Mullerian inhibiting substance (MIS) is a glycoprotein hormone produced by fetal Sertoli cells that causes regression of the Mullerian ducts in males during sexual differentiation. Cell lines derived from human ovarian epithelium and rodent Leydig cell tumors, which respond to MIS in growth inhibition assays and express the MIS type II receptors (MISR II). But the pathophysiological role of MIS in human ovarian neoplasia development has not yet been fully established. In order to understand its role in pathogenesis of ovarian neoplasia, the expression and localization of the MIS and MISR II were studied in 5 normal ovaries, 11 benign tumors, 9 borderline ovarian malignancies, 40 ovarian malignancies in paraffin embedded tissue and tissue microarrays by using immunohistochemical stain. The results were as follows; 1. The first staining for MIS and MISR II were detected in granulosa cells in primary follicles of normal ovary. Among the growing follicles, larger developing follicles stained more intensely than smaller follicles. 2. In benign ovarian tumors, 8 (72.73%) in MIS and 5 (45.45%) in MISR II out of 11 cases were stained. The intensity scores of staining were 1.18 in MIS and 0.64 in MISR II. 3. In borderline malignancies, 6 (66.67%) in MIS and 7 (77.78%) in MISR II out of 9 cases were stained. The intensity scores of staining were 0.89 in MIS and 1.22 in MISR II. 4. In ovarian malignancies, the expression of MIS and MISR II were 50% (9/18) and 50% (9/18) in epithelial, 92.30% (12/13) and 76.72% (10/13) in germ cell, and 88.9% (8/9) and 100% (9/9) in sex-cord stromal tumors. The intensity scores of MIS and MISR II expression were 0.72 and 0.72 in epithelial, 1.45 and 1.62 in germ cell, and 1.78 and 1.67 in sex-cord stromal tumors. 5. There was significant high expression of MIS and MISR II in non-epithelial (90.91%, 86.36%) than epithelial ovarian cancers (50%, 50%). The scores of expression intensity was also higher in non-elithelial cancers (MIS: 1.67 +/- 0.16 vs 0.72 +/- 0.20, p=0.003, MISR II: 1.64 +/- 0.20 vs 0.72 +/- 0.21, p=0.022). In conlusion, the expression of MIS and MISR II were not different according to the differentiation, but tissue type specific. The frequency of MIS and MISR II expression was higher in non-epithelial cancers, especially in sex-cord stromal tumors. The results of this experiment could be utilized as scientific basis of researches, furthermore clinical applications in diagnosis and treatment of non-epithelial ovarian malignancies.
Anti-Mullerian Hormone* ; Cell Line ; Diagnosis ; Epithelium ; Female ; Germ Cells ; Glycoproteins ; Granulosa Cells ; Humans ; Leydig Cell Tumor ; Male ; Mullerian Ducts ; Ovarian Neoplasms ; Ovary ; Paraffin ; Rodentia ; Sertoli Cells ; Sex Differentiation

OBJECTIVE: The aim is to evaluate the clinical findings of uterine sarcoma we had experienced. METHODS: This study was retrospectively reviewed 19 patients with uterine sarcoma who were managed at Wonju Christian Hospital between September 1982 and May 2003. We analyzed clinical features, type of surgery, adjuvant therapy, three year-survival rate, prognostic factors of uterine sarcoma, and the effects of postoperative chemotherapy and radiotherapy on death. RESULTS: Our study included four histologic types: 8 patients with leiomyosarcoma (42.1%), 5 patients with endometrial stromal sarcoma (26.3%), 4 patients with malignant mixed Mullerian tumor (21.0%), 1 patient with angiosarcoma (5.3%) and 1 patient with both leiomyosarcoma and endometrial stromal sarcoma (5.3%) (Table 1). The cases were classified according to the FIGO staging system. 13 patients (63.2%) had stage I, 2 patients (10.5%) stage II, 2 patients (10.5%) stage III, 3 patients (15.8%) stage IV (Table 1). The three-year survival rate of uterine sarcoma was 53.8%, the most common symptom was abnormal vaginal bleeding. CONCLUSION: Uerine sarcomas are aggressive tumors with poor prognosis, except when the diagnosis is low grade endometrial stromal sarcoma. The effects of postoperative chemotherapy and radiotherapy on death were not statistically significant. This is a retrospective review with small numbers and short periods. Prospective multicentric trials including a statistically evaluable number of patients are necessary.
Diagnosis ; Drug Therapy ; Gangwon-do ; Hemangiosarcoma ; Humans ; Leiomyosarcoma ; Prognosis ; Radiotherapy ; Retrospective Studies ; Sarcoma* ; Sarcoma, Endometrial Stromal ; Survival Rate ; Uterine Hemorrhage

OBJECTIVE: Previous studies were showed that adenoassocited virus (AAV) infection was had negative effects on human papillomavirus (HPV) infection and that the cervical cancer cell growth is inhibited by AAV infection. We detected of AAV 2 and high-risk HPV infection and researched correlation with AAV 2 and HPV in cervical cell. METHODS: Cell of normal cervix (49 persons), infected HPV cervix (45 persons), cervical intraepithelial neoplasm (CIN) I (31 persons), II (20 persons), III (35 persons), and invasive cancer (30 persons) were investigated by PCR using AAV-2 and HPV type 16 and 18 specific primers. RESULTS: AAV 2 was detected in 8 out of 49 normal cervix (16.3%), 2 out of 45 infected HPV cervix (4.4%), 3 out of 31 CIN I (9.7%), 4 out of 20 CIN II (20%), 8 out of 35 CIN III (22.8%), and 3 out of 30 invasive cervical cancer cases (30%). However, HPV 16 was detected in 5 out of 49 normal cervix (10.2%), 20 out of 45 infected HPV cervix (44.4%), 13 out of 31 CIN I (42%), 11 out of 20 CIN II (55%), 19 out of 35 CIN III (54.3%), and 21 out of 30 invasive cervical cancer cases (70%). HPV 18 was detected in 6 out of 49 normal cervix (12.2%), 18 out of 45 infected HPV cervix (40%), 16 out of 31 CIN I (51.6%), 10 out of 20 CIN II (50%), 22 out of 35 CIN III (62.8%), and 13 out of 30 invasive cervical cancer cases (43.3%). CONCLUSION: AAV 2 was detected in normal and infected HPV cervix, CIN (I, II, III) and invasive cervical cancer. As compared to normal, CIN I and CIN II, suggesting significant correlation between AAV 2 and HPV type 16. Further, researches continue to be done relationship to AAV 2 and HPV infection in cervix.
Cervical Intraepithelial Neoplasia ; Cervix Uteri* ; Female ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans* ; Polymerase Chain Reaction ; Uterine Cervical Neoplasms

OBJECTIVE: This study was performed to evaluate the clinicopathologic prognostic factors and overall survival in patients with uterine endometrial cancer. METHODS: From Jan, 1995 to Dec. 2000, medical records of 98 patients with endometrial cancer treated in Kosin University Gospel Hospital were reviewed and the overall survival of patients was determined by support of the death statistics of Korea National Statistical Office. Survival rate was analyzed by Kaplan-Meier method and log-rank test was used for curve comparison, Cox proportional hazards model was used for multivariate analysis. RESULTS: The median age of all patients was 53 years. The most common presenting symptom was abnormal vaginal bleeding (65.3%). The most common histological type was endometrioid adenocarcinoma. (85.1%) The overall 5 years survival rate (5YSR) for all 98 patients was 66.8%. The overall 5YSR for premenopause and postmenopause were 80% and 50%, respectively (p=0.08). The overall 5YSR for preop CA-125 level above 35 U/mL, below 35 U/mL were 40%, 80% (p=0.001). The overall 5YSR of stage I, stage II, stage III, stage IV were 86.8%, 76.9%, 39.4%, 14.4% (p=0.001). The overall 5YSR of grade 1, grade 2, grade 3 were 75%, 70%, 45% (p=0.002). The overall 5YSR of myometrium invasion of none, <1/2, >or=1/2, were 84.3%, 80.3%, 57.2% (p=0.004). The overall 5YSR of peritoneal cytology of negative, posivite were 73.4%, 23.8% (p=0.001). The overall 5YSR of lymphnode metastasis negative, positive were 80.1%, 15% (p=0.001). CONCLUSION: The age (>50), preop CA-125 level, FIGO surgical stage, grade, myometrial invasion, lymph node metastasis and peritoneal cytology were significant prognostic factors of uterine endometrial cancer affecting 5YSR by univariate analysis. The myometrium invasion and grade were significant prognostic factors affecting 5YSR by multivariate analysis.
Animals ; Carcinoma, Endometrioid ; Endometrial Neoplasms* ; Female ; Humans ; Korea ; Lymph Nodes ; Medical Records ; Mice ; Multivariate Analysis ; Myometrium ; Neoplasm Metastasis ; Postmenopause ; Premenopause ; Proportional Hazards Models ; Survival Rate ; Uterine Hemorrhage

OBJECTIVE: To evaluate the differences in the surgical and chemotherapeutic outcomes of elderly versus younger patients with epithelial ovarian cancer. METHODS: We compared clinical characteristics, operative factors and outcomes of chemotherapy of elderly patients 65 years old or over (n=26) with those of younger patients aged 41-49 years (n=47). All subjects underwent their primary surgical therapy and following adjuvant chemotherapy at Seoul National University Hospital, from January 1996 to June 2003. RESULTS: As for tumor characteristics (tumor stage, histology etc.), there were no differences between two groups. Medical comorbidities were more frequent in the elderly group, primarily due to hypertension (50.0% vs. 28.3%; p=0.02). Optimal surgical treatment and adjuvant chemotherapy were performed less frequently in the elderly group (54.2% vs. 78.3; p=0.012). Perioperative and postoperative variables (operation time, intraoperative bleeding, postoperational complications and duration of hospitalization etc.) showed no differences except episode of transfusion in the elderly group. Residual mass, diameter less than 2 cm, showed difference between two groups with marginal significance (30.4% vs 55.6%, p=0.072). Chemotherapeutic dosage reduction was more frequent in elderly group (23.1% vs. 8.5%; p=0.003), but the occurrences of the chemotherapeutic cycle delay and toxicity profiles, were similar in the two groups. Response rate to adjuvant chemotherapy and the number of recurrence were not different between two groups (p=0.119 and p=0.587). CONCLUSION: Elderly women who present the same distribution of stages as their younger counterparts are likely to be treated more conservatively than younger ovarian cancer patients.
Aged* ; Chemotherapy, Adjuvant ; Comorbidity ; Drug Therapy ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hypertension ; Ovarian Neoplasms* ; Recurrence ; Seoul

OBJECTIVE: The object of this retrospective study was to evaluate the clinical characteristics and prognosis of invasive uterine cervical cancer. METHODS: 445 evaluable patients with invasive cancer of the cervix were treated at Kyung Hee Medical Center from March 1984 to March 1998. In this retrospective study, we studied the clinico-pathologic characteristics (age, FIGO stage, histologic type, nodal metastasis, and treatment modalities et al) by the review of medical records. RESULTS: 1. The age distribution among the 445 patients ranged from 27 to 90 years, mostly at 51-60 years, which occupied 26.5%. The mean age was 48.9 years. 2. The frequent number of pregnancies was 3-4 times, which occupied 33.3%. The mean number of pregnancies was 5.3 times. The frequent number of deliveries was 3-4 times, which occupied 41.7%. The mean number of deliveries was 3.2 times. 3. Subdivision of 445 cases of invasive cervical carcinoma were made according to the FIGO clinical staging: Stage Ia 77 cases (17.3%), Stage Ib 156 cases (35.0%), Stage IIa 95 cases (21.3%), and Stage IIb 52 cases (11.7%), Stage III 40 cases (9.0%), and Stage IV 25 cases (5.6%). 4. Histologically, squamous cell carcinoma comprised 91.2%, adenocarcinoma 6.6%, adenosquamous carcinoma 1.7%, and others 0.5%. 5. The types of treatment were as follows; operation 36.2%, operation with chemoradiation 13.8%, operation with radiotherapy 11.4%, operation with chemotherapy 11.0%, radiation 8.8%, chemoradiation 6.9%, and others 12.0%. 6. All the excised pelvic and para-aortic lymph nodes (LN) were histologically examined and the incidence of metastasis by clinical stage showed as follows. In Stage Ib 16.4%, 2.3%, in Stage IIa 24.5%, 3.2%, and in the stage IIb 26.7%, 6.7% respectively. The most frequently involved LN among regional pelvic LN is the obturator LN (32%) followed by the external iliac LN (29%). 7. Based on the 445 cases who were available to follow up 5 years or more after treatment, survival rates were studied and analyzed. 5 year survival rate by stage revealed 96% in stage Ia, 87.3% in stage Ib, 81.3% in stage IIa, 72% in stage IIb, 47% in stage III, and 26.4% in stage IV. CONCLUSION: FIGO stage, involvement of resection margin, and LN involvement had prognostic significance in multivariate analysis (p<0.01). However, tumor size, histologic type, depth of cervical wall invasion, and lymphovascular space invasion did not.
Adenocarcinoma ; Age Distribution ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Pregnancy ; Prognosis* ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms*

OBJECTIVE: The aim of the present study is to evaluate pregnancy outcomes and whether to change disease progress of thyroid cancer during peripartum period in pregnant women diagnosed as thyroid cancer. to examine the effect of pregnancy on the prognosis of concomitant thyroid cancer. METHODS: The retrospective study was made by the review of medical records of 37 pregnancies of pregnant women with thyroid cancer, who had delivered in our hospital between Jan. 1990 and Jun. 2004. Pregnancy outcomes and treatment process were described. RESULTS: There were 37 deliveries of 34 women diagnosed as thyroid cancer among 23,303 deliveries of women who had delivered at our hospital during the study period. The mean age at operation for thyroid cancer and delivery was 26.7 +/- 3.6 years old and 30.1 +/- 3.8 years old, respectively. Regarding to the mode of delivery, there were 26 cases of vaginal delivery, 10 cases of cesarean section including emergency and one termination in 26-week gestational age because of severe fetal anomaly. Another women got a therapeutic abortion in 18-week gestational age because of subsequent unexpected pregnancy during postoperative radioiodine therapy. All of them undertook thyroid operation; thyroidecomy (9 cases of total thyroidectomy, 9 cases of subtotal thyroidectomy and 19 cases of lobectomy) and then got synthyroid and postoperative radioiodine therapy, if necessary. There were 11 women with relapse evidence of thyroid cancer during follow-up periods. And there was no difference of recurrence rate and clinical outcomes (e.g, lymph node metastasis or tumor size) between the group diagnosed as thyroid cancer during pregnancy and those with thyroid cancer who were not pregnant at the time of diagnosis. CONCLUSION: There was no difference in the relapse of thyroid cancer during the peripartum period. It is attributed that thyroid cancer has an excellent long-term prognosis and initial aggressive surgery and postoperative adjuvant management has developed. The women with thyroid cancer could be pregnant and deliver without a fear of relapse unless she is under radioiodine therapy or in aggravated disease state. We observed no increased risk in obstetric outcomes such as preterm delivery or small for gestational age.
Abortion, Therapeutic ; Cesarean Section ; Diagnosis ; Emergencies ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Peripartum Period ; Pregnancy ; Pregnancy Outcome ; Pregnant Women* ; Prognosis* ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

OBJECTIVE: The aim of this study was to find out the prognostic indicators of antenatally detected ventriculomegaly. METHODS: During the study period (Nov. 1995 through Jan. 2003), we identified 96 cases of fetal ventriculomegaly and reviewed their antenatal and postnatal follow-up records retrospectively. Excluding cases of termination before viable stage and incomplete follow-up, 68 cases were evaluated. Severe ventriculomegaly (fetal hydrocephalus; n=30) was defined as lateral ventricular atrial width (LVAW) greater than 15 mm, and mild ventriculomegaly (n=38) was defined as LVAW between 10 and 15 mm. Subgroup of LVAW <12 mm (n=23) was also analyzed. Antenatal workup included detailed ultrasonography, TORCH test and karyotyping. Outcome parameters were the presence of progressive lesion, NICU admission, shunt operation and critical damage that included delayed development, cerebral palsy and death after live birth. RESULTS: Overall survival rate was 89.7% (61/68) and the median postnatal follow-up duration was 17.0 (0.0-69.3) months. Severe ventriculomegaly group showed higher incidence of progressive lesion, NICU admission and shunt operation than did mild group. Within mild ventriculomegaly group, critical damage was more common in cases with associated anomalies, and this difference was present even in the subgroup of LVAW <12 mm (2/16 vs. 4/7, p<0.05). CONCLUSION: In mild ventriculomegaly group, comprehensive antenatal workup including detailed ultrasonography is important because associated anomaly is a poor prognostic factor, even in cases of LVAW <12 mm. In terms of critical damage such as developmental delay, cerebral palsy and postnatal death, the prognosis of cases with mild ventriculomegaly is also guarded.
Cerebral Palsy ; Follow-Up Studies ; Hydrocephalus ; Incidence ; Karyotyping ; Live Birth ; Prognosis ; Retrospective Studies ; Survival Rate ; Ultrasonography

OBJECTIVE: Pre-pregnancy weight and excess weight gain during pregnancy were associated with obstetric outcomes and plasma leptin was reported to have association with postpartum weight retention. The purpose of this study was to examine the relationships between pregnancy related factors including plasma leptin and weight gain during pregnancy and postpartum weight retention. METHODS: Seventy-five women were observed through pregnancy and 6 months postpartum. First trimester, third trimester and postpartum leptin were measured by radioimmunoassay. Weight gain categories were based on the Institute of Medicine recommendations. Relationships between pregnancy related factors and leptin were examined. And relationship between leptin and postpartum weight retention was also examined. RESULTS: Among subjects, 44.0% of women had concerns for postpartum weight retention and 18.9% had diet controls for postpartum weight management. Initial BMI categories by IOM classification were underweight, 29 (38.7%), normal, 37 (49.3%), and overweight group, 9 (12.0%). Underweight group was largely below IOM weight gain recommendation and overweight group was largely over IOM weight gain recommendation (P=0.013). First trimester leptin was correlated with pregravid BMI (r=0.678, P=0.000), maternal weight at term (r=0.547, P=0.006) and postpartum BMI (r=0.608, P=0.002), but not correlated with weight gain during pregnancy and postpartum weight retention. Third trimester leptin was not correlated with above variables. Initial BMI categories by IOM were significantly correlated with first trimester leptin, leptin at 5 weeks postpartum, maternal weight at term (0.741, P=0.000), weight at 5 weeks postpartum (r=0.728, P=0.001) and weight at 6 months postpartum (r=0.684, P=0.002). CONCLUSION: These results suggest that first trimester plasma leptin may predict maternal weight at term and initial BMI categories may be a predictor of maternal weight at 5 weeks postpartum and 6 months postpartum. However, weight gain during pregnancy was not correlated with postpartum weight retention.
Classification ; Diet ; Female ; Humans ; Institute of Medicine (U.S.) ; Leptin ; Overweight ; Plasma ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Radioimmunoassay ; Thinness ; Weight Gain

Significant improvements in the management of ovarian germ-cell tumors have been achieved during the past two decades. The development of more effective chemotherapeutic regimens is clearly the leading cause for improved outcome for these patients. In addition, advancements in other disciplines led to the development of a more precise surgical staging system, improved radiographic imaging, more sophisticated pathology techniques, as well as improved supportive care and symptom control. A substantial majority of patients with ovarian germ-cell tumors are long term survivals and suffer minimal morbidity from treatment. Fertility-sparing surgical procedures enable a large proportion of young women with ovarian germ-cell tumors to preserve their reproductive potential.
Female ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Pathology