Mullerian adenosarcoma is an uncommon variant of MQllerian mixed tumors of the uterus and a mixed, biphasic neoplasia in which the mesenchymal component is malignant and the epithelial component is benign. In contrast to typical malignant Miillerian mixed tumor(MMMT), Miillerian adenosarcomas are usually tumors of low malignant potential. These tumom usually present as pedunculated endometrial masses in postmenopausal women with vaginal bleeding. We experienced a case of Miillerian adenosarcoma of the uterus with squamous cell carcinoma of the uterine cervix and report with a brief review of literatures.
Adenosarcoma* ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Humans ; Uterine Hemorrhage ; Uterus*

Cellular schwannoma is a variant of schwannoma, and is diagnosed as malignant tumor in over one fourth of cases because of its cellularity, mitotic activity and the occasional presence of bone destruction. This tumor is a tumor with low malignant potential and usually occurs in peripheral nervous system, mainly in the posterior mediastinum and retroperitoneal space. But pelvic retroperitoneal cellular schwannoma is very rare. Recently, we experienced a case of pelvic retroperitoneal cellular schwannoma in a 42-year-old woman; in reporting the case a brief review of the literature is included.
Adult ; Female ; Humans ; Mediastinum ; Neurilemmoma* ; Peripheral Nervous System ; Retroperitoneal Space

Although the peritoneum is rare site for a primary neoplasm, certain malignant neoplasms may arise from it. A case of 63-year-old woman who had a serous papillary carcinoma of peritoneal origin is reported. Extraovarian peritoneal serous papillary carcinoma was characterized by ascites, malignant washings, and omental involvement with bulky infiltration and/or multiple tumor nodules. The symptoms caused by diffuse spreading of the neoplasm over the peritoneum are the most important manifestation for clinical diagnosis of malignant primary neoplasm of peritoneum, especially serous papillary carcinoma. This behaving tumor was at least partially responded to therapy. In this report, we describe a case of serous papillary carcinoma of peritoneum carring on proper management with brief review.
Ascites ; Carcinoma, Papillary* ; Diagnosis ; Female ; Humans ; Middle Aged ; Peritoneum*

Three cases of synchronous carcinomas of endometrium-fallopian tube, endometrium-cervix and endometrium-ovary are reported. Case 1 is endometrial endometrioid adenocarcinoma with FIGO stageIb, Grade 2 and tubal serous adenocarcinoma with FIGO stage Ib, Grade 2. Case 2 is endometrial serous carcinoma with FIGO stage Ilb and squamous cell carcinoma with FIGO stage Ial. Case 3 is endometrial endometrioid adenocarcinoma with FIGO stage Ia, Grade 1 and ovarian mucinous adenocarcinoma with FIGO stage IIIa, Grade 2. There is much confroversy with respect to staging and management of such cases since these tumors may represent either two synchronously occuring primaries or single primary with metastases. It is suggested that when each tumor is different histological subtype the tumors may be considered as two separate primaries and treatment may be less aggressive. It may be a favorable prognosis. The authors present three cases of synchronous carcinomas with a review of literature.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinoma, Endometrioid ; Carcinoma, Squamous Cell ; Neoplasm Metastasis ; Prognosis

OBJECTIVES: To predict of the survival of patients with epithelial ovarian cancer, multivariable analysis was done to identify variables with independent prognostic factors. Based on materials from 191 clinical trials performed by Department of Obstetrics and Gynecology, Hanyang University Hospital, we constructed a prognostic index (Pp with considerable predictive power for long-term survival of patients with epithelial ovatian cancer treated with cis-platin based combination chemotherapy, METHODS: On identifying variables with independent prognostic value, statistical analysis were performed with clinicopathologic variables including age, FIGO stage, histologic subtype, histologic grade, residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor markers(CA 125, CA 19-9). We also analyzed biological variables using immunohistochemical staining for GST-pie (glutathione-s-transferase-pie), p-glycoprotein, and MT (metallothinein) as a drug resistance and uPA (urokinase type plasminogen activator), PAI-1 (plasminogen activator inhibitor-l), nm23 (nonmetastatic gene 23) as a tumor invasion and metastasis. In addition, univariable analysis was performed followed by multivariable analysis using Coxs proportional hazards model to identify variables predictive of poor prognosis. Prognostic index (PI) was calculated based on sum of individual beta-coefficient of the most important independent prognostic value. RESULTS: With univariable analysis, age, FIGO stage, histologic grade, histologic subtype, presence of ascites, residual tumor, initial value of CA 125, MT, uPA, and PAI-1 were found to predict of patients survival. In the multivariable analysis and proportional hazard model, the pretreatment characteristics needed for the calculation of the PI are the age, the site of metastases expressed as stage, the histologic subtype, the size of residual tumor, the histological grade, and the presence of ascites. In the subgroup comprising the 10% of the patients with the best prognosis, 5-year survival rate was 78.9%, whereas in the subgmup comprising the 10% with the poorest prognosis, 5-year survival rate was 7.1%, which illustrates the large variability of the prognosis among patients. CONCLUSIONS: The PI was found to retain its value after response was achieved. The information provided by the PI can be expected to be useful in treatment planning and the proper stratification of patients in clinical trials.
Ascites ; Blood Platelets ; Drug Resistance ; Drug Therapy, Combination ; Gynecology ; Humans ; Neoplasm Metastasis ; Neoplasm, Residual ; Obstetrics ; Ovarian Neoplasms* ; P-Glycoprotein ; Plasminogen ; Plasminogen Activator Inhibitor 1 ; Prognosis ; Proportional Hazards Models ; Survival Rate

OBJECTIVES: This retrospective study was conducted to analyze the hypothesis that with neoadjuvant chemotherapy of vinblastine, bleomycin, and cisplatin followed by radical hysterectomy or radiation therapy and concurrent chemoradiation with cisplatin based regimen would improve survival in patients with barrel-shaped or bulky-endophytic (Diameter > 4cm) cervical carcinomas than those of radiation alone or combined radiation and surgery. STUDY DESIGN: Eighty-eight patients with barrel-shaped or bulky-endophytic cervical carcinomas, treated at the Hanyang University Hospital from 1983 to 1997, were the subjects of this investigation. Fifty-six of these patients were treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy ( Stage I b2, 8; IIa, 15; IIb, 20; III- IV, 13), twelve patients were treated by neoadjuvant chemotherapy followed by radiation therapy ( Stage Ilb, 4; IIJ-IV, 8), and twenty patients were treated by concurrent chemo-radiotherapy ( Stage IIb, 2; III-IV, 18). RESULTS: The incidence of parametrial extension and pelvic lymphnode metastases was higher in patients with barrel-shaped or bulky-endophytic cervical carcinomas than non-barrel-shaped cervix (p .025: .001). 5-years disease free survival rate was determined for patients treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy was 73.3 %. For patients treated by neoadjuvant chemotherapy followed by radiation therapy it was 45.7%. For patients treated by concurrent chemo-radiotherapy it was 46.1%. CONCLUSION: These data support an improvement in survival of patients with barrel-shaped or bulky-endophytic cervical carcinomas treated by neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy and concurrent chemo-radiotherapy.
Bleomycin ; Cervix Uteri* ; Cisplatin ; Disease-Free Survival ; Drug Therapy* ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Node Excision ; Neoplasm Metastasis ; Retrospective Studies ; Vinblastine

BACKGROUND: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. OBJECTIVE: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. STUDY DESIGN: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, RESULTS: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cerbix were not associated. There were no clinical factors that were associated with false-positive rate. CONCLUSION: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyand university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.
Adenomyosis ; Carcinoma in Situ ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Contraception ; Diagnosis ; Female ; Gynecology ; Humans ; Incidence ; Leiomyoma ; Mass Screening ; Menopause ; Mortality ; Obstetrics ; Pathology ; Pelvic Inflammatory Disease ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Cervical Neoplasms ; Uterine Hemorrhage

Backgrouad & Aims: Cyclophosphamide, adriamycin and cisplatin(CAP) combination chemo- therapy improved the response rate in the treatment of advanced epithelial ovarian cancer, and it has been the gold standard. However, adriamycin is a rather toxic drug, and there is still confusion concerning the choice of adriamycin to be included in optimal regimen. The present study was designed to compare the activity and toxicity of combination regimens in advanced epithelial ovarian cancer between CAP and CTP which substitutes adriamycin with pirarubicin(THP- adriamycin). PATIENTS AND METHODS: From March 1995 to December 1997, 47 patients with FIGO stage III-IV epithelial ovarian cancer who were diagnosed after initial cytoreductive surgery were divided into two groups at random: (1) The case group were treated with CTP(500/40/50 mg/m2) as a first line chemotherapy. (2) The control group were treated with CAP(500/50/50 mg/m2) as that of case group. Clinical characteristics, response rates and toxicities according to Gynecologic Oncology Group criteria were compared between those treated with CAP and CTP respectively. RESULTS: Forty one patients out of 47 were evaluable and the number of patients in case and control group was 22 and 19 respectively. There was no significant differences in patient characteristics such as age, stage, histologic type between two groups. Clinical complete response rate was 50.0%(11/22) in patients treated with CTP regimen and 47.4%(9/19) with CAP regimen and there was no significant difference between two groups. Second look operation was undergone in 10 patients of CTP group and 7 patients of CAP group who showed clinical complete response and the pathologic complete response rate was 27.3%(6/22) with CTP and 21.1%(4/19) with CAP. The incidence of leukocytopenia of grade 3 or 4 was more frequently occurred in CAP group(52.6%, 10/19) than CTP group(22.7%, 5/22). There was no significant difference in the incidence of other toxicitied such as hepatic, renal and G-I toxicities. Suspicious cardiac toxicity according to the finding of EKG was seen in 15.8%(3/19) only with CAP regimen and all of them showed decreased cardiac function in gated blood pool scan. There were no significant differences in risponse rates between two groups, but the incidence of cardiac toxicity and leukocytopenia o f grade 3 or 4 was more frequently occurred in CAP group than CTP group. CONCLUSION : CTP regimen has comparable response rates to CAP regimen, with lower incidence of hematolohic and cardiac toxicity.
Cyclophosphamide* ; Cytidine Triphosphate ; Doxorubicin* ; Drug Therapy ; Drug Therapy, Combination* ; Electrocardiography ; Humans ; Incidence ; Leukopenia ; Ovarian Neoplasms*

Apoptosis, including the programmed cell death, is important event in normal cell turnover and maintenance of adult tissues. Apoptosis exerts a homeostatic function in relation to tissues dynamics, as the steady state of continuously renewing tissues achieved by a balance between cell replication and cell death. This study was undertaken to investigate the association between apoptosis and development of the cervical neoplasia. Archival cervical samples from normal epithelium (n 10), low-grade squamous intraepithelial lesions (LSIL, n = 10), high-grade squamous intraepithelial lesions (HSIL, n 10), microinvasive squamous cell carcinomas (n 10), and invasive squamous cell carcinomas (n = 10) were evaluated for apoptosis. We used in situ end-labeling of DNA strand breaks by terminal deoxynucleotidyltransferase incorporation of biotinylated deoxyuridine to 3-OH ends of DNA, identified by nickel-avidine-peroxidase. The apoptotic index (sum of apoptotic bodies divided by the total nuclei times 100) significantly decreased (P<0.05) as the degree of neoplasia increased: 3.1 + 0.9 % in normal epithelium, 5.5 +/- 1.4 % in LSIL, 1.6 +/- 0.4 % in HSIL, 1.9 +/- 0.5 % in microinvasive carcinomas, and 0.6 +/- 0.3 % in invasive carcinomas. Compared to normal epithelium, the total cell number per 200x field increased significantly (P<0,05): 379 +/- 47 in normal epithelium, 462 +/- 228 in LSIL, 670+/-293 in HSIL, 1035 +/- 254 in microinvasive carcinomas, and 1389 +/- 247 in invasive carcinomas. Consequently, these results suggest that progession of cervical carcinogenesis is associated with a decrease in apoptotic index and an increase in the number of the total cell.
Adult ; Apoptosis* ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Count ; Cell Death ; Deoxyuridine ; DNA ; DNA Nucleotidylexotransferase ; Epithelium ; Humans

BACKGROUND: The HER-2/neu proto-oncogene (also known as c-ErbB-2) encodes a 185 kD transmembrane glycoprotein with intrinsic tyrosine kinase activity. Many studies revealed the correlation between the aberrant overexpression of HER-2/neu oncogene and poor prognosis of the malignant tumors such as breast, stomach, colon, lung cancers. But the significance of HER-2/neu oncogene overexpression as a prognostic factor in ovarian cancer remains controversial. OBJECTIVE: The aims of this study were to assess the prevalence of HER-2/neu oncogene amplification by polymerase chain reaction(PCR) and to evaluate the prognostic significance of HER-2/neu oncogene overexpression in terms of chemo-responsiveness and survival rate. MATERIALS AND METHODS: This study included 32 patients with advanced ovarian cancers(24 epithelial ovarian cancers, 2 Brenner tumors, 2 malignant mixed miillerian tumors, 2 granulosa cell tumors, 1 struma ovarii, 1 Krukenberg tumor). All patients had underwent staging laparotomy, and postoperative adjuvant chemotherapy with platinum-based combination chemotherapy. PCR was performed using tissues preserved in liquid nitrogen at the time of debulking operation. Overexpression of HER-2/neu oncogene was defined as being equal to or greater than 1.5 a.u. We analyzed whether the HER-2/neu overexpression correlated with chemoresponsiveness and 5-year survival rate(5-YSR). RESULT: HER-2/neu oncogene amplification was present in all of the ovarian cancers(32/32). Significant overexpression[gene copy number(GCN) > or =1.5 a.u.] was present in 13 of 32 ovarian cancers(41%) and 12 of 24 epithelial ovarian cancers (50%). The clinical response rate to chemotherapy in high copy group(GCN > or = 1.5 a.u.) was 67%(8/12) and that of low copy group(GCN<1.5 a.u.) was 92%(11/12)(p>0.05). Pathologic response rate to chemotherapy was 0%(0/5) and 50%(3/6), respectively(p>0.05). 5-YSR was 8% in high copy group and 25% in low copy group, but this difference was not statistically significant(p=0.17). CONCLUSION: HER-2/neu overexpression might be a poor prognostic factor, but this difference was not definitely elucidated by satistical analytsis in this study. Larger scaled prospective randomized study is needed to define the prognostidc significance of the HER-2/neu overezpression in ovarian cancer.
Breast ; Brenner Tumor ; Chemotherapy, Adjuvant ; Colon ; Drug Therapy ; Drug Therapy, Combination* ; Glycoproteins ; Granulosa Cell Tumor ; Humans ; Laparotomy ; Lung Neoplasms ; Nitrogen ; Oncogenes* ; Ovarian Neoplasms* ; Polymerase Chain Reaction ; Prevalence ; Prognosis ; Protein-Tyrosine Kinases ; Proto-Oncogenes ; Stomach ; Struma Ovarii ; Survival Rate