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Co-occurrence of an adenoma malignum and an endocervical-type adenocarcinoma of the uterine cervix in a woman with Peutz-Jeghers syndrome.

Yu Jin KOO ; Ji Eun LEE ; Sung Ran HONG ; Yong Soon KWON

Journal of Gynecologic Oncology.2010;21(3):203-206. doi:10.3802/jgo.2010.21.3.203

We report a rare co-occurrence of an adenoma malignum and an adenocarcinoma in a 30-year-old woman with Peutz-Jeghers syndrome. The woman was diagnosed with Peutz-Jeghers syndrome based on an endoscopic biopsy after vaginal bleeding. A pelvic examination and an MRI revealed the co-occurrence of a 4x5 cm protruding adenocarcinoma of FIGO stage Ib2 based on a punch biopsy and a 4.5x5.7 cm multilocular cystic mass above the solid cancer. The patient received two courses of neoadjuvant chemotherapy, followed by a laparoscopic radical hysterectomy with pelvic lymph node dissection. Pathologic findings were consistent with adenocarcinoma (40%) and adenoma malignum (60%) confined to the cervix. Three courses of adjuvant chemotherapy were performed and no clinical evidence of recurrence was seen during a 12 month follow-up period. This study will contribute to defining the best diagnosis and treatment for these rare complicating tumors.
Adenocarcinoma ; Adenoma ; Adult ; Biopsy ; Cervix Uteri ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Hysterectomy ; Lymph Node Excision ; Peutz-Jeghers Syndrome ; Recurrence ; Uterine Hemorrhage

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Primary amelanotic melanoma of the cervix: case report with review of literature.

Rajan DUGGAL ; Radhika SRINIVASAN

Journal of Gynecologic Oncology.2010;21(3):199-202. doi:10.3802/jgo.2010.21.3.199

Primary malignant melanoma of the uterine cervix is a rare neoplasm with poor prognosis. It may be misdiagnosed especially when amelanotic, in which case immunohistochemistry is useful in reaching the diagnosis. We present one such case of a 65-year-old postmenopausal female patient presenting with bleeding per vaginum. Speculum examination revealed an ulcero-proliferative growth involving the cervix. On histopathological examination it was originally suspected to be a poorly differentiated carcinoma or a non-epithelial malignant tumor, but was subsequently correctly diagnosed by immunohistochemical staining with the HMB-45 antibody and S-100 protein.
Aged ; Cervix Uteri ; Female ; Hemorrhage ; Humans ; Immunohistochemistry ; Melanoma ; Melanoma, Amelanotic ; Prognosis ; S100 Proteins ; Surgical Instruments ; Uterine Cervical Neoplasms

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Skeletal muscle metastasis from carcinoma cervix: a case report.

Gunaseelan KARUNANITHI ; Pooja SETHI ; K S REDDY ; P Reddy RANI

Journal of Gynecologic Oncology.2010;21(3):196-198. doi:10.3802/jgo.2010.21.3.196

Cervical cancer is the most common malignancy in Indian women. Cervical cancer usually spread by local extension and through the lymphatics to the retroperitoneal lymph nodes. Direct invasion of muscles by primary growth is more common than by metastatic involvement. We present a case of carcinoma of the cervix post radiotherapy to pelvis who on follow up presented with biceps muscle metastases as the initial sign of disseminated disease.
Cervix Uteri ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Muscle, Skeletal ; Muscles ; Neoplasm Metastasis ; Pelvis ; Uterine Cervical Neoplasms

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Uterine metastases in ovarian carcinoma: frequency and survival in women who underwent hysterectomy.

Joseph MENCZER ; Angela CHETRIT ; Siegal SADETZKI

Journal of Gynecologic Oncology.2010;21(3):191-195. doi:10.3802/jgo.2010.21.3.191

OBJECTIVE: Possible reasons for hysterectomy in the initial surgical management of advanced invasive epithelial ovarian carcinoma (EOC) might be a high frequency of uterine involvement and its impact on survival. The aim of the present study was to describe the frequency of uterine involvement and its association with survival in an unselected population of EOC patients who underwent hysterectomy. METHODS: All incident cases of EOC diagnosed in Israeli Jewish women between March 1994 to June 1999, were identified within the framework of a nationwide case-control epidemiological study. The target population of the present report includes all stage II-IV EOC patients who had a uterus at the time of diagnosis. Of the 822 such patients, 695 fulfilled the inclusion criterion. Excluded were 141 patients for various reasons. The present analysis is based on the remaining 554 patients. RESULTS: Uterine involvement was present in 291 (52.5%) of the patients and it was macroscopic in only 78 (14.1%). The serosa was the most common site of isolated metastases. Multivariate analysis showed that advanced stage significantly increased the risk for uterine involvement. The overall median survival with any uterine involvement was significantly lower compared to those with no involvement (38.9 months vs. 58.0 months; p<0.001). CONCLUSION: There is an association between uterine involvement, whether macro- or microscopic, and lower survival even after hysterectomy although residual tumor could not be included in the analysis. Further studies are required to establish whether uterine involvement itself is an unfavorable risk factor or merely a marker of other unfavorable prognostic factors.
Case-Control Studies ; Epidemiologic Studies ; Female ; Health Services Needs and Demand ; Humans ; Hysterectomy ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm, Residual ; Risk Factors ; Serous Membrane ; Uterus

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The type of metastasis is a prognostic factor in disseminated cervical cancer.

Kidong KIM ; Soo Youn CHO ; Beob Jong KIM ; Moon Hong KIM ; Seok Cheol CHOI ; Sang Young RYU

Journal of Gynecologic Oncology.2010;21(3):186-190. doi:10.3802/jgo.2010.21.3.186

OBJECTIVE: The objectives of this study were twofold: to verify whether the type of metastasis (lymphatic vs. hematogenous) is a prognostic factor, and to identify molecular markers associated with survival in patients with disseminated cervical cancer. METHODS: Between April 1997 and May 2008, 30 patients with disseminated cervical cancer who had supraclavicular lymph node (N=13) or hematogenous metastases (N=17) were initially treated at our institute. We reviewed medical records to extract clinicopathologic variables. For 17 patients with available pathological specimens, we evaluated the association of immunohistochemical staining for metalloproteinase (MMP)-2, vascular endothelial growth factor (VEGF)-A, and laminin V gamma (LAMC)-2 with survival and clinicopathologic variables via a log-rank test and Cox regression analysis. RESULTS: Patients who had only lymphatic metastasis (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.4 to 19.5) or completed initial treatment (OR, 3.2; 95% CI, 1.1 to 9.9) showed better survival than patients who did not, but none of the molecular markers were associated with survival. Out of 13 patients with only lymphatic metastasis, three patients who had received volume-directed radiation with concurrent chemotherapy had a long-term survival of over two years. However, patients with hematogenous metastasis showed extremely poor prognosis. CONCLUSION: The type of metastasis and completion of initial treatment were associated with prolonged survival in patients with disseminated cervical cancer, and over 20% of patients with lymphatic metastasis were salvaged with volume-directed radiation with concurrent chemotherapy. None of the molecular markers were associated with survival in patients with disseminated cervical cancer.
Humans ; Laminin ; Lymph Nodes ; Lymphatic Metastasis ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A

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High expression of mTOR is associated with radiation resistance in cervical cancer.

Min Kyu KIM ; Tae Joong KIM ; Chang Ok SUNG ; Chel Hun CHOI ; Jeong Won LEE ; Byoung Gie KIM ; Duk Soo BAE

Journal of Gynecologic Oncology.2010;21(3):181-185. doi:10.3802/jgo.2010.21.3.181

OBJECTIVE: Mammalian target of rapamycin (mTOR) is known to promote cell proliferation, survival, and resistance to radiation. The aim of this study was to determine whether mTOR expression was associated with survival and the response to radiation in patients with cervical cancer. METHODS: After reviewing 119 patients treated by primary radiotherapy for stage IIB-IVA cervical cancer, a case-control study was performed. The cases (n=12) with local recurrence or radiation failure after primary radiation therapy were selected. For each case, two controls that had no recurrence were selected. Using pretreatment paraffin-embedded tissues, the cytoplasmic expression of phosphorylated-mTOR (p-mTOR) was evaluated by immunohistochemistry. Staining was scored based on intensity (intensity score [IS] 0-3) and proportion (proportion score [PS] 0-100). The progression free survival (PFS) was defined from the end of treatment to the day of recurrence by imaging studies or biopsy. The staining distribution and PFS were compared between the two groups. The results were analyzed by the Student t-test, Mann-Whitney U-test, Fisher's exact test, and Cox proportional hazards regression model. RESULTS: The p-mTOR cytoplasmic expression was significantly associated with a poor response to radiotherapy (p<0.01). With respect to survival, a higher cytoplasmic expression of p-mTOR was associated with a worse outcome (p=0.02). The hazard ratio for recurrence or radiation failure was 6.18 for mTOR IS and 1.04 for mTOR PS (p<0.05 for both), indicating that the degree of p-mTOR staining correlated with the recurrence risk. CONCLUSION: High expression of p-mTOR was associated with radiation resistance; therefore p-mTOR may be a prognostic marker for response to radiotherapy in patients with cervical cancer.
Biopsy ; Case-Control Studies ; Cell Proliferation ; Cytoplasm ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Recurrence ; Sirolimus ; Uterine Cervical Neoplasms

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Plasma levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in women with cervical neoplasia.

Si Won LEE ; Soo Yoon LEE ; Sa Ra LEE ; Woong JU ; Seung Cheol KIM

Journal of Gynecologic Oncology.2010;21(3):174-180. doi:10.3802/jgo.2010.21.3.174

OBJECTIVE: The goal of this study was to investigate the relationship between plasma levels of insulin-like growth factors-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) and the risk for cervical intraepithelial neoplasia (CIN) and cervical cancer. METHODS: Plasma levels of IGF-1 and IGFBP-3 of 44 cervical cancer patients, 82 CIN patients and 40 neoplasm-free patients were investigated. Then the associations of the plasma levels of IGF-1 and IGFBP-3 with cervical neoplasm or its clinicopathologic parameters were analyzed. RESULTS: The mean IGF-1 concentrations were significantly different among the control, CIN, and cervical cancer groups; the levels were higher in the CIN group compared to the controls. According to the quartile category, the plasma IGF-1 level was significantly higher (p=0.0015) in the CIN group than in the controls. The IGFBP-3 level showed no association between the controls and CIN groups (p=0.842). Although the mean IGF-1/IGFBP-3 molar ratio had borderline significance (p=0.08) among the study population, the quartile comparison showed a significantly higher IGF-1/IGFBP-3 molar ratio in the CIN group compared to the control group (p=0.041). CONCLUSION: Plasma levels of IGF-1 and the IGF-1/IGFBP-3 molar ratio might be useful for the development early detection of cervical lesions and used as an adjuvant diagnostic tool for cervical neoplasia after more larger scale research.
Cervical Intraepithelial Neoplasia ; Female ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Molar ; Plasma ; Uterine Cervical Neoplasms

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GST (GSTM1, GSTT1, and GSTP1) polymorphisms in the genetic susceptibility of Turkish patients to cervical cancer.

Beray KIRAN ; Mutlu KARKUCAK ; Hakan OZAN ; Tahsin YAKUT ; Kemal OZERKAN ; Sebnem SAG ; Mehmet TURE

Journal of Gynecologic Oncology.2010;21(3):169-173. doi:10.3802/jgo.2010.21.3.169

OBJECTIVE: This work investigates the role of glutathione S-transferase M1 (GSTM1), glutathione S-transferase T1 (GSTT1), and glutathione S-transferase P1 (GSTP1) enzymes and polymorphisms, which are found in phase II detoxification reactions in the development of cervical cancer. METHODS: This study was conducted with 46 patients diagnosed with cervical cancer and 52 people with no cancer history. Multiplex PCR methods were used to evaluate the GSTM1 and GSTT1 gene polymorphism. However, the GSTP1 (Ile105Val) gene polymorphism was studied using a PCR-RFLP method. The patient and control groups were compared using a chi-square test with p<0.05. RESULTS: In the patient group, statistical significance was determined for gravidity (p=0.03), parity (p=0.01), and the number of living children (p=0.01) compared to the control group. The gene frequency of GSTM1, GSTT1, and GSTP1 polymorphisms was evaluated. We observed that GSTM1 and GSTT1 null genotype frequencies were 54.3% and 32.6% respectively, while GSTP1 (Ile/Val), (Ile/Ile), (Val/Val) genotype frequencies were 52%, 44%, and 4%, respectively, in the cervical cancer patients. No statistical variation was determined between the control and patient groups in terms of GSTM1, GSTT1, and GSTP1 polymorphisms (p>0.05). CONCLUSION: Our results demonstrate that GSTT1, GSTM1, and GSTP1 polymorphisms are not associated with cervical cancer in Turkish patients.
Child ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Glutathione Transferase ; Gravidity ; Humans ; Metabolic Detoxication, Phase II ; Multiplex Polymerase Chain Reaction ; Parity ; Uterine Cervical Neoplasms

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Survival benefit of laparoscopic surgical staging-guided radiation therapy in locally advanced cervical cancer.

Dae Gy HONG ; Nae Yoon PARK ; Gun Oh CHONG ; Young Lae CHO ; Il Soo PARK ; Yoon Soon LEE

Journal of Gynecologic Oncology.2010;21(3):163-168. doi:10.3802/jgo.2010.21.3.163

OBJECTIVE: This study was designed to evaluate the survival benefit of laparoscopic surgical staging (LSS)-guided tailored radiation therapy (RT) in locally advanced cervical cancer (LACC). METHODS: We retrospectively reviewed 89 LACC patients' medical records who primarily received non-surgical treatment, of which pretreatment LSS was performed in 20 (LSS group) and primary chemoradiation therapy (CCRT) without LSS (CCRT group) was carried out in 69 from January 2000 to January 2006. We analyzed clinical characteristics, pretreatment imaging study results and survival outcomes including disease free survival (DFS) and overall survival (OS) to compare them between the two groups. RESULTS: There were as many as eight cases (40%) of LSS related complications. The mean time interval between LSS and RT or CCRT was 26.6 days (+/-18.8 days). Six out of twenty (30%) in LSS group and 10 out of 69 (14.5%) in CCRT group received extended field RT when paraaortic lymph nodes (LNs) were positive based on the pathologic findings after LSS and the results of imaging studies, respectively. Three-year DFS and OS were both better in 33 imaging-negative CCRT group patients than those in 4 imaging-negative/pathology-positive (false negative) patients after LSS (3-year DFS, 50% vs. 87%, p=0.022; 3-year OS, 50% vs. 84%, p=0.033). The 5-year DFS rates were 52% and 55% in LSS group and in CCRT group, respectively (p=0.28). The 5-year OS rates were 68% in LSS group and 62% in CCRT group without significant difference between the two groups (p=0.79). CONCLUSION: We found that LSS-based RT tailoring did not show survival benefit in LACC despite inaccuracy of imaging-based RT tailoring. Further studies are required to find new method to overcome this inaccuracy and improve survival outcomes.
Disease-Free Survival ; Humans ; Laparoscopy ; Lymph Nodes ; Medical Records ; Retrospective Studies ; Uterine Cervical Neoplasms

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Current status in the management of uterine corpus cancer in Korea.

Nan Hee JEONG ; Jong Min LEE ; Seon Kyung LEE

Journal of Gynecologic Oncology.2010;21(3):151-162. doi:10.3802/jgo.2010.21.3.151

Uterine corpus cancer has increased in prevalence in Korean women over the last decade. Recently, elegant studies have been reported from many institutes. To improve treatment strategies, a review of our own data is warranted. This work will discuss the risks and prognostic factors for uterine corpus cancer, and the radiologic evaluation, prediction of lymph node metastasis, systematic lymphadenectomy, minimally invasive surgery, ovarian-saving surgery, fertility-sparing treatment, and adjuvant treatment in women with uterine cancer.
Academies and Institutes ; Female ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prevalence ; Uterine Neoplasms

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