse edema of medulla and inner cortex. Two cases of massive ovanan edema are reported with brief review of the literatures.
Edema* ; Female ; Ovary

Pure, nongestational ovarian choriocarcinomas is extremely rare. Most ovarian choriocarcinoma are combined with other malignant germ cell tumors or can arise as a metastaais from a primnry gestational choriocarcinoma. We experienced a case of primary ovarian choriocarcinoma that probably was associated with a past history of the mixture of germ cell tumor and present it with a review of literature.
Choriocarcinoma* ; Female ; Neoplasms, Germ Cell and Embryonal ; Pregnancy

A case of 42-year-oldI kidney transplant patient who developed invasive carcinama of the cervix after immunoauppresawe therepy is reported and the literature related to this diease is revuewed. The iatmgenic immunosuppresaionn renal transplantation recipients has been associated with increased incidence of malignancy in these patients. In particular, immunosuppressed women are al greater risk of developing cervical intraepithelial neoplasia and buman papillomavirus type 16 or 18 infection. So, all such individuals are required to receive periodic gynecologic examination before renal transplantation and at regular intervals thereafter so that the development of CIN may be diagnosed at an early Stage and treated effestively.
Allografts* ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Female ; Humans ; Incidence ; Kidney ; Kidney Transplantation

Malignant germ cell tumore occur in children and young women in reproductive age, of all the germ cell maligaanci orily pure dysgerminiomas had a high cure rate prior to 1970. This was due to the exquisite wdioseneitivity of these tumors. Multiple agent chemotherapy has dramatieally improved the pr nosis af patients with malignant ovarian germ cell tumors. The purpose of this study is to report the experience at Aaan Medical Center, department of Obstetrics and Gynecology, in 16 patients withmalignant ovarian germ cell tumors treated between July, l989 and June, l994. We analyzed the effect of age, histolagic subtype, FIGO stage, surgical pmcedurse and regimens of chemotherapy, on the prognosis of thwe tumors. The results obtained were as follows: 1. In histologic subtypes, dysgenninoma(38.0%), endodermal sinus tumor(25.0%), squamous cell carcinoma arising in mature cystic teratoma(19.0%), mixed cell tumor(6.0%), immature teratoma(6.0%), malignant ectodermal tumor in mature cystic teratoma(6.0%), were counted in order. 2. No site predilection was identifed. 3. Main initial symptoms were abdominal distension(31.0%), abdominal pain(31.0%), abdominal mass palpation(25.0%), amenorrhea(6.0%) in order. 4. Multiple tumor markers were considered to be useful in diagnosis and follow up of malignant germ cell tumors of ovary. 5. The mean age of malignant ovarian germ cell tumors was 29.5 years, and 11 cases(69.3%) of tumors under the age of 30.0 years. 6. The survival rate seemed to be decreased with advancing FIGO stage.
Carcinoma, Squamous Cell ; Child ; Diagnosis ; Drug Therapy ; Ectoderm ; Endoderm ; Female ; Follow-Up Studies ; Germ Cells* ; Gynecology ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Obstetrics ; Ovary* ; Prognosis ; Survival Rate ; Biomarkers, Tumor