OBJECTIVE: This study was performed to evaluate the overall survival and the change in treatment modalities in patients with uterine endometrial cancer in Korea. METHODS: From January 1990 to March 2005, medical records of 740 patients with endometrial cancer in nine hospitals were reviewed. The overall survival was determined supported by the death statistics of Korea National Statistical Office. RESULTS: The mean age of patients was 51.5 years (range: 21-82 years). The mean gravidity and parity were 3.3 and 2.1 (range: 0-18, 0-9), respectively. The most common stage, grade and histological type at diagnosis were FIGO stage I, grade 1 and endometrioid adenocarcinoma (76.5%, 56.4% and 87.2%), respectively. The main treatment modalities was surgery on stage I (59.8%), surgery-adjuvant radiotherapy on stage II (55.1%), surgery-adjuvant radiotherapy or surgery-adjuvant chemoradiation on stage III (38.3%) and surgery-adjuvant chemotherapy on stage IV (55.6%). The preferred treatment modality was surgery only on grade 1 (69.0%) and surgery-adjuvant radiotherapy on grade 2-3 (43.4% and 53.2%). Surgery had been the most common method of therapy before 1998 but its prevalence gradually decreased. As a result, surgery-adjuvant radiotherapy and surgery-adjuvant chemotherapy were most widely performed in 2004-2005 and surgery-adjuvant chemoradiation also increased more than a twofold. The overall 5 years survival rate (5YSR) for all 740 patients was 81.3%. The overall 5YSR of stage I was 89.0%. The overall 5YSR of grade 1, grade 2, grade 3 were 96.0%, 92.0%, 80.0%. Before 1998, the survival rate was 77.0%. Since then it increased to 83-88% and in 2000-2001 it increased to 88.0%, and it was the highest survival rate. CONCLUSION: The survival rate of endometrial cancer has been improving for the past 15 years and the method of treatment is also being changed currently. In order to improve the survival rate of endometrial cancer, a close investigation including genetic and environmental factors of the pathophysiology of endometrial cancer along with the epidemiology of risk factors, should be carried out.
Carcinoma, Endometrioid ; Diagnosis ; Drug Therapy ; Endometrial Neoplasms* ; Epidemiology ; Female ; Gravidity ; Humans ; Korea* ; Medical Records ; Parity ; Prevalence ; Radiotherapy ; Risk Factors ; Survival Rate

OBJECTIVE: The purpose of this study was to evaluate the clinicopathologic findings, treatment, and prognostic factors of uterine endometrial cancer. METHODS: We retrospectively reviewed 59 patients with histologically proven stage I and II endometrial cancer between January 1994 and December 2004, for clinical profiles and survival. The survival of patients was determined by description of last follow up date in medical records or phone calls. RESULTS: The median age at the time of diagnosis was 51 years (range: 30-71 years) and the most common presenting symptom was vaginal bleeding (83.0%). Endometrioid adenocarcinoma was the most common (96.6%) histologic type of all cases. Forty-nine patients (83.0%) were FIGO stage I and 10 patients were stage II (17.0%), and the histological grades of the tumors were 23 (39.0%) grade 1, 17 (28.8%) grade 2, 7 (11.9%) grade 3, and 12 (20.3%) unknown, respectively. All patients were treated by surgery as primary treatment and given postoperative adjuvant therapy including radiation therapy (32.2%), concurrent chemotherapy and radiation therapy (6.8%), and chemotherapy (3.4%). The 5-year disease free survival rate (DFSR) of stage I and stage II were 92.7% and 66.7%, respectively. The age (> or =60) and menopausal status were significant prognostic factors by univariate anlaysis (p=0.0077; p=0.0149, respectively). However, parity, FIGO surgical stage, histological grade, myometrial invasion, and lymph-vascular space invasion were not significant prognostic factors (p>0.05). CONCLUSION: The age (> or =60) and menopause state were significant prognostic factors of stage I and II uterine endometrial cancer affecting survival of the patients.
Carcinoma, Endometrioid ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Menopause ; Parity ; Retrospective Studies ; Uterine Hemorrhage ; Uterus*

Spontaneous intra-abdominal hemorrhage from uterine leiomyomas is rarely encountered. We present a case of a 46-year-old who presented to the emergency room with acute abdominal pain as same as that has experienced for 5-6 times. On examination, the abdomen was diffusely tender, with rebound tenderness in the suprapubic area and in both iliac fossae. Pregnancy test was negative. She had an acute abdomen, dizziness, decreasing hematocrit, and a pelvic mass with free fluid in the pelvic cavity. On transvaginal sonography, 6.3 x 6.1 cm sized hyperechoic mass was visible beside the uterus and CDS. This mass had an ill-defined margin. Large amount of fluid was visible in the CDS and uterovesical pouch. Hemoperitoneum was confirmed by culdocentesis. Magnetic Resonance Imaging revealed a mass with cystic components, diffusely heterogeneous signal intensity and T1 high signal intensity in the left superolateral aspect of uterus. An moderate amount of fluid was found in the pelvic cavity. The patient underwent an exploratory laparotomy. A ruptured, pedunculated, cystic degenerated uterine myoma with active bleeding was found, as well as approximately a liter of free, blood-stained peritoneal fluid and blood-clots. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.
Abdomen ; Abdomen, Acute ; Abdominal Pain ; Ascitic Fluid ; Diagnosis ; Dizziness ; Emergency Service, Hospital ; Female ; Hematocrit ; Hemoperitoneum* ; Hemorrhage ; Humans ; Laparotomy ; Leiomyoma* ; Magnetic Resonance Imaging ; Middle Aged ; Pregnancy ; Pregnancy Tests ; Uterus

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.
Uterine Cervical Neoplasms/complications/*pathology ; Sex Cord-Gonadal Stromal Tumors/complications/pathology ; Peutz-Jeghers Syndrome/complications/*pathology ; Ovarian Neoplasms/complications/*pathology ; Metaplasia ; Korea ; Humans ; Female ; Fallopian Tubes/pathology ; Endometrium/pathology ; Carcinoma, Ductal, Breast/complications/pathology ; Breast Neoplasms/complications/*pathology ; Adult ; Adenocarcinoma/complications/pathology

OBJECTIVE: The purpose of this study was to evaluate the clinicopathologic findings, treatment, and prognostic factors of adenocarcinoma of the uterine cervix. METHODS: This study retrospectively reviewed 80 patients with histologically proven stage I, II, and III cervical adenocarcinoma, at the Department of Obstetrics and Gynecology of Korea University Anam, Guro, and Ansan Hospitals, between January 1990 and December 2005, for clinical profiles and survival. Survival was analyzed according to the Kaplan-Meier method. Univariate analysis of prognostic factors was performed with the test of log rank. Cox regression model was used in multivariate analysis of prognostic factors. RESULTS: The mean age at the time of diagnosis was 48.5 years (range: 28-81 years) and the most common presenting symptom was uterine bleeding (51.3%). Fifty-eight patients (72.5%) presented with stage I, nineteen (23.7%) with stage II, and three (3.8%) with stage III. Surgery was the main treatment for stage I and IIa and radiation therapy for stage IIb or more. The 5-year survival rates for stages I, II, and III were 85.0%, 63.8%, and 0.0%, respectively. Univariate analysis showed that stage, lymph node metastasis, and lymph-vascular space invasion were significant prognostic factors (p<0.05). Using multivariate analysis, stage III and age (> or =50) were significant independent predictors for poor survival (OR 37.352, CI 3.167-440.579; OR 9.823, CI 1.808-53.354, respectively). CONCLUSION: The results suggest that FIGO stage and age are significant independent prognostic factors for patients with adenocarcinoma of the uterine cervix.
Adenocarcinoma* ; Cervix Uteri* ; Diagnosis ; Female ; Gyeonggi-do ; Gynecology ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Retrospective Studies ; Survival Rate ; Uterine Hemorrhage

OBJECTIVE: To compare the perinatal outcomes of pregnant women with 100 g oral glucose tolerance test (OGTT) proven impaired glucose tolerance (IGT), with normal control and gestational diabetes mellitus (GDM) groups. METHODS: 159 pregnant women who had visited our medical center between March 2002 and March 2004, positive (> or = 140 g) for 50 g OGTT were included in this study. IGT was defined by the presence of one abnormal 100 g OGTT glucose value, and they were compared with the control group, and the GDM group(with at least 2 abnormal glucose values). The maternal and neonatal outcomes were assessed among three groups. RESULTS: Even though familial history of DM was significantly higher in the IGT and GDM group (p<0.001) compared with the control group, no difference was observed in the frequency of previous GDM. The rate of fetal macrosomi a (>4 kg) and hypoglycemia was significantly increased in GDM group than other groups. The difference in the frequency of i) large for gestational age birthweight (>90 percentile) ii) preterm delivery, iii) APGAR score (1-min and 5-min), iv) shoulder dystocia, and v) congenital anomalies among the three groups was not notable-however, the incidence of neonatal hyperbilirubinemia was significantly higher and duration of NICU admission is significantly longer in the IGT group, compared to the control group (p<0.001). In maternal outcomes, whereas no significant difference was observed concerning the frequency of i) polyhydramnios (>95%) ii) infections (genitourinary and surgical wounds) in the three groups, the prevalence of preeclampsia was significantly higher in the IGT (p=0.018) and GDM group (p=0.023), compared with the control group. CONCLUSION: Neonatal hyperbilirubinemia, as well as maternal preeclampsia were significantly elevated in the IGT group. The results obtained thus far demonstrate the possibility of the need for active perinatal care with therapeutic intervention in pregnant women with IGT.
Apgar Score ; Diabetes, Gestational ; Dystocia ; Female ; Gestational Age ; Glucose Tolerance Test* ; Glucose* ; Humans ; Hyperbilirubinemia, Neonatal ; Hypoglycemia ; Incidence ; Perinatal Care ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy ; Pregnant Women* ; Prevalence ; Shoulder

OBJECTIVE: To identify the risk factors that may predict high grade lesions in glandular cell abnormalities on cervical cytology. METHODS: This study was performed from January 2002 to December 2005 and included 87 cases of glandular cell abnormalities on Pap smear. Among them, 65 (74.7%) cases were atypical glandular cells (AGC) and 22 (25.3%) cases were AGC, favor neoplastic. The histologic diagnoses were classified as low grade lesions [normal, cervical intraepithelial neoplasia (CIN) I, and simple hyperplasia without atypia] and high grade lesions [CIN II/III, adenocarcinoma in situ (AIS), and invasive cancer]. RESULTS: Fifty-three (60.9%) cases had negative biopsies or cervicitis. Twenty-five cases had cervical lesions including one CIN I, ten CIN II/III, two AIS, twelve invasive cancers. There were 7 endometrial lesions: 5 adenocarcinomas and 2 malignant mixed mullerian tumors. Two patients had one tubal cancer and one CIN II with simple hyperplasia without atypia. High-risk human papillomavirus (HPV) positive and AGC, favor neoplastic cases were significantly associated with high grade lesions (OR 15.4, CI 2.2-109.7; OR 7.0, CI 1.1-42.8). In the cervix, only high-risk HPV positive were significantly associated with high grade lesions (OR 64.6, CI 4.5-930.8). In the endometrium, age, menopausal status, and cytologic classification were significantly associated with low grade lesions or high grade lesions (p<0.05). CONCLUSION: High-risk HPV DNA detection was strongly associated with high grade lesions in women with glandular cell abnormalites on their Pap smear. These results suggest that HPV testing may be useful as a triage of the management in women with glandular cell abnormalities.
Adenocarcinoma ; Biopsy ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Classification ; Diagnosis ; DNA ; Endometrium ; Female ; Humans ; Hyperplasia ; Risk Factors* ; Triage ; Uterine Cervicitis

Miller-Dieker Syndrome (MDS) is a contiguous gene deletion syndrome of chromosome 17p13.3, characterized by classical lissencephaly (lissencephaly type 1) and distinct facial features. Children with MDS present with severe developmental delay, epilepsy and feeding problems. The lissencephaly represents the severe end of the spectrum with generalized agyria, or agyria and some frontal pachy- gyria. Prenatal diagnosis is available and consists of fetal chromosomal analysis by karyotyping or fluorescence in situ hybridization (FISH), on chorion villus sampling or amniocentesis. Sonographic diagnosis in general cannot be accomplished earlier than late second trimester, when the characteristic cerebral anomalies can be noted. The progressive microcephaly and failure of development of both sulci and gyri are suggestive of lissencephaly. We report the case of a pregnant woman of 24 weeks gestation who presented with ventriculomegaly on antenatal sonography and hydrocephalus, and corpus callosum agenesis on fetal MRI, which was diagnosed as MDS by karyotyping and FISH on amniocentesis.
Agenesis of Corpus Callosum ; Amniocentesis ; Child ; Chorion ; Classical Lissencephalies and Subcortical Band Heterotopias* ; Diagnosis ; Epilepsy ; Female ; Fluorescence ; Gene Deletion ; Humans ; Hydrocephalus ; In Situ Hybridization ; Karyotyping ; Lissencephaly ; Magnetic Resonance Imaging ; Microcephaly ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Prenatal Diagnosis ; Ultrasonography

OBJECTIVE: The purpose of this study was to investigate the clinicopathologic findings, treatment, and outcome of patients with endometrial stromal sarcoma (ESS) of the uterus. METHODS: This study retrospectively reviewed 8 patients with histologically proven stage I low-grade ESS of the uterus, at the Department of Obstetrics and Gynecology of Korea University Kuro Hospital, between May 1994 and July 2005, for clinical profiles and survival. The median follow-up was 79 months and ranged from 7 months to 131 months. RESULTS: The median age at the time of diagnosis was 43 years (range: 29-49 years). The common presenting symptoms were vaginal bleeding, lower abdominal pain and vaginal discharge. Four patients were treated with surgery followed by postoperative adjuvant chemotherapy, and four patients were treated with surgery alone. Recurrence was in one patient, and the site was the lung. The overall five-year survival rate of stage I low-grade ESS was 100%. Bilateral salpingo-oophorectomy and adjuvant chemotherapy did not significantly affect the survival of patients (p>0.05). CONCLUSION: The patients with stage I low-grade ESS have a very excellent prognosis. The role of bilateral salpingo-oophorectomy and adjuvant chemotherapy have not get been clearly defined and further studies, including prospective studies with larger numbers of patients, are needed.
Abdominal Pain ; Chemotherapy, Adjuvant ; Diagnosis ; Follow-Up Studies ; Gynecology ; Humans ; Korea ; Lung ; Obstetrics ; Prognosis ; Recurrence ; Retrospective Studies ; Sarcoma, Endometrial Stromal* ; Survival Rate ; Uterine Hemorrhage ; Uterus* ; Vaginal Discharge

OBJECTIVE: The aim of this study is to evaluate whether serum levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) are different between normotensive pregnant women and preeclampsia patients and also to investigate the relationship of VEGF and MMP-2. METHODS: We analyzed the serum levels of VEGF and MMP-2 in patients with preeclampsia (n=20) and normotensive pregnant women (n=20). RESULTS: Of the normotensive pregnant and preeclampsia women, the serum VEGF levels are 0.28 +/- 0.14 ng/mL 2.39 +/- 0.75 ng/mL, the serum MMP-2 levels are 11.81 +/- 1.75 ng/mL, 31.99 +/- 6.5 ng/mL respectively. These serum levels are higher in preeclampsia patients than normotensive pregnant women (P<0.001) The serum VEGF levels positively relate with plasma MMP-2 levels in preeclampsia (P<0.05, r=0.78). CONCLUSION: The serum VEGF levels highly correlate with the increased MMP-2 levels in preeclampsia, which may contribute the pathophysiology of preeclampsia.
Female ; Humans ; Matrix Metalloproteinase 2* ; Plasma ; Pre-Eclampsia* ; Pregnant Women* ; Vascular Endothelial Growth Factor A*