Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

OBJECTIVE: To evaluate the effectiveness of transumbilical single-port access laparoscopic surgery of ectopic pregnancy. METHODS: Retrospective analysis was performed on six patients who underwent transumbilical single-port access laparoscopic management of ectopic pregnancies. RESULTS: The median age of 6 cases was 33.5 years (range, 32 to 36), and the median body mass index was 20.6 kg/m2 (range, 16.5 to 28.7). The median largest diameter of G-sac was 4.8 cm (range, 3.0 to 5.4). Intracorporeal rupture and hemoperitoneum were accompanied in all cases. The median time needed for the surgery was 77.5 minutes (range, 59 to 95). The median estimated blood loss was 40 mL (range, 20 to 50). The median postoperative hospital day was 2 days (range, 1 to 3). There were no complications on postoperative course and follow-up. CONCLUSION: Transumbilical single-port access laparoscopic surgery for ectopic pregnancy was feasible and safe. This approach might be reasonable alternative to conventional laparoscopic surgery using 3 or 4 port in the management of ectopic pregnancy.
Body Mass Index ; Female ; Follow-Up Studies ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Retrospective Studies ; Rupture

OBJECTIVE: To evaluate the efficacy of taxane and platinum-based chemotherapy guided by extreme drug resistance assay (EDRA) in patients with epithelial ovarian cancer. METHODS: Thirty-nine patients were enrolled, who were diagnosed as epithelial ovarian cancer, tubal cancer or primary peritoneal carcinoma and received both debulking surgery and EDRA in Asan Medical Center between August 2004 and August 2006. Another thirty-nine patients were enrolled, who did not receive EDRA as control. Paclitaxel 175 mg/m2 and carboplatin AUC 5 were administered as primary combination chemotherapy to both EDRA group and the control group. In the EDRA group, paclitaxel was replaced by docetaxel 75 mg/m2 if a patient showed extreme drug resistance (EDR) to paclitaxel and not to docetaxel. Carboplatin was replaced by cisplatin 75 mg/m2 if a patient showed EDR to carboplatin and not to cisplatin. If only one drug showed low drug resistance (LDR), it was allowed to add another drug which showed LDR such as gemcitabine 1,000 mg/m2. CT scan was performed every three cycles and CA-125 was checked at each cycle. RESULTS: There was no significant difference in overall response rate between EDRA group and the control group (84.5% vs. 71.8%, p=0.107). However, 93.8% of patients in EDRA group did not show EDR to at least one drug and its response rate was significantly higher than that of the control group (93.3% vs. 71.8%, p=0.023). CONCLUSION: we could choose a combination of taxane and platinum which did not show EDR and could obtain a good response in the patients with ovarian cancer.
Area Under Curve ; Biological Assay ; Bridged Compounds ; Carboplatin ; Cisplatin ; Deoxycytidine ; Drug Resistance ; Drug Therapy, Combination ; Humans ; Neoplasms, Glandular and Epithelial ; Ovarian Neoplasms ; Paclitaxel ; Platinum ; Taxoids

OBJECTIVE: Escherichia coli (E. coli) O26 has been the most common type of non-O157 human isolates and it has been related with urinary tract infection and its sequelae. So we investigated the clinical significance of E. coli O26 among the cases of urinary tract infection. METHODS: From January, 2005 to December, 2007, the 22 E. coli isolates that were related with urinary tract infection were analyzed. The isolates were identified biochemically by Vitek 1. We performed antisera test by O157, O26, O111 diagnostic antisera about the 22 E. coli isolates. We reviewed clinical history of the same patients retrospectively. RESULTS: 331 E. coli isolates in the urine specimen were isolated from January, 2005 to December, 2007. 175 E. coli isolates that were related with urinary tract infection were analyzed by O157, O26, O111 antisera test. As a result, 22 isolates (13.5%) were O26 antisera positive. There were 8, 3, and 2 cases of watery diarrhea, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura repectively. CONCLUSION: In our study, because E. coli O26 was pathogenic and developed major complications, we concluded that patients with urinary tract infection with E. coli. should examine the antisera test about E. coli O157 and O26.
Diarrhea ; Escherichia coli ; Hemolytic-Uremic Syndrome ; Humans ; Immune Sera ; Purpura, Thrombotic Thrombocytopenic ; Urinary Tract ; Urinary Tract Infections

The current case describes a case of uterine rupture from placenta percreta in a woman who had only a single gynecologic surgery. We met the case of intrauterine fetal death (IUFD) with hemoperitoneum and found uterine rupture from placenta percreta by CT imaging. A 25-year-old woman was admitted to the emergency service for acute upper abdominal pain and severe hypotension at 33 weeks' gestation. She had undergone a single pelviscopic surgery due to cornual pregnancy 11 months previously. Ultrasonogram detected IUFD and hemoperitoneum. CT showed uterine rupture from placenta percreta. An emergency laparotomy was performed to correct the defect. The current case presents that placenta percreta can occur in a woman who had a single gynecologic surgery and clinicians should consider possible placenta percreta in diagnosing pregnant patients who present with acute abdominal pain and shock.
Abdominal Pain ; Adult ; Emergencies ; Female ; Fetal Death ; Gynecologic Surgical Procedures* ; Hemoperitoneum ; Humans ; Hypotension ; Laparotomy ; Placenta Accreta* ; Placenta* ; Pregnancy* ; Shock ; Ultrasonography ; Uterine Rupture*

OBJECTIVE: To provide clinical information for the best diagnosis and treatment of primary malignant cervical lymphoma based on the information obtained from these cases. METHODS: Between 1989 and 2006, six women with primary malignant cervical lymphoma were diagnosed and treated at our institution. Data were obtained from their medical records and were retrospectively analyzed. RESULTS: The mean patient age at the time of diagnosis was 63 (range 19-74). The chief complaint was vaginal bleeding in five women and the voiding difficulty for one woman. five of six patient had the cervical lesions (erosion and tumoral mass), while the other was non specific cervical findings. The Papanicolaou test was performed on three women, one of whom was HSIL. All six patients were confirmed with cervical lymphoma through the pathologic diagnosis. Surgical treatment (radical hysterectomy with bilateral salpingo- oophorectomy, pelvic lymph node dissection, and para-aortic lymph node dissection) was performed in one case, simple hysterectomy with complementary chemotherapy in two, and chemotherapy in one. Two patients refused treatment. Among four patients treated, one experienced recurrence in an ovary and the others have remained in remission. CONCLUSION: Primary malignant cervical lymphoma is a rare malignancy. Physicians can miss early detection of this disease because of its 'silent' symptoms and very low incidence. The accumulated data regarding this tumor can make it easy to detect at an early stage, thereby allowing it to be successfully treated. Further studies should be conducted to obtain further information regarding the cervical lymphoma.
Cervix Uteri ; Diagnosis ; Drug Therapy ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Lymphoma* ; Medical Records ; Ovariectomy ; Ovary ; Papanicolaou Test ; Recurrence ; Retrospective Studies ; Uterine Hemorrhage

PURPOSE: Docetaxel (Taxotere(R)) and capecitabine are used in combination to treat advanced gastric cancer. Thymidine phosphorylase (TP) is an essential enzyme for the activation of capecitabine in tumors. This study sought to identify the best combination therapy with capecitabine and using two different schedules for docetaxel, a TP up-regulator, to enhance capecitabine's efficacy. METHODS: The human gastric cancer cell line SNU-484 was cultured and docetaxel (2 microgram/ml) was added to the 24-well plates that contained 5 x 10(5) cells/well. The total RNA was isolated and RT-PCR was done to identify the TP expression. Four- or five-week-old BALB/c-nu/nu mice were subcutaneously inoculated with the SNU-484 cells. The nude mice were divided into two groups and they were given capecitabine 539 mg/m2 p.o. from days 1 to 14: Group 1 was given docetaxel 15 mg/m2 i.v. on day 1; Group 2 was given docetaxel 7.5mg/m2 on days 1 and 8. Tumor tissues were excised on days 1, 8 and 15 to measure the TP and bcl-2 levels. RESULTS: TP was expressed 2 hours after docetaxel administration. Group 2 had a higher TP concentration in the tumor tissues and a better antitumor effect than did Group 1. There was no difference in the bcl-2 concentration in the two groups. CONCLUSION: These results suggest that docetaxel stimulates the TP expression in tumor tissues and it enhances the antitumor activity of capecitabine. A weekly docetaxel injection with capecitabine administration can be used to treat gastric cancer more effectively than when docetaxel is injected once per cycle. Capecitabine had no bcl-2 suppressive effect in this study.
Animals ; Appointments and Schedules* ; Capecitabine ; Cell Line* ; Heterografts* ; Humans ; Mice ; Mice, Nude* ; RNA ; Stomach Neoplasms* ; Thymidine Phosphorylase* ; Thymidine*

OBJECTIVE: The vulvar cancer is an uncommon disease among female population. Because of its rare incidence, sufficient clinical studies have not been accomplished. However, the prevelance of vulvar cancer will continue to increase because of rapid growth of senile population. The goal of this study is to review the clinical outcome and prognosis of patients with vulvar cancer through the analysis of their clinical data. METHODS: We have performed a retrospective clinical study on 23 patients diagnosed with primary invasive vulvar cancer at Asan medical center from May, 1989 to December, 2003. We reviewed demographic data, pathologic findings, treatments, stages, complications, prognosis and survival time. RESULTS: The mean age was 58.9 years. The most common symptoms were palpable mass (69.5%) and itching sense (21.7%). Among the 23 patients, 21 patients have underwent operation, and two patients who refused to receive operation underwent radiotherapy only. 3 of 21 patients who were surgically treated underwent neoadjuvant chemotherapy, and 5 patients, adjuvant radiotherapy. Histopathologically, squamous cell carcinoma (69.5%) was dominant, and 15 patients turned out to have stage II disease or greater (60.8%). Among the 21 patients who have underwent operation, postoperative complications occurred in 8 patients (38.0%) and 4 of them had underwent radical vulvectomy and bilateral groin lymph node dissection. The most common postoperative complication was wound breakdown (23.8%). CONCLUSION: Although surgery is the principal treatment in vulvar cancer, radical vulvectomy and bilateral groin lymph node dissection more often result in complications than other operations such as wide local excision and hemivulvectomy. Considering the mortality and morbidity, the prognosis of vulvar cancer is poor, but early diagnosis and adequate treatment according to each individual will improve the outcome and prognosis of vulvar cancer.
Carcinoma, Squamous Cell ; Chungcheongnam-do ; Drug Therapy ; Early Diagnosis ; Female ; Groin ; Humans ; Incidence ; Lymph Node Excision ; Mortality ; Postoperative Complications ; Prognosis ; Pruritus ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies* ; Vulva ; Vulvar Neoplasms* ; Wounds and Injuries

We report a case of giant malignant gastrointestinal stromal tumor (GIST) accompanying an advanced gastric adenocarcinoma. A 73-year-old male patient was admitted to our hospital due to epigastric discomfort. In gastrofiberscopic examination, a localized Borrmann III gastric cancer at the lower body and antrum was noted. In endoscopic ultrasonographic examination, T3 hyperechoic advanced gastric cancer lesion and a relatively well-marginated heterogenous hypoechoic huge mass with a size of 10 cm were noted. In abdomen CT findings, localized wall thickening in the gastric antrum and the anterior wall, and a 11-cm-sized large heterogeneously enhancing mass in gastric body, posterior wall were noted. We did a radical subtotal gastrectomy, including a huge mass, with D2 lymph node dissection. Pathologic findings revealed double primary gastric neoplasms (synchronous occurrence of an adenocarcinoma and a huge GIST). Although closely juxtaposed, these two tumors had not merged and were separated by the thin rim of the muscularis propria.
Abdomen ; Adenocarcinoma ; Aged ; Gastrectomy ; Gastrointestinal Stromal Tumors* ; Humans ; Lymph Node Excision ; Male ; Pyloric Antrum ; Stomach Neoplasms* ; Stomach*